Diagnosis Of Cerebral Venous Thrombosis Research Articles

Abstract WMP49: Outcomes of Patients With Cerebral Venous Thrombosiswith and Without COVID-19 Infection

Introduction: COVID-19 infection has thus emerged to be a new risk factor for Cerebral Venous Thrombosis (CVT). Our study aimed to compare outcomes of patients diagnosed with CVT within 2 weeks of COVID infection compared to those without COVID-19. Methods: Adult patients with CVT diagnosis from 2020-2022 in TriNetX COVID research network were included in the study. Patients diagnosed with COVID within 2 weeks of CVT diagnosis were defined as CVT with COVID. CVT without COVID group included those without COVID diagnosis any time before and up to three months after diagnosis of CVT. All-cause mortality was the primary outcome. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), epilepsy, deep vein thrombosis and pulmonary embolism were secondary outcomes. 1:1 propensity score matching was performed to control for age, sex, race, ethnicity, obesity, malignancy and medications. The two groups were compared with cox proportional hazard analysis and reported as hazard ratio (HR) and 95% confidence interval (CI). Results: A total of 424 patients with CVT and COVID-19 and 8,969 patients with CVT without COVID met the study criteria. After 1:1 propensity score matching, 422 patients were included in both cohorts. The group CVT with COVID-19 infection within two weeks of diagnosis of CVT had two times higher risk of all-cause mortality at one month [31 (7.3%) vs 16 (3.8%); HR=1.94; 95% CI=1.06-3.55] and three months [43 (10.2%) vs 17 (4.0%); HR=2.57; 95% CI=1.46-4.50] compared to CVT without COVID. CVT patients with COVID were two times more likely to have complications of ICH [1 month: 11.6% vs 5.5%; HR=2.16; 95% CI=1.23-3.64 and three months: 11.6% vs 6.3%; HR=1.90; 95% CI=1.15-3.13] and SAH [1 month: 8.3% vs 4.2%; HR=2.00; 95% CI=1.11-3.59 and three months: 8.3% vs 4.5%; HR=1.89; 95% CI=1.07-3.36]. CVT with COVID patients were more likely to develop deep vein thrombosis at one month (19.8% vs 13.6%; HR=1.51; 95% CI=1.04-2.20) but not at three months. There was no difference in diagnosis of AIS, epilepsy and pulmonary embolism at one and three months in the two groups. Conclusion: CVT patients with COVID-19 infection in the prior two weeks are two times more likely to die and have complications of ICH and SAH compared to CVT without COVID-19.

Abstract TMP62: The Delayed Seizure CVT Score Predicts Delayed Seizure After Cerebral Venous Thrombosis - A Secondary Analysis of ACTION-CVT

Introduction: Seizures are a common initial manifestation of cerebral venous thrombosis (CVT). We sought to establish predictive factors for delayed seizures to stratify risk and guide clinical management. Methods: We analyzed data from the Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT) study of consecutive patients with CVT from 2015 - 2020. The primary outcome was delayed seizure(s), occurring after 7 days from CVT diagnosis. Patients with outcome data for late seizures and follow-up of at least 7 days from time of diagnosis were included. Univariate analysis was performed using Chi-square, rank-sum, and t-tests. Variables with P-value < 0.2 were included in the backward stepwise regression model with 0.2 as cutoff, based on which we constructed the Delayed Seizure CVT (Delayed Seizures after CVT) score. Results: We identified 599 patients who met inclusion criteria: mean age 44.9(± 16.6) years, 62.9% female. Delayed seizures occurred in 37 (6.1%) patients. Risk factors included intracranial hemorrhage (OR 2.0 95% CI 0.7-5.74 p=0.196), alcohol abuse (OR 3.88 95% CI 1.45-10.38 p=0.007), focal neurologic deficit (OR 2.05 95% CI 0.95-4.44 p=0.067), seizure on presentation (OR 2.88 95% CI 1.32-6.29 p=0.008), hormonal birth control (OR 2.38 95% CI 1.06-5.37 p=0.0036), endovascular therapy (OR 2.86 95% CI 1.16-7.07 p=0.023) and decompressive hemicraniectomy (OR 3.357 95% CI 1.02-10.99 p=0.046), respectively. Based on coefficients of these variables, a 7-item score was created with acceptable performance for seizure prediction (AUC 0.796, 95% CI 0.72 - 0.86) (Table 1). Conclusions: Delayed seizure CVT score is a clinical tool to identify risk of delayed seizure in CVT. Further research is needed to validate these findings in an external cohort.

