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Cardiac arrest alters regional ubiquitin levels in the porcine brain. Neuroprotective effects of methylene blue
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Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
Abstract — WCN 2013 No: 463 Topic: 3 — Stroke Aetiopathogenesis of cerebral ischemia in young Turkish patients
Conclusion: Identifying predictors of mortality is important for starting appropriate treatment and setting targets in the management of patients with dissection.
C. Emira, S. Çelikb, C. Örkena, S. Çelika, F. Budaka. aHealth Ministry Okmeydani Training and Education Hospital, Istanbul, Turkey; bHealth Ministry Erenköy Training Hospital, Istanbul, Turkey
doi:10.1016/j.jns.2013.07.684
This study evaluates the risk factors and etiological spectrum in young stroke patients (aged 45 or younger). Methods: Risk factors and aetiology of cerebral ischemia were retrospectively investigated in 230 patients (age ranges 9–45), admitted to our Neurology Unit with cerebral transient ischemic attacks (TIA) or infarction. 230 consecutive patients were divided into two groups according to their ages. Group I consists of patients whose age ranges 9–30 and in Group II, age range was 30–45. Results: Hypertension, hyperlipidemia, smoking were the most common risk factors. Atherosclerosis was the leading etiology occurring in group II (35%) and vasculopathy was markedly high in group I (23%). In addition cardiac embolism was determined in 20% of all cases. Among these cases cardiac valve disease (58%), atrial fibrillation (16%) and ischemic heart disease (27%) were determined by the investigation methods. Conclusion: The most striking finding of our study was the high frequency of cardiac valve disease in young adult ischemic strokes in our country when compared with the previous reports in the literature.
doi:10.1016/j.jns.2013.07.683
Abstract — WCN 2013 No: 465 Topic: 3 — Stroke Predictors of mortality in patients with craniocervical artery dissection Y. Kaplana, H. Celika, O. Kamislia, S. Kamislia, S. Altınayara, S. Yologlub, C. Ozcana. aNeurology, Inonu University, Malatya, Turkey; bBiostatistics, Inonu University, Malatya, Turkey Background: Dissection of the carotid (CAD) or vertebral (VAD) artery is a major cause of ischemic stroke in young adults. The prognosis varies and the dissection can range from asymptomatic to causing a profound neurological deficit and death. Little is known of the predictors of mortality in these patients. Objectives: The aim of the study was to investigate the predictors related to mortality in patients with craniocervical artery dissection. Material and methods: We reviewed retrospectively all patients diagnosed with CAD or VAD admitted to our clinic between January 2000 and January 2013 and included 67 such patients in the study. Age, gender, modified Rankin Scale (mRS) prestroke and at time of admission, clinical presentation of dissection, location of dissection, vascular risk factors, and length of hospital stay were considered mortality-related prognostic factors. Of the 67 patients, 12 (17.9%) patients died: 5 (7.46%) patients with CAD and 7 (10.44%) with VAD. The patients were divided into four subgroups: surviving patients with CAD, dying patients with CAD, surviving patients with VAD, and dying patients with VAD. Then, surviving-CAD versus dying-CAD and surviving-VAD versus dying-VAD compared according to prognostic factors. Results: Disability at admission (mRS 3–5) was significantly higher in dying-CAD than surviving-CAD. Comparing dying-VAD with surviving-VAD, the mean age, disability at admission (mRS 3–5), presentation with stroke, and dissection location in intracranial vertebral artery were significantly higher in dying-VAD.
