warfarin and Seizures

The usual differential diagnoses of nocturnal events in children include parasomnias, nocturnal seizures, nocturnal reflux (Sandifer syndrome), hypnic jerks, periodic limb movements of sleep, and sleep disordered breathing. We report a previously healthy young girl who presented to the sleep clinic for evaluation of nocturnal events which were diagnosed as medically refractory nocturnal seizures. It was not until a syncopal event occurred in the daytime, which prompted referral for cardiac evaluation, the diagnosis of idiopathic pulmonary arterial hyper-tension (IPAH) was made. Sleep physicians should consider IPAH in the differential diagnosis of nocturnal events in children.

Topics: Carbolines; Cardiac Output, Low; Child, Preschool; Diagnosis, Differential; Drug Therapy, Combination; Epoprostenol; Female; Humans; Hypertension, Pulmonary; Oxygen Inhalation Therapy; Parasomnias; Seizures; Severity of Illness Index; Sleep Apnea Syndromes; Tadalafil; Treatment Outcome; Warfarin

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Azetidines; Cardiomyopathies; Ezetimibe; Female; Heart Failure; Humans; Kidney Failure, Chronic; Male; Middle Aged; Pyrazoles; Pyridones; Recurrence; Risk; Seizures; Simvastatin; Ultrasonography; Warfarin

To determine if anticoagulation therapy is effective for preventing progression of pediatric sinovenous thrombosis, to determine the safety of anticoagulation therapy in the pediatric population, and to outline risk factors and clinical presentation in the authors' population of patients with sinovenous thrombosis.. A retrospective chart review was conducted of 17 consecutive pediatric patients with sinovenous thrombosis at the authors' institution regardless of treatment option and outcome.. Fifteen children underwent anticoagulation therapy; two did not. Surgical intervention was undertaken in two patients. None of the children died. None had recurrence after anticoagulation was initiated. Of the patients who had follow-up studies performed, 33% had some resolution of the clot, 60% had complete resolution, and 13% had no change. Both children who did not undergo anticoagulation therapy had resolution of the thrombus. All of the children had improvement of their symptoms at presentation. No patient had worsening of radiologic findings during the follow-up period.. Anticoagulation therapy did not result in bleeding complications. Fifteen of 17 patients were safely anticoagulated. All children had improvement of their presenting symptoms. There was no worsening of radiologic findings in any patient, and there was improvement in 13 patients. One patient has long-term neurologic sequelae (a learning disability). This patient underwent extensive surgeries for subdural and epidural empyemas.

Topics: Anticoagulants; Brain Damage, Chronic; Cerebral Hemorrhage; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Comorbidity; Drug Evaluation; Female; Heparin; Heparin, Low-Molecular-Weight; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Risk Factors; Safety; Seizures; Sinus Thrombosis, Intracranial; Treatment Outcome; Virginia; Warfarin

Cerebral venous thrombosis is relatively rare and characterized by a wide spectrum of clinical features. It is more common in young adults with women affected more than men. The diagnosis of cerebral venous thrombosis is easier nowadays due to easy access to advanced neuroimaging techniques. Abnormalities in thrombophilic profile are associated with enhanced risk of cerebral venous thrombosis. It has varied etiologies such as hypercoagulable states, infection, dehydration, pregnancy, and substance abuse. Hyperhomocysteinemia is found to be closely associated with an enhanced risk of cerebral venous thrombosis.. Here we report a case of cerebral venous thrombosis secondary to hyperhomocysteinemia caused by vitamin B. There are conflicting reports in the literature about the association of hyperhomocysteinemia, B

Topics: Adult; Anticoagulants; Anticonvulsants; Brain; Diuretics, Osmotic; Glycerol; Heparin; Humans; Hyperhomocysteinemia; Intracranial Thrombosis; Magnetic Resonance Imaging; Male; Mannitol; Seizures; Valproic Acid; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Warfarin

Drug interactions in the neurosciences intensive care unit (NICU) may involve antiepileptic drugs and warfarin. Most commonly used antiepileptic drugs are either potent hepatic enzyme inducers or inhibitors and they affect the metabolism of warfarin. Valproic acid also displaces warfarin from the protein binding sites resulting in significant INR changes but this type of drug interaction is less well known.. Case report.. A 71 year-old female patient with a glioblastoma multiforme presented to the NICU with refractory partial complex seizures. Patient was on warfarin for a prior deep venous thrombosis. After treatment with levetiracetam, seizures recurred and intravenous loading with valproic acid was administered, but resulted in a rapid increase in international normalized ratio (INR) to 7.6. A MRI of the brain showed hemorrhagic tumor, but no new major bleeding.. With both acidic drugs present, a loading dose of valproic acid may displace warfarin from the protein binding sites resulting in redistribution of warfarin in free active form and lead to a rapid increase in INR.

