55 results on '"Susanna M. Zuurbier"'
Search Results
2. Coagulation Factor XIII in Cerebral Venous Thrombosis
- Author
-
Bojun Li, Mirjam R. Heldner, Marcel Arnold, Jonathan M. Coutinho, Susanna M. Zuurbier, Joost C. M. Meijers, Hans P. Kohler, and Verena Schroeder
- Subjects
Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2019
- Full Text
- View/download PDF
Catalog
3. Female Hormone Therapy and Risk of Intracranial Hemorrhage From Cerebral Cavernous Malformations: A Multicenter Observational Cohort Study
- Author
-
Susanna M. Zuurbier, Alejandro N. Santos, Kelly D. Flemming, Börge Schmidt, Ramazan Jabbarli, Giuseppe Lanzino, Ulrich Sure, Philipp Dammann, and Neurology
- Subjects
Medizin ,Neurology (clinical) - Abstract
Background and ObjectivesFemale hormone therapy (oral contraception in female patients of reproductive age and menopausal hormone therapy in postmenopausal patients) is not withheld from patients with cerebral cavernous malformations (CCMs), although the effects of these drugs on the risk of intracranial hemorrhage are unknown. We investigated the association between female hormone therapy and intracranial hemorrhage in female patients with CCM in 2 large prospective, multicenter, observational cohort studies.MethodsWe included consecutive patients with a CCM. We compared the association between use of female hormone therapy and the occurrence of intracranial hemorrhage due to the CCM during up to 5 years of prospective follow-up in multivariable Cox proportional hazards regression. We performed an additional systematic review through Ovid MEDLINE and Embase from inception to November 2, 2021, to identify comparative studies and assess their intracranial hemorrhage incidence rate ratio according to female hormone therapy use.ResultsOf 722 female patients, aged 10 years or older at time of CCM diagnosis, 137 used female hormone therapy at any point during follow-up. Female hormone therapy use (adjusted for age, mode of presentation, and CCM location) was associated with an increased risk of subsequent intracranial hemorrhage (46/137 [33.6%] vs 91/585 [15.6%] and adjusted hazard ratio 1.56, 95% CI 1.09–2.24;p= 0.015). Use of oral contraceptives in female patients aged 10–44 years adjusted for the same factors was associated with a higher risk of subsequent intracranial hemorrhage (adjusted hazard ratio 2.00, 95% CI 1.26–3.17;p= 0.003). Our systematic literature search showed no studies reporting on the effect of female hormone therapy on the risk of intracranial hemorrhage during follow-up.DiscussionFemale hormone therapy use is associated with a higher risk of intracranial hemorrhage from CCMs. These findings raise questions about the safety of female hormone therapy in clinical practice in patients with CCM. Further studies evaluating clinical factors raising risk of thrombosis may be useful to determine which patients may be most susceptible to intracranial hemorrhage.Classification of EvidenceThis study provides Class III evidence that female hormone therapy use is associated with a higher risk of intracranial hemorrhage in patients with CCM. more...
- Published
- 2023
4. Dural arteriovenous fistulas in cerebral venous thrombosis
- Author
-
Marcel Arnold, Maryam Mansour, Martin Punter, Christophe Cognard, Blake F Giarola, Fabiola Serrano, Mayte Sánchez van Kammen, Nicole A Chiota-McCollum, Masoud Ghiasian, Carlos Garcia-Esperon, Erik Lindgren, Katarina Jood, William Allingham, Jukka Putaala, Sini Hiltunen, Susanna M. Zuurbier, Eike I. Piechowiak, Jeremy Wells, Jonathan M. Coutinho, Mirjam Rachel Heldner, Suzanne M. Silvis, Turgut Tatlisumak, Antonio Arauz, Timothy Kleinig, Alexandros Rentzos, HUS Neurocenter, Department of Neurosciences, University of Helsinki, Neurologian yksikkö, and Clinicum more...
- Subjects
long-term outcome ,SINUS THROMBOSIS ,medicine.medical_specialty ,PROGNOSIS ,Population ,610 Medicine & health ,030204 cardiovascular system & hematology ,3124 Neurology and psychiatry ,03 medical and health sciences ,0302 clinical medicine ,Dural arteriovenous fistulas ,Interquartile range ,Modified Rankin Scale ,follow-up ,medicine ,EPIDEMIOLOGY ,education ,Stroke ,dural arteriovenous fistula ,Sigmoid sinus ,education.field_of_study ,business.industry ,3112 Neurosciences ,cerebral venous thrombosis ,NATURAL-HISTORY ,IMPAIRMENT ,medicine.disease ,stroke ,Thrombosis ,3. Good health ,Surgery ,Venous thrombosis ,Neurology ,Neurology (clinical) ,610 Medizin und Gesundheit ,INTRACRANIAL VASCULAR MALFORMATIONS ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND AND PURPOSE To explore the prevalence, risk factors, time correlation, characteristics and clinical outcome of dural arteriovenous fistulas (dAVFs) in a cerebral venous thrombosis (CVT) population. METHODS We included patients from the International CVT Consortium registries. Diagnosis of dAVF was confirmed centrally. We assessed the prevalence and risk factors for dAVF among consecutive CVT patients and investigated its impact on clinical outcome using logistic regression analysis. We defined poor outcome as modified Rankin Scale score 3-6 at last follow-up. RESULTS dAVF was confirmed in 29/1218 (2.4%) consecutive CVT patients. The median (interquartile range [IQR]) follow-up time was 8��(5-23) months. Patients with dAVF were older (median [IQR] 53��[44-61] vs. 41��[29-53] years; p��30 days: 39% vs. 7%; p�� more...
- Published
- 2021
- Full Text
- View/download PDF
5. Age of onset of cerebral venous thrombosis
- Author
-
Redoy Ranjan, Gie Ken-Dror, Ida Martinelli, Elvira Grandone, Sini Hiltunen, Erik Lindgren, Maurizio Margaglione, Veronique Le Cam Duchez, Aude Bagan Triquenot, Marialuisa Zedde, Michelangelo Mancuso, Ynte M Ruigrok, Brad Worrall, Jennifer J Majersik, Jukka Putaala, Elena Haapaniemi, Susanna M Zuurbier, Matthijs C Brouwer, Serena M Passamonti, Maria Abbattista, Paolo Bucciarelli, Robin Lemmens, Emanuela Pappalardo, Paolo Costa, Marina Colombi, Diana Aguiar de Sousa, Sofia Rodrigues, Patrícia Canhao, Aleksander Tkach, Rosa Santacroce, Giovanni Favuzzi, Antonio Arauz, Donatella Colaizzo, Kostas Spengos, Amanda Hodge, Reina Ditta, Thang S Han, Alessandro Pezzini, Jonathan M Coutinho, Vincent Thijs, Katarina Jood, Turgut Tatlisumak, José M Ferro, Pankaj Sharma, Neurology, AII - Infectious diseases, ANS - Neuroinfection & -inflammation, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders more...
- Subjects
age of onset ,Cerebral venous thrombosis ,Original Research Articles ,Neurology (clinical) ,women ,Cardiology and Cardiovascular Medicine ,cerebral venous sinus thrombosis - Abstract
Background: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke in young adults. We aimed to determine the impact of age, gender and risk factors (including sex-specific) on CVT onset. Methods: We used data from the BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis), a multicentre multinational prospective observational study on CVT. Composite factors analysis (CFA) was performed to determine the impact on the age of CVT onset in males and females. Results: A total of 1309 CVT patients (75.3% females) aged ⩾18 years were recruited. The overall median (IQR-interquartile range) age for males and females was 46 (35–58) years and 37 (28–47) years ( p Conclusions: Women suffer CVT 9 years earlier in comparison to men. Female patients with multiple (⩾1) risk factors suffer CVT ~12 years earlier compared to those with no identifiable risk factors. more...
- Published
- 2023
6. A scoring tool to predict mortality and dependency after cerebral venous thrombosis
- Author
-
Erik Lindgren, Katarzyna Krzywicka, Maria A. de Winter, Mayte Sánchez Van Kammen, Mirjam R. Heldner, Sini Hiltunen, Diana Aguiar de Sousa, Maryam Mansour, Patrícia Canhão, Esme Ekizoğlu, Miguel Rodrigues, Elisa Martins Silva, Carlos Garcia‐Esperon, Valentina Arnao, Paolo Aridon, Naaem Moin Simaan, Suzanne M. Silvis, Susanna M. Zuurbier, Adrian Scutelnic, Mine Sezgin, Andrey Marisovich Alasheev, Andrey Smolkin, Daniel Guisado‐Alonso, Nilufer Yesilot, Miguel Barboza, Masoud Ghiasian, Ronen R. Leker, Antonio Arauz, Marcel Arnold, Jukka Putaala, Turgut Tatlisumak, Jonathan M. Coutinho, and Katarina Jood more...
- Subjects
Neurology ,360 Soziale Probleme, Sozialdienste ,Neurology (clinical) ,610 Medizin und Gesundheit - Abstract
BACKGROUND We developed a prognostic score to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials.. METHODS We used data from the International CVT Consortium. We excluded patients with pre-existent functional dependency. We used logistic regression to predict poor outcome (modified Rankin Scale 3-6) at 6 months and Cox regression to predict 30-day and 1-year all-cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunken using Ridge regression to adjust for optimism in internal validation. RESULTS Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, we derived the SI2 NCAL2 C score utilizing the following components: absence of female Sex-specific risk factor, Intracerebral hemorrhage, Infection of the central nervous system, Neurologic focal deficits, Coma, Age, lower Level of hemoglobin (g/L), higher Level of glucose (mmol/L) at admission, and Cancer. C-statistics were 0.80 (95%CI 0.75-0.84), 0.84 (95%CI 0.80-0.88) and 0.84 (95%CI 0.80-0.88) for the poor outcome, 30 days and 1 year mortality model, respectively. Calibration plots indicated good model fit between predicted and observed values. The SI2 NCAL2 C score calculator is freely available at www.cerebralvenousthrombosis.com. CONCLUSIONS The SI2 NCAL2 C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted. more...
- Published
- 2023
- Full Text
- View/download PDF
7. Frequency of Thrombocytopenia and Platelet Factor 4/Heparin Antibodies in Patients with Cerebral Venous Sinus Thrombosis Prior to the COVID-19 Pandemic
- Author
-
Adrian Scutelnic, Mayte Sánchez van Kammen, Saskia Middeldorp, Jukka Putaala, Sini Hiltunen, Miguel A Barboza, Diana Aguiar de Sousa, Suzanne Silvis, Verena Schroeder, Erik Lindgren, Marcel Arnold, Marcel Levi, Johanna A. Kremer Hovinga, José M. Ferro, Turgut Tatlisumak, Katarina Jood, Antonio Arauz, Urs Fischer, Susanna M. Zuurbier, Thalia S. Field, Mirjam Rachel Heldner, Maryam Mansour, Justine Brodard, Jonathan M. Coutinho, HUS Neurocenter, University of Helsinki, Neurologian yksikkö, Department of Neurosciences, Graduate School, Neurology, ANS - Neurovascular Disorders, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ARD - Amsterdam Reproduction and Development, and ACS - Atherosclerosis & ischemic syndromes more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,COVID-19 Vaccines ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Platelet Factor 4 ,DIAGNOSIS ,01 natural sciences ,Gastroenterology ,Antibodies ,03 medical and health sciences ,Sinus Thrombosis, Intracranial ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,Platelet ,030212 general & internal medicine ,0101 mathematics ,Cerebral venous sinus thrombosis ,610 Medicine & health ,Retrospective Studies ,Original Investigation ,biology ,business.industry ,Heparin ,010102 general mathematics ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Thrombocytopenia ,3. Good health ,3121 General medicine, internal medicine and other clinical medicine ,biology.protein ,Female ,Fresh frozen plasma ,Antibody ,business ,Platelet factor 4 ,medicine.drug - Abstract
Contains fulltext : 238007.pdf (Publisher’s version ) (Closed access) IMPORTANCE: Cases of cerebral venous sinus thrombosis in combination with thrombocytopenia have recently been reported within 4 to 28 days of vaccination with the ChAdOx1 nCov-19 (AstraZeneca/Oxford) and Ad.26.COV2.S (Janssen/Johnson & Johnson) COVID-19 vaccines. An immune-mediated response associated with platelet factor 4/heparin antibodies has been proposed as the underlying pathomechanism. OBJECTIVE: To determine the frequencies of admission thrombocytopenia, heparin-induced thrombocytopenia, and presence of platelet factor 4/heparin antibodies in patients diagnosed with cerebral venous sinus thrombosis prior to the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This was a descriptive analysis of a retrospective sample of consecutive patients diagnosed with cerebral venous sinus thrombosis between January 1987 and March 2018 from 7 hospitals participating in the International Cerebral Venous Sinus Thrombosis Consortium from Finland, the Netherlands, Switzerland, Sweden, Mexico, Iran, and Costa Rica. Of 952 patients, 865 with available baseline platelet count were included. In a subset of 93 patients, frozen plasma samples collected during a previous study between September 2009 and February 2016 were analyzed for the presence of platelet factor 4/heparin antibodies. EXPOSURES: Diagnosis of cerebral venous sinus thrombosis. MAIN OUTCOMES AND MEASURES: Frequencies of admission thrombocytopenia (platelet count 0.4, in a subset of patients with previously collected plasma samples). RESULTS: Of 865 patients (median age, 40 years [interquartile range, 29-53 years], 70% women), 73 (8.4%; 95% CI, 6.8%-10.5%) had thrombocytopenia, which was mild (100-149 ×103/μL) in 52 (6.0%), moderate (50-99 ×103/μL) in 17 (2.0%), and severe ( more...