Homonymous hemianopia due to cerebral venous thrombosis: A case report

Rationale: Diagnosing cerebral venous thrombosis (CVT) can be difficult because of nonspecific symptoms, such as headache and homonymous hemianopia (HH). Herein, we present a case of delayed CVT diagnosis due to nonspecific neurological symptoms and nonprominent lesions in a patient with HH. Patient concern: A 65-year-old woman presented with a sudden onset headache accompanied by right HH that lasted for 1 day. Brain computed tomography and magnetic resonance imaging were initially performed due to suspicion of ischemic lesions or hemorrhage in the left postchiasmal visual pathway; however, no remarkable acute brain lesions were detected. Ophthalmological examinations revealed no notable findings, except for a definite field defect in the Humphrey visual field test. The headaches then waxed and waned but recurred 3 days after the initial symptom. A repeat brain magnetic resonance imaging was performed, which revealed left sectoral gyral swelling and vascular enhancement in the occipital lobe. To further evaluate venous drainage, additional 3-dimensional cerebral computed tomography angiography and 4-vessel angiography were conducted, revealing a partial filling defect in the left transverse sinus and superior venous drainage impairment. These findings suggested the presence of venous thrombosis in the left transverse sinus. Diagnosis: The patient was diagnosed with thrombosis of the left transverse sinus, which subsequently caused the right HH. Intervention: Anticoagulation therapy with parenteral heparin was started as soon as the diagnosis of CVT was confirmed. Eventually, the patient was solely managed with oral warfarin administration. Outcomes: Following 3 days of treatment, her headache resolved, and a subsequent visual field testing conducted 2 weeks later revealed a definite improvement in the field defect. Lessons: Despite its favorable prognosis, CVT can be challenging to diagnose. CVT should be considered as a differential diagnosis when diagnosing patients who present with headaches accompanied by HH without prominent brain lesions.

Prognosis after cerebral venous thrombosis: Mortality during initial admission and at 30 days and one year after discharge in a large Canadian population-based cohort

BackgroundPrognosis following cerebral venous thrombosis (CVT) is more favorable than other stroke types, but longer-term literature is limited, and trends over time are under-explored. ObjectiveUsing administrative data, we examined factors associated with mortality in the inpatient setting, at 30 days and at one year following hospital discharge among a large consecutive cohort of Canadian patients with CVT. Design/methodsCVT patients from British Columbia (BC), Canada from 2000 to 2017 were identified using ICD diagnosis codes from the BC subset of the Canadian Institute for Health Information's Discharge Abstract Database. Logistic regression was used to investigate factors associated with inpatient mortality and survival analysis with Cox regression was used to explore factors associated with mortality at 30 days and one year. ResultsOf 554 incident CVT patients identified, 508 (92 %) survived their index admission. Older age (OR 1.04, 95 % CI 1.03–1.06, p < 0.01) and the presence of seizures (OR 2.31, 95 % CI 1.08–4.94, p = 0.03) or intracranial bleeding (OR 2.28, 95 % CI 1.08–4.85, p = 0.03) were associated with increased odds of inpatient mortality. Mortality after hospital discharge was 3.0 % at 30 days and 9.4 % at one year. Older age (HR 1.05, 95 % CI 1.02–1.08, p < 0.01 at 30 days; HR 1.05, 95 % CI 1.04–1.07, p < 0.01 at 1 year) and having recent or active malignancy (HR 4.17, 95 % CI 1.51–11.52, p < 0.01 at 30 days; HR 4.60, 95 % CI 2.60–8.11, p < 0.01 at 1 year) were significantly associated with higher risks of mortality at 30 days and one year after discharge. There were decreases in inpatient mortality over the study period, but this was offset by higher mortality within 30 days after discharge in the later study epochs. ConclusionsAmong patients discharged with a diagnosis of CVT, one-year mortality was high at 9.4 %. Older age and a history of cancer were associated with higher mortality after discharge.