Abstract — WCN 2013 No: 456 Topic: 3 — Stroke Heat stress induces selective cell damage in the cerebellum. An experimental study using immunohistochemistry and ultrastructural investigations in rats H.S. Sharmaa, D.F. Muresanub, A. Sharmaa. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bClinical Neurosciences, Medicine & Pharmacy Cluj-Napoca, Cluj-Napoca, Romania The possibility that thermal stress caused by systemic heat exposure may lead to a specific cellular damage in the cerebellum was examined in young rats (age 8–9 weeks). The cell changes in the cerebellum were examined using immunohistochemistry and light and electron microscopy. Subjection of conscious young animals to a 4-h HS resulted in marked hyperthermia (41.6 ± 0.45 °C). In these animals the cerebellum showed pronounced and selective cellular damage in the Purkinje cell layers and granule cells. This damage was most marked in specific regions of the vermis and in the lateral cerebellar cortices. Deeper cerebellar nuclei also showed marked cell damage. Immunohistochemistry showed profound upregulation of GFAP, S-100 and Vimentin indicating abnormal glial cell reactions in the cerebellum. Marked decrease in MBP suggests profound degradation of myelinated nerve fibers. Electron microscopy showed marked damage to the cerebral endothelium. Lanthanum an electron dense particle was found to be present within the endothelial cells, basal lamina and in vesicular profiles. Nerve cells showed abnormal reactions, edema and distortion in many parts of the cerebellum. Loss of Nissl substance was much pronounced in several regions of the cerebellum. These nerve, glial and myelin cell changes were less evident in animals subjected to similar heat stress under anesthesia. These observations for the first time show that cerebellum is vulnerable in heat stress and this selective vulnerability is somehow associated with a specific breakdown of the BBB permeability. doi:10.1016/j.jns.2013.07.685
Abstract — WCN 2013 No: 458 Topic: 3 — Stroke Cardiac arrest alters regional ubiquitin levels in the porcine brain. Neuroprotective effects of methylene blue H.S. Sharmaa, R. Patnaikb, A. Sharmaa, L. Wiklunda. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bNational Institute of Technology, School of Biomedical Engineering, Banaras Hindu University, Varanasi, India Ubiquitin is recently implicated the central nervous system (CNS) diseases. Overexpression of ubiquitin occurs in stroke, trauma, Alzheimer's disease, Parkinson's disease and Huntington's disease in the areas associated with neuronal damages. However, the role of ubiquitin in brain pathology or neuroprotection is still not well known. Cardiac arrest (CA) and subsequent cardiopulmonary resuscitation induces widespread brain damages. In a porcine model of CA our laboratory showed marked neuronal, glial and myelin damages in
Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
the cortex, hippocampus, cerebellum, thalamus, hypothalamus and the brain stem following 30 to 180 min after return of spontaneous circulation (ROSC) in pig model. Interestingly these neuropathological changes in CA were considerably reduced by pretreatment with methylene blue (MB), an antioxidant dye following 60 min to 180 min after ROSC. Thus, it would be interesting to see whether ubiquitin levels are also altered after CA and/or ROSC in identical brain areas and this effect could be further influenced by MB treatment. Our observations using ELISA showed selective and specific increase in ubiquitin levels in most of the above brain areas immediately after untreated CA and progressively from 30 min to 180 min after ROSC. Cerebellum and cortex showed most pronounced increase in ubiquitin levels. Pretreatment with MB during cardiopulmonary resuscitation significantly attenuated ubiquitin levels from 60 min on to 180 min after ROSC. These observations suggest that increased levels of ubiquitin are related with brain ischemic pathology and a reduction in this level is associated with neuroprotection in CA, not reported earlier. doi:10.1016/j.jns.2013.07.686
Abstract — WCN 2013 No: 472 Topic: 3 — Stroke Indian Aphasia battery: Tool for specific diagnosis of language disorder post stroke A. Nehraa, D. Pershadb, V. Sreenivasc. aClinical Neuropsychology, All India Institute of Medical Sciences (AIIMS), New Delhi, India; bClinical Neuropsychology, Department of Psychiatry, Ex-Post Graduate Institute of Medical Education & Research, Chandigarh, New Delhi, India; c Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India Background & aims: Aphasia is a language disorder which may disrupt an individual's functioning. To plan a mode of therapeutic/rehabilitative work, it is important to assess problems from neuropsychological perspective focussed on remediation of the impaired processes or compensation via the intact processes or both (Hillis AE, 2001). It targets sequence set of representations (stored visual, orthographic, semantic, phonological information) for solving particular task (e.g. naming). Since no test available to assess north Indian population with specific colloquial expression thus, need was felt to assess these patients. Hence, the aims are to: 1. Develop standardized neuropsychological test to diagnose the presence, degree, specificity & type of aphasic disorders. 