- Published
- 2021
- Full Text
- View/download PDF
8. Late seizures in cerebral venous thrombosis
- Author
-
Marcel Arnold, Erik Lindgren, Saleem Al-Asady, Suzanne M. Silvis, Jonathan M. Coutinho, Sini Hiltunen, Nilufer Yesilot, Turgut Tatlisumak, Antonio Arauz, Esme Ekizoglu, Patrícia Canhão, Jukka Putaala, Maryam Mansour, Fabiola Serrano, Johan Zelano, Miguel A Barboza, Susanna M. Zuurbier, Masoud Ghiasian, Mirjam Rachel Heldner, José M. Ferro, Valentina Arnao, Katarina Jood, Petra Redfors, Martin N.M. Punter, Diana Aguiar de Sousa, Paolo Aridon, Mayte Sánchez van Kammen, Sánchez van Kammen, Mayte, Lindgren, Erik, Silvis, Suzanne M, Hiltunen, Sini, Heldner, Mirjam Rachel, Serrano, Fabiola, Zelano, Johan, Zuurbier, Susanna M, Mansour, Maryam, Aguiar de Sousa, Diana, Canhão, Patrícia, Al-Asady, Saleem, Ekizoglu, Esme, Redfors, Petra, Yesilot, Nilufer, Ghiasian, Masoud, Barboza, Miguel A, Arnao, Valentina, Aridon, Paolo, Punter, Martin N M, Ferro, José M, Arauz, Antonio, Tatlisumak, Turgut, Arnold, Marcel, Putaala, Jukka, Jood, Katarina, Coutinho, Jonathan M, Graduate School, Neurology, ANS - Neurovascular Disorders, and ACS - Atherosclerosis & ischemic syndromes more...
- Subjects
Adult ,Male ,Status epilepticus ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Recurrence ,Risk Factors ,Seizures ,Interquartile range ,medicine ,Humans ,Stroke ,Venous Thrombosis ,Intracerebral hemorrhage ,business.industry ,Incidence ,Hazard ratio ,cerebral venous thrombosis ,Symptomatic seizures ,Middle Aged ,medicine.disease ,3. Good health ,Venous thrombosis ,Anesthesia ,Female ,Settore MED/26 - Neurologia ,Neurology (clinical) ,Intracranial Thrombosis ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
ObjectiveTo examine the incidence, characteristics, treatment, and predictors of late seizures (LS) after cerebral venous thrombosis (CVT), we described these features in a registry of 1,127 patients with CVT.MethodsWe included consecutive adult patients from an international consortium of 12 hospital-based CVT registries. We excluded patients with a history of epilepsy or with 7 days after diagnosis of CVT. We used multivariable Cox regression to identify predictors of LS.ResultsWe included 1,127 patients with CVT. During a median follow-up of 2.0 years (interquartile range [IQR] 1.0–6.3), 123 patients (11%) experienced ≥1 LS (incidence rate for first LS 30 per 1,000 person-years, 95% confidence interval [CI] 25–35). Median time to first LS was 5 months (IQR 1–16 months). Baseline predictors of LS included status epilepticus in the acute phase (hazard ratio [HR] 7.0, 95% CI 3.9–12.6), decompressive hemicraniectomy (HR 4.2, 95% CI 2.4–7.3), acute seizure(s) without status epilepticus (HR 4.1, 95% CI 2.5–6.5), subdural hematoma (HR 2.3, 95% CI 1.1–4.9), and intracerebral hemorrhage (HR 1.9, 95% CI 1.1–3.1). Eighty-five patients (70% of patients with LS) experienced a recurrent seizure during follow-up, despite the fact that 94% received antiepileptic drug treatment after the first LS.ConclusionDuring a median follow-up of 2 years, ≈1 in 10 patients with CVT had LS. Patients with baseline intracranial bleeding, patients with acute symptomatic seizures, and those who underwent decompressive hemicraniectomy were at increased risk of developing LS. The high recurrence risk of LS justifies epilepsy diagnosis after a first LS. more...
- Published
- 2020
- Full Text
- View/download PDF
9. Ten-year risks of recurrent stroke, disability, dementia and cost in relation to site of primary intracerebral haemorrhage: population-based study
- Author
-
Nicola C Beddows, Philippa Lavallee, Peter M. Rothwell, Wilhelm Küker, Louise E. Silver, Susanna M. Zuurbier, Linxin Li, Ramon Luengo-Fernandez, Neurology, ACS - Atherosclerosis & ischemic syndromes, and Amsterdam Neuroscience - Neurovascular Disorders more...
- Subjects
Male ,Risk ,Pediatrics ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Recurrent stroke ,Recurrence ,mental disorders ,medicine ,Dementia ,Humans ,cardiovascular diseases ,Patient group ,education ,Aged ,Cerebral Hemorrhage ,Aged, 80 and over ,education.field_of_study ,business.industry ,Incidence ,Health Care Costs ,Middle Aged ,medicine.disease ,Hospital care ,3. Good health ,nervous system diseases ,Population based study ,Stroke ,Psychiatry and Mental health ,Cerebrovascular Disease ,Hospital admission ,Quality of Life ,Surgery ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BackgroundPatients with primary intracerebral haemorrhage (ICH) are at increased long-term risks of recurrent stroke and other comorbidities. However, available estimates come predominantly from hospital-based studies with relatively short follow-up. Moreover, there are also uncertainties about the influence of ICH location on risks of recurrent stroke, disability, dementia and quality of life.MethodsIn a population-based study (Oxford Vascular Study/2002–2018) of patients with a first ICH with follow-up to 10 years, we determined the long-term risks of recurrent stroke, disability, quality of life, dementia and hospital care costs stratified by haematoma location.ResultsOf 255 cases with primary ICH (mean/SD age 75.5/13.1), 109 (42.7%) had lobar ICH, 144 (56.5%) non-lobar ICH and 2 (0.8%) had uncertain location. Annual rates of recurrent ICH were higher after lobar versus non-lobar ICH (lobar=4.0%, 2.7–7.2 vs 1.1%, 0.3–2.8; p=0.02). Moreover, cumulative rate of dementia was also higher for lobar versus non-lobar ICH (n/% lobar=20/36.4% vs 16/20.8%, p=0.047), and there was a higher proportion of disability at 5 years in survivors (15/60.0% vs 9/31.0%, p=0.03). The 10-year quality-adjusted life years (QALYs) were also lower after lobar versus non-lobar ICH (2.9 vs 3.8 for non-lobar, p=0.04). Overall, the mean 10-year censor-adjusted costs were £19 292, with over 80% of costs due to inpatient hospital admission costs, which did not vary by haematoma location (p=0.90).ConclusionCompared with non-lobar ICH, the substantially higher 10-year risks of recurrent stroke, dementia and lower QALYs after lobar ICH highlight the need for more effective prevention for this patient group. more...
- Published
- 2020
10. Dural arteriovenous fistulas in cerebral venous thrombosis: Data from the International Cerebral Venous Thrombosis Consortium: Data from the International Cerebral Venous Thrombosis Consortium
- Author
-
Erik, Lindgren, Alexandros, Rentzos, Sini, Hiltunen, Fabiola, Serrano, Mirjam R, Heldner, Susanna M, Zuurbier, Suzanne M, Silvis, Maryam, Mansour, William, Allingham, Martin N M, Punter, Blake F, Giarola, Jeremy, Wells, Mayte, Sánchez van Kammen, Eike I, Piechowiak, Nicole, Chiota-McCollum, Carlos, Garcia-Esperon, Christophe, Cognard, Timothy, Kleinig, Masoud, Ghiasian, Jonathan M, Coutinho, Marcel, Arnold, Antonio, Arauz, Jukka, Putaala, Katarina, Jood, and Turgut, Tatlisumak more...
- Subjects
Central Nervous System Vascular Malformations ,Male ,Venous Thrombosis ,Sinus Thrombosis, Intracranial ,Risk Factors ,Humans ,Intracranial Thrombosis - Abstract
To explore the prevalence, risk factors, time correlation, characteristics and clinical outcome of dural arteriovenous fistulas (dAVFs) in a cerebral venous thrombosis (CVT) population.We included patients from the International CVT Consortium registries. Diagnosis of dAVF was confirmed centrally. We assessed the prevalence and risk factors for dAVF among consecutive CVT patients and investigated its impact on clinical outcome using logistic regression analysis. We defined poor outcome as modified Rankin Scale score 3-6 at last follow-up.dAVF was confirmed in 29/1218 (2.4%) consecutive CVT patients. The median (interquartile range [IQR]) follow-up time was 8 (5-23) months. Patients with dAVF were older (median [IQR] 53 [44-61] vs. 41 [29-53] years; p 0.001), more frequently male (69% vs. 33%; p 0.001), more often had chronic clinical CVT onset (30 days: 39% vs. 7%; p 0.001) and sigmoid sinus thrombosis (86% vs. 51%; p 0.001), and less frequently had parenchymal lesions (31% vs. 55%; p = 0.013) at baseline imaging. Clinical outcome at last follow-up did not differ between patients with and without dAVF. Additionally, five patients were confirmed with dAVF from non-consecutive CVT cohorts. Among all patients with CVT and dAVF, 17/34 (50%) had multiple fistulas and 23/34 (68%) had cortical venous drainage. Of 34 patients with dAVF with 36 separate CVT events, 3/36 fistulas (8%) were diagnosed prior to, 20/36 (56%) simultaneously and 13/36 after (36%, median 115 [IQR 38-337] days) diagnosis of CVT.Dural arteriovenous fistulas occur in at least 2% of CVT patients and are associated with chronic CVT onset, older age and male sex. Most CVT-related dAVFs are detected simultaneously or subsequently to diagnosis of CVT. more...
- Published
- 2021
11. Genome-wide association study identifies first locus associated with susceptibility to cerebral venous thrombosis
- Author
-
Serena M. Passamonti, Aleksander Tkach, José M. Ferro, Susanna M. Zuurbier, Stéphanie Debette, Pankaj Sharma, Christina Jern, Ida Martinelli, Elena Haapaniemi, Patrícia Canhão, Braxton D. Mitchell, Giovanni Favuzzi, Guillaume Paré, Alessandro Pezzini, Antonio Arauz, Erik Lindgren, Donatella Colaizzo, Aude Bagan Triquenot, Véronique Le Cam Duchez, K. Spengos, Marina Colombi, Jonathan M. Coutinho, Rosa Santacroce, Paolo Bucciarelli, B. B. Worrall, Ioana Cotlarciuc, Jukka Putaala, Paolo Costa, Reina Ditta, Maurizio Margaglione, Emanuela Pappalardo, Tiina M. Metso, Jennifer J. Majersik, Steven J. Kittner, Turgut Tatlisumak, Sini Hiltunen, Michelangelo Mancuso, Elvira Grandone, Amanda Hodge, Robin Lemmens, Katarina Jood, Marialuisa Zedde, Matthijs C. Brouwer, Sofia Leal Rodrigues, Gie Ken-Dror, Thomas Marjot, Ynte M. Ruigrok, Maria Abbattista, Diana Aguiar de Sousa, Vincent Thijs, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), HUS Neurocenter, Department of Neurosciences, University of Helsinki, Neurologian yksikkö, Neurology, ANS - Neuroinfection & -inflammation, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders more...
- Subjects
Adult ,Male ,Oncology ,Linkage disequilibrium ,medicine.medical_specialty ,LINKAGE DISEQUILIBRIUM ,LD ,Single-nucleotide polymorphism ,Genome-wide association study ,DISEASE ,3124 Neurology and psychiatry ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,ABO blood group system ,Internal medicine ,Genetic predisposition ,medicine ,Humans ,Thrombophilia ,Genetic Predisposition to Disease ,Allele ,030304 developmental biology ,Venous Thrombosis ,0303 health sciences ,business.industry ,3112 Neurosciences ,Odds ratio ,Middle Aged ,3. Good health ,Neurology ,Chromosomal region ,RISK-FACTORS ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Neurology (clinical) ,Intracranial Thrombosis ,business ,STROKE ,030217 neurology & neurosurgery ,Genome-Wide Association Study - Abstract
Objective Cerebral venous thrombosis (CVT) is an uncommon form of stroke affecting mostly young individuals. Although genetic factors are thought to play a role in this cerebrovascular condition, its genetic etiology is not well understood. Methods A genome-wide association study was performed to identify genetic variants influencing susceptibility to CVT. A 2-stage genome-wide study was undertaken in 882 Europeans diagnosed with CVT and 1,205 ethnicity-matched control subjects divided into discovery and independent replication datasets. Results In the overall case-control cohort, we identified highly significant associations with 37 single nucleotide polymorphisms (SNPs) within the 9q34.2 region. The strongest association was with rs8176645 (combined p = 9.15 x 10(-24); odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.76-2.31). The discovery set findings were validated across an independent European cohort. Genetic risk score for this 9q34.2 region increases CVT risk by a pooled estimate OR = 2.65 (95% CI = 2.21-3.20, p = 2.00 x 10(-16)). SNPs within this region were in strong linkage disequilibrium (LD) with coding regions of the ABO gene. The ABO blood group was determined using allele combination of SNPs rs8176746 and rs8176645. Blood groups A, B, or AB, were at 2.85 times (95% CI = 2.32-3.52, p = 2.00 x 10(-16)) increased risk of CVT compared with individuals with blood group O. Interpretation We present the first chromosomal region to robustly associate with a genetic susceptibility to CVT. This region more than doubles the likelihood of CVT, a risk greater than any previously identified thrombophilia genetic risk marker. That the identified variant is in strong LD with the coding region of the ABO gene with differences in blood group prevalence provides important new insights into the pathophysiology of CVT. ANN NEUROL 2021 more...