Arterial Spin Labelling Magnetic Resonance Perfusion Imaging for the Diagnosis of Acute Cerebral Venous Thrombosis

Abstract&#x0D; &#x0D; Background: Early diagnosis of cerebral venous thrombosis (CVT) is crucial for a favourable prognosis as CVT can lead to severe outcomes. However, certain scenarios, such as during pregnancy, restrict the use of contrast agents, thus rendering conventional magnetic resonance imaging (MRI) methods insufficient for accurate diagnosis. In light of these challenges, our study endeavours to assess the diagnostic potential of the arterial spin labelling magnetic resonance perfusion (ASL-MRP) technique, a contrast-agent–free approach, in the context of CVT diagnosis. &#x0D; &#x0D; Materials and Methods: Between 1 March 2022 and 30 May 2022, patients diagnosed with CVT via contrast-enhanced MR venography in the neurology clinic of our hospital were evaluated through ASL-MRP. Patient-specific demographics, including age, gender, presenting symptoms, underlying causes, impacted cortical sinus structures and MRI findings, were documented. Within the framework of ASL-MRP, an elevation in cerebral blood flow (CBF) detected within the affected sinus and/or neighbouring structures was deemed indicative of pathological conditions.&#x0D; &#x0D; Results: Among the 13 patients included in our study, six were diagnosed with acute CVT, whereas seven were diagnosed with chronic CVT. The assessment of CBF using ASL-MRP revealed CBF elevation in five out of the six cases (83.3%) exhibiting acute CVT. However, no anomalous findings were observed in the ASL-MRP scans of patients presenting with chronic CVT. &#x0D; &#x0D; Discussion: The utilisation of ASL-MRP eliminates the need for contrast agent administration. It is a promising technique in facilitating the diagnosis of acute CVT and distinguishing it from chronic CVT cases.

Direct oral anticoagulants for the treatment of cerebral venous thrombosis - a protocol of an international phase IV study.

Current guidelines recommend that patients with cerebral venous thrombosis (CVT) should be treated with vitamin K antagonists (VKAs) for 3-12 months. Direct oral anticoagulants (DOACs), however, are increasingly used in clinical practice. An exploratory randomized controlled trial including 120 patients with CVT suggested that the efficacy and safety profile of dabigatran (a DOAC) is similar to VKAs for the treatment of CVT, but large-scale prospective studies from a real-world setting are lacking. DOAC-CVT is an international, prospective, observational cohort study comparing DOACs to VKAs for the prevention of recurrent venous thrombotic events after acute CVT. Patients are eligible if they are 18 years or older, have a radiologically confirmed CVT, and have started oral anticoagulant treatment (DOAC or VKA) within 30 days of CVT diagnosis. Patients with an absolute contra-indication for DOACs, such as pregnancy or severe renal insufficiency, are excluded from the study. We aim to recruit at least 500 patients within a three-year recruitment period. The primary endpoint is a composite of recurrent venous thrombosis and major bleeding at 6 months of follow-up. We will calculate an adjusted odds ratio for the primary endpoint using propensity score inverse probability treatment weighting. DOAC-CVT will provide real-world data on the comparative efficacy and safety of DOACs versus VKAs for the treatment of CVT. ClinicalTrials.gov, NCT04660747.

Risk and Prognosis of Cancer in Patients With Cerebral Venous Thrombosis Compared With the Danish General Population.

