Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium

Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium Qing Gai, Changmu Leng, Shuyan Cong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.111/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cerebral venous sinus thrombosis (CVST) is a rare and serious complication during pregnancy and puerperium with a variety of clinical features. Little is known about the prognostic factors of CVST during the acute phase, subsequent pregnancy outcomes, and the risk of recurrence of CVST. The purpose of the study is to investigate the clinical features and prognosis of pregnancy-related CVST in China. Methods: We retrospectively analyzed the clinical data of 41 patients diagnosed with CVST during pregnancy or puerperium from January 2007 through March 2018 in Shengjing Hospital. Poor outcome was defined as modified Rankin Scale (mRS) ³3 at discharge. Independent prognostic factors for CVST outcome were identified via multivariate logistic regression analysis. Long-term outpatient interview was followed to know the next pregnancies outcome and CVST relapse rate. Results: CVST occurred about 2.4 times (29 vs. 12) during puerperium than in pregnancy. Headache (90%) was found the most common clinical feature, followed by focal neurologic deficits (61%), seizure (59%), visual disorder (37%) and impaired consciousness (29%). The multivariate analysis revealed D-dimer levels >1134 µg/L (OR=18.67, 95% CI:1.79-194.84) and impaired consciousness (OR=33.85, 95% CI: 3.14-365.45) were independent prognostic factors of a poor outcome during acute phase. Twenty-eight (68%) patients underwent a long-term interview. Only three women had multiple pregnancies (six pregnancies, two in each women), but no birth occurred from these. One patient had a relapse of CVST three years later, which had no relationship with pregnancy or puerperium. Conclusions: CVST occurred mostly during puerperium. D-dimer levels >1134µg/L and impaired consciousness could predict poor outcomes of pregnancy-related CVST. The subsequent pregnancy rate and CVST relapse rate was low in this Chinese population. Internal Medicine Specialties Cerebral venous sinus thrombosis Pregnancy Puerperium Headache D-dimer Figures Figure 1 Background Cerebral venous sinus thrombosis (CVST) is a rare type of cerebrovascular disease that accounts for 0.5% of all strokes [1]. Pregnancy and puerperium are the most common causes of CVST due to specific pathophysiological changes that occur during these times [2,3]. Compared to non-pregnant women of reproductive age, pregnant women are at an approximately 3-fold increased risk of having CVST [4]. The reported incidence of pregnancy-related CVST is 8.9 to 450 per 100000 deliveries per year [5-9] and the maternal mortality rate is up to 9%-18.5% [3,8,10], which is catastrophic both to the family and to society. Therefore, it is important to diagnosis and treat CVST in a timely manner, to reduce disability and mortality. The manifestations of CVST during pregnancy and puerperium can vary from a headache to a deep coma and can be easily confused with eclampsia, reversible cerebral vasoconstriction syndrome (RCVS), or posterior reversible encephalopathy syndrome (PRES) [11]. In addition to, the prognostic factors of CVST during the acute phase, the subsequent outcome of the pregnancy and the risk of CVST recurrence are unclear. Therefore, the aim of the present study is to characterize the clinical features of pregnancy-related CVST, identify independent risk factors of poor outcome in the acute phase, and to provide information on the influence on subsequent pregnancies and relapse rate of CVST. Methods Patient selection We performed a retrospective study of CVST in pregnancy and puerperium women at Shengjing Hospital of China Medical University from January 2007 through March 2018. The Ethics Committee of the University Hospital approved this study protocol. Inclusionary criteria were comprised of four distinct categories, including (1) age was older than 18 but younger than 45 years old; (2) development of CVST in pregnancy or within 6 weeks after delivery; (3) a confirmed diagnosis of CVST by brain magnetic resonance imaging/venography (MRI/MRV) or brain digital subtraction angiography (DSA); and (4) no venous thrombotic events in the past and no related family genetic history. Patients who had history of seizure, malignancies, hematological diseases, inflammatory bowel disease, nephritic syndrome, or connective tissue disorders were excluded. Clinical Variables Data were analyzed in seven distinct categories, namely (1) baseline demographics, including age at the onset of CVST, number of pregnancies, time since the onset of symptoms to hospital admission (acute: 30 days), and mean duration from symptom initiation to treatment; (2) risk factors such as hypertension, diabetes mellitus, hyperlipidemia, smoking or drinking; (3) clinical presentations, including headache, seizures, focal neurological signs (motor/sensory deficits or aphasia), visual disturbance (blurry vision, hemianopsia, visual neglect, or cortical blindness), and impaired consciousness; (4) all laboratory tests within 24 hours after admission in the hospital and neuroimaging such as magnetic resonance imaging (MRI)/magnetic resonance venography (MRV) or digital subtraction angiography (DSA). D-dimer level, as measured by immunoturbidimetry assay with the coagulational laboratory autoanalyzer (reference interval 0-252µg/L); (5) treatment in the hospital and after discharge; (6) modified Rankin scale (mRS) on the day at discharge as estimated by two neurological physicians (poor outcome was defined as mRS of three or greater); and (7) information on subsequent pregnancies outcome and CVST relapse rate. Statistical analysis Continuous variables are presented as the mean ± standard deviation (SD) or the median with interquartile range (IQR), depending on the distribution of the data, while discrete variables are presented as counts (percentage). Comparisons were made with student’s t-test or Mann-Whitney U test for continuous variables and Pearson’s χ2 test or Fisher’s exact test for categorical variables. Variables with a p value of < 0.2 by univariate analysis were presented to a logistic regression model with a forward selection procedure. Evaluation of the logistic regression model was conducted using the Hosmer-Lemeshow goodness of fit test. The receiver operating characteristic (ROC) curve was applied to determine the optical cut-off point of the D-dimer level that predicted poor outcomes of CVST during the acute phase. All analyses were conducted using SPSS, version 21.0 (IBM). A p value <0.05 was considered statistically significant. Results A total of 41 patients met the inclusion criteria. The baseline characteristics were shown in Table 1. The mean age was 29.7(5.9 years. All patients were diagnosed with either acute or subacute onset. The median hospital stay was 23 (10.5-33.5) days. Twenty-nine patients developed CVST in puerperium, which was about 2.4 times as many as in pregnancy. The mean time from delivery to symptom onset was eight days, with a range from 1 to 40 days. During pregnancy, CVST was most common during the 1st and 2nd trimester. Only 2 patients had history of hypertension before pregnancy and no patient had diabetes mellitus, cardiac disease, smoking or alcoholism history. Thirteen patients (32%) were diagnosed with gestational hypertension, eleven (27%) were diagnosed with preeclampsia, and four (10%) were diagnosed with eclampsia, diagnosed concurrent with CVST. Clinical presentations, laboratory, and neuroimaging findings The most common presenting features were