Letter to the Editor
SARS-CoV-2 infection: possible underdiagnosis of cerebral venous sinus thrombosis
Infección por SARS-CoV-2: posible infradiagnóstico de trombosis de senos venosos cerebrales
M.L. Almarcha-Menargues
, M.M. Martínez-Martínez, J. Fernández-Travieso
Corresponding author
Servicio de Neurología, Hospital Universitario Infanta Sofía, Madrid, San Sebastián de los Reyes, Spain
Read
1262
Timeswas read the article
261
Total PDF
1001
Total HTML
Share statistics
array:24 [ "pii" => "S2173580821001280" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2021.06.003" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "1642" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2021;36:575-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485321001092" "issn" => "02134853" "doi" => "10.1016/j.nrl.2021.06.003" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "1642" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2021;36:575-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Infección por SARS-CoV-2: posible infradiagnóstico de trombosis de senos venosos cerebrales" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "576" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "SARS-CoV-2 infection: Possible underdiagnosis of cerebral venous sinus thrombosis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1158 "Ancho" => 900 "Tamanyo" => 52980 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">RM craneal secuencia FLAIR (A) y eco de gradiente (B) que muestran áreas de edema, isquemia y transformación hemorrágica en región parietal izquierda y cerebelo izquierdo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.L. Almarcha-Menargues, M.M. Martínez-Martínez, J. Fernández-Travieso" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.L." "apellidos" => "Almarcha-Menargues" ] 1 => array:2 [ "nombre" => "M.M." "apellidos" => "Martínez-Martínez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Fernández-Travieso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580821001280" "doi" => "10.1016/j.nrleng.2021.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001280?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485321001092?idApp=UINPBA00004N" "url" => "/02134853/0000003600000007/v1_202108290608/S0213485321001092/v1_202108290608/es/main.assets" ] ] "itemAnterior" => array:20 [ "pii" => "S2173580821001255" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2021.05.003" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "1637" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2021;36:572-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute transverse myelitis following SARS-CoV-2 infection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "572" "paginaFinal" => "574" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mielitis transversa aguda asociada a infección por SARS-CoV-2" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2089 "Ancho" => 755 "Tamanyo" => 123536 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sagittal T2-weighted MRI sequence of the spinal cord, showing slight hyperintensity of the T6-T11 segments, compatible with longitudinally extensive transverse myelitis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Jauregui-Larrañaga, A. Ostolaza-Ibáñez, M. Martín-Bujanda" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Jauregui-Larrañaga" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Ostolaza-Ibáñez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Martín-Bujanda" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485321001006" "doi" => "10.1016/j.nrl.2021.05.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485321001006?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001255?idApp=UINPBA00004N" "url" => "/21735808/0000003600000007/v1_202109160551/S2173580821001255/v1_202109160551/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "SARS-CoV-2 infection: possible underdiagnosis of cerebral venous sinus thrombosis" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "576" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.L. Almarcha-Menargues, M.M. Martínez-Martínez, J. Fernández-Travieso" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.L." "apellidos" => "Almarcha-Menargues" "email" => array:2 [ 0 => "almarcha.menargues@gmail.com" 1 => "marialuisa.almarcha@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.M." "apellidos" => "Martínez-Martínez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Fernández-Travieso" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neurología, Hospital Universitario Infanta Sofía, Madrid, San Sebastián de los Reyes, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección por SARS-CoV-2: posible infradiagnóstico de trombosis de senos venosos cerebrales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1136 "Ancho" => 900 "Tamanyo" => 39147 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI angiography revealing extensive venous thrombosis affecting the superior longitudinal, transverse, and sigmoid sinuses of both hemispheres (A). One-month follow-up image (B) showing partial recanalisation of the left superior longitudinal, transverse, and sigmoid sinuses after treatment with dabigatran.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hypercoagulability is a documented manifestation of SARS-CoV-2 infection, especially in more severe cases in which patients are admitted to the intensive care unit (ICU). Its aetiopathogenic mechanisms are yet to be fully understood, although it is reported to cause endothelial dysfunction, excess thrombin, and inhibition of fibrinolysis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most frequent thrombotic complications include pulmonary thromboembolism, myocardial infarction, and ischaemic and haemorrhagic stroke, which manifest 1-2 weeks after diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cerebral venous sinus thrombosis (CVT) has been described in small case series,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> but it has not been observed in larger registries of hospitalised patients with COVID-19.