- Published
- 2021
- Full Text
- View/download PDF
12. Blood pressure control and recurrent stroke after intracerebral hemorrhage in 2002 to 2018 versus 1981 to 1986: population-based study
- Author
-
Charles Warlow, Wilhelm Küker, Linxin Li, Susanna M. Zuurbier, Peter M. Rothwell, and Neurology
- Subjects
Blood pressure control ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Recurrent stroke ,Internal medicine ,Perindopril ,medicine ,ischemic stroke ,risk ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,cerebral hemorrhage ,business.industry ,blood pressure ,survivors ,medicine.disease ,Population based study ,Blood pressure ,Ischemic stroke ,Cardiology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background and Purpose: The PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study) conducted in the early 1990s showed that blood pressure (BP) lowering therapy reduced the risks of recurrent stroke by about 50% after spontaneous intracerebral hemorrhage (ICH). However, the ICH subgroup was a minority, and trial cohorts are invariably selective. Therefore, it is unclear whether the impact of BP control on risk of recurrent stroke in ICH observed in PROGRESS would be as great in real-world practice. Methods: We compared BP control (mean BP during study follow-up) and risks of recurrent stroke after first-ever primary ICH in 2 colocated population-based studies before and after the PROGRESS trial (1995–2001) in Oxfordshire: Oxfordshire Community Stroke Project (OCSP; 1981–1986) and OXVASC (Oxford Vascular Study; 2002–2018). Results: Two hundred seventy-seven patients (753 patient-years of follow-up) with first-ever primary ICH were ascertained in OXVASC and OCSP. Baseline systolic BP was comparable between the 2 studies (mean/SD=183.8/36.5 in OXVASC versus 178.1/38.2 in OCSP, P =0.30) but among one hundred thirty-seven 90-day survivors, mean BP during follow-up was substantially lower in OXVASC versus OCSP (135.2/16.4 versus 157.3/17.8, P P =0.006), predominantly driven by a reduction at younger ages (5-year risk at age P =0.001; hazard ratio, 0.14 [0.04–0.54]). Conclusions: Risks of recurrent stroke after primary ICH have fallen significantly in Oxfordshire over the past 4 decades, coinciding with substantial improvements in BP control during follow-up. more...
- Published
- 2021
13. Journal Club: Trends in Incidence and Epidemiological Characteristics of Cerebral Venous Thrombosis in the United States
- Author
-
Susanna M. Zuurbier, Mirjam Rachel Heldner, and Nikolaos Raptis
- Subjects
Pediatrics ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Population ,610 Medicine & health ,medicine.disease ,Autopsy series ,Venous thrombosis ,Epidemiology ,medicine ,Human medicine ,Neurology (clinical) ,Journal club ,education ,business - Abstract
Cerebral venous thrombosis (CVT) is rare. Early estimations of its incidence were derived from autopsy series and were extrapolated to be around 0.1 to 0.2 patients with CVT per 100,000 per year.1 Recently, a cross-sectional study in the Netherlands and a population-based study in Australia found a much higher incidence of up to 1.6 per 100,000 per year.2,3 Even higher incidences have been reported in the Middle East.4 Wider availability of imaging, technological advances, and a shift in risk factors might explain these differences.2–4 more...
- Published
- 2021
- Full Text
- View/download PDF
14. Be aware: COVID-19 the new stroke mimicker
- Author
-
Soetkin Vantyghem, Laetitia Yperzeele, Hanne-Laure Verschelde, Susanna M Zuurbier, Peter Vanacker, and Neurology
- Subjects
Stroke mimic ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Neurology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Clinical Neurology ,Stroke mimics ,COVID-19 ,General Medicine ,medicine.disease ,Stroke ,Emergency medicine ,medicine ,Neurology (clinical) ,Human medicine ,business ,Letter to the Editor ,Neuroradiology - Published
- 2020
- Full Text
- View/download PDF
15. Features of intracranial hemorrhage in cerebral venous thrombosis
- Author
-
Robin Lemmens, Jonathan M. Coutinho, Antonio Arauz, Alessandro Pezzini, Miguel A Barboza, Nicole Hinteregger, Christian Weimar, Susanna M. Zuurbier, Sini Hiltunen, Vincent Thijs, Pieter-Jan Buyck, Joan Montaner, Carlos Garcia Esperon, Turgut Tatlisumak, Patricia Luiza Nunes Costa, J. Jiménez Conde, Jukka Putaala, K. Afifi, Irene Escudero, G Bellanger, Dimitri Renard, Eva Giralt-Steinhauer, Marc Schlamann, Thomas Gattringer, Franz Fazekas, Philippe Demaerel, ANS - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, and Neurology more...
- Subjects
Adult ,Male ,Cerebral veins ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Bleeding ,Medizin ,Hemorrhage ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Mexico ,Stroke ,Aged ,Retrospective Studies ,Venous Thrombosis ,business.industry ,Subdural hemorrhage ,medicine.disease ,Cerebral Veins ,Thrombosis ,Europe ,Venous thrombosis ,Intracranial Thrombosis ,Neurology ,Cerebral venous thrombosis ,Female ,Neurology (clinical) ,Radiology ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,Superior sagittal sinus - Abstract
[Background] Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage., [Aim] To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage., [Methods] We performed a retrospective analysis of an international, multicenter cohort of patients with confirmed cerebral venous thrombosis who underwent computed tomography within 2 weeks of symptom onset. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging., [Results] We enrolled 260 patients from 10 institutions in Europe and Mexico. The mean age was 42 years and 74% were female. Intracranial hemorrhage was found in 102 (39%). Among them parenchymal hemorrhage occurred in 64 (63%), in addition, small juxta-cortical hemorrhage was found in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Multiple concomitant types of hemorrhage occurred in 23 (23%). Older age and superior sagittal thrombosis involvement were associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracranial hemorrhage (median number IQRInterquartile ratio] of sinuses/veins involved with hemorrhage 2 (1–3) vs. 2 (1–3) without hemorrhage, p = 0.4)., [Conclusion] The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with higher bleeding risk. more...
- Published
- 2020
16. Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial
- Author
-
Maarten Uyttenboogaart, Jonathan M. Coutinho, Charles B. L. M. Majoie, Bart J. Emmer, Stefan D. Roosendaal, Patrícia Canhão, René van den Berg, Jim A. Reekers, Jian Chen, José M. Ferro, Jan Stam, Ana Paiva Nunes, Xunming Ji, Isabelle Crassard, Rob J. de Haan, To-Act investigators, Emmanuel Houdart, Marie-Germaine Bousser, Yvo B.W.E.M. Roos, Susanna M. Zuurbier, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, ACS - Microcirculation, APH - Methodology, and Clinical Research Unit more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Mechanical Thrombolysis ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,Fibrinolytic Agents ,law ,Modified Rankin Scale ,Interquartile range ,Internal medicine ,Severity of illness ,Outcome Assessment, Health Care ,medicine ,Clinical endpoint ,Humans ,Single-Blind Method ,030212 general & internal medicine ,Original Investigation ,Intracerebral hemorrhage ,business.industry ,Anticoagulants ,Middle Aged ,medicine.disease ,Interim analysis ,Cerebral Veins ,Combined Modality Therapy ,Urokinase-Type Plasminogen Activator ,Relative risk ,Tissue Plasminogen Activator ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Importance: To date, only uncontrolled studies have evaluated the efficacy and safety of endovascular treatment (EVT) in patients with cerebral venous thrombosis (CVT), leading to the lack of recommendations on EVT for CVT.Objective: To evaluate the efficacy and safety of EVT in patients with a severe form of CVT.Design, Setting, and Participants: TO-ACT (Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis) was a multicenter, open-label, blinded end point, randomized clinical trial conducted in 8 hospitals in 3 countries (the Netherlands, China, and Portugal). Patients were recruited from September 2011 to October 2016, and follow-up began in March 2012 and was completed in December 2017. Adult patients with radiologically confirmed CVT who had at least 1 risk factor for a poor outcome (mental status disorder, coma state, intracerebral hemorrhage, or thrombosis of the deep venous system) were included. Data were analyzed according to the intention-to-treat principle from March 2018 to February 2019. The trial was halted after the first interim analysis for reasons of futility.Interventions: Patients were randomized to receive either EVT with standard medical care (intervention group) or guideline-based standard medical care only (control group). The EVT consisted of mechanical thrombectomy, local intrasinus application of alteplase or urokinase, or a combination of both strategies. Patients in the intervention group underwent EVT as soon as possible but no later than 24 hours after randomization.Main Outcomes and Measures: Primary end point was the proportion of patients with a good outcome at 12 months (recovered without a disability; modified Rankin Scale [mRS] score of 0-1). Secondary end points were the proportion of patients with an mRS score of 0 to 1 at 6 months and an mRS score of 0 to 2 at 6 and 12 months, outcome on the mRS across the ordinal continuum at 12 months, recanalization rate, and surgical interventions in relation to CVT. Safety end points included symptomatic intracranial hemorrhage.Results: Of the 67 patients enrolled and randomized, 33 (49%) were randomized to the intervention group and 34 (51%) were randomized to the control group. Patients in the intervention group vs those in the control group were slightly older (median [interquartile range (IQR)] age, 43 [33-50] years vs 38 [23-48] years) and comprised fewer women (23 women [70%] vs 27 women [79%]). The median (IQR) baseline National Institutes of Health Stroke Scale score was 12 (7-20) in the EVT group and 12 (5-20) in the standard care group. At the 12-month follow-up, 22 intervention patients (67%) had an mRS score of 0 to 1 compared with 23 control patients (68%) (relative risk ratio, 0.99; 95% CI, 0.71-1.38). Mortality was not statistically significantly higher in the EVT group (12% [n = 4] vs 3% [n = 1]; P = .20). The frequency of symptomatic intracerebral hemorrhage was not statistically significantly lower in the intervention group (3% [n = 1] vs 9% [n = 3]; P = .61).Conclusions and Relevance: The TO-ACT trial showed that EVT with standard medical care did not appear to improve functional outcome of patients with CVT. Given the small sample size, the possibility exists that future studies will demonstrate better recovery rates after EVT for this patient population.Trial Registration: ClinicalTrials.gov Identifier: NCT01204333. more...
- Published
- 2020
17. Long-term antithrombotic therapy and risk of intracranial haemorrhage from cerebral cavernous malformations: a population-based cohort study, systematic review, and meta-analysis
- Author
-
Susanna M. Zuurbier, Robert J. Wityk, David Bervini, Leon A. Rinkel, Christos S. Tolias, Rebecca Leyrer, Hans Martin Schneble, Rustam Al-Shahi Salman, Kelly D. Flemming, Giuseppe Lanzino, Ulrich Sure, Charlotte R. Hickman, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders more...
- Subjects
Adult ,Male ,Hemangioma, Cavernous, Central Nervous System ,Pediatrics ,medicine.medical_specialty ,CLINICAL-COURSE ,Medizin ,610 Medicine & health ,030204 cardiovascular system & hematology ,Lower risk ,Rate ratio ,Article ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Randomized controlled trial ,law ,Antithrombotic ,medicine ,Humans ,Stroke ,Aged ,business.industry ,Hazard ratio ,Anticoagulants ,Middle Aged ,medicine.disease ,Long-Term Care ,3. Good health ,Scotland ,Meta-analysis ,Female ,Neurology (clinical) ,business ,Intracranial Hemorrhages ,Platelet Aggregation Inhibitors ,030217 neurology & neurosurgery ,Cohort study - Abstract
Summary Background Antithrombotic (anticoagulant or antiplatelet) therapy is withheld from some patients with cerebral cavernous malformations, because of uncertainty around the safety of these drugs in such patients. We aimed to establish whether antithrombotic therapy is associated with an increased risk of intracranial haemorrhage in adults with cerebral cavernous malformations. Methods In this population-based, cohort study, we used data from the Scottish Audit of Intracranial Vascular Malformations, which prospectively identified individuals aged 16 years and older living in Scotland who were first diagnosed with a cerebral cavernous malformation during 1999–2003 or 2006–10. We compared the association between use of antithrombotic therapy after first presentation and the occurrence of intracranial haemorrhage or persistent or progressive focal neurological deficit due to the cerebral cavernous malformations during up to 15 years of prospective follow-up with multivariable Cox proportional hazards regression assessed in all individuals identified in the database. We also did a systematic review and meta-analysis, in which we searched Ovid MEDLINE and Embase from database inception to Feb 1, 2019, to identify comparative studies to calculate the intracranial haemorrhage incidence rate ratio according to antithrombotic therapy use. We then generated a pooled estimate using the inverse variance method and a random effects model. Findings We assessed 300 of 306 individuals with a cerebral cavernous malformation who were eligible for study. 61 used antithrombotic therapy (ten [16%] of 61 used anticoagulation) for a mean duration of 7·4 years (SD 5·4) during follow-up. Antithrombotic therapy use was associated with a lower risk of subsequent intracranial haemorrhage or focal neurological deficit (one [2%] of 61 vs 29 [12%] of 239, adjusted hazard ratio [HR] 0·12, 95% CI 0·02–0·88; p=0·037). In a meta-analysis of six cohort studies including 1342 patients, antithrombotic therapy use was associated with a lower risk of intracranial haemorrhage (eight [3%] of 253 vs 152 [14%] of 1089; incidence rate ratio 0·25, 95% CI 0·13–0·51; p Interpretation Antithrombotic therapy use is associated with a lower risk of intracranial haemorrhage or focal neurological deficit from cerebral cavernous malformations than avoidance of antithrombotic therapy. These findings provide reassurance about safety for clinical practice and require further investigation in a randomised controlled trial. Funding UK Medical Research Council, Chief Scientist Office of the Scottish Government, The Stroke Association, Cavernoma Alliance UK, and the Remmert Adriaan Laan Foundation. more...
