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