Trombosis de senos venosos cerebrales: epidemiología, características clínicas, imaginología y pronóstico / Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis

Introducción. La trombosis de senos venosos cerebrales representa entre 0,5 y 1 % de las enfermedades cerebrovasculares en adultos, y sus factores de riesgo son diferentes a los del resto de dichas enfermedades. Objetivo. Determinar la epidemiología, las características clínicas e imaginológicas, así como los resultados en pacientes con trombosis de senos venosos cerebrales, y explorar los aspectos asociados con los puntajes desfavorables en la escala modificada de Rankin. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de corte transversal en el Instituto Neurológico de Colombia entre marzo de 2006 y junio de 2011, periodo en el que se analizaron las historias clínicas de 37 pacientes con diagnóstico confirmado por neuroimágenes. Resultados. El 86,5 % de los pacientes eran mujeres, con una edad promedio de 41 años. El síntoma más frecuente fue la cefalea (86,5 %), el cual se presentó como único síntoma en el 40,5 % de los casos. El 68 % tenía, por lo menos, un antecedente de riesgo para trombosis de senos venosos cerebrales, siendo el más frecuente la obesidad (24,3 %), seguido del uso de anticonceptivos hormonales (21,9 %). El examen neurológico fue normal en el 43,2 %. El hallazgo más frecuente en la tomografía fue la hiperdensidad de los senos venosos (33 %) y, en la resonancia magnética, el infarto venoso (37,5 %). El promedio de senos comprometidos fue de 2,27+1,3, siendo más frecuente el compromiso de los transversos. La estancia hospitalaria promedio fue de 7,8+3,6 días. El 92 % de los pacientes presentaba resultados funcionales favorables al dárseles de alta. La mortalidad hospitalaria fue de 5,4 % y se relacionó directamente con la trombosis de senos venosos cerebrales. Conclusiones. La trombosis de senos venosos cerebrales difiere de los otros tipos de enfermedad cerebrovascular en cuanto a su perfil epidemiológico, factores de riesgo, presentación clínica y pronóstico. Es una condición que exige un alto grado de sospecha diagnóstica, pues su presentación clínica es inespecífica.

Introduction: Cerebral venous sinus thrombosis represents 0.5 - 1% of all cerebrovascular diseases. Objective: The aim of this study was to determine the epidemiological, clinical, and imaging features of the disease, as well as the outcomes of patients with cerebral venous sinus thrombosis, and to explore the characteristics associated with unfavorable patient outcomes. Materials and methods: In this cross-sectional, retrospective study, the medical records of 37 patients with cerebral venous sinus thrombosis were analyzed. Results: Eighty-six percent of the patients were women, and the mean patient age was 41 years. The most frequently reported symptom was headache (86.5%); headache was the single presenting symptom in 40.5% of the patients. Sixty-eight percent of the patients had at least one risk factor, the most frequent of which was obesity (24.3%). A total of 43.2% of the patients had no focal neurological findings. The most common finding on computerized tomography (CT) was hyperdense venous sinuses; on Magnetic Resonance Imaging (MRI), the most common finding was venous infarction. On average, 2.27±1.3 sinuses were involved; most frequently, the transverse venous sinuses were affected. The average hospital stay was 7.8±3.6 days. At hospital discharge, the outcomes were favorable in 92% of the patients, and the mortality rate was 5.4%. Conclusions: Cerebral venous sinus thrombosis is a different type of cerebrovascular disorder, with distinct epidemiology, risk factors, clinical presentations and functional outcomes. The diagnosis is based on clinical suspicion because of the unspecific clinical presentation of the disease.

Accidente vascular encefálico. Presentación clínica y factores de riesgo / Clinical presentation and risk factors of cerebrovascular accident

Introducción: La alteración focal aguda de la función cerebral en el adulto permite diagnosticar un accidente vascular encefálico (AVE) e iniciar precozmente el rescate de tejido cerebral. En los niños, las diferencias clínicas de esta patología en relación al adulto generan atraso, subdiagnóstico e impiden el tratamiento en la etapa aguda. Objetivo: Describir la presentación clínica y factores de riesgo del AVE isquémico en 156 niños, comparar la presentación clínica según edad y tipo de AVE. Pacientes y Método: Se analiza un registro de AVE isquémico, confirmado con imágenes cerebrales, en población menor de 18 años, iniciado en Enero 2003. Resultados: La mediana de edad: 4,9 meses (33 por ciento recién nacidos, 46 por ciento menores 6 años y 21 por ciento mayor de 6 años), 64 por ciento fueron hombres. Los infartos arteriales correspondieron al 85 por ciento y el resto fueron trombosis de senos venosos. Predominaron los signos difusos (67 por ciento) en menores de 6 años (p = 0,001). Las convulsiones fueron observadas en el 61 por ciento de los niños menores de 6 años (p = 0,03), el 33 por ciento presentó signos focales. Los factores de riesgo más frecuentes fueron patologías sistémicas agudas y cardiopatías. En 14,7 por ciento no se encontraron factores de riesgo. Conclusiones: La búsqueda de signos focales agudos de AVE no tiene utilidad diagnóstica en el niño, a diferencia de los adultos, pues su ausencia no excluye patología vascular isquémica focal. La patología sistémica aguda fue el factor de riesgo más frecuente para AVE.