headache (37, 90%), followed by focal neurologic deficits (25, 61%), seizures (24, 59%), visual disorders (15, 37%), and impaired consciousness (12, 29%) (see Table 1). In laboratory examinations, 21 (66%) patients had hyperlipidemia , 20 (49%) had hypoproteinemia, 19 (46%) had anemia, and three (7%) had Hellp syndrome. The median of D-dimer was 1001 (715-2486.5) µg/L, while the D-dimer level in three cases was lower than 500 µg/L. CVST was diagnosed with brain MRI and MRV in 40 patients and DSA in 1 patient. Infarction was noted in 28 (68%) patients and haemorrhage was present in 23 (56%) patients. The parietal lobe (21, 51%) was the most commonly involved on the MRI, followed by the frontal lobe (12, 29%), the occipital lobe(10, 24%), the temporal lobe (5, 12%), the basal ganglia (3, 7%), and the cerebellum (2, 5%). MRV revealed sigmoid sinus (24, 59%), transverse sinus (22, 54%), and superior sagittal sinus (21, 51%) were the most common sinuses to be affected. Twenty-six (63%) patients had more than one venous sinus involvement. Treatment and outcome at discharge All patients received symptom treatment (e.g., treatment for control of seizures and intracranial hypertension, hypertension treatment). Anticoagulation therapy was stared immediately after CVST diagnosis in 37 patients with sufficient low-molecular weight heparin (LMWH) for about two weeks, followed by oral anticoagulant drugs after discharge. Four patients, however, didn’t receive anticoagulation therapy due to concerns of aggravating intracerebral hemorrhage (ICH); one of them received surgery because of a brain midline shift. Forty-one patients were divided into two groups based on mRS scores at discharge. Baseline characteristics of patients in the two groups are showed in Table 2. Twenty-seven (66%) patients had a good outcome (mRS (2) and fourteen (34%) had a poor outcome (mRS (3) at discharge (including two death while still at the hospital). The univariate identified factors related to poor outcome were gestational hypertension, pre-eclampsia, eclampsia, headache, focal neurologic deficits, intracerebral hemorrhage, impaired consciousness, D-dimer level, and anti-coagulation ( p <0.2). ROC curve demonstrated D-dimer was predictive of a poor outcome of CVST, with area under the curve (AUC) of 0.828 (95% CI: 0.703-0.953, p =0.001) and the cut-off value was 1134 µg/L (sensitivity 85.7%, specificity 74.1%) (Fig.1). Univariate analysis revealed a D-dimer level >1134µg/L was related to poor outcome(26% vs 86%, p 1134µg/L(OR=18.67, 95% CI: 1.79-194.84) and impaired consciousness (OR=33.85, 95% CI: 3.14-365.45) were independent risk factors of a poor outcome of pregnancy-related CVST (Hosmer-Lemeshow test, p =0.513 ) (see Table 3). Long-term follow up Twenty-eight (68%) patients underwent long-term interviews, the median follow up time was 3.5 years (range 0.3 to 8.4 years). Twenty-five patients recovered completely without any sequela, one had vision decrease and two had severe disability (mRS=4). Twenty-two (79%) women were afraid of becoming pregnant again, because of the worry about recurrence of CVST. Only three women had multiple pregnancies (six pregnancies, two in each women, but no birth occurred. Two of them chose abortion during early pregnancy due to fear of recurrence of CVST and one had two miscarriage due to low levels of progesterone. One patient had a relapse of CVST three years later after the first incidence of CVST, without finding the specific etiology. Discussion Pregnancy and postpartum are associated with increased risk of CVST because of a hypercoagulable state, increased venous stasis, and endothelial dysfunction [12,13]. Consistent with previous reports, our study showed that CVST was highest in puerperium [10,11]. The possible pathological mechanisms may include postpartum hemorrhage, large loss of body fluid, anemia, postpartum infection, and prolonged bed rest [7,11-13]. The clinical presentation of CVST is extremely variable, depending upon the extent and location of the dural sinus and draining veins involved, collateral circulation, and the effects on intracranial pressure [14]. Headache is the most common symptom reported in 60-90% patients of CVST [15]. Consistent with this, our study also reported headache as the most frequent initial symptom in 37 patients (90%): four among them had an isolated headache without any other symptom. Headache is common in both normal pregnant and puerperium women, but there are some red flags that should draw clinicians’ attention [11], such as a thunderclap headache, changes in headache pattern, and a headache with high blood pressure. Increased serum cholesterol or triglycerides, diluted anemia, and hypoproteinemia are common physiological changes during pregnancy and were not related to the prognosis of CVST in the current study. Sigmoid sinus, transverse sinus and superior sagittal sinus were the most common sites of CVST in general population [16,17], similar to patients in our study during pregnancy or puerperium. Previous studies have reported that the outcome of pregnancy-related CVST is more favorable than other causes that lead to CVST [3] and has a fairly good prognosis when compared with ischemic stroke and intracerebral hemorrhage in pregnancy and puerperium [10,16]. Prognostic factors for CVST in the general population have been suggested to include coma, ICH, seizures, age, and neurological deficits [17,18]. However, the prognostic factors for pregnancy-related CVST are not clear. In the current study, multivariate logistic analysis revealed that D-dimer levels >1134µg/L and impaired consciousness were independent risk factors of poor outcome. D-dimer, a degration product of cross-linked fibrin, is a hypercoagulability marker and could be used in predicting CVST [19,20]. A high D-dimer level is correlated with greater thrombosis extension and severity of CVST [21]. Therefore, monitoring the level of D-dimer is important for assessing the prognosis of CVST. Preeclampsia and eclampsia were the most common factors associated with pregnancy-related ICH and ischemic stroke, but were uncommon in CVST [10]. Our study revealed they were not related to the prognosis of pregnancy-related CVST. LMWH is considered the first choice of treatment in patients with CVST, regardless of the presence of ICH [22]. The optimal duration of anticoagulation is not clear. The American Heart Association(AHA)/American Stroke Association(ASA) advise that sufficient LMWH should be used throughout pregnancy and LMWH or vitamin K antagonists with a target International Normalized Ratio (INR) of two to three should be continued after delivery for at least six months [22,23]. Endovascular thrombolytic therapy should also be considered in patients with poor prognosis [18]. To the best of our knowledge, this is the first study examining the recurrence state of pregnancy-related CVST. Previous studies focused on the impact of CVST in women at childbearing age. Mehraein et al [24] found no recurrence of CVT when following 22 pregnancies and 19 births in 14 women with a history of CVT during childbearing age. Additionally, Aguiar de Sousa et al found CVT recurrence in 3 of 393 individuals (8 per 1000; 95% CI: 3-22) in a systematic review [25]. The result from our long-term interviews demonstrated that most patients took contraceptive measures for the fear of recurrence of CVST and terminated a pregnancy if they became pregnant again. Therefore, only three women had multiple pregnancies (six pregnancies, two in each woman), but no birth occurred. There was only one CVST recurrence in 28 patients, however, it was not pregnancy-related. The current evidence suggests that women with