- Published
- 2019
- Full Text
- View/download PDF
18. Anaemia at admission is associated with poor clinical outcome in cerebral venous thrombosis
- Author
-
Jukka Putaala, Sini Hiltunen, Marcel Arnold, Maryam Mansour, Erik Lindgren, Jonathan M. Coutinho, Antonio Arauz, Turgut Tatlisumak, Miguel A Barboza, Katarina Jood, E Reinstra, Susanna M. Zuurbier, Mirjam Rachel Heldner, Adrien E. Groot, Suzanne M. Silvis, Masoud Ghiasian, HUS Neurocenter, Department of Neurosciences, Neurologian yksikkö, University of Helsinki, Graduate School, ACS - Atherosclerosis & ischemic syndromes, AII - Inflammatory diseases, ANS - Neurovascular Disorders, and Neurology more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anemia ,610 Medicine & health ,3124 Neurology and psychiatry ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Venous Thrombosis ,Coma ,anaemia ,business.industry ,3112 Neurosciences ,Cancer ,cerebral venous thrombosis ,Original Articles ,Odds ratio ,Middle Aged ,Models, Theoretical ,medicine.disease ,Thrombosis ,Confidence interval ,3. Good health ,Hospitalization ,Venous thrombosis ,Neurology ,Female ,Original Article ,Neurology (clinical) ,prognosis ,Intracranial Thrombosis ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose Anaemia is associated with poor clinical outcome after ischaemic and haemorrhagic stroke. The association between anaemia and outcome in patients with cerebral venous thrombosis (CVT) was examined. Methods Consecutive adult patients with CVT were included from seven centres. Anaemia at admission was scored according to World Health Organization definitions. Poor clinical outcome was defined as a modified Rankin Scale score 3-6 at last follow-up. A multiple imputation procedure was applied for handling missing data in the multivariable analysis. Using binary logistic regression analysis, adjustments were made for age, sex, cancer and centre of recruitment (model 1). In a secondary analysis, adjustments were additionally made for coma, intracerebral haemorrhage, non-haemorrhagic lesion and deep venous system thrombosis (model 2). In a sensitivity analysis, patients with cancer were excluded. Results Data for 952 patients with CVT were included, 22% of whom had anaemia at admission. Patients with anaemia more often had a history of cancer (17% vs. 7%, P more...
- Published
- 2020
- Full Text
- View/download PDF
19. Coagulation Factor XIII in Cerebral Venous Thrombosis
- Author
-
Susanna M. Zuurbier, Mirjam Rachel Heldner, Marcel Arnold, Jonathan M. Coutinho, Bojun Li, Joost C. M. Meijers, Verena Schroeder, and Hans P. Kohler
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,business.industry ,Coagulation factor XIII ,610 Medicine & health ,medicine.disease ,Venous thrombosis ,lcsh:RC666-701 ,Internal medicine ,Cardiology ,medicine ,business ,Letter to the Editor - Published
- 2019
- Full Text
- View/download PDF
20. Elevated factor VIII increases the risk of cerebral venous thrombosis: a case–control study
- Author
-
Loes Vecht, Jonathan M. Coutinho, Joost C. M. Meijers, Susanna M. Zuurbier, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Neurology, ACS - Pulmonary hypertension &; thrombosis, and Vascular Medicine more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Logistic regression ,Gastroenterology ,Statistics, Nonparametric ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Risk factor ,Retrospective Studies ,Venous Thrombosis ,Factor VIII ,business.industry ,Case-control study ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Venous thrombosis ,Intracranial Thrombosis ,Neurology ,Case-Control Studies ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background: Elevated factor VIII (FVIII) is a risk factor for leg-vein thrombosis and pulmonary embolism. We assessed whether elevated FVIII is also a risk factor for cerebral venous thrombosis (CVT). Methods: We performed a matched case–control study. We assessed patients with CVT, as cases, admitted between July 2006 and December 2016. The controls were healthy hospital-staff employees matched for age (within 5 years) and sex. FVIII activity was measured at least 3 months after CVT diagnosis. Elevated FVIII was defined as activity > 150 IU/dl. We used logistic regression analysis, adjusting for age and sex. Results: We included 116 cases and 116 controls (85% women for both groups). Mean age was 40 (SD 11) and 41 (SD 11) years for cases and controls, respectively. Median time between CVT diagnosis and blood collection was 18 months (IQR 7–39 months). Cases more often had elevated FVIII as compared to controls (83.6 vs 28.4%, p < 0.001). After adjustment, elevated FVIII was associated with a 15-fold increased risk of CVT (OR 15.3, 95% CI 7.8–30.1). Stratification by sex showed a stronger association in men (OR 22.8, 95% CI 2.8–184.3) than in women (OR 14.7, 95% CI 7.2–30.2). Conclusion: Elevated FVIII occurs frequently in patients with CVT and is a strong risk factor for this condition. more...
- Published
- 2018
- Full Text
- View/download PDF
21. Postpartum Period Is a Risk Factor for Cerebral Venous Thrombosis
- Author
-
Suzanne M, Silvis, Erik, Lindgren, Sini, Hiltunen, Sharon, Devasagayam, Luuk J, Scheres, Katarina, Jood, Susanna M, Zuurbier, Timothy J, Kleinig, Frank L, Silver, Daniel M, Mandell, Saskia, Middeldorp, Jukka, Putaala, Suzanne C, Cannegieter, Turgut, Tatlisumak, and Jonathan M, Coutinho more...
- Subjects
Adult ,Pregnancy Complications ,Pregnancy ,Risk Factors ,Case-Control Studies ,Postpartum Period ,Age Factors ,Humans ,Female ,Intracranial Thrombosis - Abstract
Background and Purpose- Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk. Methods- Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals and controls from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). Men, women over the age of 50, women using oral contraceptives or with a recent abortion or miscarriage were excluded. We adjusted for age and history of cancer, and stratified for pregnancy versus postpartum, and 0 to 6 versus 7 to 12 weeks postpartum. Results- In total 163/813 cases and 1230/6296 controls were included. Cases were younger (median 38 versus 41 years) and more often had a history of cancer (14% versus 4%) than controls. In total 41/163 (25%) cases and 82/1230 (7%) controls were pregnant or postpartum (adjusted odds ratio, 3.8; 95% CI, 2.4-6.0). The association was fully attributable to an increased risk of CVT during the postpartum period (adjusted odds ratio, 10.6; 95% CI, 5.6-20.0). We found no association between pregnancy and CVT (adjusted odds ratio, 1.2; 95% CI, 0.6-2.3). The risk was highest during the first 6 weeks postpartum (adjusted odds ratio, 18.7; 95% CI, 8.3-41.9). Conclusions- Women who have recently delivered are at increased risk of developing CVT, while there does not seem to be an increased risk of CVT during pregnancy. more...
- Published
- 2019
22. Interventions for Treating Brain Arteriovenous Malformations in Adults
- Author
-
Rustam Al-Shahi Salman and Susanna M. Zuurbier
- Subjects
Adult ,Intracranial Arteriovenous Malformations ,Pediatrics ,medicine.medical_specialty ,Subarachnoid hemorrhage ,bias ,Randomization ,medicine.medical_treatment ,intracranial hemorrhages ,arteriovenous malformation ,MEDLINE ,Cochrane Library ,Conservative Treatment ,Radiosurgery ,law.invention ,Young Adult ,systematic review ,Randomized controlled trial ,law ,Modified Rankin Scale ,Medicine ,Humans ,Pharmacology (medical) ,Embolization ,Stroke ,Cerebral Hemorrhage ,Randomized Controlled Trials as Topic ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,Epilepsy ,business.industry ,Arteriovenous malformation ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Clinical trial ,Relative risk ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Brain arteriovenous malformations (AVMs) are the single most common cause of intracerebral haemorrhage in young adults. Brain AVMs also cause seizure(s) and focal neurological deficits (in the absence of haemorrhage, migraine or an epileptic seizure); approximately one-fifth are incidental discoveries. Various interventions are used in an attempt to eradicate brain AVMs: neurosurgical excision, stereotactic radiosurgery, endovascular embolization, and staged combinations of these interventions. This is an update of a Cochrane Review first published in 2006, and last updated in 2009. Objectives To determine the effectiveness and safety of the different interventions, alone or in combination, for treating brain AVMs in adults compared against either each other, or conservative management, in randomized controlled trials (RCTs). Search methods The Cochrane Stroke Group Information Specialist searched the Cochrane Stroke Group Trials Register (last searched 7 January 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library, MEDLINE Ovid (1980 to 14 January 2019), and Embase OVID (1980 to 14 January 2019). We searched international registers of clinical trials, the contents pages of relevant journals, and bibliographies of relevant articles (November 2009). We also contacted manufacturers of interventional treatments for brain AVMs (March 2005). Selection criteria We sought RCTs of any intervention for brain AVMs (used alone or in combination), compared against each other or against conservative management, with relevant clinical outcome measures. Data collection and analysis One author screened the results of the updated searches for potentially eligible RCTs for this updated review. Both authors independently read the potentially eligible RCTs in full and confirmed their inclusion according to the inclusion criteria. We resolved disagreement by discussion. We assessed the risk of bias in included studies and applied GRADE. Main results We included one trial with 226 participants: A Randomized trial of Unruptured Brain Arteriovenous Malformations (ARUBA), comparing intervention versus conservative management for unruptured brain AVMs (that had never bled). The quality of evidence was moderate because we found just one trial that was at low risk of bias other than a high risk of performance bias due to participants and treating physicians not being blinded to allocated treatment. Data on functional outcome and death at a follow-up of 12 months were provided for 218 (96%) of the participants in ARUBA. In this randomized controlled trial (RCT), intervention compared to conservative management increased death or dependency (modified Rankin Scale score ≥ 2, risk ratio (RR) 2.53, 95% confidence interval (CI) 1.28 to 4.98; 1 trial, 226 participants; moderate-quality evidence) and the proportion of participants with symptomatic intracranial haemorrhage (RR 6.75, 95% CI 2.07 to 21.96; 1 trial, 226 participants; moderate-quality evidence), but there was no difference in the frequency of epileptic seizures (RR 1.14, 95% CI 0.63 to 2.06; 1 trial, 226 participants; moderate-quality evidence). Three RCTs are ongoing. Authors' conclusions We found moderate-quality evidence from one RCT including adults with unruptured brain AVMs that conservative management was superior to intervention with respect to functional outcome and symptomatic intracranial haemorrhage over one year after randomization. More RCTs will help to confirm or refute these findings. more...
- Published
- 2020
- Full Text
- View/download PDF
23. Prediction of Cerebral Venous Thrombosis with a new clinical score and D-dimer levels
- Author
-
Hans P. Kohler, Susanna M. Zuurbier, Mirjam Rachel Heldner, Jonathan M. Coutinho, Urs Fischer, Bastian Volbers, Verena Schroeder, Simon Jung, Marcel Arnold, Rebekka Zimmermann, Joost C. M. Meijers, Marwan El-Koussy, Rascha von Martial, Bojun Li, ANS - Neurovascular Disorders, Experimental Vascular Medicine, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Amsterdam Cardiovascular Sciences, Neurology, and ACS - Atherosclerosis & ischemic syndromes more...