2. Assess all language areas, from perceptual modalities (auditory, visual, & gestural), processing functions (comprehension, analysis, problemsolving) to response modalities (writing, articulation, manipulation) for specific prognosis. Method: The study had 2 phases. 1st phase: development of test material & 2nd phase: administration on aphasics (A), normals (N) & other than aphasics (OA). The test consisted of 5 sections, viz., Acoustic Problems (5), Speech & Language Problems (10), Simple Mathematical Problems (3), Perceptuomotor & Writing Problems (5) &Visual & Verbal Problems (3). All sub-sections were in auditory & orthographic mode. The test was administered on 122 (A), 74 (N) and 64 (OA) aged 18–81 years. Results: The test was 75% sensitive to (A) while 72% sensitivity to (OA) on the entire task in all modalities. Conclusion: It can be used for assessment of specific aphasia for planning better prognosis along with other pharmacological treatment, thereby improving quality of patient's life. doi:10.1016/j.jns.2013.07.687
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Abstract — WCN 2013 No: 491 Topic: 3 — Stroke Superficial siderosis of the central nervous system: A post-mortem 7.0 tesla magnetic resonance imaging study with neuropathological correlates J. De Reuck. Université Lille Nord de France, Lille, France Background: This study aims to elucidate the pathological substrate of superficial siderosis (SS), regarded as a radiological marker of cerebral amyloid angiopathy (CAA). The present study investigates the prevalence of SS and underlying lesions with 7.0 T MRI in postmortem brains of patients with various neurodegenerative and cerebrovascular diseases. Materials and methods: Hundred-twenty post-mortem brains were examined with 7.0 T MRI and their neuropathological correlates. The MRI examination consisted of a positioning, a T2 and a T2*-weighted sequence of coronal sections of a cerebral hemisphere and horizontal sections through pons and cerebellum. Results: Fourty-five brains (37.5%) with 83 separate zones of SS were detected, including 25 zones of disseminated siderosis (macro-SS) and of 58 areas of focal siderosis, restricted to less than 3 sulci (micro-SS). Macro-SS was associated with 14 lobar hematomas and 11 cerebral infarcts (p = 0.64), while micro-SS was associated with 19 micro-bleeds and 39 micro-infarcts (p b 0.001). Comparison of the 15 CAA to the 30 non-CAA brains showed that macro-SS was due to a lobar hematoma in 53% in the former compared to 3% in the latter group (p = 0.003). Micro-SS was due to a micro-bleed in 7% in the CAA brains and to 40% in the non-CAA brains (p = 0.03). Conclusions: SS is due to cerebral bleeds as well as to cerebral infarcts. It should not to be considered as an additional Boston criterion for CAA. Macro-SS is mainly related to lobar hematomas while micro-SS is mainly due to cortical micro-infarcts. doi:10.1016/j.jns.2013.07.688
Abstract — WCN 2013 No: 517 Topic: 3 — Stroke Factors associated with remote seizure in cerebral vein and dural sinus thrombosis V. Davoudi, K. Keyhanian, M. Saadatnia. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Introduction: Whether initiating anticonvulsants treatment for all cerebral vein and sinus thrombosis patients or to wait for a seizure before starting the treatment is a vital question in management of cerebral vein and sinus thrombosis. Here in this study we wanted to define the possible risk factors of presenting, early and remote seizures in cerebral vein and sinus thrombosis patients. Materials and methods: We have designed a prospective cohort study from April 2007 to April 2012, in 94 patients in al-Zahra Hospital, Isfahan, Iran. On admission, complete neurologic examination and further brain imaging were performed to evaluate probable risk factors for seizure. To recognize seizure predictors, we compared demographic, clinical and imaging factors among patients with or without presenting early and remote seizures. Results: Among 94 patients, 32 ones (34%) have experienced at least one seizure on the basis of cerebral vein and sinus thrombosis. Bivariate analysis has shown significant association with remote seizure in patients with low consciousness, supratentorial lesion, lesion in occipital, temporal and parietal lobe, thrombophilia, seizure in acute phase and sigmoid sinus thrombosis. In logistic multiple regression analysis, there was no factor who can predict remote seizure.
Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
Abstract — WCN 2013 No: 463 Topic: 3 — Stroke Aetiopathogenesis of cerebral ischemia in young Turkish patients
Conclusion: Identifying predictors of mortality is important for starting appropriate treatment and setting targets in the management of patients with dissection.
C. Emira, S. Çelikb, C. Örkena, S. Çelika, F. Budaka. aHealth Ministry Okmeydani Training and Education Hospital, Istanbul, Turkey; bHealth Ministry Erenköy Training Hospital, Istanbul, Turkey
doi:10.1016/j.jns.2013.07.684
This study evaluates the risk factors and etiological spectrum in young stroke patients (aged 45 or younger). Methods: Risk factors and aetiology of cerebral ischemia were retrospectively investigated in 230 patients (age ranges 9–45), admitted to our Neurology Unit with cerebral transient ischemic attacks (TIA) or infarction. 230 consecutive patients were divided into two groups according to their ages. Group I consists of patients whose age ranges 9–30 and in Group II, age range was 30–45. Results: Hypertension, hyperlipidemia, smoking were the most common risk factors. Atherosclerosis was the leading etiology occurring in group II (35%) and vasculopathy was markedly high in group I (23%). In addition cardiac embolism was determined in 20% of all cases. Among these cases cardiac valve disease (58%), atrial fibrillation (16%) and ischemic heart disease (27%) were determined by the investigation methods. Conclusion: The most striking finding of our study was the high frequency of cardiac valve disease in young adult ischemic strokes in our country when compared with the previous reports in the literature.
doi:10.1016/j.jns.2013.07.683
Abstract — WCN 2013 No: 465 Topic: 3 — Stroke Predictors of mortality in patients with craniocervical artery dissection Y. Kaplana, H. Celika, O. Kamislia, S. Kamislia, S. Altınayara, S. Yologlub, C. Ozcana. aNeurology, Inonu University, Malatya, Turkey; bBiostatistics, Inonu University, Malatya, Turkey Background: Dissection of the carotid (CAD) or vertebral (VAD) artery is a major cause of ischemic stroke in young adults. The prognosis varies and the dissection can range from asymptomatic to causing a profound neurological deficit and death. Little is known of the predictors of mortality in these patients. Objectives: The aim of the study was to investigate the predictors related to mortality in patients with craniocervical artery dissection. Material and methods: We reviewed retrospectively all patients diagnosed with CAD or VAD admitted to our clinic between January 2000 and January 2013 and included 67 such patients in the study. Age, gender, modified Rankin Scale (mRS) prestroke and at time of admission, clinical presentation of dissection, location of dissection, vascular risk factors, and length of hospital stay were considered mortality-related prognostic factors. Of the 67 patients, 12 (17.9%) patients died: 5 (7.46%) patients with CAD and 7 (10.44%) with VAD. The patients were divided into four subgroups: surviving patients with CAD, dying patients with CAD, surviving patients with VAD, and dying patients with VAD. Then, surviving-CAD versus dying-CAD and surviving-VAD versus dying-VAD compared according to prognostic factors. Results: Disability at admission (mRS 3–5) was significantly higher in dying-CAD than surviving-CAD. Comparing dying-VAD with surviving-VAD, the mean age, disability at admission (mRS 3–5), presentation with stroke, and dissection location in intracranial vertebral artery were significantly higher in dying-VAD.
