background and purpose Clinical features of epileptic seizures after cerebral venous sinus thrombosis(CVST)among Chinese patients are not known,and it is still controversial whether seizures would affect the outcome o...background and purpose Clinical features of epileptic seizures after cerebral venous sinus thrombosis(CVST)among Chinese patients are not known,and it is still controversial whether seizures would affect the outcome of CVST.Methods In a Chinese hospital-based study of consecutive patients with CVST between 2003 and 2015,we described the clinical features of seizures and determined the predictors of seizure onset using multivariable logistic regression analysis.We also compared the in-hospital case-fatality and short-term functional outcome(modified Rankin Scale(mRS)at discharge)in patients with versus without seizures using ordinal regression analysis.results Among 151 patients with CVST,52(34.4%)presented seizures,of which 42(80.8%)were generalised seizures.Male gender(OR 6.32,95% CI 2.06 to 19.35,p=0.001),motor deficits(OR 4.89,95% CI 1.52 to 15.68,p=0.008),intracerebral haemorrhage(OR 3.93,95% CI 1.16 to 13.26,p=0.027),cerebral infarction(OR 3.78,95% CI 1.15 to 12.36,p=0.029)and superior sagittal sinus thrombosis(OR 3.38,95% CI 91.16 to 9.86,p=0.026)were independent predictors for seizures.The overall in-hospital case-fatality rate was 2.0%(3/151),and 21(13.9%)had mRS>2 at discharge.Compared with patients without seizures,patients with seizures were more likely to have a worse outcome(p=0.02)at discharge,independent of age,gender,clinical presentation,clot burden and presence of parenchymal lesions.conclusions In Chinese Han patients,compared with patients without seizures,patients with seizures after CVST had a worse outcome.Risk factors such as male gender,paresis,parenchymal lesion and superior sagittal sinus thrombosis were independently associated with seizure onset after CVST.Generalised seizure was the main form of seizures after CVST,which was obviously different to seizures after strokes of arterial origin.展开更多
Background and purpose Non-traditional risk factors such as chronic inflammation,oxidative stress and thrombogenic factors are believed to contribute to the excess stroke risk in chronic kidney disease(CKD)by triggeri...Background and purpose Non-traditional risk factors such as chronic inflammation,oxidative stress and thrombogenic factors are believed to contribute to the excess stroke risk in chronic kidney disease(CKD)by triggering vascular injury and endothelial dysfunction.We aimed to determine how well a panel of biomarkers representative of these factors would correlate with estimated glomerular filtration rate(eGFR)in patients with recent transient ischaemic attack(TIA)or stroke.We also investigated whether eGFR would confound previously reported associations between biomarkers and mortality.Methods We studied a panel of 16 blood biomarkers related to inflammation,thrombosis,atherogenesis and cardiac or neuronal cell damage in TIA or ischaemic stroke in a population-based study(Oxford Vascular Study).Biomarker levels were log-transformed and correlated with eGFR,adjusted for age.Cox proportional hazard models were used for survival analysis.Results Among 1297 patients with TIA or stroke,52.7%(n=684)of patients had CKD(eGFR<60 mL/min/1.73 m^(2)).There was a moderate correlation between log-eGFR and the log-transformed soluble tumour necrosis factor receptor-1(R^(2)=0.21),attenuating with adjustment for age(R^(2)=0.12).There were moderate-to strong correlations with markers of cardiac injury,N-terminal pro-brain natriuretic peptide and heart-type fatty acid binding protein(hFABP,R2=0.14 and 0.34,respectively).The strongest correlation after adjustment for age was between hFABP and eGFR(R^(2)=0.20).Adjusting for eGFR did not impact any biomarker associations with mortality.Conclusions Correlations between biomarkers related to inflammation and thrombosis with renal dysfunction in the setting of cerebrovascular events were generally modest after adjustment for age,suggesting that putative risk factors such as chronic inflammation or coagulopathy are unlikely to be important stroke mechanisms in patients with CKD.展开更多
