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Cerebral venous thrombosis in pregnancy

Ava L Liberman, Hooman Kamel, Michael T Mullen, Steven R Messé
BACKGROUND: Cerebral venous thrombosis (CVT) is a relatively rare and understudied disease. We sought to determine the accuracy of International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes to identify CVT. METHODS: Retrospective chart review using the electronic medical record (EMR) to identify all patients discharged with CVT following admission or emergency department visit from May 1, 2010 to May 1, 2015 at our center. RESULTS: We identified 111 patients with an ICD-9 discharge diagnosis code of 325...
October 2016: Neurohospitalist
I Martinelli, S M Passamonti, A Maino, M Abbattista, P Bucciarelli, E Somigliana, A Artoni, F Gianniello, F Peyvandi
: Essentials Little is known about recurrences and pregnancy outcome after cerebral vein thrombosis (CVT). We studied a cohort of pregnant women with CVT. Women with CVT appear at increased risk of late obstetrical complications despite prophylaxis. Risks of recurrent thrombosis and bleeding in women on heparin prophylaxis while pregnant are low. SUMMARY: Background The risk of recurrent thrombosis and bleeding episodes in women with previous cerebral vein thrombosis (CVT) on antithrombotic prophylaxis with low-molecular-weight heparin (LMWH) during pregnancy is not established and little information is available on pregnancy outcome...
September 6, 2016: Journal of Thrombosis and Haemostasis: JTH
Samia Ben Sassi, Nahla Touati, Hela Baccouche, Cyrine Drissi, Neila Ben Romdhane, Fayçal Hentati
OBJECTIVE: Data regarding cerebral venous thrombosis in North Africa are scarce. This study aims to identify the clinical features, risk factors, outcome, and prognosis of cerebral venous thrombosis in Tunisia. METHODS: Data of 160 patients with radiologically confirmed cerebral venous thrombosis, hospitalized in Mongi Ben Hmida National Institute of Neurology (Tunis, Tunisia), were retrospectively collected and analyzed. RESULTS: The mean age was 37...
August 31, 2016: Clinical and Applied Thrombosis/hemostasis
Venkatesh Thammishetti, Subrahmanyam Dharanipragada, Debdatta Basu, Ramesh Ananthakrishnan, Deepanjali Surendiran
INTRODUCTION: Cerebral Venous Thrombosis (CVT) is a well known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in diagnosis of CVT. AIM: To study various aspects of CVT and role of D-dimer...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
A G M Aya, B Ondze, J Ripart, P Cuvillon
The occurrence of seizures in the peripartum period is a rare but particularly challenging situation. Seizures in the peripartum period could result from three categories of conditions: first and most frequent is the exacerbation of a known pre-existing seizure disorder, mainly epilepsy. A therapeutic evaluation is needed; second is the new onset of seizures due to a non-pregnancy-related problem. An accurate diagnosis and a specific treatment are required; third is range of pregnancy-related conditions. The present review focuses on this third category, with a special attention to disorders occurring in the peripartum period...
October 2016: Anaesthesia, Critical Care & Pain Medicine
Prabhat Singh, J Kalita, U K Misra
BACKGROUND & OBJECTIVES: There is paucity of studies on the quality of anticoagulation in neurological patients from India. This study evaluates the quality of oral anticoagulation therapy in neurology patients. METHODS: Consecutive patients attending a tertiary care neurology service in north India who were prescribed oral anticoagulant (OAC), were included. Their international normalized ratio (INR) values were prospectively monitored and the earlier INR values of the patients who were already on OAC were retrospectively analyzed...
April 2016: Indian Journal of Medical Research
H Steven Block
Physiologic alterations during pregnancy create an environment for the occurrence of disease states that are either unique to pregnancy, occur more frequently in pregnancy, or require special management considerations that may be different from the nonpregnancy state. In the realm of cerebrovascular disease, preeclampsia, eclampsia, reversible cerebral vasoconstriction syndrome, sources of cardiogenic embolization including peripartum cardiomyopathy, cerebral venous thrombosis, pituitary apoplexy, subarachnoid hemorrhage, intracerebral hemorrhage, and special considerations for anticoagulation during pregnancy will be discussed...