Abstract — WCN 2013 No: 456 Topic: 3 — Stroke Heat stress induces selective cell damage in the cerebellum. An experimental study using immunohistochemistry and ultrastructural investigations in rats H.S. Sharmaa, D.F. Muresanub, A. Sharmaa. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bClinical Neurosciences, Medicine & Pharmacy Cluj-Napoca, Cluj-Napoca, Romania The possibility that thermal stress caused by systemic heat exposure may lead to a specific cellular damage in the cerebellum was examined in young rats (age 8–9 weeks). The cell changes in the cerebellum were examined using immunohistochemistry and light and electron microscopy. Subjection of conscious young animals to a 4-h HS resulted in marked hyperthermia (41.6 ± 0.45 °C). In these animals the cerebellum showed pronounced and selective cellular damage in the Purkinje cell layers and granule cells. This damage was most marked in specific regions of the vermis and in the lateral cerebellar cortices. Deeper cerebellar nuclei also showed marked cell damage. Immunohistochemistry showed profound upregulation of GFAP, S-100 and Vimentin indicating abnormal glial cell reactions in the cerebellum. Marked decrease in MBP suggests profound degradation of myelinated nerve fibers. Electron microscopy showed marked damage to the cerebral endothelium. Lanthanum an electron dense particle was found to be present within the endothelial cells, basal lamina and in vesicular profiles. Nerve cells showed abnormal reactions, edema and distortion in many parts of the cerebellum. Loss of Nissl substance was much pronounced in several regions of the cerebellum. These nerve, glial and myelin cell changes were less evident in animals subjected to similar heat stress under anesthesia. These observations for the first time show that cerebellum is vulnerable in heat stress and this selective vulnerability is somehow associated with a specific breakdown of the BBB permeability. doi:10.1016/j.jns.2013.07.685
Abstract — WCN 2013 No: 458 Topic: 3 — Stroke Cardiac arrest alters regional ubiquitin levels in the porcine brain. Neuroprotective effects of methylene blue H.S. Sharmaa, R. Patnaikb, A. Sharmaa, L. Wiklunda. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bNational Institute of Technology, School of Biomedical Engineering, Banaras Hindu University, Varanasi, India Ubiquitin is recently implicated the central nervous system (CNS) diseases. Overexpression of ubiquitin occurs in stroke, trauma, Alzheimer's disease, Parkinson's disease and Huntington's disease in the areas associated with neuronal damages. However, the role of ubiquitin in brain pathology or neuroprotection is still not well known. Cardiac arrest (CA) and subsequent cardiopulmonary resuscitation induces widespread brain damages. In a porcine model of CA our laboratory showed marked neuronal, glial and myelin damages in
Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
the cortex, hippocampus, cerebellum, thalamus, hypothalamus and the brain stem following 30 to 180 min after return of spontaneous circulation (ROSC) in pig model. Interestingly these neuropathological changes in CA were considerably reduced by pretreatment with methylene blue (MB), an antioxidant dye following 60 min to 180 min after ROSC. Thus, it would be interesting to see whether ubiquitin levels are also altered after CA and/or ROSC in identical brain areas and this effect could be further influenced by MB treatment. Our observations using ELISA showed selective and specific increase in ubiquitin levels in most of the above brain areas immediately after untreated CA and progressively from 30 min to 180 min after ROSC. Cerebellum and cortex showed most pronounced increase in ubiquitin levels. Pretreatment with MB during cardiopulmonary resuscitation significantly attenuated ubiquitin levels from 60 min on to 180 min after ROSC. These observations suggest that increased levels of ubiquitin are related with brain ischemic pathology and a reduction in this level is associated with neuroprotection in CA, not reported earlier. doi:10.1016/j.jns.2013.07.686
Abstract — WCN 2013 No: 472 Topic: 3 — Stroke Indian Aphasia battery: Tool for specific diagnosis of language disorder post stroke A. Nehraa, D. Pershadb, V. Sreenivasc. aClinical Neuropsychology, All India Institute of Medical Sciences (AIIMS), New Delhi, India; bClinical Neuropsychology, Department of Psychiatry, Ex-Post Graduate Institute of Medical Education & Research, Chandigarh, New Delhi, India; c Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India Background & aims: Aphasia is a language disorder which may disrupt an individual's functioning. To plan a mode of therapeutic/rehabilitative work, it is important to assess problems from neuropsychological perspective focussed on remediation of the impaired processes or compensation via the intact processes or both (Hillis AE, 2001). It targets sequence set of representations (stored visual, orthographic, semantic, phonological information) for solving particular task (e.g. naming). Since no test available to assess north Indian population with specific colloquial expression thus, need was felt to assess these patients. Hence, the aims are to: 1. Develop standardized neuropsychological test to diagnose the presence, degree, specificity & type of aphasic disorders. 