- Subjects
Adult ,Male ,Adolescent ,Computed Tomography Angiography ,Physical examination ,Logistic regression ,Thrombophilia ,Fibrin Fibrinogen Degradation Products ,Young Adult ,Predictive Value of Tests ,D-dimer ,Humans ,Medicine ,610 Medicine & health ,Aged ,Aged, 80 and over ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Headache ,Area under the curve ,Middle Aged ,medicine.disease ,Venous thrombosis ,Predictive value of tests ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,business ,Nuclear medicine ,Blood sampling - Abstract
ObjectiveTo investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels.MethodsThis prospective multicenter study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood sampling for D-dimers measuring (ELISA test), and magnetic resonance/CT venography. Predictive value of clinical variables and D-dimers for CVT was calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established with multivariate logistic regression.ResultsCVT was confirmed in 26.2% (94 of 359) of patients by neuroimaging. The optimal estimate of clinical probability was based on 6 variables: seizure(s) at presentation (4 points), known thrombophilia (4 points), oral contraception (2 points), duration of symptoms >6 days (2 points), worst headache ever (1 point), and focal neurologic deficit at presentation (1 point) (area under the curve [AUC] 0.889). We defined 0 to 2 points as low CVT probability (negative predictive value [NPV] 94.1%). Of the 186 (51.8%) patients who had a low probability score, 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34 of 120) in patients with a moderate (3–5 points) and 92.5% (49 of 53) in patients with a high (6–12 points) probability score. All low CVT probability patients with CVT had D-dimers >500 μg/L. Predictive value of D-dimers for CVT for >675 μg/L (best cutoff) vs >500 μg/L was as follows: sensitivity 77.7%, specificity, 77%, NPV 90.7%, and accuracy 77.2% vs sensitivity 89.4%, specificity 66.4%, NPV 94.6%, and accuracy 72.4%, respectively. Adding the clinical score to D-dimers >500 μg/L resulted in the best CVT prediction score explored (at the cutoff ≥6 points: sensitivity 83%/specificity 86.8%/NPV 93.5%/accuracy 84.4%/AUC 0.937).ConclusionThe proposed new clinical score in combination with D-dimers may be helpful for predicting CVT as a pretest score; none of the patients with CVT showed low clinical probability for CVT and D-dimers ClinicalTrials.gov identifierNCT00924859. more...
- Published
- 2020
- Full Text
- View/download PDF
24. Correction to: Features of intracranial hemorrhage in cerebral venous thrombosis
- Author
-
Vincent Thijs, Sini Hiltunen, Eva Giralt-Steinhauer, Alessandro Pezzini, K. Afifi, Antonio Arauz, Susanna M. Zuurbier, Thomas Gattringer, Jonathan M. Coutinho, Carlos Garcia-Esperon, G Bellanger, Joan Montaner, Jordi Jimenez-Conde, Marc Schlamann, Irene Escudero, Christian Weimar, Philippe Demaerel, Nicole Hinteregger, Franz Fazekas, Robin Lemmens, Turgut Tatlisumak, Pieter-Jan Buyck, Paolo Costa, Jukka Putaala, Miguel A Barboza, and Dimitri Renard more...
- Subjects
Venous thrombosis ,medicine.medical_specialty ,Neurology ,business.industry ,medicine ,MEDLINE ,Medizin ,Neurology (clinical) ,Radiology ,medicine.disease ,business ,Neuroradiology - Abstract
The original version of this article unfortunately contained mistakes. The correct information is given below.
- Published
- 2020
25. Acute symptomatic seizures in cerebral venous thrombosis
- Author
-
Katarina Jood, Mayte Sánchez van Kammen, Fabiola Serrano, Masoud Ghiasian, Marcel Arnold, Miguel A Barboza, Sini Hiltunen, Turgut Tatlisumak, Nilufer Yesilot, Martin N.M. Punter, Jonathan M. Coutinho, Sara Penas, Jukka Putaala, Awet Ahmed, Timothy Kleinig, Suzanne M. Silvis, Diana Aguiar de Sousa, Esme Ekizoglu, Johan Zelano, Paolo Aridon, Valencia Arnao, Michele de Scisco, Erik Lindgren, Antonio Arauz, Saleem Al-Asady, José M. Ferro, Petra Redfors, Susanna M. Zuurbier, Mirjam Rachel Heldner, Maryam Mansour, Repositório da Universidade de Lisboa, ANS - Neurovascular Disorders, Graduate School, Neurology, ACS - Atherosclerosis & ischemic syndromes, Lindgren, Erik, Silvis, Suzanne M, Hiltunen, Sini, Heldner, Mirjam R, Serrano, Fabiola, de Scisco, Michele, Zelano, Johan, Zuurbier, Susanna M, Sánchez van Kammen, Mayte, Mansour, Maryam, Aguiar de Sousa, Diana, Penas, Sara, Al-Asady, Saleem, Ekizoglu, Esme, Redfors, Petra, Ahmed, Awet, Yesilot, Nilufer, Ghiasian, Masoud, Barboza, Miguel A, Arnao, Valentina, Aridon, Paolo, Punter, Martin N M, Ferro, José M, Kleinig, Timothy, Arauz, Antonio, Tatlisumak, Turgut, Arnold, Marcel, Putaala, Jukka, Coutinho, Jonathan M, and Jood, Katarina more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Infarction ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,Risk Factors ,Seizures ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Intracerebral hemorrhage ,Venous Thrombosis ,business.industry ,cerebral venous thrombosis ,Symptomatic seizures ,Odds ratio ,Middle Aged ,medicine.disease ,Thrombosis ,Cerebral Veins ,3. Good health ,Venous thrombosis ,Anesthesia ,Settore MED/26 - Neurologia ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,business ,030217 neurology & neurosurgery - Abstract
© 2020 American Academy of Neurology, Objective: To identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium. Methods: We defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into prediagnosis and solely postdiagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS and the association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression. Results: Of 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage (ICH; adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0-5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0-4.0), cortical vein thrombosis (aOR 2.1, 95% CI 1.5-2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5-2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4-2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1-2.5), and female-specific risk factors (aOR 1.5, 95% CI 1.1-2.1). Ninety-three (7%) patients had solely postdiagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits, and cerebral edema/infarction. Neither ASS nor SE was independently associated with outcome. Conclusion: ASS occurred in one-third of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In the absence of prediagnosis ASS, no subgroup was identified with sufficient risk of postdiagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome. more...
- Published
- 2020
26. Postpartum Period Is a Risk Factor for Cerebral Venous Thrombosis A Case-Control Study
- Author
-
Luuk J. J. Scheres, Jonathan M. Coutinho, Suzanne M. Silvis, Daniel M. Mandell, Saskia Middeldorp, Suzanne C. Cannegieter, Sini Hiltunen, Frank L. Silver, Turgut Tatlisumak, Timothy Kleinig, Sharon Devasagayam, Erik Lindgren, Jukka Putaala, Katarina Jood, and Susanna M. Zuurbier more...
- Subjects
medicine.medical_specialty ,030204 cardiovascular system & hematology ,Abortion ,Miscarriage ,postpartum period ,03 medical and health sciences ,0302 clinical medicine ,medicine ,risk factors ,Risk factor ,Advanced and Specialized Nursing ,Pregnancy ,Obstetrics ,business.industry ,Cancer ,Odds ratio ,medicine.disease ,3. Good health ,Venous thrombosis ,Neurology (clinical) ,pregnancy ,venous thrombosis ,Cardiology and Cardiovascular Medicine ,business ,hospitals ,030217 neurology & neurosurgery ,Postpartum period - Abstract
Background and Purpose— Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk. Methods— Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals and controls from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). Men, women over the age of 50, women using oral contraceptives or with a recent abortion or miscarriage were excluded. We adjusted for age and history of cancer, and stratified for pregnancy versus postpartum, and 0 to 6 versus 7 to 12 weeks postpartum. Results— In total 163/813 cases and 1230/6296 controls were included. Cases were younger (median 38 versus 41 years) and more often had a history of cancer (14% versus 4%) than controls. In total 41/163 (25%) cases and 82/1230 (7%) controls were pregnant or postpartum (adjusted odds ratio, 3.8; 95% CI, 2.4–6.0). The association was fully attributable to an increased risk of CVT during the postpartum period (adjusted odds ratio, 10.6; 95% CI, 5.6–20.0). We found no association between pregnancy and CVT (adjusted odds ratio, 1.2; 95% CI, 0.6–2.3). The risk was highest during the first 6 weeks postpartum (adjusted odds ratio, 18.7; 95% CI, 8.3–41.9). Conclusions— Women who have recently delivered are at increased risk of developing CVT, while there does not seem to be an increased risk of CVT during pregnancy. more...
- Published
- 2019
27. Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis
- Author
-
Marie-Germaine Bousser, Jan Stam, Susanna M. Zuurbier, José M. Ferro, Patrícia Canhão, Jonathan M. Coutinho, Fernando Barinagarrementeria, Iscvt Investigators, Neurology, ANS - Neurovascular Disorders, and ACS - Amsterdam Cardiovascular Sciences more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Infections ,Young Adult ,03 medical and health sciences ,Central Nervous System Infections ,0302 clinical medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,In patient ,Skin Diseases, Infectious ,Young adult ,Prospective cohort study ,Venous Thrombosis ,Advanced and Specialized Nursing ,Heparin ,business.industry ,Anticoagulants ,Middle Aged ,medicine.disease ,Surgery ,Otorhinolaryngologic Diseases ,Venous thrombosis ,Intracranial Thrombosis ,Anticoagulant therapy ,Anesthesia ,Hemorrhagic complication ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Head ,Intracranial Hemorrhages ,Neck ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background and Purpose— Local infections of the head or neck are a cause of cerebral venous thrombosis. Treatment of infectious cerebral venous thrombosis with heparin is controversial. We examined whether this treatment was associated with intracranial hemorrhagic complications and poor clinical outcome. Methods— We retrieved data from a prospective cohort study of 624 cerebral venous thrombosis patients. We compared patients with and without an infection of the head or neck and anticoagulated versus not anticoagulated. We examined death or dependency and new intracerebral hemorrhages. Results— Six hundred four of 624 patients were eligible for the study. Fifty-seven patients had an infection of the head or neck (9.4%). Comparing data between infection and noninfection patients, the frequency of therapeutic doses of heparin was similar in both groups (82.5% versus 83.7%). New intracerebral hemorrhages were more common in patients with an infection (12.3% versus 5.3%; P =0.04), but death or dependency did not differ between patients with and without an infection (15.8% versus 13.7%). In patients with an infection of the head or neck, there was no significant difference in the frequency of new intracerebral hemorrhages and poor outcome between patients who did or did not receive therapeutic doses of heparin. Conclusions— New intracerebral hemorrhages were more frequent in patients with an infection. The use of therapeutic doses of heparin did not seem to influence the risk of new intracranial hemorrhages or poor clinical outcome, but the number of patients who did not receive anticoagulation was too small to draw firm conclusions about safety of heparin in adults with cerebral venous thrombosis and an infection of the head or neck. more...
- Published
- 2016
- Full Text
- View/download PDF
28. Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis
- Author
-
Jukka Putaala, Miguel A Barboza, Pieter-Jan Buyck, Christian Weimar, Irene Escudero, Hamed Asadi, Susanna M. Zuurbier, Jonathan M. Coutinho, Philippe Demaerel, Franz Fazekas, Vincent Thijs, Jordi Jimenez Conde, Eva Giralt-Steinhauer, Carlos Garcia-Esperon, Nicole Hinteregger, Thomas Gattringer, Sini Hiltunen, Paolo Costa, Leonid Churilov, Alessandro Pezzini, Dimitri Renard, Antonio Arauz, Robin Lemmens, Turgut Tatlisumak, Joan Montaner, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders more...
- Subjects
Adult ,Male ,Computed Tomography Angiography ,Medizin ,Hematocrit ,Sensitivity and Specificity ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Sinus Thrombosis, Intracranial ,0302 clinical medicine ,D-dimer ,medicine ,Humans ,Computed tomography angiography ,Retrospective Studies ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Area under the curve ,Phlebography ,Middle Aged ,medicine.disease ,Thrombosis ,Cerebral Veins ,Confidence interval ,Cerebral Angiography ,Venous thrombosis ,Area Under Curve ,Case-Control Studies ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,Nuclear medicine ,business ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery ,Magnetic Resonance Angiography - Abstract
[Objective] To assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT)., [Methods] In a retrospective, multicenter, blinded, case-control study of patients with recent onset (, [Results] We enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74–0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74–0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8–0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70–0.81)., [Conclusion] Semiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT., [Classification of evidence] This study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT. more...
- Published
- 2019
29. Sex differences in cerebral venous thrombosis: A systematic analysis of a shift over time
- Author
-
Jonathan M. Coutinho, Susanna M. Zuurbier, Jan Stam, and Saskia Middeldorp
- Subjects
medicine.medical_specialty ,Neurology ,Time Factors ,Population ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Sex Ratio ,education ,Stroke ,Venous Thrombosis ,education.field_of_study ,Sex Characteristics ,business.industry ,medicine.disease ,Thrombosis ,Surgery ,Patient recruitment ,Venous thrombosis ,Embolism ,Intracranial Thrombosis ,business ,030217 neurology & neurosurgery ,Sex ratio ,Contraceptives, Oral - Abstract
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. Pediatric studies were analyzed separately. Out of 6068 publications identified by our search, 112 studies (23,638 patients), published between 1966 and 2014, were included. The proportion of women among patients with cerebral venous thrombosis significantly increased over time from a median of 54.8% in studies prior to 1981 to 69.8% after 2001 ( p = 0.002). There was a significant correlation between time of the study and proportion of women (Pearson’s correlation coefficient 0.25, p = 0.01). Oral contraceptive use among women with cerebral venous thrombosis also increased over time (Pearson’s correlation coefficient 0.29, p = 0.01). In contrast, the percentage of pregnancy-related cases remained stable (Pearson’s correlation coefficient 0.04, p = 0.77). Among 1702 patients from pediatric studies, 39% were female and there was no correlation between sex ratio and time of the study (Pearson’s correlation coefficient −0.42, p = 0.14). Conclusions In adult patients with cerebral venous thrombosis, there is a shift in sex ratio over time with an increase in the proportion of women, whereas this is not observed in pediatric populations. A possible explanation for this phenomenon is an increase over time in the use of oral contraceptives by adult women. more...