July 2016: Current Neurology and Neuroscience Reports
Yan-Ting Lu, Che-Wei Hsu, Wan-Chen Tsai, Mei-Yun Cheng, Fu-Yuan Shih, Ting-Ying Fu, Yao-Chung Chuang, Meng-Han Tsai
BACKGROUND: Status epilepticus (SE) is a neurological emergency associated with a high mortality rate and long-term cognitive sequelae. Status epilepticus in pregnancy poses a tremendous threat to both mother and fetus, making a correct diagnosis and treatment a challenging task for clinicians. The prevalence, underlying etiology, and outcomes of pregnancy-related SE remain largely unknown. METHODS: We retrospectively studied all SE episodes (n=366) in patients admitted to our neurological ICU over a period of 8...
June 2016: Epilepsy & Behavior: E&B
Elna M Masuda, Raymond W Lee, Ian J Okazaki, Pouya Benyamini, Robert L Kistner
Management of venous thromboembolism (VTE) includes evaluation for hypercoagulable state, especially if the VTE occurs in young patients, is recurrent, or is associated with a positive family history. These laboratory tests are costly, and surprisingly, there is little evidence showing that testing leads to improved clinical outcomes. Evidence based on observational prospective studies suggests that optimal duration of anticoagulation should be based on clinical risks resulting in VTE, such as transient, permanent, and idiopathic or unprovoked risks, and less on abnormal thrombophilia values...
April 2015: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Eliza C Miller, Shadi Yaghi, Amelia K Boehme, Joshua Z Willey, Mitchell S V Elkind, Randolph S Marshall
BACKGROUND: Pregnancy-associated stroke remains incompletely characterized because of the rarity of these potentially devastating events. We investigated whether mechanism and outcome of ischemic pathophysiology stroke differ between young pregnant and nonpregnant women. METHODS: We identified 135 consecutive women ages 18-40 years admitted to our center from January 2008 through June 2014 with ischemic stroke, TIA, cerebral venous thrombosis, or nonaneurysmal subarachnoid hemorrhage due to reversible cerebral vasoconstriction syndrome (RCVS)...
February 2016: Neurology. Clinical Practice
Diana Aguiar de Sousa, Patrícia Canhão, José M Ferro
BACKGROUND AND PURPOSE: Pregnancy and puerperium are associated with an increased risk of venous thrombotic events (VTEs), including cerebral venous thrombosis (CVT). We aimed to systematically review, in pregnant woman with previous CVT, (1) the risk of recurrence of CVT or other VTE; (2) the result of pregnancy; and (3) the association of antithrombotic prophylaxis with these outcomes. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials...
March 2016: Stroke; a Journal of Cerebral Circulation
Susanna M Zuurbier, Saskia Middeldorp, Jan Stam, Jonathan M Coutinho
BACKGROUND: In contemporary studies, cerebral venous thrombosis is three times more common in adult women than in men. AIM: To study the change in sex ratio over time in cerebral venous thrombosis. SUMMARY OF REVIEW: We systematically reviewed the literature. Any type of study with at least 40 patients with cerebral venous thrombosis that reported sex ratio was eligible. We ranked studies according to the year halfway the period of patient recruitment...
February 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Lotfi Hacein-Bey, Panayiotis N Varelas, John L Ulmer, Leighton P Mark, Kesav Raghavan, James M Provenzale
OBJECTIVE: The purpose of this article is to review the unique physiologic changes that characterize pregnancy and the puerperium, some that substantially affect the cerebrovascular system. Conditions that can cause neurologic deterioration and share features with preeclampsia-eclampsia include postpartum angiopathy, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and amniotic fluid embolism. Other conditions not specific to this patient group include cerebral venous thrombosis, cervicocephalic arterial dissection, ischemic stroke, and hemorrhagic stroke, which can pose specific diagnostic and therapeutic challenges...
