Risk Of Cerebral Venous Sinus Thrombosis Research Articles

Stroke Following Coronavirus Disease 2019 Vaccination: Evidence Based on Different Designs of Real-World Studies.

We aimed to evaluate whether coronavirus disease 2019 (COVID-19) vaccination was associated with stroke. We conducted a systematic meta-analysis of studies using cohort, self-controlled case series (SCCS), and case-crossover study (CCOS) designs to evaluate incidence risk ratios (IRRs) and 95% confidence intervals (CIs) of ischemic stroke (IS), hemorrhagic stroke (HS), and cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination. Risks of stroke were pooled among subpopulations categorized by vaccine type, dose, age, and sex. Sensitivity analysis was performed by different defined risk periods. Fourteen studies involving 79 918 904 individuals were included. Cohort studies showed decreased risks of IS (IRR, 0.82 [95% CI, .75-.90]) and HS (IRR, 0.75 [95% CI, .67-.85]) postvaccination, but not CVST (IRR, 1.18 [95% CI, .70-1.98]). SCCS identified increased risks 1-21 days postvaccination (IRRIS, 1.05 [95% CI, 1.00-1.10]; IRRHS, 1.16 [95% CI, 1.06-1.26]) or 1-28 days postvaccination (IRRIS, 1.04 [95% CI, 1.00-1.08]; IRRHS, 1.37 [95% CI, 1.15-1.64]), similar to CVST (IRR, 1.58 [95% CI, 1.08-2.32]). CCOS reported an increased risk of CVST after ChAdOx1 vaccination (IRR, 2.9 [95% CI, 1.1-7.2]). Although different study designs yielded inconsistent findings, considering the relatively low background incidence of stroke and benefits of vaccination, even a potentially increased risk of stroke postvaccination should not justify vaccine hesitancy.

Postpartum Cerebral Venous Sinus Thrombosis Following Obstetric Neuraxial Blockade: A Literature Review With Analysis of 58 Case Reports

(Int J Obstet Anes. 2022;49:103218) Cerebral venous sinus thrombosis (CVST) is a rare pregnancy complication that can cause maternal stroke and death. The risk of CVST is increased in the first 6 weeks postpartum, and primarily presents as a headache with no specific characteristics. CVST may be overlooked in patients who have received neuraxial anesthesia because postdural puncture headache (PDPH) is also characterized by a headache following delivery. These 2 conditions require different management approaches, so it is important that clinicians can differentiate between the 2. Anesthetists are often involved in viewing these cases. This literature review describes the characteristics and outcomes of CVST and how to discern between the 2 complications.

Comparative risk of cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination or infection: A national cohort study using linked electronic health records

ABSTRACT To inform the public and policy makers, we investigated and compared the risk of cerebral venous sinus thrombosis (CVST) after SARS-Cov-2 vaccination or infection using a national cohort of 2,643,699 individuals aged 17 y and above, alive, and resident in Wales on 1 January 2020 followed up through multiple linked data sources until 28 March 2021. Exposures were first dose of Oxford-ChAdOx1 or Pfizer-BioNTech vaccine or polymerase chain reaction (PCR)-confirmed SARS-Cov-2 infection. The outcome was an incident record of CVST. Hazard ratios (HR) were calculated using multivariable Cox regression, adjusted for confounders. HR from SARS-Cov-2 infection was compared with that for SARS-Cov-2 vaccination. We identified 910,556 (34.4%) records of first SARS-Cov-2 vaccination and 165,862 (6.3%) of SARS-Cov-2 infection. A total of 1,372 CVST events were recorded during the study period, of which 52 (3.8%) and 48 (3.5%) occurred within 28 d after vaccination and infection, respectively. We observed slight non-significant risk of CVST within 28 d of vaccination [aHR: 1.34, 95% CI: 0.95-1.90], which remained after stratifying by vaccine [BNT162b2, aHR: 1.18 (95% CI: 0.63-2.21); ChAdOx1, aHR: 1.40 (95% CI: 0.95-2.05)]. Three times the number of CVST events is observed within 28 d of a positive SARS-Cov-2 test [aHR: 3.02 (95% CI: 2.17-4.21)]. The risk of CVST following SARS-Cov-2 infection is 2.3 times that following SARS-Cov-2 vaccine. This is important information both for those designing COVID-19 vaccination programs and for individuals making their own informed decisions on the risk-benefit of vaccination. This record-linkage approach will be useful in monitoring the safety of future vaccine programs.