previous venous thrombotic events (VTE) had a very low risk of recurrence, particularly if the previous venous thrombosis was associated with a temporary risk factor (for example, oral contraceptives or fracture induced immobilization) [26]. Risk is increased, however, if a thrombophilia is present or the prior thrombotic event was idiopathic [24]. Therefore, women should be tested for thrombophilia and avoid additional risk factors, if possible [7,11], to reduce the risk of recurrence CVST during subsequent pregnancies. Antithrombotic prophylaxis with LMWH in future pregnancies may be beneficial [25,27]. Limittions There were also some limitations to our study. First, it was a single hospital-based study, with limited generalisability. Secondly, genetically related factors were not screened, such as mutation in the methylenetetrahydrofolate reductase gene (MTHFR) or Factor V Leiden. However, these patients had no thrombotic events before and no related familial event, so it is not likely that this would be a factor. Conclusions In conclusion, as a rare complication during pregnancy or puerperium, CVST could cause severe disability or even death. We found D-dimer levels >1134µg/L and impaired consciousness could predict poor outcomes of pregnancy-related CVST. The subsequent pregnancy rate and CVST relapse rate was low in this Chinese population. Large multicenter cohort studies should be conducted in the future to further study the prognosis of pregnancy-related CVST, which could give physicians more medical evidence when counseling these patients. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Affiliated Shengjing Hospital of China Medical Univeristy. Written informed consent was obtained from all patients or the patient’s next-of-kin. Consent for publication Not applicable. Availability of data and material All relevant data are included in the manuscript. The individual data in our study cannot be provided in order to protect the participants’ identity. Competing interests The authors declare that they have no competing interests. Funding The study was supported by the National Natural Science Foundation of China (grant number: 81371271) . Authors’ contributions QG collected, analyzed and interpreted the data, as well as drafted the manuscript. CML participated in data collection and statistical analysis. SYC contributed the study design and manuscript writing. All authors read and approval the final manuscript. Acknowledgements Not applicable. References 1. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007; 6:162-170. 2. Sassi SB, Touati N, Baccouche H, Drissi C, Romdhane NB, Hentati F. Cerebral venous thrombosis: A Tunisian monocenter study on 160 patients. Clin Appi Thromb Hemost. 2017; 23:1005-1009. 3. Cantú C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke. 1993; 24:1880-1884. 4. Hovsepian DA, Sriram N, Kamel H, Fink ME, Navi BB. 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Tables Table 1 Demographic data, clinical, laboratory and neuroimaging findings of CVT Characteristics Data Age (year) 29.7 ± 5.9 Multiple pregnancy( ³ 2) 20 (49%) Mode of onset Acute Subacute 17 (41%) 24 (59%) Pregnancy 1st trimester 2nd trimester 3rd trimester 5 (12%) 5 (12%) 2 (5%) Puerperium 29 (71%) Hypertension 2 (5%) Gestational hypertension 13 (32%) Preeclampsia 11 (27%) Eclampsia 4 (10%) Initial symptom Headache 37 (90%) Focal neurologic deficits 25 (61%) Epileptic seizure 24 (59%) Visual disorder 15 (37%) Impaired consciousness 12 (29%) Laboratoty examinations Hyperlipidemia * 21 (66%) Hypoprotein † 20 (49%) Anemia ‡ 19 (46%) Hellp syndrome § 3 (7%) D-dimer 1001(715,2486.5) Neuroimaging Infarction 28 (68%) Hemorrhage 23 (56%) Sigmoid sinus 24 (59%) Transverse sinus 22 (54%) Superior sagittal sinus 21 (51%) Inferior sagittal/straight sinus 7 (17%) Multiple sinus( ³ 2) 26 (63%) * missing data(N=9), a total of 32 people received blood lipid test † albumin<25g/L or total protein<60g/L ‡ hemoglobin concentration <110g/L in pregnancy § hemolysis, elevated liver enzymes and low platelet count Table 2 Univariate analysis: Prognostic factors associated with outcome at discharge Variable mRS £ 2(n=27) mRS≥3(n=14) p Value Age （ years ） 29.4 ± 6.0 30.4 ± 5.8 0.618 Multiple pregnancy 13/27 (48%) 7/14 (50%) 0.910 Gestational hypertension 5/27 (19%) 8/14 (57%) 0.030 Preeclampsia 5/27 (19%) 6/14 (43%) 0.195 Eclampsia 1/27 (4%) 3/14 (21%) 0.107 Systolic blood pressure 132.4 ± 26.8 143.6 ± 32.9 0.249 Diastolic blood pressure 85.3 ± 19.3 92.9 ± 22.1 0.262 Puerperium 21/27 (78%) 8/14 (57%) 0.310 Headache 26/27 (96%) 11/14 (79%) 0.107 Seizure 15/27 (56%) 9/14 (64%) 0.591 Visual disorder 9/27 (33%) 6/14 (43%) 0.548 Focal neurologic deficits 13/27 (48%) 12/14 (86%) 0.019 Impaired consciousness 2/27 (7%) 10/14 (71%) <0.001 Hyperlipidemia * 15/24 (63%) 6/8 (75%) 0.830 Anemia 11/27 (41%) 8/14 (57%) 0.318 Hypoprotein 14/27 (52%) 6/14 (43%) 0.585 Hellp syndrome 1/27(4%) 2/14 (14%) 0.265 D-dimer 800 (692,1541) 2186.5 (1177,5492) 0.001 Intracerebral hemorrhage 11/27 (41%) 12/14 (86%) 0.006 Multiple sinus( ³ 2) 17/27 (63%) 9/14 (64%) 0.934 Anti-coagulation 26/27 (96%) 11/14 (79%) 0.107 * missing data(N=9), a total of 32 people received blood lipid test Table 3 independent predictors for poor outcome of CVT during pregnancy and puerperium Variable Exp(B) Regression coefficient(95%CI) P value D-dimer>1134 µ g/L 18.67 1.79-194.83 0.014 Impaired consciousness 33.85 3.14-365.45 0.004 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-111","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":1959,"identity":"a7f130ff-99c9-47e3-9325-37cd3545ba71","order_by":1,"name":"Qing Gai","email":"","orcid":"https://orcid.org/0000-0002-1607-5627","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Gai","suffix":""},{"id":1960,"identity":"43d74982-4bbb-42ff-80e7-bcdc65a9d9f5","order_by":2,"name":"Changmu Leng","email":"","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Changmu","middleName":"","lastName":"Leng","suffix":""},{"id":1961,"identity":"2eefe076-d25e-4aa7-9ea3-79f005df06e3","order_by":3,"name":"Shuyan Cong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYLACxgYQyXwMzGFjJ14LWxoDQwKQYiZeC48ZWAsDIS387b2HX/7ccTixf3bPtwcff2yT52NmYPzwMQe3Fokz59Ksec8cTpxx5+x2wxkJtw3bmBmYJWduw63FQCLHzJix7XBiw43cbdI8CbcZgVrYmHkJaDH8CdQy/0bOM5AWe2K0GD/gBWrZcCOHDaQlkaAWiTNnzJh529KNN95IM5OckXY7uY2ZsRmvX/jbe4w//myzlp13I/mZxAeb27bz25sPfviIRwsQsEkACccGhABjAw6VcMD8AUjYE1I1CkbBKBgFIxgAANVPUmoVKxdHAAAAAElFTkSuQmCC","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shuyan","middleName":"","lastName":"Cong","suffix":""}],"badges":[],"createdAt":"2018-12-14 18:49:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.111/v1","doiUrl":"https://doi.org/10.21203/rs.2.111/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":2605577,"identity":"8d10eeef-e31d-4167-ba7f-95fcd402285c","added_by":"dc4675f8-2fd7-4265-8811-cd74e352f5f6","created_at":"2020-09-25 20:48:18","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1749432,"visible":true,"origin":"","legend":"Receiver operating characteristic(ROC) curve for D-dimer on predicting poor outcome of CVT during pregnancy and puerperium. AUC: area under the curve, CI: confidence interval","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-111/v1/figure_1.jpg"},{"id":13465861,"identity":"0b141307-2cd7-482d-921e-4ec6df9834f4","added_by":"auto","created_at":"2021-09-16 20:48:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":326303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-111/v1/4bfbc3b4-40b8-4e53-a19a-cc154eb80f86.pdf"}],"financialInterests":"","formattedTitle":"Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium","fulltext":[{"header":"Background","content":"\u003cp