|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 299-300
Pathophysiological mechanism of seizure in cerebral venous sinus thrombosis
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Medicine Department, Federal University of Santa Maria, Santa Maria, Brazil
|Date of Submission||15-Jan-2021|
|Date of Acceptance||10-Feb-2022|
|Date of Web Publication||30-Jun-2022|
Jamir Pitton Rissardo
Medicine Department, Federal University of Santa Maria, Santa Maria
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pitton Rissardo J, Fornari Caprara AL. Pathophysiological mechanism of seizure in cerebral venous sinus thrombosis. Med J Babylon 2022;19:299-300
We read the article titled “Outcomes of Cerebral Venous Thrombosis in Al-Yarmook Teaching Hospital” on the esteemed “Medical Journal of Babylon” with great interest. Mizeel et al. studied the incidence of seizures and their associated risk factors for patients with cerebral venous sinus thrombosis (CVST). They found that the most common type of seizure was generalized, which was correlated with superior sagittal sinus occlusion. Also, oral contraceptives were significantly associated with early seizure onset.
CVST can present with variable clinical manifestations such as headaches, unexplained altered sensorium, focal neurological deficit, and subarachnoid hemorrhage. In this context, the occurrence of seizures in CVST may adversely affect the prognosis because they are correlated with high morbidity and mortality. In addition, the mechanism of seizure in individuals with CVST is not clear, so the majority of studies aimed at determining the potential risk factors for epileptogenesis.
Herein, we would like to discuss the pathophysiological mechanism of seizure in CVST [Figure 1]. A literature search was performed in Medline/Pubmed, on a set of terms that included cerebral venous sinus thrombosis, seizure, and mechanism [Table 1]. The seizures presented in CVST appear to have a different mechanism from those in epilepsy-related stroke. This can be supported by the fact that some studies showed a higher percentage of Todd’s paralysis and abnormal dynamic control of intracranial pressure in CVST.
|Figure 1: Pathophysiological mechanism of seizure in cerebral venous sinus thrombosis (CVST)|
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Amornpojnimman et al. retrospectively studied 180 individuals with CVST in Thailand. They showed that intracerebral hemorrhage and dependency status at admission predict seizures in CVST. Also, focal to bilateral tonic-clonic seizure was the most frequent seizure type. These findings are interesting since they could support the hypothesis of hemosiderin deposition and selective neuronal damage leading to abnormal electrical discharge.
Another cohort from Serbia revealed that CVST individuals without headache at presentation have the worst outcome when compared with those with headache. Petrović et al. observed that the seizure group had more neurological deficits or altered mental status. This can support the hypothesis of diffuse cerebral damage due to thrombosis. Increased intracranial pressure, inflammatory reactions, and hypoxic–ischemic injury pathways could explain these neurological manifestations.
A recent study from China assessed the outcomes of individuals with CVST during pregnancy and postpartum managed with anticoagulation therapy. Meng et al. revealed that pregnancy-related CVST subjects are three times more likely to have seizures when compared with non-pregnancy-related individuals. Other parameters that were more prevalent in the pregnancy group included hyperlipidemia, headache, nausea, fever, neurological deficits, and prothrombotic state. Thus, we can assume that, apparently, there is some role in immunological reactions contributing to worse outcomes.
In sum, there are six main mechanisms proposed, which are abnormal immunological response, deposition of extracellular substances, hypoxic–ischemic injury, abnormal inflammatory reaction, increased intracranial pressure, and selective neuronal loss. Moreover, we believe that seizures in CVST are related to a combined group of mechanisms rather than only a simple pathway.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Mizeel AK, Taher NM Outcomes of cerebral venous thrombosis in Al-Yarmook teaching hospital. Med J Babylon 2021;18:208-12.
Amornpojnimman T, Mitarnun W, Korathanakhun P Predictors of seizures in patients with cerebral venous thrombosis in the Thai population: A retrospective study. Seizure 2022;96:1-5.
Crabtree G, Miller C Cerebral venous thrombosis. In: White J, editor. Neurocritical Care for the Advanced Practice Clinician. Cham: Springer; 2018. 151-64.
Petrović J, Švabić T, Zidverc-Trajković J, Stanarčević P, Jovanović D, Mijajlović M Cerebral venous thrombosis: A retrospective unicentric analysis of clinical and neuroimaging characteristics. Neurol Sci2022;43:1839-47.
Meng SH, Li JH, Zuo LJ, Feng LM The outcomes of pregnant and postpartum patients with cerebral venous sinus thrombosis after anticoagulant therapy. Medicine (Baltimore) 2021;100:e26360.