- Published
- 2016
- Full Text
- View/download PDF
30. Cancer and risk of cerebral venous thrombosis: a case-control study
- Author
-
Suzanne Silvis, Jonathan M. Coutinho, Erik Lindgren, Sini Hiltunen, Suzanne C. Cannegieter, Saskia Middeldorp, Jukka Putaala, Turgut Tatlisumak, Katarina Jood, Susanna M. Zuurbier, ANS - Neurovascular Disorders, Graduate School, Other departments, ARD - Amsterdam Reproduction and Development, Vascular Medicine, ACS - Amsterdam Cardiovascular Sciences, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Pulmonary hypertension & thrombosis more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,intracranial ,cerebral thrombosis ,Time Factors ,neoplasms ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Registries ,Risk factor ,Stroke ,thrombosis ,Venous Thrombosis ,business.industry ,Case-control study ,Cancer ,Hematology ,Odds ratio ,Middle Aged ,medicine.disease ,Thrombosis ,stroke ,Pulmonary embolism ,Surgery ,Europe ,Venous thrombosis ,sinus thrombosis ,Case-Control Studies ,Female ,Intracranial Thrombosis ,business ,030217 neurology & neurosurgery - Abstract
Essentials The risk of cerebral venous thrombosis (CVT) in patients with cancer is not known. We performed a case-control study including 594 patients with CVT and 6278 controls. History of cancer increased the risk of CVT approximately 5-fold. The association was strongest with hematological cancer in the first year after diagnosis.Background Cancer is an established risk factor for leg vein thrombosis and pulmonary embolism. Controlled studies assessing the risk of cerebral venous thrombosis (CVT) in patients with cancer have not been performed. Objective To assess whether cancer is a risk factor for CVT. Patients/Methods This was a case-control study. We assessed consecutive adult patients with CVT from three academic hospitals from 1987 to 2015, and control subjects from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). We adjusted for age, sex and oral contraceptive use, and stratified for type of cancer and time since diagnosis of cancer. Results We included 594 cases and 6278 controls. In total, 53 cases (8.9%) and 160 controls (2.5%) had a history of cancer. Cases were younger (median 42 vs. 48 years), more often female (68% vs. 54%) and more often used oral contraceptives (55% vs. 23%) than controls. The risk of CVT was increased in patients with cancer compared with those without cancer (adjusted odds ratio [aOR], 4.86; 95% confidence interval [CI], 3.46-6.81). Patients with a hematological type of cancer had a higher risk of CVT (aOR, 25.14; 95% CI, 11.64-54.30) than those with a solid type of cancer (aOR, 3.07; 95% CI, 2.03-4.65). The association was strongest in the first year after diagnosis of cancer (hematological aOR, 85.57; 95% CI, 19.70-371.69; solid aOR, 10.50; 95% CI, 5.40-20.42). Conclusions Our study indicates that cancer is a strong risk factor for CVT, particularly within the first year of diagnosis and in patients with a hematological type of cancer. more...
- Published
- 2018
31. Clinical Course of Cerebral Venous Thrombosis in Adult Acute Lymphoblastic Leukemia
- Author
-
Jan J. Cornelissen, Jan Stam, Saskia Middeldorp, Bronno van der Holt, Susanna M. Zuurbier, Bart J. Biemond, Mandy N. Lauw, Jonathan M. Coutinho, Charles B. L. M. Majoie, Hematology, Neurology, Vascular Medicine, Clinical Haematology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, AII - Amsterdam institute for Infection and Immunity, and CCA -Cancer Center Amsterdam more...
- Subjects
Adult ,Male ,Asparaginase ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Spinal Puncture ,Drug Administration Schedule ,Young Adult ,chemistry.chemical_compound ,Clinical Trials, Phase II as Topic ,Predictive Value of Tests ,Risk Factors ,Seizures ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Risk factor ,Injections, Spinal ,Netherlands ,Retrospective Studies ,Venous Thrombosis ,Chemotherapy ,medicine.diagnostic_test ,Lumbar puncture ,business.industry ,Rehabilitation ,Headache ,Venous Thromboembolism ,Middle Aged ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,medicine.disease ,Cerebrovascular Disorders ,Venous thrombosis ,Methotrexate ,chemistry ,Anesthesia ,Cohort ,Adult Acute Lymphoblastic Leukemia ,Female ,Surgery ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Background Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT). Methods To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case–control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients. Results Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character. Conclusions CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy. more...
- Published
- 2015
- Full Text
- View/download PDF
32. Cerebral Venous Thrombosis in Older Patients
- Author
-
Erik Lindgren, Suzanne M. Silvis, Jonathan M. Coutinho, Daniel M. Mandell, Susanna M. Zuurbier, Katarina Jood, Jukka Putaala, Frank L. Silver, Sharon Devasagayam, Turgut Tatlisumak, Timothy Kleinig, Sini Hiltunen, Neurology, ANS - Neurovascular Disorders, Graduate School, ACS - Amsterdam Cardiovascular Sciences, and ACS - Atherosclerosis & ischemic syndromes more...
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Malignancy ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Older patients ,Interquartile range ,Neoplasms ,medicine ,Humans ,Registries ,Stroke ,Retrospective Studies ,Advanced and Specialized Nursing ,Adult patients ,business.industry ,Middle Aged ,medicine.disease ,Survival Rate ,Venous thrombosis ,Quartile ,Observational study ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background and Purpose— Cerebral venous thrombosis (CVT) is rare in older patients. We investigated whether clinical features and outcomes differ in older and younger patients. Methods— We used data from a multicenter observational registry of consecutive adult patients with CVT admitted between 1987 and 2016. We compared demographics, clinical manifestations, and outcomes between older (upper quartile of the age distribution) and younger (lower 3 quartiles of the age distribution) patients. Results— Data for 843 patients with CVT were available. The median age was 43 years (interquartile range, 30–55 years). Older patients (≥55 years; n=222) were less often women than younger patients (48% versus 71%; P P P P Conclusions— The sex ratio of CVT is evenly distributed in older patients, probably because of the dissipation of hormonal influences. Malignancy should be considered as a potential precipitant in older patients with CVT. more...
- Published
- 2017
33. Small juxtacortical hemorrhages in cerebral venous thrombosis
- Author
-
Jonathan M. Coutinho, Jan Stam, Ed VanBavel, Susanna M. Zuurbier, Dirk Troost, René van den Berg, and Charles B. L. M. Majoie
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Retrospective cohort study ,medicine.disease ,Thrombosis ,Surgery ,White matter ,Venous thrombosis ,medicine.anatomical_structure ,Neurology ,medicine ,Neurology (clinical) ,Radiology ,medicine.symptom ,Papilledema ,business ,Pathological ,Superior sagittal sinus - Abstract
Objective Intracerebral hemorrhages (ICHs) are common in patients with cerebral venous thrombosis (CVT). We examined whether small juxtacortical hemorrhages (JCHs) are characteristic for CVT and studied their radiological and pathological properties. Methods We identified all patients with CVT and an ICH at baseline admitted between 2000 and 2011 (prospectively from July 2006). JCH was defined as a hemorrhage (diameter more...
- Published
- 2014
- Full Text
- View/download PDF
34. Declining mortality in cerebral venous thrombosis: a systematic review
- Author
-
Jan Stam, Jonathan M. Coutinho, Susanna M. Zuurbier, Neurology, ACS - Amsterdam Cardiovascular Sciences, and ANS - Amsterdam Neuroscience
- Subjects
Advanced and Specialized Nursing ,Adult ,Male ,Venous Thrombosis ,Pediatrics ,medicine.medical_specialty ,business.industry ,MEDLINE ,Disease ,medicine.disease ,Surgery ,Venous thrombosis ,Cohort ,medicine ,Humans ,Female ,Neurology (clinical) ,Good outcome ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose— Cerebral venous thrombosis (CVT) is nowadays considered a disease with a good outcome in most cases, but in the past, these patients were thought to have a grave prognosis. We systematically studied the apparent decline in mortality of patients with CVT over time. Methods— A systematic review of the literature (MEDLINE and EMBASE) was performed. Studies with ≥40 patients with CVT that reported mortality at discharge or follow-up were eligible. Duplicate publications based on the same patient cohort were excluded. Studies were ranked according to the year halfway the period of patient inclusion. Two of the authors independently screened all eligible studies. Results— We screened 4585 potentially eligible studies, of which 74 fulfilled the selection criteria. The number of patients per study varied from 40 to 706 (median, 76). Data from 8829 patients with CVT, included from 1942 to 2012, were analyzed. The average age was 32.9 years, and 64.7% were women. There was a significant inverse correlation between mortality and year of patient recruitment (Pearson correlation coefficient, −0.72; P Conclusions— There is a clear trend in declining mortality among patients with CVT over time. Possible explanations are improvements in treatment, a shift in risk factors, and, most importantly, the identification of less severe cases by improved diagnostic methods. more...
- Published
- 2014
- Full Text
- View/download PDF
35. Mechanical Thrombectomy versus Intrasinus Thrombolysis for Cerebral Venous Sinus Thrombosis: A Non-Randomized Comparison
- Author
-
Mark D. Johnson, Muhammad Wasay, Fazeel M. Siddiqui, Jan Stam, Chirantan Banerjee, Qing Hao, David S Liebeskind, Charles B. L. M. Majoie, Glenn L Pride, Susanna M. Zuurbier, Chul Ahn, Neurology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, and Radiology and Nuclear Medicine more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Mechanical Thrombolysis ,medicine.medical_treatment ,Sinus Thrombosis, Intracranial ,Young Adult ,Fibrinolytic Agents ,Modified Rankin Scale ,medicine ,Humans ,Thrombolytic Therapy ,Cerebral venous sinus thrombosis ,Child ,Stroke ,Injections, Intraventricular ,business.industry ,Retrospective cohort study ,Thrombolysis ,Original Articles ,Middle Aged ,medicine.disease ,Surgery ,Radiography ,Venous thrombosis ,Treatment Outcome ,Anesthesia ,Child, Preschool ,Ambulatory ,Female ,business ,Fibrinolytic agent - Abstract
Small retrospective studies have shown the benefit of endovascular treatment with intrasinus thrombolysis (IST) or mechanical thrombectomy (MT) with/without IST (MT+/−IST) in cases of multifocal cerebral venous thrombosis (CVT). Our study compares the mortality, functional outcome and periprocedural complications among patients treated with MT +/– IST versus IST alone. We reviewed clinical and angiographic findings of 63 patients with CVT who received endovascular treatment at three tertiary care centers. Primary outcome variables were discharge mortality and neurological dysfunction, and intermediate (three months) and long-term (>six months) morbidity. The modified Rankin scale (mRS) was used to assess morbidity. mRS ≤1 was considered a good recovery. Neurological dysfunction was rated as neuroscore: 0, normal; 1, mild (ambulatory, communicative); 2, moderate (non-ambulatory, communicative); and 3, severe (non-ambulatory, non-communicative/comatose). In patients who received IST alone, presenting neurological deficits were comparatively minor (p Compared to IST, MT was performed in severe cases with extensive sinus involvement. When adjusted for admission neurological dysfunction, both groups had similar mortality and discharge neurological dysfunction and similar intermediate and long-term morbidity. more...
- Published
- 2014
- Full Text
- View/download PDF
36. Risk Factors for Cerebral Venous Thrombosis
- Author
-
Saskia Middeldorp, Suzanne C. Cannegieter, Suzanne M. Silvis, Jonathan M. Coutinho, Susanna M. Zuurbier, ANS - Neurovascular Disorders, Neurology, and Vascular Medicine
- Subjects
Adult ,Male ,Cerebral veins ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Administration, Oral ,030204 cardiovascular system & hematology ,Thrombophilia ,Head trauma ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Craniocerebral Trauma ,Humans ,risk factors ,Young adult ,Risk factor ,Child ,Heparin ,business.industry ,Anticoagulants ,Infant ,cerebral venous thrombosis ,Hematology ,medicine.disease ,Cerebral Veins ,Venous thrombosis ,Intracranial Thrombosis ,sinus thrombosis ,Child, Preschool ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involving the cerebral veins and dural sinuses. In contrast to more common sites of venous thromboembolism (VTE), such as the legs and lungs, CVT mainly affects young adults and children, and women are affected three times more often than men. Although presenting symptoms are variable, headache is usually the first symptom, often in combination with focal neurologic deficits and epileptic seizures. The primary therapy for CVT consists of heparin followed by oral anticoagulation for at least 3 to 6 months. The mortality in the acute phase is 5 to 10% and a substantial proportion of survivors suffer from long-term disabilities. A large number of risk factors have been linked to CVT, although the scientific evidence for an association varies considerably between risk factors. Some risk factors, such as hereditary thrombophilia, correspond with risk factors for more common sites of VTE, whereas others, such as head trauma, are specific to CVT. In most patients, at least one risk factor can be identified. In this review, we provide an overview of the risk factors for CVT. more...