Whether cerebral venous thrombosis (CVT) is a marker of cancer in clinical practice remains unknown. Little is known about the prognosis of cancer detected subsequent to CVT. We used Danish nationwide registries (1996-2019) to identify patients with a first-time primary inpatient diagnosis of CVT without a history of cancer (N=811, 65% women, median age 42 years). We assessed the risk of an incident cancer diagnosis using standardized incidence ratios (SIRs). This measure contrasts the number of observed cancers among patients with CVT to the number of expected cancers where patients with CVT have the same cancer risk as the general population. We used Kaplan-Meier survival analysis and Cox regression to compare the survival of patients with both cancer and CVT with the survival of patients with cancer but without CVT, matched on cancer site, sex, age, and year of cancer diagnosis. Observing 43 incident cancer cases during follow-up, the overall SIR was unity (SIR, 1.04 [95% CI, 0.75-1.40]). However, the risk was ≈7-fold the expected level in the first 3 months following CVT diagnosis (SIR, 7.00 [95% CI, 3.02-13.80]) and ≈2-fold the expected level from 3 to 12 months following CVT diagnosis (SIR, 2.21 [95% CI, 0.89-4.56]). By 12 months following CVT diagnosis, the risk resembled the expected level (SIR, 0.76 [95% CI, 0.50-1.09]). Survival among cancer patients with prior CVT versus cancer patients without prior CVT was 91% versus 87% after 6 months and 65% versus 70% after 5 years. The adjusted hazard ratio of death was 0.78 (95% CI, 0.44-1.38). Patients with CVT were not at overall increased risk of a cancer diagnosis, except in the first 3 months after diagnosis during which period the risk was elevated ≈7-fold. The estimate from this early period, however, was based on only a few cancer diagnoses. Unlike other forms of venous thrombosis, a prior diagnosis of CVT did not negatively impact cancer survival.

Utility of 3D T1-weighted turbo spin echo black blood sequence for the diagnosis of cerebral venous thrombosis.

Accurate assessment of dural sinus, deep and cortical venous thrombosis on MR imaging is challenging. The aim of this study is to evaluate the accuracy of 3D-T1 turbo spin echo (T1S), sequences in detecting venous thrombosis and comparing it with susceptibility-weighted imaging (SWI), magnetic resonance venography (MRV) and post contrast T1 magnetization-prepared rapid acquisition gradient echo (T1C). A blinded retrospective observational analysis of 71 consecutive patients evaluated for cerebral venous thrombosis (CVT) and 30 control patients was performed. Multimodality reference standard adopted included T1C, SWI with MRV. Sub-analyses in superficial, deep and cortical venous segments were performed in addition to correlation of signal intensity of thrombus with the clinical stage. A total of 2222 segments in 101 complete MRI examinations were evaluated. Sensitivity/specificity/positive predictive value/negative predictive value/accuracy and precision of T1S for detection of cortical vein thrombosis was 0.994/1/1/0.967/0.995/1, 1/0.874/0.949/1/0.963/0.950 for detection of superficial venous sinus thrombosis and 1/1/1/1/1/1 for deep venous thrombosis. The AUC yield for T1S was 0.997 for cortical, 1 for deep and 0.988 for superficial venous segments. T1S paralleled the accuracy of conventional sequences in the overall detection of CVT but showed superior accuracy in the detection of cortical venous thrombosis. It makes a fitting addition to the CVT MRI protocol in scenarios demanding negation of gadolinium administration.

A Study of Clinico-Radiological Profile and Outcomes of Cerebral Venous Thrombosis

ABSTRACT Background: Cerebral venous thrombosis (CVT) includes highly variable clinical presentations ranging from headache to coma. It often affects young to middle-aged patients. Early diagnosis and treatment improve outcomes. Outcome determinant factors are the extent of the disease, jugular occlusion, spread to deep or cortical veins, level of sensorium at onset, background factors, and presence of raised intracranial pressure. Objectives: This study aims to study the clinical profile, radiological features, and outcomes of CVT. Materials and Methods: Fifty-seven patients admitted to SSIMS&amp;RC, Davangere, clinically suspected of CVT, were subjected to neuroimaging techniques, patients with a confirmed diagnosis of CVT (radiologically) were recruited by simple random sampling, and data collected was analyzed by correlational studies. Follow-up was done until 6 months. Results: Of the 57 patients, 30 (53%) were females and 27 (47%) were males, with a maximum incidence of 84% in the age group 18–40 years. The most common symptoms were headache (86%), seizures (65%), focal deficits (58%), and altered sensorium (52.6%). Radiologically, the most common sinus involved was the superior sagittal sinus 72%. In total, out of 57 patients, 6 patients died during hospitalization. Out of the surviving patients, 39 patients (70%) had a complete recovery. Poor prognostic factors were stupor and coma on admission and evidence of hemorrhagic infarction in the primary computed tomography (CT) scan. Conclusion: Compared to the previous studies, the prevalence of CVT was higher in women. Clinical manifestations, prognostic factors, “commonly involved sinuses,” and “image findings of this study” were similar to those of other studies. The overall prognosis was good, but a small percentage of patients died.