class=\"正文\"\u003eCerebral venous sinus thrombosis (CVST) is a rare type of cerebrovascular disease that accounts for 0.5% of all strokes [1]. Pregnancy and puerperium are the most common causes of CVST due to specific pathophysiological changes that occur during these times [2,3]. Compared to non-pregnant women of reproductive age, pregnant women are at an approximately 3-fold increased risk of having CVST [4]. The reported incidence of pregnancy-related CVST is 8.9 to 450 per 100000 deliveries per year [5-9] and the maternal mortality rate is up to 9%-18.5% [3,8,10], which is catastrophic both to the family and to society. Therefore, it is important to diagnosis and treat CVST in a timely manner, to reduce disability and mortality. The manifestations of CVST during pregnancy and puerperium can vary from a headache to a deep coma and can be easily confused with eclampsia, reversible cerebral vasoconstriction syndrome (RCVS), or posterior reversible encephalopathy syndrome (PRES) [11]. In addition to, the prognostic factors of CVST during the acute phase, the subsequent outcome of the pregnancy and the risk of CVST recurrence are unclear. Therefore, the aim of the present study is to characterize the clinical features of pregnancy-related CVST, identify independent risk factors of poor outcome in the acute phase, and to provide information on the influence on subsequent pregnancies and relapse rate of CVST. \u003c/p\u003e"},{"header":"Methods","content":"\u003cp class=\"正文\"\u003ePatient selection\u003c/p\u003e\n\u003cp class=\"正文\"\u003eWe performed a retrospective study of CVST in pregnancy and puerperium women at Shengjing Hospital of China Medical University from January 2007 through March 2018. The Ethics Committee of the University Hospital approved this study protocol. Inclusionary criteria were comprised of four distinct categories, including (1) age was older than 18 but younger than 45 years old; (2) development of CVST in pregnancy or within 6 weeks after delivery; (3) a confirmed diagnosis of CVST by brain magnetic resonance imaging/venography (MRI/MRV) or brain digital subtraction angiography (DSA); and (4) no venous thrombotic events in the past and no related family genetic history. Patients who had history of seizure, malignancies, hematological diseases, inflammatory bowel disease, nephritic syndrome, or connective tissue disorders were excluded. \u003c/p\u003e\n\u003cp class=\"正文\"\u003eClinical Variables \u003c/p\u003e\n\u003cp class=\"正文\"\u003eData were analyzed in seven distinct categories, namely (1) baseline demographics, including age at the onset of CVST, number of pregnancies, time since the onset of symptoms to hospital admission (acute: \u0026lt;48 hours, subacute: 48 hours-30 days, chronic: \u0026gt;30 days), and mean duration from symptom initiation to treatment; (2) risk factors such as hypertension, diabetes mellitus, hyperlipidemia, smoking or drinking; (3) clinical presentations, including headache, seizures, focal neurological signs (motor/sensory deficits or aphasia), visual disturbance (blurry vision, hemianopsia, visual neglect, or cortical blindness), and impaired consciousness; (4) all laboratory tests within 24 hours after admission in the hospital and neuroimaging such as magnetic resonance imaging (MRI)/magnetic resonance venography (MRV) or digital subtraction angiography (DSA). D-dimer level, as measured by immunoturbidimetry assay with the coagulational laboratory autoanalyzer (reference interval 0-252µg/L); (5) treatment in the hospital and after discharge; (6) modified Rankin scale (mRS) on the day at discharge as estimated by two neurological physicians (poor outcome was defined as mRS of three or greater); and (7) information on subsequent pregnancies outcome and CVST relapse rate. \u003c/p\u003e\n\u003cp class=\"正文\"\u003eStatistical analysis\u003c/p\u003e\n\u003cp class=\"正文\"\u003eContinuous variables are presented as the mean ± standard deviation (SD) or the median with interquartile range (IQR), depending on the distribution of the data, while discrete variables are presented as counts (percentage). Comparisons were made with student’s t-test or Mann-Whitney U test for continuous variables and Pearson’s \u003ci\u003eχ2\u003c/i\u003e test or Fisher’s exact test for categorical variables. Variables with a \u003ci\u003ep \u003c/i\u003evalue of \u0026lt; 0.2 by univariate analysis were presented to a logistic regression model with a forward selection procedure. Evaluation of the logistic regression model was conducted using the Hosmer-Lemeshow goodness of fit test. The receiver operating characteristic (ROC) curve was applied to determine the optical cut-off point of the D-dimer level that predicted poor outcomes of CVST during the acute phase. All analyses were conducted using SPSS, version 21.0 (IBM). A \u003ci\u003ep \u003c/i\u003evalue \u0026lt;0.05 was considered statistically significant. \u003c/p\u003e"},{"header":"Results","content":"\u003cp class=\"正文\"\u003eA total of 41 patients met the inclusion criteria. The baseline characteristics were shown in Table 1. The mean age was 29.7(5.9 years. All patients were diagnosed with either acute or subacute onset. The median hospital stay was 23 (10.5-33.5) days. Twenty-nine patients developed CVST in puerperium, which was about 2.4 times as many as in pregnancy. The mean time from delivery to symptom onset was eight days, with a range from 1 to 40 days. During pregnancy, CVST was most common during the 1st and 2nd trimester. Only 2 patients had history of hypertension before pregnancy and no patient had diabetes mellitus, cardiac disease, smoking or alcoholism history. Thirteen patients (32%) were diagnosed with gestational hypertension, eleven (27%) were diagnosed with preeclampsia, and four (10%) were diagnosed with eclampsia, diagnosed concurrent with CVST. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eClinical presentations, laboratory, and neuroimaging findings \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eThe most common presenting features were headache (37, 90%), followed by focal neurologic deficits (25, 61%), seizures (24, 59%), visual disorders (15, 37%), and impaired consciousness (12, 29%) (see Table 1). In laboratory examinations, 21 (66%) patients had hyperlipidemia\u003cb\u003e, \u003c/b\u003e20 (49%) had hypoproteinemia, 19 (46%) had anemia, and three (7%) had Hellp syndrome. The median of D-dimer was 1001 (715-2486.5) µg/L, while the D-dimer level in three cases was lower than 500 µg/L. CVST was diagnosed with brain MRI and MRV in 40 patients and DSA in 1 patient. Infarction was noted in 28 (68%) patients and haemorrhage was present in 23 (56%) patients. The parietal lobe (21, 51%) was the most commonly involved on the MRI, followed by the frontal lobe (12, 29%), the occipital lobe(10, 24%), the temporal lobe (5, 12%), the basal ganglia (3, 7%), and the cerebellum (2, 5%). MRV revealed sigmoid sinus (24, 59%), transverse sinus (22, 54%), and superior sagittal sinus (21, 51%) were the most common sinuses to be affected. Twenty-six (63%) patients had more than one venous sinus involvement. