Cerebral Venous Thrombosis in the Absence of Headache

Coutinho, Jonathan M.; Stam, Jan; Canhão, Patrı́cia; Barinagarrementería, Fernando; Bousser, Marie‐Germaine; Ferro, José M.

doi:10.1161/strokeaha.114.007584

Cited by 56 publications

(36 citation statements)

References 10 publications

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“…The association of motor deficit with ASS is also confirmed by other studies, but in contrast to the Mahale study, aphasia was a predictor of ASS, in ISCVT, and in the VENOPORT study ASS were associated with sensory deficits . Conversely, the risk of early seizures in patients presenting with isolated intracranial hypertension is low (<3%) and the comparison of patients with and without headache as a presenting symptom has shown that seizures are significantly more common in patients without headache (58% vs. 32%) . It can be obviously concluded that involvement of brain parenchyma at or near the motor cortex leading to motor or sensory deficit predisposes patients to ASS.…”

Section: Discussionmentioning

confidence: 99%

Seizure in cerebral venous and sinus thrombosis

2018

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SummaryMany conflicting issues exist about seizure in the setting of cerebral venous and sinus thrombosis (CVST). In this article we aimed to address the existing data regarding incidence, characteristics, predictors, treatment, and prognosis of acute and late seizures in patients with CVST and to prepare more practical information for clinicians. PubMed, Embase, Web of science and Cochrane databases were searched within 1966–2016 using relevant keywords. A total of 63 papers met the inclusion criteria. Seizures are classified as acute symptomatic seizures (ASS; first 14 days) and post‐CVST epilepsy (PCE; after 14 days). The incidence had been reported in a wide range of 6.9–76% for ASS and 4–16% for PCE. Focal and generalized seizures were observed with different predominance. ASS commonly occurred in patients with loss of consciousness, focal neurological deficits, supratentorial lesions and thrombosis in superior sagittal sinus, straight sinus, and cortical veins. PCE had been predisposed by occurrence of ASS, motor deficit, and supratentorial lesions, particularly hemorrhage. Most experts believe that primary prophylaxis with antiepileptic drugs in the acute phase is not indicated. However, the initiation of prophylaxis after the first seizure in patients with supratentorial lesions or focal neurological deficit should be recommended. The quality of current evidence is low and most conclusions are based on expert opinions. More accurate reports of seizure semiology, detailed antiepileptic treatment plans, and outcomes are necessary to answer the existing questions.

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Section: Discussionmentioning

confidence: 99%

Seizure in cerebral venous and sinus thrombosis

2018

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“…Plausible presentations, therefore may range from absent clinical signs and symptoms, to vague or severe signs and symptoms related to acute increases in intracranial pressure (1,2). Headache is the most common presenting symptom by far accounting for approximately 90% of patients diagnosed with DVST, followed by seizures (6,48,49). …”

Section: Discussionmentioning

confidence: 99%

New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

Konakondla¹,

Schirmer²,

Li³

et al. 2017

Aging and disease

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Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large randomized trials for this low incidence disease process with large pathophysiological heterogeneity.

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“…Headache is the most common symptom in CVT, but patients without headache are sometimes reported. In ISCVT, CVT patients without headache were frequently older male patients [9,10,13]. Our study showed a low incidence of headache, 62.5%, which we suspected was due to the high percentage of older men in our study.…”

Section: Discussionmentioning

confidence: 49%

“…A meta-analysis of 17 clinical studies showed that oral contraceptive use, Leiden mutation of Factor V, and hyperHcy were recognized as statistically significant risk factors 8). A multinational (21 countries), multicenter (89 centers) prospective observational study entitled the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) [9][10][11][12][13] examined 624 cases of CVT and reported that the prevalence of hyper-Hcy is 4.5%. However, Boncoraglio et al reported from Italy that 10 of 26 patients (38.5%) with CVT had hyper-Hcy7).…”

Section: Archivos De Medicina Issn 1698-9465 Journal Of Neurology Andmentioning

confidence: 99%