January 2016: AJR. American Journal of Roentgenology
Jonathan M Coutinho, Susanna M Zuurbier, Aafke E Gaartman, Arienne A Dikstaal, Jan Stam, Saskia Middeldorp, Suzanne C Cannegieter
BACKGROUND AND PURPOSE: Anemia is often considered to be a risk factor for cerebral venous thrombosis (CVT), but this assumption is mostly based on case reports. We investigated the association between anemia and CVT in a controlled study. METHODS: Unmatched case-control study: cases were adult patients with CVT included in a single-center, prospective database between July 2006 and December 2014. Controls were subjects from the control population of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) study...
October 2015: Stroke; a Journal of Cerebral Circulation
A Koch, B Schick
Cerebral venous and dural sinuses thrombosis (CVT) is a relatively rare but very serious disease, because of the risk of mortality. Cardinal symptoms are usually severe sudden-onset localized headaches, which may or not be accompanied by focal or generalized neurological deficits or seizures. It is particularly important to consider CVT in the presence of underlying prothrombotic conditions (genetically predisposed or acquired defects of the coagulation system) or well-known risk factors (hormonal contraception, pregnancy, puerperium, smoker status)...
March 2016: HNO
Susanna Melkas, Hanna Harno, Elina Pälvimäki, Jari Siironen
Of all cerebral sinus thromboses, 5 to 20% occur in connection with pregnancy or childbirth, or during the puerperium. The risk is highest during the first month following delivery. Approximately half of the women developing sinus thrombosis possess several concomitant risk factors predisposing to venous thrombosis, and about a fifth of them have a trombophilic disorder. We describe a postpartum cerebral sinus thrombosis leading with the associated complications to the patient's death. The patient was afterwards shown to possess the most common factor predisposing to venous thrombosis, the factor V Leiden mutation...
2015: Duodecim; Lääketieteellinen Aikakauskirja
Imanda M E Alons, Korné Jellema, Marieke J H Wermer, Ale Algra
BACKGROUND: Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may play the same role in low risk CVT patients with isolated headache. METHODS: We included consecutive patients suspected of CVT from our teaching hospital with isolated headache, a normal neurological examination and normal standard head CT in whom D-dimer was determined...
2015: BMC Neurology
Mesut Yenigün, Martin Jünemann, Tibo Gerriets, Erwin Stolz
Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young patients. CVST represents with 0.5-3% of stroke cases a relatively rare disease. CVST affects 3-4 cases per 1 million overall and 7 cases per 1 million children and neonates. Typical clinical symptoms include headache, visual deficits and seizures. Beside the main condition associated with CVST in women in pregnancy and puerperium, the most frequently identified risk factors are oral hormonal contraceptives in combination with coagulation disorders...
June 2015: Annals of Translational Medicine
Pauli Ylikotila, Raimo A Ketola, Susanna Timonen, Heli Malm, Jori O Ruuskanen
Cerebral venous thrombosis (CVT) is an uncommon cause of stroke, accounting to less than 1% of all strokes. We describe a pregnant woman with a massive CVT in early pregnancy, complicated by status epilepticus. The mother was treated with levetiracetam, lacosamide, and enoxaparin throughout pregnancy. A male infant was born on pregnancy week 36, weighing 2.2kg. Both levetiracetam and and lacosamide were present in cord blood in levels similar to those in maternal blood. The infant was partially breast-fed and experienced poor feeding and sleepiness, starting to resolve after two first weeks...
November 2015: Reproductive Toxicology
Farnoush Farzi, Mehrsima Abdollahzadeh, Roya Faraji, Tahereh Chavoushi
INTRODUCTION: Seizure involves less than 1% of pregnancies; however it is associated with increased maternal and fetal complications. Cerebral venous sinus thrombosis is a rare, but potentially life-threatening cause of seizure during pregnancy, presenting primarily as seizure in 12% - 31.9% of cases. Pregnancy and puerperium are known as the risk factors of cerebral venous sinus thrombosis. CASE PRESENTATION: Here is presented a case of seizure after delivery by cesarean section in an otherwise healthy woman...
June 2015: Anesthesiology and Pain Medicine
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