2. Assess all language areas, from perceptual modalities (auditory, visual, & gestural), processing functions (comprehension, analysis, problemsolving) to response modalities (writing, articulation, manipulation) for specific prognosis. Method: The study had 2 phases. 1st phase: development of test material & 2nd phase: administration on aphasics (A), normals (N) & other than aphasics (OA). The test consisted of 5 sections, viz., Acoustic Problems (5), Speech & Language Problems (10), Simple Mathematical Problems (3), Perceptuomotor & Writing Problems (5) &Visual & Verbal Problems (3). All sub-sections were in auditory & orthographic mode. The test was administered on 122 (A), 74 (N) and 64 (OA) aged 18–81 years. Results: The test was 75% sensitive to (A) while 72% sensitivity to (OA) on the entire task in all modalities. Conclusion: It can be used for assessment of specific aphasia for planning better prognosis along with other pharmacological treatment, thereby improving quality of patient's life. doi:10.1016/j.jns.2013.07.687
e165
Abstract — WCN 2013 No: 491 Topic: 3 — Stroke Superficial siderosis of the central nervous system: A post-mortem 7.0 tesla magnetic resonance imaging study with neuropathological correlates J. De Reuck. Université Lille Nord de France, Lille, France Background: This study aims to elucidate the pathological substrate of superficial siderosis (SS), regarded as a radiological marker of cerebral amyloid angiopathy (CAA). The present study investigates the prevalence of SS and underlying lesions with 7.0 T MRI in postmortem brains of patients with various neurodegenerative and cerebrovascular diseases. Materials and methods: Hundred-twenty post-mortem brains were examined with 7.0 T MRI and their neuropathological correlates. The MRI examination consisted of a positioning, a T2 and a T2*-weighted sequence of coronal sections of a cerebral hemisphere and horizontal sections through pons and cerebellum. Results: Fourty-five brains (37.5%) with 83 separate zones of SS were detected, including 25 zones of disseminated siderosis (macro-SS) and of 58 areas of focal siderosis, restricted to less than 3 sulci (micro-SS). Macro-SS was associated with 14 lobar hematomas and 11 cerebral infarcts (p = 0.64), while micro-SS was associated with 19 micro-bleeds and 39 micro-infarcts (p b 0.001). Comparison of the 15 CAA to the 30 non-CAA brains showed that macro-SS was due to a lobar hematoma in 53% in the former compared to 3% in the latter group (p = 0.003). Micro-SS was due to a micro-bleed in 7% in the CAA brains and to 40% in the non-CAA brains (p = 0.03). Conclusions: SS is due to cerebral bleeds as well as to cerebral infarcts. It should not to be considered as an additional Boston criterion for CAA. Macro-SS is mainly related to lobar hematomas while micro-SS is mainly due to cortical micro-infarcts. doi:10.1016/j.jns.2013.07.688
Abstract — WCN 2013 No: 517 Topic: 3 — Stroke Factors associated with remote seizure in cerebral vein and dural sinus thrombosis V. Davoudi, K. Keyhanian, M. Saadatnia. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Introduction: Whether initiating anticonvulsants treatment for all cerebral vein and sinus thrombosis patients or to wait for a seizure before starting the treatment is a vital question in management of cerebral vein and sinus thrombosis. Here in this study we wanted to define the possible risk factors of presenting, early and remote seizures in cerebral vein and sinus thrombosis patients. Materials and methods: We have designed a prospective cohort study from April 2007 to April 2012, in 94 patients in al-Zahra Hospital, Isfahan, Iran. On admission, complete neurologic examination and further brain imaging were performed to evaluate probable risk factors for seizure. To recognize seizure predictors, we compared demographic, clinical and imaging factors among patients with or without presenting early and remote seizures. Results: Among 94 patients, 32 ones (34%) have experienced at least one seizure on the basis of cerebral vein and sinus thrombosis. Bivariate analysis has shown significant association with remote seizure in patients with low consciousness, supratentorial lesion, lesion in occipital, temporal and parietal lobe, thrombophilia, seizure in acute phase and sigmoid sinus thrombosis. In logistic multiple regression analysis, there was no factor who can predict remote seizure.