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> The clinical manifestations of CVT are variable (from headache, focal symptoms, and epileptic seizures to altered level of consciousness<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>), which may lead to underdiagnosis or diagnostic delay in patients with SARS-CoV-2 infection, as COVID-19 may also present with neurological manifestations.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,7</span></a> We describe the case of a patient with CVT secondary to SARS-CoV-2 infection.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 36-year-old woman with history of bronchial asthma and perinatal hypoxic encephalopathy with mild disability. She attended the emergency department due to progressive hypoactivity and bed confinement at home, where she had self-isolated for 8 days after receiving positive results for SARS-CoV-2 in a PCR test of nasopharyngeal exudate; the patient reported no other symptoms. Oxygen saturation at hospital arrival was 89% and did not improve with high-flow oxygen therapy; the patient subsequently underwent orotracheal intubation and was admitted to the ICU. A chest radiography revealed bilateral interstitial pneumonia. A blood analysis showed lymphocytopaenia and D-dimer level of 25 830 ng/mL.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On day 11 of hospitalisation, we conducted a neurological wake-up test; the patient presented spontaneous eye opening with mild motor dysphasia and right-sided, predominantly brachial, hemiparesis. An emergency head CT scan with contrast showed filling defects in the left superior sagittal, straight, transverse, and sigmoid venous sinuses associated with the CVT, and infarctions in the left frontotemporal region and cerebellar hemisphere, with haemorrhagic areas. We started treatment with low–molecular weight heparin and requested a brain MRI scan and a brain MRI angiography, which confirmed the diagnosis (<a class="elsevierStyleCrossRefs" href="#fig0005">Fig. 1 and 2</a>). A hypercoagulability study yielded positive results for lupus anticoagulant. Considering the presence of haemorrhagic infarction and the available evidence,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> we decided to maintain anticoagulant treatment with dabigatran. Over the following weeks of hospitalisation, the patient presented a slowly progressive improvement with respiratory stability; she then started rehabilitation treatment, which improved the hemiparesis and achieved partial recanalisation of the CVT, which was followed up by MRI at 2 months. No other complications were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that the CVT in our patient was a complication of the SARS-CoV-2 infection, which causes systemic inflammation and promotes a hypercoagulable state. It should also be noted that in these patients, the dehydration induced by the infection and blood stasis caused by prolonged immobility may also participate as additional causal mechanisms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Furthermore, the laboratory study revealed antiphospholipid antibodies, of uncertain significance and transient nature, which have also been reported in previous articles.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In our case, we opted for oral anticoagulation with dabigatran due to its lower rate of intracranial haemorrhagic complications and its efficacy in the treatment of CVT,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> as our patient already presented haemorrhagic complication of the cerebellar infarct, with no other complications and good radiological outcomes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the high prevalence of thrombotic complications in patients with COVID-19, few cases of CVT have been reported to date.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Large Spanish series<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> identified no cases of CVT during the first wave of COVID-19. In our case, although our patient attended the emergency department with progressively reduced consciousness and very elevated D-dimer levels,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> it was not until respiratory stability was achieved that we were able to establish a diagnosis and start treatment. This form of presentation and diagnostic delay may support the hypothesis that CVT is underdiagnosed in patients with SARS-CoV-2 infection.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore, we recommend that the possible presence of intracranial thrombotic complications be considered in patients with SARS-CoV-2 infection presenting reduced level of consciousness or presence of subacute or progressive focal symptoms not limited to a defined arterial territory.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Almarcha-Menargues ML, Martínez-Martínez MM, Fernández-Travieso J. Infección por SARS-CoV-2: posible infradiagnóstico de trombosis de senos venosos cerebrales. Neurología. 2021;36:575–576.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1158 "Ancho" => 900 "Tamanyo" => 50708 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain MRI: FLAIR (A) and gradient-echo (B) sequences revealing areas of oedema, ischaemia, and haemorrhagic transformation in the left parietal region and cerebellum.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1136 "Ancho" => 900 "Tamanyo" => 39147 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI angiography revealing extensive venous thrombosis affecting the superior longitudinal, transverse, and sigmoid sinuses of both hemispheres (A). One-month follow-up image (B) showing partial recanalisation of the left superior longitudinal, transverse, and sigmoid sinuses after treatment with dabigatran.