Abstract 51: Age Stratified Risk Of Cerebral Venous Sinus Thrombosis After Sars-Cov-2 Vaccination

Introduction: Cerebral Venous Sinus Thrombosis (CVST) as a part of the thrombosis and thrombocytopenia syndrome is a rare adverse drug reaction of SARS-CoV-2 vaccination. The estimated background rate of CVST in adults is around 1 case per million per month, and CVST with thrombocytopenia accounts for 8% of all CVST. We assessed the age-stratified risk of CVST with and without thrombocytopenia after SARS-CoV-2 vaccination. Methods: We estimated the absolute risk of any CVST, CVST with thrombocytopenia, and CVST without thrombocytopenia, within 28 days of first dose SARS-CoV-2 vaccination, using data from the European Medicines Agency’s EudraVigilance database (until 13 June 2021). As a denominator, we used data on vaccine delivery from 31 European countries. For 22.8 million adults from 25 countries we estimated the absolute risk of CVST after the first dose of ChAdOx1 nCov-19 per age category. Results: The absolute risk of CVST within 28 days of first dose vaccination was 7.5 (95%CI 6.9-8.3), 0.7 (95%CI 0.2-2.4), 0.6 (95%CI 0.5-0.7) and 0.6 (95%CI 0.3-1.1) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2 and mRNA-1273, respectively. The absolute risk of CVST with thrombocytopenia within 28 days of first dose vaccination was 4.4 (95%CI 3.9-4.9), 0.7 (95%CI 0.2-2.4), 0.0 (95%CI 0.0-0.1) and 0.0 (95%CI 0.0-0.2) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2 and mRNA-1273, respectively. In recipients of ChAdOx1 nCov-19, the risk of CVST, both with and without thrombocytopenia, was the highest in the 18-24 years age group (7.3 per million, 95%CI 2.8-18.8 and 3.7, 95%CI 1.0-13.3, respectively). The risk of CVST with thrombocytopenia was the lowest in ChAdOx1 nCov-19 recipients ≥70 years (0.2, 95%CI 0.0-1.3). Age <60 compared to ≥60 was a predictor for CVST with thrombocytopenia (incidence rate ratio 5.79; 95%CI 2.98-11.24, p<0.001). Discussion: The risk of CVST with thrombocytopenia within 28 days of first dose vaccination with ChAdOx1 nCov-19 was higher in younger age groups. The risk of CVST with thrombocytopenia was slightly increased in patients receiving Ad26.COV2.S, comparing with the estimated background risk. The risk of CVST with thrombocytopenia was not increased in recipients of mRNA vaccines for SARS-CoV-2.

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study

ObjectiveTo assess the association between covid-19 vaccines and risk of thrombocytopenia and thromboembolic events in England among adults.DesignSelf-controlled case series study using national data on covid-19 vaccination and hospital admissions.SettingPatient...

Vitamin D levels and C-reactive protein/albumin ratio in pregnant women with cerebral venous sinus thrombosis.

