Mohammad Wasay1, Subash Kaul2, Bindu Menon3, Alper I Dai4, Mohammad Saadatnia5, Abdul Malik6, Ahmed Khalifa7, Afshin Borhani-Haghighi8, Manmohan Mehndiratta9, Maria Khan10, Nimalendu Bikash Bhowmik11, Safia Awan12. 1. Department of Medicine, Aga Khan University, Karachi, Pakistan. Electronic address: mohammad.wasay@aku.edu. 2. Department of Neurology, Nizam Institute of Neurology, Hyderabad, India. 3. Department of Neurology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India. 4. Department of Neurology, Gaziantep University, Gaziantep, Turkey. 5. Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran. 6. Liaquat Medical and Dental College, Karachi, Pakistan. 7. Department of Neurology, Damascus University, Damascus, Syria. 8. Department of Neurology, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 9. Department of Neurology, Janakpuri Speciality Hospital, New Delhi, India. 10. Department of Neurology, Rashid Hospital, Dubai, UAE. 11. Asghar Ali Hospital, Dhaka, Bangladesh. 12. Department of Medicine, Aga Khan University, Karachi, Pakistan.
Abstract
BACKGROUND/ OBJECTIVE: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients. METHODS: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT. RESULTS: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT. CONCLUSIONS: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.
BACKGROUND/ OBJECTIVE: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients. METHODS: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT. RESULTS: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT. CONCLUSIONS: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.
Authors: Piers Klein; Liqi Shu; Thanh N Nguyen; James E Siegler; Setareh Salehi Omran; Alexis N Simpkins; Mirjam Heldner; Adam de Havenon; Hugo J Aparicio; Mohamad Abdalkader; Marios Psychogios; Maria Cristina Vedovati; Maurizio Paciaroni; Rascha von Martial; David S Liebeskind; Diana Aguiar de Sousa; Jonathan M Coutinho; Shadi Yaghi Journal: J Stroke Date: 2022-09-30 Impact factor: 8.632