Topics: Aged; Anticoagulants; Anticonvulsants; Blood Coagulation Disorders; Drug Interactions; Female; Humans; International Normalized Ratio; Seizures; Valproic Acid; Warfarin

Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) are EEG epileptiform periodic discharges (PD) induced by arousal. SIRPIDs lie along an ictal-interictal continuum with debate regarding urgency of treatment. In a patient with SIRPIDs, aphasia and confusion, i.v. lorazepam during EEG resulted in improved level of consciousness, return of verbal interaction and regression of SIRPIDs. This suggests that some forms of SIRPIDs may be associated with an ictal confusional state.

Topics: Aged; Anticoagulants; Anticonvulsants; Confusion; Consciousness Disorders; Diabetes Complications; Electroencephalography; Female; Humans; Lorazepam; Seizures; Status Epilepticus; Warfarin

To improve the safety and effectiveness of warfarin (WF) therapy, the initial dose trends to be practically decided based on single nucleotide polymorphism (SNP) genotyping of two genes, cytochrome P450 (CYP) 2C9 and vitamin K epoxide reductase complex1 (VKORC1). We encountered a 43-year-old female who was hospitalized for investigation and treatment because of intermittent convulsive seizures. Right brain cortical vein thrombi were confirmed by magnetic resonance imaging (MRI) scan; therefore, a 3 mg dose of WF was empirically initiated. The prothrombin time (PT), expressed as the international normalized ratio (INR), did not change at all, even when WF was increased to a dose of 11 mg/day. Direct sequence analysis revealed *3 in CYP2C9 and 3673 GA, 6484 CT, 6853 GC and 9041 GA in VKORC1, indicating that the genotypic pattern of the two genes is the responsible SNP for the moderate phenotype on WF sensitivity. Conclusively, our case may present an unknown mechanism other than the concern mentioned above.

Topics: Adult; Aryl Hydrocarbon Hydroxylases; Cerebral Veins; Cytochrome P-450 CYP2C9; Drug Resistance; Female; Genotype; Humans; International Normalized Ratio; Intracranial Thrombosis; Mixed Function Oxygenases; Polymorphism, Single Nucleotide; Seizures; Vitamin K Epoxide Reductases; Warfarin

Topics: Adult; Churg-Strauss Syndrome; Female; Humans; Intracranial Thrombosis; Magnetic Resonance Imaging; Mononeuropathies; Phenytoin; Seizures; Steroids; Treatment Outcome; Warfarin

Cerebral venous thrombosis (CVT) is an uncommon but serious type of stroke. Thrombosis may involve the cortical or deep veins or the venous sinuses. The presenting clinical features are non-specific. We report a 48-year-old man with CVT who presented with fever, bitemporal throbbing headache, and generalised convulsion. Computed tomography (CT) of the brain revealed acute haemorrhages over right anterior frontal and posterior temporal regions with surrounding oedema and right anterior temporal subcortical oedema. The initial diagnosis was herpes simplex encephalitis. Absence of venous flow over the right transverse and sigmoid sinuses during the venous phase of digital subtraction angiography (DSA) revealed CVT. He was anti-coagulated for 6 months. An underlying cause of CVT was not detected. A high index of suspicion is required when risk factors of CVT are present. CT brain may be normal or showing non-specific findings. Magnetic resonance imaging plus venography, CT venography, or DSA is diagnostic.