文摘background and purpose Clinical features of epileptic seizures after cerebral venous sinus thrombosis(CVST)among Chinese patients are not known,and it is still controversial whether seizures would affect the outcome of CVST.Methods In a Chinese hospital-based study of consecutive patients with CVST between 2003 and 2015,we described the clinical features of seizures and determined the predictors of seizure onset using multivariable logistic regression analysis.We also compared the in-hospital case-fatality and short-term functional outcome(modified Rankin Scale(mRS)at discharge)in patients with versus without seizures using ordinal regression analysis.results Among 151 patients with CVST,52(34.4%)presented seizures,of which 42(80.8%)were generalised seizures.Male gender(OR 6.32,95% CI 2.06 to 19.35,p=0.001),motor deficits(OR 4.89,95% CI 1.52 to 15.68,p=0.008),intracerebral haemorrhage(OR 3.93,95% CI 1.16 to 13.26,p=0.027),cerebral infarction(OR 3.78,95% CI 1.15 to 12.36,p=0.029)and superior sagittal sinus thrombosis(OR 3.38,95% CI 91.16 to 9.86,p=0.026)were independent predictors for seizures.The overall in-hospital case-fatality rate was 2.0%(3/151),and 21(13.9%)had mRS>2 at discharge.Compared with patients without seizures,patients with seizures were more likely to have a worse outcome(p=0.02)at discharge,independent of age,gender,clinical presentation,clot burden and presence of parenchymal lesions.conclusions In Chinese Han patients,compared with patients without seizures,patients with seizures after CVST had a worse outcome.Risk factors such as male gender,paresis,parenchymal lesion and superior sagittal sinus thrombosis were independently associated with seizure onset after CVST.Generalised seizure was the main form of seizures after CVST,which was obviously different to seizures after strokes of arterial origin.
基金PR has received funding from Wellcome Trust(Grant No:104040/Z/14/Z)the NIHR Oxford Biomedical Research Centre(Grant No:IS-BRC-1215-20008)has received payment for membership of a randomised trial Executive Committee(Bayer).DMK has received a scholarship from the Irish Nephrology Society.
文摘Background and purpose Non-traditional risk factors such as chronic inflammation,oxidative stress and thrombogenic factors are believed to contribute to the excess stroke risk in chronic kidney disease(CKD)by triggering vascular injury and endothelial dysfunction.We aimed to determine how well a panel of biomarkers representative of these factors would correlate with estimated glomerular filtration rate(eGFR)in patients with recent transient ischaemic attack(TIA)or stroke.We also investigated whether eGFR would confound previously reported associations between biomarkers and mortality.Methods We studied a panel of 16 blood biomarkers related to inflammation,thrombosis,atherogenesis and cardiac or neuronal cell damage in TIA or ischaemic stroke in a population-based study(Oxford Vascular Study).Biomarker levels were log-transformed and correlated with eGFR,adjusted for age.Cox proportional hazard models were used for survival analysis.Results Among 1297 patients with TIA or stroke,52.7%(n=684)of patients had CKD(eGFR<60 mL/min/1.73 m^(2)).There was a moderate correlation between log-eGFR and the log-transformed soluble tumour necrosis factor receptor-1(R^(2)=0.21),attenuating with adjustment for age(R^(2)=0.12).There were moderate-to strong correlations with markers of cardiac injury,N-terminal pro-brain natriuretic peptide and heart-type fatty acid binding protein(hFABP,R2=0.14 and 0.34,respectively).The strongest correlation after adjustment for age was between hFABP and eGFR(R^(2)=0.20).Adjusting for eGFR did not impact any biomarker associations with mortality.Conclusions Correlations between biomarkers related to inflammation and thrombosis with renal dysfunction in the setting of cerebrovascular events were generally modest after adjustment for age,suggesting that putative risk factors such as chronic inflammation or coagulopathy are unlikely to be important stroke mechanisms in patients with CKD.
