Acute symptomatic seizures in cerebral venous thrombosis

To identify characteristics, predictors, and outcomes of acute symptomatic
seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281
consecutive adult patients with CVT included from 12 hospitals within the
International CVT Consortium. We defined ASS as any seizure between
symptom onset and 7 days after diagnosis of CVT. We stratified ASS into
pre-diagnosis and solely post-diagnosis ASS. Status epilepticus (SE) was
also analyzed separately. We analyzed predictors for ASS, and association
between ASS and clinical outcome (modified Rankin Scale) with
multivariable logistic regression. Of 1,281 eligible patients, 441 (34%)
had ASS. Baseline predictors for ASS were intracerebral hemorrhage ([ICH],
adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0–5.5),
cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0–4.0), cortical
vein thrombosis (aOR 2.1, 95%CI 1.5–2.9), superior sagittal sinus
thrombosis (aOR 2.0, 95% CI 1.5–2.6), focal neurologic deficit (aOR 1.9,
95% CI 1.4–2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1–2.5)
and female-specific risk factors (aOR 1.5, 95% CI 1.1–2.1). Ninety-three
(7%) patients had solely post-diagnosis ASS, best predicted by cortical
vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%)
patients had SE, independently predicted by ICH, focal neurologic deficits
and cerebral edema/infarction. Neither ASS nor SE were independently
associated with outcome. ASS occurred in 1/3 of patients with CVT and was
associated with brain parenchymal lesions and thrombosis of the
superficial system. In absence of pre-diagnosis ASS, no subgroup was
identified with sufficient risk of post-diagnosis ASS to justify
prophylactic antiepileptic drug treatment. We found no association between
ASS and outcome.