Changes in coagulation system during pregnancy have been put forth as risk factors for cerebral venous sinus thrombosis (CVT), yet we still have limited knowledge on markers for predicting the risk of CVT in pregnant women. Therefore, we aimed to investigate the significance of vitamin D (VD) levels and C-reactive protein (CRP)/albumin ratio (CAR), an inflammation marker, as risk factors for CVT in pregnant women. 23 pregnant women who were followed up for CVT, 26 healthy pregnant women who had no pregnancy complications, and 31 non-pregnant fertile women were included in the study. CAR and VD levels were compared between groups. CAR was significantly higher in the pregnant CVT group compared to the other two groups (p < 0.001). CAR was also significantly higher in the healthy pregnant group than the non-pregnant fertile group (p < 0.001). VD levels were determined to be statistically significantly lower in the pregnant CVT group compared to the other two groups (p < 0.001). However, VD levels did not significantly differ between healthy pregnant group and non-pregnant fertile group (p > 0.05). We found no significant correlation between CAR and VD levels in any of the three groups. Pregnant women with CVT were found to have a high rate of severe VD deficiency. Low VD levels and high CAR levels in pregnant women may be associated with an increased risk of CVT.

Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients with Essential Thrombocythemia.

Background and ObjectiveEssential thrombocythemia (ET) is a rare cause of cerebral venous sinus thrombosis (CVST). Analysis of the risk factors and treatment therapies of CVST in ET has yielded controversial findings.Subjects and MethodsWe retrospectively investigated the clinical characteristics of CVST events in ET and compared baseline characteristics, causative factors, hematological effects, and treatments between ET patients with and without CVST.ResultsOverall, 91 of 115 patients who met the ET diagnosis were included in this study. Among them, 23 (25.27%) patients met the diagnostic criteria of ET with CVST for inclusion, 14 (60.87%) of whom were females, with a median age of 34 (range 25–50). CVST diagnosis was made concomitantly to ET in 19 patients (82.61%). The most common symptom and sites of thrombosis of CVST was an acute or subacute headache and sigmoid sinuses, respectively. Compared with ET patients without CVST, ET patients with CVST were significantly younger (37.65±14.45 vs 60.93±13.46, P<0.001) and had lower prevalence of hypertension (4.34 vs 32.35%, P=0.003) and coronary artery disease (0 vs 14.71%, P = 0.045). Patients with CVST presented with significant lower platelet count (510.39±176.71 vs 750.82±249.10, P< 0.001) and higher score of IPSET-thrombosis (P=0.017). Multivariate logistic regression analysis indicated that age (P=0.002, OR 1.096, 95% CI 1.035–1.161), at least one CVRF (P = 0.024, OR 0.037, 95% CI 0.002–0.649), platelet count (P=0.045, OR 0.994, 95% CI 0.989–1.001), and lower percentage of antiplatelet therapy (P=0.035, OR 0.307, 95% CI 0.001-1.280) significantly contributed to the risk of CVST in ET.ConclusionMost patients (95.65%) had a favorable outcome without recurrence after standard anticoagulant and cytoreductive treatment at last follow-up. These findings indicate that CVST may be the initial presentation of ET, with its detection crucial for early diagnosis and appropriate management. Anticoagulant and cytoreductive therapies should be recommended for preventing ET-related CVST with JAK2 V617F mutation.

Cerebral venous sinus thrombosis secondary to tonsillectomy

Cerebral venous sinus thrombosis(CVST) is considered to be a rare, high-risk, easily misdiagnosed disease with a mortality rate of 9.4%. Early diagnosis and timely anticoagulant thrombolytic therapy can reduce the mortality and disability rate and improve the prognosis of patients. This report describes the situation of a young male patient with bilateral tonsillectomy who, after going under low temperature plasma and general anesthesia surgery, presented with headache on the 4th day after the operation, and was diagnosed to be CVST by computed tomography(CT) and Magnetic Resonance Imaging(MRI). Due to severe pharynx swallowing pain after the surgery, his total daily intake was less than 2000 ml. After treatment, his prognosis was optimistic. The rarity and high risk of CVST after tonsillectomy suggest that we should pay attention to the related problems in the perioperative management of tonsillectomy include Bacterial infections, high condensation state of dehydration, using hemostatic drugs sparingly, etc.