- Published
- 2016
37. Cerebral Venous Thrombosis
- Author
-
Susanna M, Zuurbier and Jonathan M, Coutinho
- Subjects
Male ,Venous Thrombosis ,Headache ,Anticoagulants ,Phlebography ,Heparin, Low-Molecular-Weight ,Decompression, Surgical ,Magnetic Resonance Imaging ,Cerebral Angiography ,Risk Factors ,Seizures ,Humans ,Cognitive Dysfunction ,Female ,Intracranial Thrombosis ,Cerebral Hemorrhage - Abstract
Cerebral venous thrombosis is an important cause of stroke in the young. Unlike venous thromboembolism (VTE), women are affected three times more often than men by CVT. The most common symptoms are headache, seizures and focal neurological deficits. The diagnosis can be confirmed with MRI, CT-venography, or catheter angiography. An intracerebral hemorrhage is found on cerebral imaging in approximately 40 % of patients, and can range from small juxtacortical hemorrhages to large space-occupying lesions. Many risk factors for CVT have been reported, most of which overlap with those of VTE. The primary therapy for CVT is anticoagulation with heparin, based on limited evidence from randomized trials. Both unfractionated or low-molecular weight heparin can be used to treat CVT, although the latter is generally preferable. Small studies have shown promising results of endovascular treatment in severe patients, but these data require confirmation in a randomized trial. In patients who develop clinical and radiological signs of impending herniation decompressive surgery can be both life-saving and result in a good functional outcome. The prognosis is nowadays favorable in most cases, especially compared to arterial stroke, although a significant proportion of patients do suffer from chronic symptoms. more...
- Published
- 2016
38. Risk of Cerebral Venous Thrombosis in Obese Women
- Author
-
Saskia Middeldorp, Jan Stam, Julia Anne Meisterernst, Jonathan M. Coutinho, Suzanne M. Silvis, Anne Broeg-Morvay, Banne Nemeth, Susanna M. Zuurbier, Mirjam Rachel Heldner, Suzanne C. Cannegieter, E R Meulendijks, Marcel Arnold, Neurology, ANS - Neurovascular Disorders, Vascular Medicine, and Other departments more...
- Subjects
Adult ,medicine.medical_specialty ,Pediatrics ,610 Medicine & health ,030204 cardiovascular system & hematology ,Overweight ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Risk Factors ,Internal medicine ,medicine ,Odds Ratio ,Humans ,Obesity ,Risk factor ,Venous Thrombosis ,business.industry ,Case-control study ,Odds ratio ,Middle Aged ,medicine.disease ,Pulmonary embolism ,Venous thrombosis ,Case-Control Studies ,Female ,Neurology (clinical) ,medicine.symptom ,Intracranial Thrombosis ,business ,Body mass index ,030217 neurology & neurosurgery ,Cohort study - Abstract
IMPORTANCE Obesity is a risk factor for deep vein thrombosis of the leg and pulmonary embolism. To date, however, whether obesity is associated with adult cerebral venous thrombosis (CVT) has not been assessed. OBJECTIVE To assess whether obesity is a risk factor for CVT. DESIGN, SETTING, AND PARTICIPANTS A case-control study was performed in consecutive adult patients with CVT admitted from July 1, 2006 (Amsterdam), and October 1, 2009 (Berne), through December 31, 2014, to the Academic Medical Center in Amsterdam, the Netherlands, or Inselspital University Hospital in Berne, Switzerland. The control group was composed of individuals from the control population of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis study, which was a large Dutch case-control study performed from March 1, 1999, to September 31, 2004, and in which risk factors for deep vein thrombosis and pulmonary embolism were assessed. Data analysis was performed from January 2 to July 12, 2015. MAIN OUTCOMES AND MEASURES Obesity was determined by body mass index (BMI). A BMI of 30 or greater was considered to indicate obesity, and a BMI of 25 to 29.99 was considered to indicate overweight. A multiple imputation procedure was used for missing data. We adjusted for sex, age, history of cancer, ethnicity, smoking status, and oral contraceptive use. Individuals with normal weight (BMI more...
- Published
- 2016
- Full Text
- View/download PDF
39. Cerebral Venous Thrombosis
- Author
-
Jonathan M. Coutinho and Susanna M. Zuurbier
- Subjects
Intracerebral hemorrhage ,medicine.medical_specialty ,business.industry ,Heparin ,030204 cardiovascular system & hematology ,medicine.disease ,law.invention ,03 medical and health sciences ,Venous thrombosis ,0302 clinical medicine ,Catheter angiography ,Randomized controlled trial ,law ,medicine ,In patient ,Limited evidence ,Radiology ,business ,Stroke ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Cerebral venous thrombosis is an important cause of stroke in the young. Unlike venous thromboembolism (VTE), women are affected three times more often than men by CVT. The most common symptoms are headache, seizures and focal neurological deficits. The diagnosis can be confirmed with MRI, CT-venography, or catheter angiography. An intracerebral hemorrhage is found on cerebral imaging in approximately 40 % of patients, and can range from small juxtacortical hemorrhages to large space-occupying lesions. Many risk factors for CVT have been reported, most of which overlap with those of VTE. The primary therapy for CVT is anticoagulation with heparin, based on limited evidence from randomized trials. Both unfractionated or low-molecular weight heparin can be used to treat CVT, although the latter is generally preferable. Small studies have shown promising results of endovascular treatment in severe patients, but these data require confirmation in a randomized trial. In patients who develop clinical and radiological signs of impending herniation decompressive surgery can be both life-saving and result in a good functional outcome. The prognosis is nowadays favorable in most cases, especially compared to arterial stroke, although a significant proportion of patients do suffer from chronic symptoms. more...
- Published
- 2016
- Full Text
- View/download PDF
40. Association Between Anemia and Cerebral Venous Thrombosis Case-Control Study
- Author
-
Jonathan M. Coutinho, Susanna M. Zuurbier, Arienne A. Dikstaal, Jan Stam, Saskia Middeldorp, Suzanne C. Cannegieter, Aafke E. Gaartman, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Neurology, and Vascular Medicine more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,intracranial ,Anemia ,Malignancy ,Logistic regression ,medicine ,Humans ,risk factors ,Risk factor ,Advanced and Specialized Nursing ,Venous Thrombosis ,Pregnancy ,business.industry ,Obstetrics ,case-control studies ,Case-control study ,Middle Aged ,medicine.disease ,anemia ,Surgery ,Venous thrombosis ,sinus thrombosis ,Female ,Neurology (clinical) ,Hemoglobin ,pregnancy ,Cardiology and Cardiovascular Medicine ,business - Abstract
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. Anemia was defined according to World Health Organization criteria: nonpregnant women hemoglobin Results— We included 152 cases and 2916 controls. Patients with CVT were younger (mean age, 40 versus 48 years) and more often women (74% versus 53%) than controls. Anemia was more frequent in cases (27.0%) than in controls (6.5%; P Conclusion— Our data suggest that anemia is a risk factor for CVT. more...
- Published
- 2015
41. Hydrocephalus in cerebral venous thrombosis
- Author
-
Jonathan M. Coutinho, Jan Stam, Susanna M. Zuurbier, Charles B. L. M. Majoie, René van den Berg, Dirk Troost, Neurology, Amsterdam Neuroscience, Radiology and Nuclear Medicine, Pathology, and Amsterdam Cardiovascular Sciences more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Neurology ,Clinical Neurology ,Imaging ,Young Adult ,Edema ,medicine ,Humans ,Longitudinal Studies ,Sinus thrombosis ,Neuroradiology ,Intracranial pressure ,Cerebral Cortex ,Venous Thrombosis ,Original Communication ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,3. Good health ,Surgery ,Hydrocephalus ,nervous system diseases ,Venous thrombosis ,Intraventricular hemorrhage ,Cerebral venous thrombosis ,Case-Control Studies ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and 2010 (prospectively since July 2006). Hydrocephalus was defined as a bicaudate index larger than the 95th percentile for age, and/or a radial width of the temporal horn of ≥5 mm. We excluded patients in whom hydrocephalus was caused by a disease other than CVT or if it was iatrogenic. 20 out of 99 patients with CVT had hydrocephalus. 6 patients with hydrocephalus were excluded from the analysis. Patients with hydrocephalus more often had focal neurological deficits (86 vs. 49 %, p = 0.02) and were more frequently comatose (43 vs. 16 %, p = 0.06), as compared to patients without hydrocephalus. Deep cerebral venous thrombosis (64 vs. 9 %, p more...
- Published
- 2015
42. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases
- Author
-
Jonathan M. Coutinho, Chirantan Banerjee, Jan Stam, Sudeepta Dandapat, Susanna M. Zuurbier, Mark D. Johnson, Fazeel M. Siddiqui, Neurology, ACS - Amsterdam Cardiovascular Sciences, and ANS - Amsterdam Neuroscience more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Secondary outcome ,Modified Rankin Scale ,Risk Factors ,medicine ,Humans ,In patient ,Thrombolytic Therapy ,Good outcome ,Thrombectomy ,Advanced and Specialized Nursing ,Intracerebral hemorrhage ,Venous Thrombosis ,business.industry ,Thrombolysis ,Middle Aged ,medicine.disease ,Surgery ,Mechanical thrombectomy ,Venous thrombosis ,Treatment Outcome ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business ,Intracranial Hemorrhages - Abstract
Background and Purpose— Cerebral venous thrombosis is generally treated with anticoagulation. However, some patients do not respond to medical therapy and these might benefit from mechanical thrombectomy. The aim of this study was to gain a better understanding of the efficacy and safety of mechanical thrombectomy in patients with cerebral venous thrombosis, by performing a systematic review of the literature. Methods— We identified studies published between January 1995 and February 2014 from PubMed and Ovid. We included all cases of cerebral venous thrombosis in whom mechanical thrombectomy was performed with or without intrasinus thrombolysis. Good outcome was defined as normal or mild neurological deficits at discharge (modified Rankin Scale, 0–2). Secondary outcome variables included periprocedural complications and recanalization rates. Results— Our study included 42 studies (185 patients). Sixty percent of patient had a pretreatment intracerebral hemorrhage and 47% were stuporous or comatose. AngioJet was the most commonly used device (40%). Intrasinus thrombolysis was used in 131 patients (71%). Overall, 156 (84%) patients had a good outcome and 22 (12%) died. Nine (5%) patients had no recanalization, 38 (21%) had partial, and 137 (74%) had near to complete recanalization. The major periprocedural complication was new or increased intracerebral hemorrhage (10%). The use of AngioJet was associated with lower rate of complete recanalization (odds ratio, 0.2; 95% confidence interval, 0.09–0.4) and lower chance of good outcome (odds ratio, 0.5; 95% confidence interval, 0.2–1.0). Conclusions— Our systematic review suggests that mechanical thrombectomy is reasonably safe but controlled studies are required to provide a definitive answer on its efficacy and safety in patients with cerebral venous thrombosis. more...
- Published
- 2014
43. Isolated cortical vein thrombosis: systematic review of case reports and case series
- Author
-
Jan Stam, Jorn J. Gerritsma, Jonathan M. Coutinho, and Susanna M. Zuurbier
- Subjects
Male ,medicine.medical_specialty ,Autopsy ,Pregnancy ,Risk Factors ,Medicine ,Humans ,Papilledema ,Stroke ,Advanced and Specialized Nursing ,business.industry ,Increased cerebrospinal fluid pressure ,Computed tomography venography ,Puerperal Disorders ,medicine.disease ,Cortical Vein ,Thrombosis ,Cerebral Veins ,Surgery ,Cerebral Angiography ,Case-Control Studies ,Female ,Neurology (clinical) ,Radiology ,medicine.symptom ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Magnetic Resonance Angiography ,Contraceptives, Oral - Abstract
Background and Purpose— Isolated cortical vein thrombosis is a distinct subtype of cerebral venous and sinus thrombosis. Because of the rarity of isolated cortical vein thrombosis, limited knowledge on its clinical and radiological manifestations is available. Methods— We performed a systematic review of published data. Isolated cortical vein thrombosis had to have been diagnosed by MRI, conventional angiography, computed tomography venography, autopsy, or surgery. Cases with concurrent thrombosis of a cerebral sinus were excluded. Results— Of 175 potentially relevant studies, 47 were included in the analysis, with a total of 116 patients. All studies were case reports and case series. Mean age was 41 years and 68% were women. The most common symptoms were headache (71%), seizures (58%), and focal neurological deficits (62%). Papilledema was not reported in any patient, and increased cerebrospinal fluid pressure was reported only in 2. Infection (19%), pregnancy or puerperium (35% of women), and oral contraceptive use (21% of women) were the most common risk factors. Most cases (73%) were diagnosed with MRI, but conventional angiography was also performed in 47%. A total of 81% had a parenchymal brain lesion and 80% were treated with anticoagulation. In-hospital mortality was 6%. Conclusions— Signs of increased intracranial pressure seem to be less common in isolated cortical vein thrombosis compared with cerebral venous and sinus thrombosis. MRI and in some cases conventional angiography are the most frequently used diagnostic modalities and anticoagulation is the most widely used therapy. more...