Introduction: Acute focal brain dysfunction in adults serves to diagnose and to provide early rescue of the brain tissue. In children, the clinical differences of this condition compared to adults results in delayed diagnosis and treatment. Objective: To describe the clinical presentation and risk factors of CVA in 156 children and related to age and type of CVA. Patients and Method: A CVA registry of newborn to 18 years old was started in January 2003 were analized. Diagnosis was confirmed by brain imaging. Results: The median of age was 4.9 month (33 percent was newborn, 46 percent < 6 years old, 21 percent > 6 years old); 64 percent were males. Arterial ischemic stroke represented 85 percent, the rest were cerebral sinovenous thrombosis. In the clinical manifestations the diffuse signs were more frequently seen (67 percent) in children < 6 years of age (p 0.001). Seizures were observed in 61 percent in children < 6 years old (p = 0.03), 33 percent presented focal signs. The most common risk factors were acute systemic diseases and heart disease. 14.7 percent of the patients did not present risk factors. Conclusions: Acute focus signals of CVA in children have no diagnostic value, unlike adults; however absence doesn't exclude focal ischemic vascular disease. The acute systemic disease was the most common risk factor for stroke.

Cerebral venous thrombosis in Saudi Arabia. Clinical variables, response to treatment, and outcome

To investigate cerebral venous thrombosis [CVT] clinical presentations, risk factors, and response to treatment in Saudi Arabia. Retrospective analysis of the King Fahad Medical City, Riyadh, acute stroke database from April 2005 through February 2008 revealed 22 patients with CVT. Hypercoagulable work-up and neuroimaging were performed. Sixteen patients were female [72.7%], and the median age was 35 years. Clinical presentations included: headache [77.3%], seizures [54.5%], focal neurological signs [54.5%], and decreased level of consciousness [50%]. Over two-thirds [n=11; 69%] of female patients had a history of oral contraceptive use, which was the most common risk factor. Protein S deficiency [n=3], antiphospholipid antibody syndrome secondary to systemic lupus erythematosus [SLE] [n=1], rhinocerebral mucormycosis [n=1], leukemia [n=1], non-Hodgkin's lymphoma [n=1], sepsis [n=1], and unknown [n=6] were causes. Affected areas included superior sagittal [n=13], transverse [n=16], sigmoid [n=14], straight [n=6] and cavernous sinus [n=1]; internal cerebral vein [n=2]; vein of Galen [n=3]; cortical veins [n=10]; and internal jugular vein [n=12]. Two patients had quadriparesis, and 2 patients died. The remainder [n=18, 81.8%] improved. Bilateral hemorrhagic presentation or venous infarction, deep venous system thrombosis, and underlying malignancy had less favorable results. Presentations in our series were similar to those in other reports, although altered consciousness and seizures were more common, Cortical vein involvement was also higher than commonly reported. Oral contraceptive use was a primary risk factor in female patients. Outcomes were favorable in 81.8% of patients

Trombose venosa cerebral: evolução clínica e fatores prognósticos em 111 pacientes / Cerebral venous thrombosis: clinical outcome and prognostic factors in 111 patients