Cerebral venous sinus thrombosis associated with oligosymptomatic COVID-19 infection: A case report

Introduction. Severe acute respiratory syndrome coronavirus 2 infection-induced coagulopathy may cause various thrombotic complications, such as cerebral venous sinus thrombosis, a less common type of stroke with a variable clinical presentation and high mortality rate. The objective of this paper was to identify clinical, laboratory and radiological characteristics, risk factors, therapeutic modalities, and outcome of a young patient with cerebral venous sinus thrombosis associated with oligosymptomatic coronavirus disease 2019 infection. Case Report. We present a case of a 32-year-old woman suffering from a stroke due to cerebral venous sinus thrombosis associated with a mild form of coronavirus disease 2019 infection. The patient was without a history of previous diseases and risk factors for cerebral venous sinus thrombosis. Two weeks before the cerebrovascular incident, the patient presented with oligosymptomatic coronavirus disease 2019 infection associated with headache. Laboratory findings were characterized by two conditions: hypercoagulability and systemic inflammation. Bilateral thalamic and right frontal hemorrhagic venous infarctions with superior sagittal and straight sinus thrombosis and thrombosis of the vein of Galen were established by magnetic resonance imaging of the head. The main therapeutic approaches included anticoagulant therapy, therapeutic protocol for coronavirus disease 2019 infection, seizure control therapy and intracranial hypertension management. The treatment outcome was good, with minimal residual symptoms. Conclusion. Physicians should always consider the high risk of cerebral venous sinus thrombosis with nonspecific neurological symptoms in patients with mild coronavirus disease 2019 infection in order to provide early diagnosis, the most effective individually tailored treatment, and to prevent complications.

Cerebral Venous Sinus Thrombosis in the COVID-19 Pandemic.

Recent studies have noted concern for increased thromboembolic events in the setting of Coronavirus Disease 2019 (COVID-19). Cerebral venous sinus thrombosis (CVST) is a form of thromboembolism that has been observed as a neuro-ophthalmologic complication of COVID-19. Review of the scientific literature. In this article, we report an overview of CVST epidemiology, clinical presentation, diagnostics, disease pathophysiology, and management in the setting of COVID-19. CVST is an uncommon thromboembolic event with variable phenotypes and multiple etiologies. Neurologic complications can be severe, including significant visual deficits and death. Current observations suggest that the risk of CVST may be profoundly impacted by this novel COVID-19 pandemic, thus prompting increased attention to disease presentation, pathogenesis, and management.

Prothrombogenic polymorphic variants of hemostatic and folate metabolism genes In patients with aseptic cerebral venous thrombosis

Cerebral venous sinus thrombosis (CVT) becomes the cause of stroke in less than 1% of patients. In 20-30% of patients, the cause of thrombosis remains unclear, and thrombosis is considered idiopathic. Inherited hypercoagulable conditions significantly increase the risk of CVT. The aim of the study was to evaluate the frequency of prothrombogenic polymorphic variants of hemostatic and methionine-homocysteine metabolism genes alleles and genotypes in patients with aseptic CVT. Fifty one patients aged 18–75 with aseptic CVT were examined. The control group included 36 healthy volunteers. Neuroimaging methods included brain MRI in standard modes (T1, T2, T2 d-f (FLAIR), DWI) and MR venosinusography. All patients were surveyed to identify carriers of prothrombogenic polymorphic variants of hemostatic and folate metabolism genes alleles and genotypes. Prothrombogenic polymorphic variants of hemostatic genes were detected in 94% of patients, and the variants of the methionine-homocysteine metabolism genes were observed in 86% of patients. The differences between distributions of alleles and genotypes 5G6754G of the PAI-1 gene, G103T of the FXIIIA1 gene, A66G of the MTRR gene, A2756G of the MTR gene in the group of patients with CVT and in the control group were significant. Allele 4G, genotypes 4G/4G and 5G/4G of 5G6754G polymorphism of the PAI-1 gene; allele T of G103Т polymorphism of the FXIIIA1 gene; allele G and genotype A/G of A66G polymorphism of the MTRR gene; allele G and genotype A/G of A2756G polymorphism of the MTR gene correlated with aseptic CVT. It was concluded that the gene polymorphisms 5G6754G (PAI-1), G103T (FXIIIA1), A66G (MTRR) and A2756G (MTR) carriage increased the risk of aseptic CVT and did not affect the thrombosis clinical manifestations.