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eTreatment and outcome at discharge \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eAll patients received symptom treatment (e.g., treatment for control of seizures and intracranial hypertension, hypertension treatment). Anticoagulation therapy was stared immediately after CVST diagnosis in 37 patients with sufficient low-molecular weight heparin (LMWH) for about two weeks, followed by oral anticoagulant drugs after discharge. Four patients, however, didn’t receive anticoagulation therapy due to concerns of aggravating intracerebral hemorrhage (ICH); one of them received surgery because of a brain midline shift. Forty-one patients were divided into two groups based on mRS scores at discharge. Baseline characteristics of patients in the two groups are showed in Table 2. Twenty-seven (66%) patients had a good outcome (mRS (2) and fourteen (34%) had a poor outcome (mRS (3) at discharge (including two death while still at the hospital). The univariate identified factors related to poor outcome were gestational hypertension, pre-eclampsia, eclampsia, headache, focal neurologic deficits, intracerebral hemorrhage, impaired consciousness, D-dimer level, and anti-coagulation (\u003ci\u003ep\u003c/i\u003e\u0026lt;0.2). ROC curve demonstrated D-dimer was predictive of a poor outcome of CVST, with area under the curve (AUC) of 0.828 (95% CI: 0.703-0.953, \u003ci\u003ep\u003c/i\u003e=0.001) and the cut-off value was 1134 µg/L (sensitivity 85.7%, specificity 74.1%) (Fig.1). Univariate analysis revealed a D-dimer level \u0026gt;1134µg/L was related to poor outcome(26% vs 86%, \u003ci\u003ep\u003c/i\u003e\u0026lt;0.001). Additionally, multivariate analysis revealed a D-dimer level \u0026gt;1134µg/L(OR=18.67, 95% CI: 1.79-194.84) and impaired consciousness (OR=33.85, 95% CI: 3.14-365.45) were independent risk factors of a poor outcome of pregnancy-related CVST (Hosmer-Lemeshow test, \u003ci\u003ep\u003c/i\u003e=0.513 ) (see Table 3). \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eLong-term follow up \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eTwenty-eight (68%) patients underwent long-term interviews, the median follow up time was 3.5 years (range 0.3 to 8.4 years). Twenty-five patients recovered completely without any sequela, one had vision decrease and two had severe disability (mRS=4). Twenty-two (79%) women were afraid of becoming pregnant again, because of the worry about recurrence of CVST. Only three women had multiple pregnancies (six pregnancies, two in each women, but no birth occurred. Two of them chose abortion during early pregnancy due to fear of recurrence of CVST and one had two miscarriage due to low levels of progesterone. One patient had a relapse of CVST three years later after the first incidence of CVST, without finding the specific etiology.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp class=\"正文\"\u003ePregnancy and postpartum are associated with increased risk of CVST because of a hypercoagulable state, increased venous stasis, and endothelial dysfunction [12,13]. Consistent with previous reports, our study showed that CVST was highest in puerperium [10,11]. The possible pathological mechanisms may include postpartum hemorrhage, large loss of body fluid, anemia, postpartum infection, and prolonged bed rest [7,11-13]. The clinical presentation of CVST is extremely variable, depending upon the extent and location of the dural sinus and draining veins involved, collateral circulation, and the effects on intracranial pressure [14]. Headache is the most common symptom reported in 60-90% patients of CVST [15]. Consistent with this, our study also reported headache as the most frequent initial symptom in 37 patients (90%): four among them had an isolated headache without any other symptom. Headache is common in both normal pregnant and puerperium women, but there are some red flags that should draw clinicians’ attention [11], such as a thunderclap headache, changes in headache pattern, and a headache with high blood pressure. Increased serum cholesterol or triglycerides, diluted anemia, and hypoproteinemia are common physiological changes during pregnancy and were not related to the prognosis of CVST in the current study. Sigmoid sinus, transverse sinus and superior sagittal sinus were the most common sites of CVST in general population [16,17], similar to patients in our study during pregnancy or puerperium. \u003c/p\u003e\n\u003cp class=\"正文\"\u003ePrevious studies have reported that the outcome of pregnancy-related CVST is more favorable than other causes that lead to CVST [3] and has a fairly good prognosis when compared with ischemic stroke and intracerebral hemorrhage in pregnancy and puerperium [10,16]. Prognostic factors for CVST in the general population have been suggested to include coma, ICH, seizures, age, and neurological deficits [17,18]. However, the prognostic factors for pregnancy-related CVST are not clear. In the current study, multivariate logistic analysis revealed that D-dimer levels \u0026gt;1134µg/L and impaired consciousness were independent risk factors of poor outcome. D-dimer, a degration product of cross-linked fibrin, is a hypercoagulability marker and could be used in predicting CVST [19,20]. A high D-dimer level is correlated with greater thrombosis extension and severity of CVST [21]. Therefore, monitoring the level of D-dimer is important for assessing the prognosis of CVST. Preeclampsia and eclampsia were the most common factors associated with pregnancy-related ICH and ischemic stroke, but were uncommon in CVST [10]. Our study revealed they were not related to the prognosis of pregnancy-related CVST. LMWH is considered the first choice of treatment in patients with CVST, regardless of the presence of ICH [22]. The optimal duration of anticoagulation is not clear. The American Heart Association(AHA)/American Stroke Association(ASA) advise that sufficient LMWH should be used throughout pregnancy and LMWH or vitamin K antagonists with a target International Normalized Ratio (INR) of two to three should be continued after delivery for at least six months [22,23]. Endovascular thrombolytic therapy should also be considered in patients with poor prognosis [18]. \u003c/p\u003e\n\u003cp class=\"正文\"\u003eTo the best of our knowledge, this is the first study examining the recurrence state of pregnancy-related CVST. Previous studies focused on the impact of CVST in women at childbearing age. Mehraein et al [24] found no recurrence of CVT when following 22 pregnancies and 19 births in 14 women with a history of CVT during childbearing age. Additionally, Aguiar de Sousa et al found CVT recurrence in 3 of 393 individuals (8 per 1000; 95% CI: 3-22) in a systematic review [25]. The result from our long-term interviews demonstrated that most patients took contraceptive measures for the fear of recurrence of CVST and terminated a pregnancy if they became pregnant again. Therefore, only three women had multiple pregnancies (six pregnancies, two in each woman), but no birth occurred. There was only one CVST recurrence in 28 patients, however, it was not pregnancy-related. The current evidence suggests that women with previous venous thrombotic events (VTE) had a very low risk of recurrence, particularly if the previous venous thrombosis was associated with a temporary risk factor (for example, oral contraceptives or fracture induced immobilization) [26]. Risk is increased, however, if a thrombophilia is present or the prior thrombotic event was idiopathic [24]. Therefore, women should be tested for thrombophilia and avoid additional risk factors, if possible [7,11], to reduce the risk of recurrence CVST during subsequent pregnancies. Antithrombotic prophylaxis with LMWH in future pregnancies may be beneficial [25,27]. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eLimittions\u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eThere were also some limitations to our study. First, it was a single hospital-based study, with limited generalisability. Secondly, genetically related factors were not screened, such as mutation in the methylenetetrahydrofolate reductase gene (MTHFR) or Factor V Leiden. However, these patients had no thrombotic events before and no related familial event, so it is not likely that this would be a factor. \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp class=\"正文\"\u003eIn conclusion, as a rare complication during pregnancy or puerperium, CVST could cause severe disability or even death. We found D-dimer levels \u0026gt;1134µg/L and impaired consciousness could predict poor outcomes of pregnancy-related CVST. The subsequent pregnancy rate and CVST relapse rate was low in this Chinese population. Large multicenter cohort studies should be conducted in the future to further study the prognosis of pregnancy-related CVST, which could give physicians more medical evidence when counseling these patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp class=\"正文\"\u003e\u003cb\u003eEthics approval and consent to participate \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eThis study was approved by the Ethics Committee of Affiliated Shengjing Hospital of China Medical Univeristy. Written informed consent was obtained from all patients or the patient’s next-of-kin. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eConsent for publication \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eNot applicable.\u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eAvailability of data and material \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eAll relevant data are included in the manuscript. The individual data in our study cannot be provided in order to protect the participants’ identity. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eCompeting interests \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eThe authors declare that they have no competing interests. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eFunding \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eThe study was supported by the National Natural Science Foundation of China (grant number: 81371271) .\u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eAuthors’ contributions \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eQG collected, analyzed and interpreted the data, as well as drafted the manuscript. CML participated in data collection and statistical analysis. SYC contributed the study design and manuscript writing. All authors read and approval the final manuscript. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e\u003cb\u003eAcknowledgements \u003c/b\u003e\u003c/p\u003e\n\u003cp class=\"正文\"\u003eNot applicable. \u003c/p\u003e"},{"header":"References","content":"\u003cp class=\"正文\"\u003e1. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007; 6:162-170. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e2. Sassi SB, Touati N, Baccouche H, Drissi C, Romdhane NB, Hentati F. Cerebral venous thrombosis: A Tunisian monocenter study on 160 patients. Clin Appi Thromb Hemost. 2017; 23:1005-1009. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e3. Cantú C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke. 1993; 24:1880-1884. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e4. Hovsepian DA, Sriram N, Kamel H, Fink ME, Navi BB. Acute cerebrovascular Disease Occurring after Hospital Discharge for labor and Delivery. 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Stroke. 2011; 42:1158-1192. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e23. Bushnell C, McCullough LD, Award IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45:1545-1588. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e24. Mehraein S, Ortwein H, Busch M, Weih M, Einhäupl K, Masuhr F. Risk of recurrence of cerebral venous and sinus thrombosis during subsequent pregnancy and puerpwrium. J Neurol Neurosurg Psychiatry. 2003; 74:814-816. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e25. Aguiar de Sousa D, Canhão P, Ferro JM. Safety of pregnancy after cerebral venous thrombosis: systematic review update. J Neurol. 2018; 265:211-212. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e26. Brill-Edwards P, Ginsberg JS, Gent M, Hirsh J, Burrows R, Kearon C, et al. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. Recurrence of Clot in This Pregnancy Study Group. N Engl J Med. 2000; 343:1439-1444. \u003c/p\u003e\n\u003cp class=\"正文\"\u003e27. Martinelli I, Passamonti SM, Maino A, Abbattista M, Bucciarelli P, et al. Pregnancy outcome after a first episode of cerebral vein thrombosis. J Thromb Haemost. 2016; 14:2386-2393.\u003c/p\u003e"},{"header":"Tables","content":"\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003cb\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003eTable 1\u003c/span\u003e\u003c/b\u003e\u003cspan style='font-size:\n12.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp; Demographic data, clinical,\nlaboratory and neuroimaging findings of CVT \u003c/span\u003e\u003c/p\u003e\n\n\u003ctable class=MsoNormalTable border=1 cellspacing=0 cellpadding=0\n style='border-collapse:collapse;border:none'\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eCharacteristics\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Data\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:20.55pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:20.55pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eAge (year)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:20.55pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 29.7\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:Symbol'\u003e±\u003c/span\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e5.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:20.55pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:20.55pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eMultiple\n pregnancy(\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:Symbol'\u003e\u0026sup3;\u003c/span\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:20.55pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 20 (49%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:20.55pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:20.55pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eMode of\n onset\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;Acute\u003c/span\u003e\u003c/p\u003e\n \u003cp class=MsoNormal style='text-indent:112.5pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eSubacute\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:20.55pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 17 (41%)\u003c/span\u003e\u003c/p\u003e\n \u003cp class=MsoNormal style='text-indent:.5in;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e24 (59%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003ePregnancy\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n \u0026nbsp;1st trimester\u003c/span\u003e\u003c/p\u003e\n \u003cp class=MsoNormal style='text-indent:112.5pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e2nd\n trimester\u003c/span\u003e\u003c/p\u003e\n \u003cp class=MsoNormal style='text-indent:112.5pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e3rd\n trimester\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 5 (12%)\u003c/span\u003e\u003c/p\u003e\n \u003cp class=MsoNormal style='text-indent:4.5pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 5 (12%)\u003c/span\u003e\u003c/p\u003e\n \u003cp class=MsoNormal style='text-indent:.5in;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e2 (5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:16.8pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003ePuerperium\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n \u003cspan style='color:red'\u003e\u0026nbsp;\u003c/span\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 29 (71%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:16.8pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eHypertension\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 