Introdução: A evolução clínica da trombose venosa cerebral (TVC) pode variar desde a recuperação completa ao óbito. Séries européias e um estudo multicêntrico identificaram alguns fatores indicativos de prognóstico da TVC, dado importante na decisão da melhor terapêutica para os pacientes. Este estudo busca identificar, a partir do seguimento prospectivo de cento e onze pacientes com TVC, os fatores prognósticos envolvidos na evolução clínica durante o período de 2 anos. Pacientes Métodos: Foram acompanhados prospectivamente 111 pacientes com diagnóstico de TVC desde a fase aguda do diagnóstico, confirmado por meio de RM de encéfalo e/ou angiografia cerebral (ARM, ATC ou angiografia digital). Obtidos dados do quadro clínico e seguimento por um protocolo clínico. 96% dos pacientes foram anticoagulados na fase aguda com heparina e seguida de anticoagulação com warfarina. Submetidos a investigação para os fatores predisponentes para TVC. A evolução clínica foi quantificada por meio da escala modificada de Rankin (EMR) após 3, 6, 12 e 24 meses, definindo os pacientes de bom prognóstico EMR 1, e mau prognóstico EMR 2. Comparamos dados clínicos da fase aguda e resultados encontrados nos exames de imagem e laboratoriais como possíveis fatores prognósticos, através da análise univariada pelo teste 2 e os fatores de significância estatística (p<0,1), foram analisados com regressão logística ajustada e cálculo da razão de chances (RC), (intervalo de confiança IC=95%). Resultados: A média da idade dos pacientes foi de 35 anos, 72% mulheres, 40% afro-brasileiros. As principais manifestações clínicas foram: cefaléia 97%, déficit focal 47%, crise epiléptica 40%, alteração da consciência 28%, síndrome de HIC (SHIC) isolada 40%. Quanto aos fatores predisponentes; 75% das mulheres usavam anticoncepcional, 31% dos pacientes apresentavam trombofilia hereditária, 13% SAAF, 6% eram portadores de vasculites, 25% outros estados pro trombóticos, 7 % apresentavam fatores...

Introduction: The cerebral venous thrombosis (CVT) clinical evolution is quite variable from complete recovery to death. Some European series and a multicenter study had identified prognostic factors related to CVT prognosis. The identification of these factors is important for the best therapeutic decision to patients. This study aims to identify the prognostic factors enrolled in clinical evolution of 111 patients with CVT in a prospective outcome clinical trial during two years. Subjects and Methods: One hundred and eleven patients were prospective followed with the diagnosis of CVT since acute phase diagnosis, confirmed by brain MRI and/or brain angiography (MRA , CTA or digital angiography). Information about clinical features and follow-up were filled on a clinical form. 96% of the patients were anticoagulated on heparin followed by warfarin treatment. The patients were investigated to predisposing factors to CVT. The clinical evaluation was accessed by the modified Rakin scale (mRs) after 3, 6, 12 and 24 months, considering patients with good outcome when mRs < 1 and poor outcome when mRs > 2. The acute phase clinical features, laboratory and imaging data were compared as possible prognosis factors beyond univariate 2 test and the factors with statistical significance (p<0,1) and then analyzed by logistic regression adjusted and Odds Ratio values (confidence interval CI=95%). Results: The mean age of the patients was 35 years, 72% were women, and 40% were African Brazilian. The main clinical features observed were: headache 97%, focal sign 47%, epileptic seizure 40%, isolated ICH syndrome 40% and altered mental status 28%. All the patients were investigated to predisposing factors; 75% of the women were on oral contraceptive, 31% of the patients presented hereditary thrombophilia, 13 % antiphospholipid syndrome, 6% presented vasculitis, 25% other protrhrombotic state, 7% presented some local feature (arterialvenous malformation or infection) and 5%...

Trombosis venosa cerebral durante el embarazo y puerperio / Cerebral Venous Thrombosis During Pregnancy and Puerperium.

Se presentan seis casos de trombosis venosa cerebral durante el embarazo y el puerperio. Cinco durante el embarazo y uno en el puerperio. Se discute la etiopatogenia, los aspectos clínicos diagnóstico diferencial, diagnóstico por imagenes y los alcances terapéuticos. Tratamiento activo con anticoagulantes fue llevado a cabo en dos pacientes y los otros fueron manejados sintomáticamente. Tres pacientes fallecieron y tres sobrevivieron todos con secuelas neurológicas.

Trombosis de senos venosos cerebrales / Cerebral venous sinus thrombosis

Se presentan 9 casos de trombosis de senos venosos cerebrales diagnosticados en el Hospital San Juan de Dios entre 1954 y 1987. Se encontraron 5 hombres y 4 mujeres con una edad promedio de 27.3 anos. Todos presentaban una o mas condiciones predisponentes: utilizacion de anticonceptivos orales, sepsis, carcinoma, trauma craneano y sinusitis. Los cuadros clinicos neurologicos correspondieron a diversos sindromes clinicos como sindrome de hipertension endocraneana, sindrome convulsivo y sindrome mental, y en todos los casos hubo manifestaciones clinicas relacionadas con la enfermedad de base. Solo en tres pacientes se hizo el diagnostico en vida y en dos de ellos fue posible iniciar terapeutica anticoagulante y evitar la aparicion de secuelas. Los nuevos metodos de diagnostico actualmente disponibles en nuestro medio, facilitan el diagnostico precoz y la iniciacion oportuna de la anticoagulacion, aceptada como el tratamiento de eleccion en esta entidad.