Timing and Predictors of Recanalization After Anticoagulation in Cerebral Venous Thrombosis.

Vessel recanalization after cerebral venous thrombosis (CVT) is associated with favorable outcomes and lower mortality. Several studies examined the timing and predictors of recanalization after CVT with mixed results. We aimed to investigate predictors and timing of recanalization after CVT. We used data from the multicenter, international AntiCoagulaTION in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT) study of consecutive patients with CVT from January 2015 to December 2020. Our analysis included patients that had undergone repeat venous neuroimaging more than 30 days after initiation of anticoagulation treatment. Prespecified variables were included in univariate and multivariable analyses to identify independent predictors of failure to recanalize. Among the 551 patients (mean age, 44.4±16.2 years, 66.2% women) that met inclusion criteria, 486 (88.2%) had complete or partial, and 65 (11.8%) had no recanalization. The median time to first follow-up imaging study was 110 days (interquartile range, 60-187). In multivariable analysis, older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.07), male sex (OR, 0.44; 95% CI, 0.24-0.80), and lack of parenchymal changes on baseline imaging (OR, 0.53; 95% CI, 0.29-0.96) were associated with no recanalization. The majority of improvement in recanalization (71.1%) occurred before 3 months from initial diagnosis. A high percentage of complete recanalization (59.0%) took place within the first 3 months after CVT diagnosis. Older age, male sex, and lack of parenchymal changes were associated with no recanalization after CVT. The majority recanalization occurred early in the disease course suggesting limited further recanalization with anticoagulation beyond 3 months. Large prospective studies are needed to confirm our findings.

Assessment of fibrinogen albumin ratio in patients with pregnancy-related cerebral venous thrombosis.

Cerebral venous thrombosis (CVT) is a cerebrovascular disease observed more commonly in women of childbearing age. There is currently no biomarker used to predict the risk of CVT during the follow-up of pregnant/postpartum patients. In this context, the objective of this study is to investigate the importance of fibrinogen and albumin levels and fibrinogen-to-albumin ratio (FAR) values, which predispose to thromboembolism, in pregnant/postpartum patients. The study sample consisted of 19 pregnant/postpartum patients with a diagnosis of CVT, 20 pregnant/postpartum patients without CVT. Albumin and fibrinogen levels and FAR values were compared between these two groups. Fibrinogen level was significantly higher in pregnant/postpartum CVT patients compared to pregnant/postpartum patients without CVT (p = 0.010). On the other hand, albumin level was significantly lower in pregnant/postpartum CVT patients compared to the other group (p = 0.010). Lastly, FAR level was significantly higher in pregnant/postpartum CVT patients compared to the other group (p = 0.011). There was no correlation between FAR values and modified Rankin score. The study findings indicated that high fibrinogen and low albumin levels and high FAR values are associated with an increased risk of CVT in pregnant/postpartum patients.

Thromboembolic events, bleeding, and mortality in patients with cerebral venous thrombosis: a nationwide cohort study.

Cerebral venous thrombosis (CVT) predominantly affects young to middle-aged women. Scarce data exist regarding the long-term prognosis. We examined the clinical course of patients with CVT overall and according to their age and sex. Using Danish registries, we identified all patients with a first-time primary inpatient diagnosis of CVT from 1996-2018 (N= 653; median age, 41 years; 67% women) and individuals from the general population matched for age, sex, and calendar year (N= 65 300). Patients with CVT were at an increased risk of venous thromboembolism (VTE) at other sites, ischemic stroke, major bleeding, and mortality. For both sexes, the increased risks of VTE at other sites were most prominent among younger patients (18-54 years), whereas the increased risks of ischemic stroke, major bleeding, and mortality were most prominent among older patients (≥55 years). Among young women, the 10-year risks of VTE at other sites for patients with CVT compared with members of the matched cohort were 2.2% vs 0.4% (risk difference, 1.8%; 95% confidence interval [CI], 0.0-3.6). Among older women, compared with members of the matched cohort, the 10-year risks were 12.8% vs 3.1% (risk difference, 9.7%; 95% CI, 1.6-17.9) for ischemic stroke, 11.1% vs 4.6% (risk difference, 6.5%; 95% CI,-1.0 to 14.1) for major bleeding, and 43.1% vs 26.7% (risk difference, 16.4%; 95% CI, 3.7-29.1) for all-cause mortality. The risk of myocardial infarction was not elevated. Clinicians should be aware of the importance of age and sex heterogeneity in the prognosis of CVT.