Topics: Angiography, Digital Subtraction; Anticoagulants; Brain; Diagnosis, Differential; Encephalitis, Herpes Simplex; Fever; Frontal Lobe; Heparin, Low-Molecular-Weight; Humans; Intracranial Hemorrhages; Intracranial Thrombosis; Male; Middle Aged; Seizures; Temporal Lobe; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Phenytoin has been reported to have major interactions with warfarin. Phenytoin induces warfarin's metabolism. However, there are many case reports which provide conflicting conclusions. Here, we report a case of a 65-year-old man with mechanical heart valve on chronic warfarin therapy who experienced persistent fluctuations of INR and bleeding secondary to probable warfarin-phenytoin interactions. The patient's anticoagulation clinic visits prior to hospitalization were thoroughly evaluated and we continued to follow-up the case for 3 months post-hospitalization. The reported interaction could be reasonably explained from the chronology of events and the pattern of INR fluctuations whenever phenytoin was either added or discontinued from his drug regimen.

Topics: Aged; Anticoagulants; Anticonvulsants; Drug Synergism; Heart Valve Prosthesis; Humans; International Normalized Ratio; Male; Phenytoin; Seizures; Warfarin

A 19-year-old woman, 8 days postpartum, presented to the Emergency Department (ED) with a chief complaint of headache, decreased vision, and agitation. Past medical history was unremarkable. Physical examination was remarkable only for dry mucous membranes, decreased visual acuity, and trace pedal edema bilaterally. While in the ED, the patient experienced a generalized tonic-clonic seizure. Computed tomography (CT) scan of the head was suspicious for venous infarction. Magnetic resonance imaging (MRI) and MR venography revealed sagittal sinus and left transverse sinus thrombosis. The risk factors, clinical presentation, diagnostic evaluation, and management of cerebral venous thrombosis are reviewed.

Topics: Adult; Anticoagulants; Cerebral Angiography; Female; Headache; Humans; Hypertension; Phenytoin; Puerperal Disorders; Risk Factors; Seizures; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

Topics: Cardiac Catheterization; Child; Child, Preschool; Diagnosis, Differential; Diltiazem; Echocardiography; Humans; Hypokalemia; Male; Oxygen; Paralyses, Familial Periodic; Potassium; Seizures; Syncope; Tricuspid Valve Insufficiency; Tuberous Sclerosis; Warfarin

Topics: Abortion, Habitual; Adult; Animals; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Autoimmune Diseases; Drug Monitoring; Female; Humans; International Normalized Ratio; Intracranial Embolism; Intracranial Thrombosis; Male; Middle Aged; Pregnancy; Recombinant Proteins; Recurrence; Risk; Seizures; Thromboembolism; Thrombophilia; Thrombophlebitis; Thromboplastin; Warfarin

Cerebral dural sinus thrombosis is an unusual syndrome in which a patient presents with a severe headache that may be associated with diverse neurologic and physical findings. The case of a 31-year-old woman with headache, vomiting, generalized tonic-clonic seizure, and subsequent dense hemiplegia is presented. The patient was diagnosed as having a cerebral dural sinus thrombosis, but only after the diagnosis was missed initially. The syndrome may be difficult to detect because it can mimic several other entities. There are several known or suspected predisposing factors. The syndrome, diagnostic modalities, and therapeutic options are reviewed.

Topics: Adult; Cerebral Hemorrhage; Contraceptives, Oral; Diagnosis, Differential; Female; Headache; Hemiplegia; Heparin; Humans; Magnetic Resonance Imaging; Mannitol; Phenytoin; Seizures; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

Several toxic agents were compared in order to test the effect of various types of illness in producing learned taste aversions. After a 10-min sucrose drinking trial, groups of rats were injected intraperitoneally with lithium chloride or with a strong, near lethal dose of a rodenticide. Strong sucrose aversions were acquired by groups injected with lithium chloride, copper sulfate, sodium fluoroacetate, or red squill, and very weak or no aversions were learned by groups injected with thallium, warfarin cyanide, or strychnine. The results were discussed in terms of onset of symptoms, duration of symptoms, and kinds of physiological effects necessary to produce aversions. It was concluded that the effects of different drugs may be mediated by different physiological systems learned taste aversions.

Topics: Animals; Avoidance Learning; Copper; Cyanides; Diarrhea; Female; Fluoroacetates; Lithium; Male; Motor Activity; Plants, Medicinal; Rats; Rodenticides; Seizures; Sex Factors; Strychnine; Sulfates; Taste; Thallium; Time Factors; Warfarin