2 (5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:16.8pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eGestational\n hypertension\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 13 (32%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:16.8pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003ePreeclampsia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 11 (27%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:16.8pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eEclampsia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:16.8pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 4 (10%)\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eInitial\n symptom\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;Headache\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 37 (90%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Focal neurologic deficits\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 25 (61%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:.25in;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Epileptic seizure\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 24 (59%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Visual disorder\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 15 (37%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Impaired consciousness\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 12 (29%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eLaboratoty\n examinations\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;Hyperlipidemia\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:.5in;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e21 (66%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Hypoprotein\u003c/span\u003e\u003cspan lang=ZH-CN style='font-size:9.0pt;font-family:SimSun'\u003e\u0026#8224;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:.5in;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e20 (49%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Anemia\u003c/span\u003e\u003cspan lang=ZH-CN style='font-size:9.0pt;font-family:SimSun'\u003e\u0026#8225;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 19 (46%)\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n Hellp syndrome\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:9.0pt;font-family:SimSun'\u003e§\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 3 (7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n D-dimer\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 1001(715,2486.5) \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eNeuroimaging\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n \u0026nbsp;Infarction \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 28 (68%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:117.0pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eHemorrhage\n \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 23 (56%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:117.0pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eSigmoid\n sinus\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 24 (59%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:117.0pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eTransverse\n sinus\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 22 (54%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:117.0pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eSuperior\n sagittal sinus\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 21 (51%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:117.0pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eInferior\n sagittal/straight sinus \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 7 (17%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:17.75pt'\u003e\n \u003ctd width=366 valign=top style='width:274.75pt;border:none;border-bottom:\n solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:17.75pt'\u003e\n \u003cp class=MsoNormal style='text-indent:117.0pt;line-height:normal;layout-grid-mode:\n char'\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eMultiple\n sinus(\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:Symbol'\u003e\u0026sup3;\u003c/span\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=180 valign=top style='width:134.65pt;border:none;border-bottom:\n solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:17.75pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal;layout-grid-mode:char'\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\n 26 (63%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n\u003c/table\u003e\n\n\u003cp class=MsoNormal align=left style='margin-bottom:0in;margin-bottom:.0001pt;\ntext-align:left;line-height:200%;text-autospace:none'\u003e\u003cspan style='font-size:\n12.0pt;line-height:200%;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal align=left style='margin-bottom:0in;margin-bottom:.0001pt;\ntext-align:left;line-height:200%;text-autospace:none'\u003e\u003cspan style='font-size:\n12.0pt;line-height:200%;font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003csup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003e*\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003emissing data(N=9), a total of 32 people\nreceived blood lipid test\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003csup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003e\u0026#8224;\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003ealbumin\u0026lt;25g/L or total protein\u0026lt;60g/L\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003csup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003e\u0026#8225;\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003ehemoglobin concentration \u0026lt;110g/L in\npregnancy\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003csup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003e§\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003ehemolysis, elevated liver enzymes and low\nplatelet count\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan\nclass=apple-converted-space\u003e\u003cb\u003e\u003cspan style='font-size:12.0pt;font-family:\"Times New Roman\",serif'\u003eTable\n2 \u003c/span\u003e\u003c/b\u003e\u003c/span\u003e\u003cspan class=apple-converted-space\u003e\u003cspan style='font-size:\n12.0pt;font-family:\"Times New Roman\",serif'\u003eUnivariate analysis: Prognostic\nfactors associated with outcome at discharge\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\n\u003ctable class=MsoNormalTable border=0 cellspacing=0 cellpadding=0\n style='border-collapse:collapse'\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eVariable \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003emRS\u003c/span\u003e\u003cspan style='font-size:9.0pt;\n font-family:Symbol'\u003e\u0026pound;\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e2(n=27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003emRS≥3(n=14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003ci\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003ep \u003c/span\u003e\u003c/i\u003e\u003cspan style='font-size:\n 9.0pt;font-family:\"Times New Roman\",serif'\u003eValue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eAge\u003c/span\u003e\u003cspan lang=ZH-CN\n style='font-size:9.0pt;font-family:SimSun'\u003e（\u003c/span\u003e\u003cspan style='font-size:\n 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style='line-height:normal'\u003e\u003cspan\n class=apple-converted-space\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003eGestational\n hypertension\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e5/27 (19%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e8/14 (57%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal 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height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e6/14 (43%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.195\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eEclampsia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e1/27 (4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e3/14 (21%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.107\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eSystolic blood pressure \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e132.4\u003c/span\u003e\u003cspan style='font-size:9.0pt;\n font-family:Symbol'\u003e±\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e26.