Cerebral Venous Thrombosis After Unintentional Dural Puncture: Raising awareness for an uncommon cause of postpartum headache.

Headache is a common symptom in the postpartum period, which can have a varied aetiology. Although rare, cerebral venous thrombosis can be a fatal complication in the parturient. Dural puncture is considered as one of the risk factors for cerebral venous thrombosis and the proposed mechanism pathogenesis can be explained by the components of Virchow's triad: stasis of the blood, hypercoagulability, and endothelial damage. Headache is usually the most frequent symptom and can mimic those of postdural puncture headache, which can delay the diagnosis. We will report a case of an 18-year-old woman that develops a postpartum headache after an accidental dural puncture during epidural catheter placement for labour analgesia. Our patient was initially managed for postdural puncture headache, but later the character changed, which made us look for a differential diagnosis. After a multidisciplinary approach, neuroimaging confirmed the diagnosis of cerebral venous thrombosis. This case report emphasises the importance of a careful differential diagnosis of postpartum headache particularly if the headache persists or changes its character. Brain imaging and multidisciplinary evaluation can lead to prompt diagnosis and initiation of appropriate treatment.

Clinical course and diagnosis of cerebral vein and sinus thrombosis associated with COVID-19 in young and middle-aged patients

Cerebral venous thrombosis (CVT) is a form of cerebrovascular disorders that is difficult to recognize, it is potentially a life threatening condition and requires timely anticoagulant therapy. In the era of the COVID-19 pandemic, there is a steady increase in CVT (4.2% vs. 0.5–1%). At the same time, mortality in patients with CVT on the background of COVID-19 significantly exceeds the mortality in patients with CVT without COVID-19 (45.5% vs. 15%). Objective: to study the clinical course of CVT, to determine the diagnostic value of radiological methods and the significance of genetic risk factors for thrombosis in the development of CVT in young and middle-aged patients against the background of COVID-19. Material and methods. Seven patients were examined: six women (five of them of reproductive age) and one man, aged 26 to 57 years (mean age 37 years). The main clinical and neurological manifestations of CVT, the results of laboratory examination, neuroimaging, and the data of molecular genetic analysis of risk factors for thrombosis were analyzed. Results. The course of COVID-19 was severe in one case, and moderate in the rest of cases. The interval between the onset of COVID-19 symptoms and the development of CVT ranged from 7 to 25 days. In three cases CVT had an acute course and was accompanied by the development of a stroke (in two cases, hemorrhagic stroke was noted, in one case, multifocal ischemic stroke), in other cases, a subacute course of CVT was noted. Genetic risk factors for thrombosis were identified in all patients.Conclusion. The diagnosis of CVT in the era of the COVID-19 pandemic is particularly difficult, since the most common symptom of CVT – headache (90%) – can be regarded as a manifestation of COVID-19. At the same time, timely diagnosis of CVT and immediate initiation of anticoagulant therapy are associated with a relatively favorable prognosis.

Rivaroxaban for the treatment of cerebral venous thrombosis (P7-5.020)

<h3>Objective:</h3> This study aims to assess the effectiveness and bleeding risk of Rivaroxaban in comparison with Warfarin for the treatment of CVT. <h3>Background:</h3> New Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk. There is a lack of evidence on the effectiveness and safety of Rivaroxaban in Cerebral venous thrombosis (CVT). <h3>Design/Methods:</h3> 36 patients with a diagnosis of CVT were included. Clinical and background information was assessed on admission and patients were followed for at least 12 months. Measured outcomes were modified Rankin Scale (mRS), evidence of recanalization on contrast-enhanced Brain MR venography (MRV), and major or minor bleeding. Patients were divided into two groups according to the type of oral anticoagulant (Rivaroxaban vs Warfarin). Groups were compared in terms of final outcomes and side effects. <h3>Results:</h3> Overall, 13 (36.11%) patients received Warfarin and 23 (63.89%) received Rivaroxaban. Optimal mRS score (0–1) was attained in 9 of 10 (90%) of patients treated with Rivaroxaban and 19 of 22 (86.36%) of patients who received Warfarin. MRV showed complete or partial recanalization in 12 of 14 (85.71%) patients treated with Rivaroxaban and all patients in the Warfarin group. There was no significant difference between the two groups in terms of major and minor hemorrhage. <h3>Conclusions:</h3> Rivaroxaban holds promise for the treatment of CVT. <b>Disclosure:</b> Dr. Esmaeili has nothing to disclose. Dr. Mirzaasgari has nothing to disclose. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Zabeti has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Horizon. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Janssen . Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for BMS.