Risk of cerebral venous thrombosis in oral contraceptives pills users

The aim of this study is to assess the relative risk of cerebral venous sinus thrombosis (CVST) in Oral contraceptive pills (OCP) users compared with a control group of non-hormone users. Patients & methodsThis retrospective case-control, age – group matched study done in about two years and included 40 female patients and 30 control females, aged 30–50 years-with 50% of them above the age of 35 years. All patients diagnosed as CVST with the consumption of OCP were included in the study. The diagnosis is based on the MRI & MRV study. T1, T2, FLAIR &Diffusion weighted image. The MRV was done using the 2 D-TOF technique. ResultsThe MRI result was negative (no parenchymal changes) in 16 patients (40%), and positive in the remaining 60%; 12 patients (30%) showed haemorrhagic infarction only, represented by heterogeneous mixed hypo and hyperintesity in the brain parenchyma with brain edema and 8 patients (20%) showed non-haemorrhagic infarction in the form of low SI in T1WI and a high SI in T2WI and FLAIR and restricted diffusion on DWI, 4 (10%) patients showed a parasagittal high T2 SI indicating superior sagittal sinus thrombosis. The control group showed no parenchymal changes in four (20%) females, but showed hemorrhagic infarction in eight (40%) females, and non-hemorrhagic infarction in six (30%) females and parasagittal high T2 SI in two (10%) females. ConclusionThe risk of CVST increased more in women taking OCP than in non-hormonal users. To reduce the risk, Knowledge of it is of crucial importance.

Hormonal contraceptives and cerebral venous thrombosis risk: a systematic review and meta-analysis.

Objectives: Use of oral contraceptive pills (OCP) increases the risk of cerebral venous sinus thrombosis (CVST). Whether this risk varies by type, duration, and other forms of hormonal contraceptives is largely unknown. This systematic review and meta-analysis update the current state of knowledge.Methods: We performed a search to identify all published studies on the association between hormonal contraceptive use and risk of CVST in women aged 15–50 years.Results: Of 861 studies reviewed, 11 were included. The pooled odds of developing CVST in women aged 15–50 years taking OCPs was 7.59 times higher compared to women not taking OCPs (OR = 7.59, 95% CI 3.82–15.09). Data are insufficient to make conclusions about duration of use and other forms of hormonal contraceptives.Conclusion: Oral contraceptive pills use increases the risk of developing CVST in women of reproductive age. Future studies are required to determine if duration and type of hormonal contraceptives modify this risk.

Cerebral venosus sinus thrombosis in a healthy women taking oral contraceptive: a case report and review of literature

SUMMARY Cerebral venous sinus thrombosis (CVST) is rare than arterial thrombosis. It can affect all age groups but is seen mostly in young women. The diagnosis of CVST is not easy because of variability of clinical symptoms and signs. The patients can present with headache, papilledema, focal deficit, seizures and coma. The most frequent symptom is severe headache. The most common causes of CVST are pregnancy, puerperium, systemic inflammatory diseases, inherited and acquired coagulation disorders, trauma, lumbar puncture, drugs and infection. The use of oral contraceptive (OC) increases the risk of cerebral sinus thrombosis. If there is an additional hereditary prothrombotic factor, the risk of CVST is more. CVST affects superior sagittal sinus and the lateral sinuses more frequently. More than one sinus is affected in one-third of cases. Computed tomografi helps to exclude other intracranial condition but diagnostic value of CT in CVST is limited. Combination of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) have replaced cerebral angiography for diagnosis of CVST. The treatment of CVST contain supportive (hydration, antibiotheraphy, anticonvulsant) and anticoagulan treatment. Heparin is effective and safety for the treatment of CVST because of this, it is the first-line treatment. The safety of heparin treatment also has been shown in those patients who had hemorrhagic infarcts. Outcomes of CVST is variable from death to complete improvement, but in general it is favorable. Recurrence of CVT is not common. Herein we present a 33-years old previously healthy women with CVST who taking OC.

