Elsevier

Epilepsy Research

Volume 123, July 2016, Pages 1-5
Epilepsy Research

Acute seizures in cerebral venous sinus thrombosis: What predicts it?

https://doi.org/10.1016/j.eplepsyres.2016.01.011Get rights and content

Highlights

Abstract

Background

Seizures are the presenting feature of cerebral venous sinus thrombosis (CVST) in 12–31.9% of patients. 44.3% of patients have seizures in the early stage of the disease. Acute seizures (AS), refers to seizures which take place before the diagnosis or during the first 2 weeks afterward.

Objective

To report the predictors of acute seizures in cerebral venous sinus thrombosis (CVST).

Methods

100 patients with CVST were included in the study. The occurrence of acute seizures was noted. The predictors of acute seizure were evaluated by univariate analysis including the demographic (gender, age), clinical (headache, focal neurological deficit, papilloedema, GCS score), type and number of risk factors, MRI findings (Type of lesion: hemorrhagic infarction or hematoma, location of lesion) and MRV findings (superficial or deep sinus, cortical veins).

Results

A total of 46 patients had acute seizures. On univariate analysis, altered mental status (p < 0.001), paresis (p = 0.03), GCS score <8 (p = 0.009), hemorrhagic infarct on imaging (p = 0.04), involvement of frontal lobe (p = 0.02), superior sagittal sinus (p = 0.008), and high D-dimer levels (p = 0.03) were significantly associated with acute seizure. On multivariate analysis, the hemorrhagic infarct on MRI and high D-dimer was independently predictive for early seizure.

Conclusion

The predictive factors for the acute seizures are altered mental status (GCS < 8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels.

Introduction

Seizures are more specific to cerebral vein and sinus thrombosis (CVST) than to other types of stroke (Conrad et al., 2013). About 12–31.9% of patients with CVST have seizures as the presenting feature of the disease. Among them, 44.3% of patients have seizures in the early stage of the disease (Ferro et al., 2003, Masuhr et al., 2006). The rate of mortality is three times higher in CVST patients with seizures than those without seizures (Masuhr et al., 2006). Seizures in CVST can occur during different periods of the disease's course and can be categorized as either “early/acute seizures”, which take place before the diagnosis or during the first 2 weeks afterward, or as “late/remote seizures”, which occur in the years following CVST development (Ferro et al., 2004). The risk of an acute seizure after the diagnosis of CVT is unknown. However, based on the previous case series, following risk factors have been identified for acute seizures that include motor or sensory deficits, cortical vein thrombosis, and hemorrhagic brain lesion on admission (Masuhr et al., 2006, Preter et al., 1996). The incidence of CVST appear more in India as compared to the western countries as many large hospital-based series of puerperal CVST have been reported from India. The exact incidence of CVST in India is still not known; due to the lack of any population-based study or nationwide multicentric hospital-based studies. And, there are no elaborative studies that have evaluated the predictors of acute seizures in CVST. The present study was aimed at determining the predictors of acute seizures in patients with CVST.

Section snippets

Subjects

This is a retrospective, cross-sectional, single centre, hospital-based study. The study was approved by the institutional scientific committee and ethics review board. The hospital registry was screened to identify records with a diagnosis of CVST from January 2011 to January 2015. 100 consecutive patients with CVST were included in the study. Patients with epilepsy and on anti-epileptic drug treatment were excluded.

Demographic data and clinical characteristics

Data on the demographic characteristics, presenting symptoms that include

Results

100 consecutive patients with CVST were included in the study. The mean age of the patients were 35.9 ± 14 (range: 21–68) years. A total of 60 (60%) patients were males. 9 patients had recurrent CVST. Out of 100 patients, 46 (46%) patients had acute seizure and 54 (54%) patients did not have seizures. The mean duration of symptoms before the diagnosis of CVST (n = 100) was 7.6 ± 11.1 (range: 1–60) days. In patients with CVST, the mean duration of symptoms before the diagnosis of CVST (n = 46) was 6.9 ± 

Discussion

In the present study, 46 patients (46%) out of 100 consecutive patients with CVST had acute seizures during presentation and within 2 weeks of the diagnosis of CVST. The present study aimed at determining the predictive factors for the occurrence of acute seizures in patients with CVST. Acute seizures in CVST can cause neurological and systemic deterioration, status epilepticus, and death (Stolz et al., 2005, Einhäupl and Masuhr, 1994). The knowledge regarding the predictive factors is

Conclusion

The occurrence of acute seizures in CVST is common. The predictive factors for the occurrence of acute seizures deduced from the present study are altered mental status (GCS < 8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels.

Source of funding

Nil.

Conflict of interest statement

Nil.

Acknowledgements

Nil.

References (16)

There are more references available in the full text version of this article.

Cited by (42)

  • Predicting the occurrence of early seizures after cerebral venous thrombosis using a comprehensive nomogram

    2021, Epilepsy Research
    Citation Excerpt :

    Accurate prediction of the ES occurrence of individuals is crucial in planning the treatment strategy (Gazioglu et al., 2020). In previous studies, various risk factors for seizure in patients with CVT, including focal neurological deficits, supratentorial parenchymal lesions, intracerebral hemorrhage (ICH), ischemic infarction, SSST, cortical vein thrombosis, and pregnancy or puerperium, have been identified (Mahale et al., 2016; Uluduz et al., 2020). Nevertheless, there is no clear consensus on the validity and efficacy of these factors in ES prediction.

  • Burden of acute symptomatic seizures in cerebral venous sinus thrombosis: A nationwide United States analysis

    2021, Clinical Neurology and Neurosurgery
    Citation Excerpt :

    These may be focal or focal to bilateral tonic-clonic seizures [2]. Poor mentation at presentation, motor or sensory deficits, cortical vein thrombosis, and any the presence of any cerebral lesion have all been associated with an increased risk of seizures in CVT [4–6]. Such seizures can cause neurologic and systemic deterioration, progress to status epilepticus, and increase mortality [5].

  • Cerebral Venous Thrombosis

    2021, Stroke: Pathophysiology, Diagnosis, and Management
  • Critical Care of the Patient With Acute Stroke

    2021, Stroke: Pathophysiology, Diagnosis, and Management
View all citing articles on Scopus
View full text