Potential role of plasma branched-chain amino acids in the differential diagnosis of acute cerebral venous thrombosis

Cerebral venous thrombosis (CVT) is a special and easily misdiagnosed or undiagnosed subtype of stroke. To identify specific biomarkers with a high predictive ability for the diagnosis of acute CVT, we performed metabolomic analysis in plasma samples from acute CVT patients and healthy controls and confirmed the results in validation cohorts. In the discovery stage, there were 343 differential metabolites, and the caffeine metabolism pathway and the biosynthesis pathway for the branched chain amino acids (BCAAs) valine, leucine, and isoleucine were two significant pathways between the CVT and healthy cohorts. The area under the curve (AUC) for metabolites associated with valine, leucine, and isoleucine biosynthesis was 0.934. In the validation stage, the BCAA concentrations demonstrated an AUC of 0.935 to differentiate patients with acute CVT from the control cohort. In addition, BCAAs combined with D-dimer levels were used to establish a diagnostic model for CVT, and the AUC was 0.951, showing good diagnostic efficacy of separating CVT patients from the control cohort. BCAAs as plasma biomarkers deserve to be further studied and even developed in clinical CVT management.

Transverse and Sigmoid Venous Thrombosis Presenting as Proptosis and Acute Loss of Vision: An Unreported Association

Cerebral venous sinus thrombosis is a rare disorder characterized by thrombosis in the venous channels of the brain. Nonspecific symptoms such as headache, focal neurologic deficits and seizures make this condition difficult to diagnose. We describe a case of cerebral venous thrombosis in the sigmoid and transverse sinuses which presented as reversible, rapid-onset proptosis and loss of vision in a patient of subclinical hypothyroidism. Such an occurrence of proptosis due to thrombosis of the sigmoid and transverse sinuses has never been reported in literature. The diagnosis of cerebral venous thrombosis in this patient was arrived at in a stepwise fashion.&#x0D; Thus, this case in addition to reporting a novel finding, stresses by example, the importance of acute suspicion on part of the physician for timely diagnosis and treatment of this eluding yet reversible disease.

Clinical and prognostic characteristics of cerebral venous thrombosis at high altitude: a single-center retrospective study of Tibet.

Data regarding diagnosis, management, and prognosis of patients with cerebral venous thrombosis (CVT) from high altitude are limited. The aim of the present study is to identify the clinical features, risk factors, and outcomes of cerebral venous thrombosis (CVT) in Tibet. We retrospectively included patients with a diagnosis of CVT consecutively admitted to Tibet Autonomous Region People's Hospital between July 2015, and September 2022. The risk factors, clinical and radiological presentations, treatment and outcomes were analyzed. A total of 38 patients with CVT were included in this study. The median age was 31years, and females accounted for 63.2%. Patients of Tibetan nationality accounted for 71.1% (n = 27) and the median altitude of residence in Tibet was 3800m (3657, 4054). Headache was the most common symptom (92.1%). The most common risk factors of CVT were infection in the past 4weeks (34.2%) and pregnancy or puerperium (23.7%). Lateral sinus (transverse and/or sigmoid sinus) (68.4%) and superior sagittal sinus (55.3%) were the most commonly involved. The D-dimer increased in 31 patients (81.6%). All three patients who died in hospital and during follow-up had risk factor of recent infection. Favorable outcome at follow-up with a median length of 454days (189, 1059) was observed in 85.3% of patients. CVT at high altitude is more common in young patients and women, with various clinical manifestations and risk factors. Recent infection is the most common risk factor and may increase the mortality of CVT at high altitude. The long-term prognosis of CVT at high altitude is favorable.