- Published
- 2014
44. Abstract W P145: Shift in Sex Ratio Over Time in Cerebral Venous Thrombosis
- Author
-
Jonathan M Coutinho, Susanna M Zuurbier, and Jan Stam
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: In contemporary studies on cerebral venous thrombosis (CVT) there is a predominance of female patients. The change in sex ratio over time, however, has not been systematically studied Methods: We performed a systematic review of the literature up to April 2013. Studies with ≥ 40 CVT patients that reported outcome were eligible. Pediatric studies, studies which selectively included women and those in which no sex ratio was reported were excluded. We ranked studies according to the year halfway the period of patient inclusion. If no time span was reported, we assumed a period of inclusion of 10 years prior to the year of publication. Results: Fifty-three studies, with a total of 20.881 patients were included. The mean age was 36 years (SD 4.7) and 71% of patients were women. In studies that reported gender specific risk factors, 25% had a pregnancy related CVT and 37% used oral contraceptives at the time of diagnosis. There was a significant correlation between the period of the study and the percentage of women (Pearson correlation coefficient 0.37, p=0.006, figure). Similarly, there was a significant increase of oral contraceptive use among female patients, from a mean of 14% in studies before 1970 to a mean of 39% in those after 2001 (correlation coefficient 0.34, p=0.05). In contrast, the percentage of pregnancy related CVT cases did not increase over time (correlation coefficient 0.01, p=0.96). Conclusions: The sex ratio among CVT patients has significantly shifted over time, with a gradual increasing percentage of women. Our results suggest that this change is related to the increased proportion of women using oral contraceptives. more...
- Published
- 2014
- Full Text
- View/download PDF
45. Abstract W P318: Declining Mortality in Cerebral Venous Thrombosis: A Systematic Review
- Author
-
Jonathan M Coutinho, Susanna M Zuurbier, and Jan Stam
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Cerebral venous thrombosis (CVT) is nowadays considered a disease with a good outcome in most cases, but in the past these patients were believed to have a grave prognosis. This apparent decline in mortality has not been investigated systematically Methods: We performed a systematic review of the literature. Older studies were identified from books and by scanning reference lists. Studies with 40 CVT patients or more that minimally reported mortality at discharge were eligible. Care was taken to exclude duplicate publications based on the same patient cohort. Studies were ranked according to the year halfway the period of patient inclusion. If no time span was reported, we assumed a period of inclusion of 10 years prior to the year of publication. Results: Of 4.585 potentially eligible studies, 74 fulfilled the selection criteria and were included in the analysis. The majority of studies were retrospective (80%) and single-center (59%). In total, 23.031 patients were included in the analysis. The number of patients per study varied from 40 to 11.400 (median 79). Seven studies included only children. There was a significant inverse correlation between mortality and year of patient recruitment (Pearson’s correlation coefficient -0.70, p Conclusions: There is a clear trend in declining mortality among patients with CVT over time. Possible explanations include better diagnosis (with identification of less severe cases), improved treatment and a declining incidence of infection related CVT. more...
- Published
- 2014
- Full Text
- View/download PDF
46. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial
- Author
-
Jim A. Reekers, Isabelle Crassard, Charles B. L. M. Majoie, Jonathan M. Coutinho, Jan Stam, Patrícia Canhão, Emmanuel Houdart, José M. Ferro, Marieke S J Mink, Marie-Germaine Bousser, Susanna M. Zuurbier, Rob J. de Haan, Neurology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, APH - Amsterdam Public Health, and Clinical Research Unit more...
- Subjects
medicine.medical_specialty ,Poor prognosis ,medicine.medical_treatment ,Treatment outcome ,Hemorrhage ,law.invention ,Sinus Thrombosis, Intracranial ,Fibrinolytic Agents ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Multicenter Studies as Topic ,Thrombolytic Therapy ,Prospective Studies ,Cerebral venous sinus thrombosis ,Prospective cohort study ,Randomized Controlled Trials as Topic ,Heparin ,business.industry ,Anticoagulants ,Thrombolysis ,medicine.disease ,Urokinase-Type Plasminogen Activator ,Surgery ,Venous thrombosis ,Treatment Outcome ,Neurology ,Research Design ,Tissue Plasminogen Activator ,Cardiology ,business ,medicine.drug - Abstract
Rationale Endovascular thrombolysis, with or without mechanical clot removal, may be beneficial for a subgroup of patients with cerebral venous sinus thrombosis (CVT) who have a poor prognosis despite treatment with heparin. Published experience with endovascular thrombolysis is promising but only based on case series and not on controlled trials. Aim The objective of the Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis (TO-ACT) trial is to determine if endovascular thrombolysis improves the functional outcome of patients with a severe form of CVT. Design The TO-ACT trial is a multicenter, prospective, randomized, open-label, blinded endpoint trial. Patients are eligible if they have a radiologically proven CVT, a high probability of poor outcome (defined by presence of one or more of the following risk factors: mental status disorder, coma, intracranial hemorrhagic lesion, or thrombosis of the deep cerebral venous system), and if the responsible physician is uncertain if endovascular thrombolysis or standard anticoagulant treatment is better. One hundred sixty-four patients (82 in each treatment arm) will be included to detect a 50% relative reduction (from 40% to 20%) of poor outcomes. Study Patients will be randomized to receive either endovascular thrombolysis or standard therapy (therapeutic doses of heparin). Endovascular thrombolysis is composed of local application of rt-plasminogen activator (PA) or urokinase within the thrombosed sinuses, mechanical thrombosuction, or a combination of both. Patients randomized to endovascular thrombolysis will be treated with heparin before and after the interventional procedure, according to international guidelines. Outcomes The primary endpoint is the modified Rankin score (mRS) at 12 months, with a score ≥2 defined as poor outcome. Secondary outcomes are six-months mRS, mortality, and recanalization rate. Major intracranial and extracranial hemorrhagic complications within one-week after the intervention are the principal safety outcomes. Results will be analyzed according to the ‘intention-to-treat’ principle. Blinded assessors not involved in the treatment of the patient will assess endpoints with standardized questionnaires. more...
- Published
- 2013
47. Towards the genetic basis of cerebral venous thrombosis—the BEAST Consortium: a study protocol: Table 1
- Author
-
Elena Haapaniemi, José M. Ferro, Serena M. Passamonti, Vincent Thijs, K. Spengos, Reina Ditta, Paolo Bucciarelli, Emanuela Pappalardo, Tiina M. Metso, Sini Hiltunen, Amanda Hodge, Ida Martinelli, Elvira Grandone, Patrícia Canhão, Pankaj Sharma, Guillaume Paré, Alessandro Pezzini, Jonathan M. Coutinho, Thomas Marjot, Donatella Colaizzo, Antonio Arauz, Paolo Costa, Jukka Putaala, Maurizio Margaglione, Marina Colombi, Marialuisa Zedde, Matthijs C. Brouwer, Turgut Tatlisumak, Tasmin Patel, Aleksander Tkach, Stéphanie Debette, Ioana Cotlarciuc, Giovanni Favuzzi, Susanna M. Zuurbier, Muhammad Saleem Khan, Rosa Santacroce, and Jennifer J. Majersik more...
- Subjects
medicine.medical_specialty ,business.industry ,education ,Case-control study ,Genome-wide association study ,General Medicine ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,Biobank ,Comorbidity ,3. Good health ,Surgery ,03 medical and health sciences ,Venous thrombosis ,0302 clinical medicine ,Biorepository ,medicine ,Intensive care medicine ,business ,030217 neurology & neurosurgery ,Genetic association - Abstract
Introduction Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition accounting for Methods and analysis To better understand the genetic basis of CVT, we have established an international biobank of CVT cases, Biorepository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) which aims to recruit highly phenotyped cases initially of European descent and later from other populations. To date we have recruited 745 CVT cases from 12 research centres. As an initial step, the consortium plans to undertake a genome-wide association analysis of CVT using the Illumina Infinium HumanCoreExome BeadChip to assess the association and impact of common and low-frequency genetic variants on CVT risk by using a case–control study design. Replication will be performed to confirm putative findings. Furthermore, we aim to identify interactions of genetic variants with several environmental and comorbidity factors which will likely contribute to improve the understanding of the biological mechanisms underlying this complex disease. Ethics and dissemination BEAST meets all ethical standards set by local institutional review boards for each of the participating sites. The research outcomes will be published in international peer-reviewed open-access journals with high impact and visibility. The results will be presented at national and international meetings to highlight the contributions into improving the understanding of the mechanisms underlying this uncommon but important disease. This international DNA repository will become an important resource for investigators in the field of haematological and vascular disorders. more...
- Published
- 2016
- Full Text
- View/download PDF
48. Mechanical thrombectomy cannot be considered as first-line treatment for cerebral venous thrombosis
- Author
-
R. van den Berg, Jonathan M. Coutinho, Jan Stam, Charles B. L. M. Majoie, and Susanna M. Zuurbier
- Subjects
Male ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,Thrombolysis ,medicine.disease ,Surgery ,First line treatment ,Mechanical thrombectomy ,Radiography ,Venous thrombosis ,Sinus Thrombosis, Intracranial ,Thrombolytic drug ,Internal medicine ,Hemorrhagic complication ,medicine ,Cardiology ,Humans ,Female ,Neurology (clinical) ,business ,Stroke ,Thrombectomy - Abstract
The paper by Dashti et al 1 describes 13 patients who received mechanical thrombectomy with the AngioJet device as first-line treatment for cerebral venous thrombosis (CVT). Mechanical thrombectomy is a promising alternative to endovascular thrombolysis with thrombolytic drugs. Hemorrhagic infarcts are common among patients with CVT and it is plausible—although unproven—that mechanical thrombectomy gives fewer hemorrhagic complications. There are, however, some issues that render the authors' suggestion to use mechanical thrombectomy as a first-line treatment … more...
- Published
- 2012
49. The Incidence of Cerebral Venous Thrombosis A Cross-Sectional Study
- Author
-
Jan Stam, Jonathan M. Coutinho, Majid Aramideh, Susanna M. Zuurbier, Neurology, ACS - Amsterdam Cardiovascular Sciences, and ANS - Amsterdam Neuroscience
- Subjects
Cerebral veins ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Population ,Young Adult ,medicine ,Humans ,education ,Stroke ,Netherlands ,Retrospective Studies ,Advanced and Specialized Nursing ,Venous Thrombosis ,education.field_of_study ,Inpatients ,business.industry ,Incidence (epidemiology) ,Medical record ,Incidence ,Retrospective cohort study ,medicine.disease ,Cerebral Veins ,Hospitalization ,Venous thrombosis ,Cross-Sectional Studies ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose— The purpose of this study was to determine the incidence of adult cerebral venous thrombosis. Methods— A retrospective cross-sectional study was conducted among all 19 hospitals located in 2 Dutch provinces serving 3.1 million people. Adult cerebral venous thrombosis cases diagnosed between January 1, 2008, and December 31, 2010, were identified using the Dutch financial coding system for hospital care and the International Classification of Diseases, 9th Revision . Medical records of potential patients were hand searched to identify cerebral venous thrombosis cases. The Dutch National Bureau for Statistics provided population figures of the 2 provinces during 2008 to 2010. Results— Among 9270 potential cases, we identified 147 patients diagnosed with cerebral venous thrombosis. Of these, 53 patients did not meet the inclusion criteria; therefore, 94 patients were included in the analysis. The overall incidence was 1.32 per 100 000 person-years (95% CI, 1.06–1.61). Among women between the ages of 31 and 50 years, the incidence was 2.78 (95% CI, 1.98–3.82). Conclusions— The incidence of cerebral venous thrombosis among adults is probably higher than previously believed. more...
- Published
- 2012
50. Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series
- Author
-
Jan Stam, Jonathan M. Coutinho, Bert A Coert, Charles B. L. M. Majoie, Susanna M. Zuurbier, Pepijn van den Munckhof, Neurology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, and Neurosurgery more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Hemicraniectomy ,Clinical Neurology ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Brain herniation ,Cerebral edema ,03 medical and health sciences ,0302 clinical medicine ,Midline shift ,Modified Rankin Scale ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Stroke ,Sinus thrombosis ,Neuroradiology ,Venous Thrombosis ,Original Communication ,business.industry ,Middle Aged ,Decompression, Surgical ,medicine.disease ,Intracranial ,3. Good health ,Surgery ,Venous thrombosis ,Treatment Outcome ,Neurology ,Female ,Neurology (clinical) ,Intracranial Thrombosis ,business ,Craniotomy ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Small retrospective case series suggest that decompressive hemicraniectomy can be life saving in patients with cerebral venous thrombosis (CVT) and impending brain herniation. Prospective studies of consecutive cases are lacking. Thus, a single centre, prospective study was performed. In 2006 we adapted our protocol for CVT treatment to perform acute decompressive hemicraniectomy in patients with impending herniation, in whom the prognosis with conservative treatment was considered infaust. We included all consecutive patients with CVT between 2006 and 2010 who underwent hemicraniectomy. Outcome was assessed at 12 months with the modified Rankin Scale (mRS). Ten patients (8 women) with a median age of 41 years (range 26–52 years) were included. Before surgery 5 patients had GCS more...
- Published
- 2012
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.