Underlying prothrombotic states in pregnancy associated cerebral venous thrombosis

Aaron, Sanjith; Alexander, Mathew; Maya, T; Mathew, Vivek; Goel, Manjusha; Nair, Sukesh C.; Mammen, Joy John

doi:10.4103/0028-3886.68676

Cited by 23 publications

(11 citation statements)

References 23 publications

(28 reference statements)

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“…Aaron et al . [19] in their study of 41 patients reported that 34% had hyperhomocysteinemia with a 17% mortality. Similarly in our study, 24% of the population had hyperhomocysteinemia with an overall mortality rate of 16%.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of cerebral venous sinus thrombosis at tertiary care center

Patil

Choraria

Desai

et al. 2014

J Neurosci Rural Pract

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Background:Thrombosis of the cerebral venous sinuses (CVST) is an uncommon form of stroke, usually affecting young individuals. Clinical features of CVST are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions.Materials and Methods:This study was conducted over a period of 1 year (Jan 2011 to Dec 2011). This was a retrospective, observational, and noninterventional study. This study was conducted in the Department of Medicine at a tertiary care teaching center. Total 50 patients where diagnosis of CVST was confirmed by computed tomography/magnetic resonance imaging brain venogram were included in this study. All patients with diagnosis of CVST were treated according to the standard protocol and guidelines.Statistical Analysis:The mean and standard deviation were obtained. The Chi-square test was used to analyze the data and P < 0.05 was considered as statistically significant.Results:Of total 50 patients with diagnosis of CVST, 21 (42%) were males and 29 (58%) were females with 39 ± 10 years and 29 ± 7 years, respectively. Total 45 (90%) patients presented with symptoms of headache and vomiting, 13 (26%) had seizures, 12 (24%) had hemiplegia, and 19 (38%) had fever. A total of 13 (26%) patients had papilledema on fundoscopy. Total 9 (31%) out of 29 patients had diagnosis of CVST during peripartum period. Total 12 (24%) patients had hyperhomocysteinemia. Total 23 (46%) patients had sagittal sinus thrombosis, 10 (20%) had multiple sinus thrombosis, 16 (32%) had sigmoid/transverse sinus thrombosis. There was 1 (2%) patient who had bilateral cavernous sinus thrombosis, who presented with bilateral proptosis, conjunctival congestion, and external ophthalmoplegia with a history of acute or chronic maxillary and sphenoid sinusitis. Total 38 patients had evidence of infection in the form of fever, paranasal sinus (PNS) infections, Chronic suppurative otitis media (CSOM). Total 19 (38%) patients had a history and evidence of dehydration. Total 8 (16%) patients died during the course of treatment and 42 (84%) were discharged with partial and/or total recovery. Three (6%) patients required neurosurgical intervention in the form of decompressive craniotomy. Eight (16%) patients died with cerebral edema with transtentorial herniation. The mean age of death in male was significantly greater than in female patients with P < 0.02. Majority of patients succumbed had sigmoid, transverse, and/or multiple sinus involvement. Patients with multiple sinus thrombosis had greater case fatality rate.Conclusions:The current study highlights the burden of CVST in the study population with headache and vomiting, which was the most common presenting complaint. The superior sagittal sinus thrombosis was the most common and bilateral cavernous sinus thrombosis was the uncommon affection in CVST. One third of female population was affected in peripartum period. The infection and/or dehydration was the most commonly associated precipitating event for development of CVST and more than one fifth of ...

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Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of cerebral venous sinus thrombosis at tertiary care center

Patil

Choraria

Desai

et al. 2014

J Neurosci Rural Pract

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“…More than 90% of the CVST occurs in people below 60 years of age and it is more commonly seen in women between 20 and 35 years. Young women have a higher risk due to pregnancy, puerperium, and oral contraceptive usage (16–20). The incidence of CVST is estimated to be 1–13 cases per 100,000 per year (5, 16, 21).…”

Section: Introductionmentioning

confidence: 99%

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Avanali¹,

Gopalakrishnan

Devi

et al. 2019

Front. Neurol.

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Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively reduce intracranial pressure just like it works for malignant middle cerebral artery infarcts and traumatic brain injury. But because of the relative rarity of this type of stroke, strong evidence from randomized controlled trials that DC is a life-saving procedure is not available unlike in the latter two conditions. There is a possibility that other forms of interventions like endovascular recanalization, thrombectomy, thrombolysis, and anticoagulation, which cannot be used in established middle cerebral artery infarcts and TBI, can reverse the ongoing pathology of increasing edema in CVST. Such interventions, although presently unproven, could theoretically obviate the need for DC when used in early stages. However, in the absence of such evidence, we recommend that DC be considered early as a life-saving measure whenever there are large hemorrhagic infarcts, expanding edema, radiological, and clinical features of impending herniation. This review gives an overview of the etiology and risk factors of CVST in different patient populations and examines the effectiveness of DC and other forms of interventions.

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“…A study from the same region[ 9 ] had earlier found that a traditional practice of restricting water in the postpartum period can be a modifiable risk factor in postpartum CVT.…”

Section: Discussionmentioning

confidence: 99%

Cerebral venous thrombosis, seasonal trends, and climatic influence: A region-specificstudy

Aaron

Lakshmanan

Sudarsanam

et al. 2020

Ann Indian Acad Neurol

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Background and Purpose: Studies looking at seasonal variation on cerebral venous thrombosis (CVT) are few with conflicting conclusions. In this region-specific study, we looked for climatic influence and seasonal trends on the incidence of CVT. Methods: Imaging proven adult CVT cases treated over a period of 18 years from a specific geographical location with similar seasons and climatic conditions were studied. Metrological parameters prepared using 30 years of data was used. Quantum geographical information system (QGIS software) and SPSS v 22 were used for patient plotting and analysis. Results: Total of 970 cases were studied. The incidence was significantly higher in summer 411 (42.3%) compared with autumn 317 (32.7%) and winter 242 (25.05); P = 0.038. This trend was consistent across all the 18 years in time series analysis. Mean age was 33.5 years (range 18–88 years). A significant majority 673 (69.4%) were below 40 years of age; P = 0.012. Females constituted 394 (40.6%) of cases. Postpartum CVT cases constituted 237 (30%). Interaction analysis showed younger age (<40 years) were more vulnerable for CVT in summer; P = 0.009. There was no seasonal influence on postpartum CVT. Apart for a weak positive correlation between rain fall ( r = 0.18, P < 0.01); humidity and cloud cover was not influencing the incidence. Conclusions: Higher ambient temperatures were consistently associated with higher incidence of CVT. This is the largest region-specific study on CVT in the world. These results may be applicable to other regions with similar climatic conditions.

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Underlying prothrombotic states in pregnancy associated cerebral venous thrombosis

Cited by 23 publications

References 23 publications

Clinical profile and outcome of cerebral venous sinus thrombosis at tertiary care center

Clinical profile and outcome of cerebral venous sinus thrombosis at tertiary care center

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Cerebral venous thrombosis, seasonal trends, and climatic influence: A region-specificstudy

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