Abstract TMP55: Factors Associated With Delayed Diagnosis Of Cerebral Venous Thrombosis: Secondary Analysis Of ACTION-CVT Study

Introduction: Few clinical features have been associated with delayed diagnosis of cerebral venous thrombosis with variable impact of delay on patient outcomes. We therefore sought to use the data from a recent, multicenter study ACTION-CVT (Anticoagulation in the Treatment of CVT) to identify factors associated with delayed CVT diagnosis and evaluate the effect of delay on functional outcome. Methods: All ACTION-CVT patients with available data on date of neurological symptom onset and date of CVT diagnosis were included. Delayed diagnosis of CVT was defined as diagnosis occurring in the fourth (final) quartile of days from symptom onset. We also report the proportion of patients who were discharged from hospital or ED within 3 months prior to index CVT admission for any neurological symptom without being diagnosed with CVT. The primary study outcome was an excellent functional outcome at 90 days defined as modified Rankin Scale (mRS) ≤1. Secondary outcome was partial or complete CVT recanalization on last available venous imaging. Chi-squared and Student’s t-tests were used to identify variables associated with delayed diagnosis. Logistic regression was used to identify independent predictors of delayed diagnosis in CVT as well as the association of delay with outcomes. Results: We included 935 CVT patients in our analysis. Median time from symptom onset to diagnosis was 4 days (IQR: 1-10). Delayed CVT diagnosis occurred in 212 (23%) patients (median time to diagnosis &gt;10 days). Out of 212 patients with delayed CVT diagnosis, 64 (30.2%) patients were discharged from hospital/ED in the 3 months prior to their index CVT admission. Headache symptoms were a predictor of delayed diagnosis (OR: 2.36 [1.26-4.42]; p&lt;0.01), and seizure was inversely related to delayed diagnosis (0.39 [0.21-0.74]; p=0.001). Delayed diagnosis was not associated with mRS ≤1 at 90 days (OR 0.83 [95% CI: 0.42-1.64]; p=0.58) or venous recanalization (OR 1.78 [95% CI 0.79-3.99]; p=0.16). Conclusion: In a large, multicenter cohort we found that CVT patients presenting with headache were at increased risk of delayed diagnosis, however, delayed diagnosis was not associated with adverse outcomes. CVT diagnosis should be considered in patients presenting with a new headache.

Clinical and diagnostic features of course of cerebral venous thrombosis during COVID‑19 pandemic

Relevance. During the COVID‑19 pandemic, there has been an increase in the frequency of cerebral venous thrombosis (CVT) by 30–60 times. At the same time, the development of CVT does not depend on the severity of COVID‑19. Diagnosis of CVT during the COVID‑19 pandemic is particularly difficult, since the most common symptom of CVT, headache, can be regarded as a manifestation of COVID‑19. A wide range of clinical symptoms and low alertness of doctors leads to late diagnosis and verification of CVT.Purpose of the study. To analyze the features of clinical manifestations and neuroimaging signs of CVT against the background of COVID‑19. Patients and methods. We examined 70 young and middle-aged patients with COVID‑19 of varying severity, who underwent inpatient treatment in angio-neurological and re-profiled infectious diseases departments of North-Western State Medical University n. a. I. I. Mechnikov (Saint Petersburg, Russia) at the age of 18 to 59 years (38.5 ± 11.58), of which 49 (70 %) women and 21 (30 %) men.Results. The most common neurological symptom in patients with CVT due to COVID‑19 was diffuse headache. The severity of COVID‑19 and the degree of lung damage did not correlate with the severity of CVT. In 32 (46 %) cases, CVT was accompanied by the development of venous stroke: ischemic – in 13 (19 %) patients, hemorrhagic – in 7 (10 %), ischemic stroke with hemorrhagic impregnation – in 12 (17 %) patients. According to the localization of the thrombus, thrombosis of the left transverse sinus was most often noted – in 39 (57 %) cases.Conclusions. The leading symptom in all patients with CVT was headache, which was not relieved by taking conventional analgesics, which caused clinical alertness of doctors. Early diagnosis of CVT ensured the immediate start of anticoagulant therapy and contributed to positive dynamics in all patients in the form of regression of neurological deficit and improvement in general condition.