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral venous thrombosis associated with COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.D. Cavalcanti" 1 => "E. Raz" 2 => "M. Shapiro" 3 => "S. Dehkharghani" 4 => "S. Yaghi" 5 => "K. Lillemoe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3174/ajnr.A6644" "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol." "fecha" => "2020" "volumen" => "41" "paginaInicial" => "1370" "paginaFinal" => "1376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32554424" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral venous sinus thrombosis might be under-diagnosed in the COVID-19 era" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Shakibajahromi" 1 => "A. Borhani-Haghighi" 2 => "S. Haseli" 3 => "A. Mowla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ensci.2020.100256" "Revista" => array:3 [ "tituloSerie" => "eNeurologicalSci." "fecha" => "2020" "volumen" => "20" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral venous sinus thrombosis associated with SARS-CoV-2; a multinational case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Mowla" 1 => "B. Shakibajahromi" 2 => "S. Shahjouei" 3 => "A. Borhani-Haghighi" 4 => "N. Rahimian" 5 => "H. Baharvahdat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jns.2020.117183" "Revista" => array:3 [ "tituloSerie" => "J Neurol Sci." "fecha" => "2020" "volumen" => "419" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Romero-Sánchez" 1 => "I. Díaz-Maroto" 2 => "E. Fernández-Díaz" 3 => "Á Sánchez-Larsen" 4 => "A. Layos-Romero" 5 => "J. García-García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0000000000009937" "Revista" => array:6 [ "tituloSerie" => "Neurology." "fecha" => "2020" "volumen" => "95" "paginaInicial" => "e1060" "paginaFinal" => "e1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32482845" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurological complications in critical patients with COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Abenza-Abildúa" 1 => "M.T. Ramírez-Prieto" 2 => "R. Moreno-Zabaleta" 3 => "N. Arenas-Valls" 4 => "M.A. Salvador-Maya" 5 => "C. Algarra-Lucas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2020.07.014" "Revista" => array:6 [ "tituloSerie" => "Neurologia." "fecha" => "2020" "volumen" => "35" "paginaInicial" => "621" "paginaFinal" => "627" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32912745" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis—endorsed by the European Academy of Neurology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Ferro" 1 => "M.G. Bousser" 2 => "P. Canhão" 3 => "J.M. Coutinho" 4 => "I. Crassard" 5 => "F. Dentali" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2396987317719364" "Revista" => array:7 [ "tituloSerie" => "Eur Stroke J." "fecha" => "2017" "volumen" => "2" "paginaInicial" => "195" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31008314" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0959804915009223" "estado" => "S300" "issn" => "09598049" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Mao" 1 => "H. Jin" 2 => "M. Wang" 3 => "Y. Hu" 4 => "S. Chen" 5 => "Q. He" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamaneurol.2020.1127" "Revista" => array:7 [ "tituloSerie" => "JAMA Neurol." "fecha" => "2020" "volumen" => "77" "paginaInicial" => "683" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32275288" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109703007599" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Ferro" 1 => "J.M. Coutinho" 2 => "F. Dentali" 3 => "A. Kobayashi" 4 => "A. Alasheev" 5 => "P. Canhão" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamaneurol.2019.2764" "Revista" => array:6 [ "tituloSerie" => "JAMA Neurol." "fecha" => "2019" "volumen" => "76" "paginaInicial" => "1457" "paginaFinal" => "1465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31479105" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R.J. Arachchillage" 1 => "M. Laffan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14820" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost." "fecha" => "2020" "volumen" => "18" "paginaInicial" => "1233" "paginaFinal" => "1234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32291954" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulopathy and antiphospholipid antibodies in patients with Covid-19" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Zhang" 1 => "M. Xiao" 2 => "S. Zhang" 3 => "P. Xia" 4 => "W. Cao" 5 => "W. Jiang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMc2007575" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med." "fecha" => "2020" "volumen" => "382" "paginaInicial" => "e38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32268022" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003600000007/v1_202109160551/S2173580821001280/v1_202109160551/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003600000007/v1_202109160551/S2173580821001280/v1_202109160551/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001280?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 23 | 1 | 24 |
| 2024 September | 30 | 4 | 34 |
| 2024 August | 18 | 3 | 21 |
| 2024 July | 12 | 3 | 15 |
| 2024 June | 16 | 3 | 19 |
| 2024 May | 14 | 11 | 25 |
| 2024 April | 36 | 7 | 43 |
| 2024 March | 23 | 11 | 34 |
| 2024 February | 25 | 3 | 28 |
| 2024 January | 25 | 7 | 32 |
| 2023 December | 39 | 8 | 47 |
| 2023 November | 30 | 8 | 38 |
| 2023 October | 29 | 13 | 42 |
| 2023 September | 17 | 2 | 19 |
| 2023 August | 15 | 5 | 20 |
| 2023 July | 17 | 3 | 20 |
| 2023 June | 35 | 4 | 39 |
| 2023 May | 55 | 7 | 62 |
| 2023 April | 52 | 1 | 53 |
| 2023 March | 14 | 4 | 18 |
| 2023 February | 15 | 4 | 19 |
| 2023 January | 12 | 4 | 16 |
| 2022 December | 17 | 6 | 23 |
| 2022 November | 31 | 27 | 58 |
| 2022 October | 33 | 14 | 47 |
| 2022 September | 26 | 9 | 35 |
| 2022 August | 33 | 7 | 40 |
| 2022 July | 17 | 8 | 25 |
| 2022 June | 48 | 7 | 55 |
| 2022 May | 28 | 6 | 34 |
| 2022 April | 43 | 6 | 49 |
| 2022 March | 53 | 8 | 61 |
| 2022 February | 28 | 4 | 32 |
| 2022 January | 19 | 6 | 25 |
| 2021 December | 23 | 7 | 30 |
| 2021 November | 14 | 7 | 21 |
| 2021 October | 15 | 12 | 27 |
| 2021 September | 13 | 8 | 21 |
| 2021 August | 2 | 3 | 5 |
Show all