The Combined Vaginal Contraceptive Ring, NuvaRing, and Cerebral Venous Sinus Thrombosis: A Case Report and Review of the Literature

BackgroundCombined oral contraceptives are known to confer a risk of venous thromboembolism, including cerebral venous sinus thrombosis (CVST), to otherwise healthy women. NuvaRing (Organon USA, Inc., Roseland, NJ) is a contraceptive vaginal ring that delivers 120 μg of etonogestrel and 15 μg of ethinyl estradiol per day. Its use has been associated with rare venous thromboembolic events, but few cases of CVST associated with NuvaRing have been reported. ObjectiveTo describe a case that illustrates the increased risk of CVST associated with use of NuvaRing. We describe the case of a NuvaRing user who presented to our emergency department with a headache, who was diagnosed with CVST. ConclusionEvidence suggests that NuvaRing has at least as much prothrombotic potential as combined oral contraceptives. Thus, emergency physicians should suspect serious venous thromboembolic events, including CVST, deep venous thrombosis, and pulmonary embolism, in NuvaRing users in the proper clinical setting.

Cerebral venous sinus thrombosis after gender reassignment surgery

Many factors have been implicated in the etiology of cerebral venous sinus thrombosis (CVT). These include head injury, cancer, infections (sepsis, sinusitis, and mastoiditis), coagulopathies, pregnancy, systemic lupus erythematosus, and dehydration. We present the case of a patient who received long-term estrogen therapy for approximately 15 years after feminizing genitoplasty. The patient experienced a CVT with an excellent clinical outcome. A similar case has not been reported in the literature. Because CVT may be associated with morbidity, mortality, and risks from the complications and treatments of the condition, further research is needed to clarify the factors that may contribute to the long-term risk of CVT in patients receiving long-term estrogen therapy after feminizing genitoplasty.

Cerebral venous sinus thrombosis in users of four hormonal contraceptives: levonorgestrel-containing oral contraceptives, norgestimate-containing oral contraceptives, desogestrel-containing oral contraceptives and the contraceptive patch

Background It has been suggested that the risk for cerebral venous sinus thrombosis (CVST) may be greater among users of the contraceptive patch than among users of oral contraceptives (OCs). Methods From the PharMetrics database, we identified women aged 15–44 years who filled at least one prescription for either the contraceptive patch or desogestrel-containing, norgestimate-containing or levonorgestrel-containing OCs to assess the risk of CVST. The person-time of current exposure to each study drug, as well as the incidence rates (IRs) and incidence rate ratios (IRRs) of CVST, was calculated. Results We identified over 1 million users of the four study drugs. There were five cases of CVST among current users of desogestrel, seven cases among current users of norgestimate, two cases among current users of levonorgestrel and none among current users of the contraceptive patch. The IRs per 100,000 woman-years were 2.7 [95% confidence interval (95% CI)=0.9–6.3], 1.6 (95% CI=0.7–3.3), 0.7 (95% CI=0.1–2.4) and 0.0 (95% CI=0.0–4.8), respectively, in users of desogestrel, norgestimate, levonorgestrel and the contraceptive patch. There were two women who had CVST while not currently taking a hormonal contraceptive (IR=0.4 per 100,000 woman-years; 95% CI=0.1–1.3). The IRRs were 4.0 (95% CI=0.7–42.4) for desogestrel-containing versus levonorgestrel-containing OCs, and 2.4 (95% CI=0.5–24.0) for norgestimate-containing versus levonorgestrel-containing OCs. The IRR for the patch could not be calculated. Conclusions There is no evidence of an increased risk of CVST in users of the contraceptive patch compared to users of levonorgestrel-containing OCs.