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e143.6\u003c/span\u003e\u003cspan style='font-size:9.0pt;\n font-family:Symbol'\u003e±\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e32.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.249\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eDiastolic blood pressure\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e85.3\u003c/span\u003e\u003cspan style='font-size:9.0pt;\n font-family:Symbol'\u003e±\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e19.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e92.9\u003c/span\u003e\u003cspan style='font-size:9.0pt;\n font-family:Symbol'\u003e±\u003c/span\u003e\u003cspan style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e22.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.262\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003ePuerperium\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e21/27 (78%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e8/14 (57%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.310\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eHeadache\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e26/27 (96%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e11/14 (79%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.107\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eSeizure\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e15/27 (56%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e9/14 (64%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.591\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eVisual disorder\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e9/27 (33%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e6/14 (43%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.548\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eFocal neurologic deficits\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e13/27 (48%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e12/14 (86%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.019\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eImpaired consciousness\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e2/27 (7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e10/14 (71%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eHyperlipidemia\u003csup\u003e*\u003cb\u003e \u003c/b\u003e\u003c/sup\u003e\u003cb\u003e\u0026nbsp;\u0026nbsp;\u003c/b\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e15/24 (63%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e6/8 (75%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.830\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eAnemia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e11/27 (41%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e8/14 (57%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.318\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eHypoprotein\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e14/27 (52%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e6/14 (43%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.585\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eHellp syndrome\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e1/27(4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e2/14 (14%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.265\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eD-dimer\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e800 (692,1541)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e2186.5 (1177,5492)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eIntracerebral hemorrhage \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e11/27 (41%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e12/14 (86%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.006\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eMultiple sinus(\u003c/span\u003e\u003cspan\n style='font-size:9.0pt;font-family:Symbol'\u003e\u0026sup3;\u003c/span\u003e\u003cspan style='font-size:\n 9.0pt;font-family:\"Times New Roman\",serif'\u003e2) \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e17/27 (63%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e9/14 (64%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;padding:0in 5.4pt 0in 5.4pt;\n height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.934\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style='height:22.7pt'\u003e\n \u003ctd width=162 valign=top style='width:121.5pt;border:none;border-bottom:solid windowtext 1.5pt;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eAnti-coagulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=145 valign=top style='width:108.85pt;border:none;border-bottom:\n solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e26/27 (96%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=135 valign=top style='width:101.5pt;border:none;border-bottom:solid windowtext 1.5pt;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e11/14 (79%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=126 valign=top style='width:94.25pt;border:none;border-bottom:solid windowtext 1.5pt;\n padding:0in 5.4pt 0in 5.4pt;height:22.7pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e0.107\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n\u003c/table\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003csup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003e*\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003emissing data(N=9), a total of 32 people\nreceived blood lipid test\u003c/span\u003e\u003c/p\u003e\n\n\u003cp class=MsoNormal style='line-height:normal'\u003e\u003cb\u003e\u003cspan style='font-size:12.0pt;\nfont-family:\"Times New Roman\",serif'\u003eTable 3 \u003c/span\u003e\u003c/b\u003e\u003cspan style='font-size:\n12.0pt;font-family:\"Times New Roman\",serif'\u003eindependent predictors for poor\noutcome of CVT during pregnancy and puerperium\u003c/span\u003e\u003c/p\u003e\n\n\u003ctable class=MsoNormalTable border=1 cellspacing=0 cellpadding=0\n style='border-collapse:collapse;border:none'\u003e\n \u003ctr style='height:26.2pt'\u003e\n \u003ctd width=158 valign=top style='width:1.65in;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:26.2pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=95 valign=top style='width:70.9pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:26.2pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eExp(B)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=189 valign=top style='width:141.75pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:26.2pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eRegression coefficient(95%CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=113 valign=top style='width:85.05pt;border-top:solid windowtext 1.5pt;\n border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;\n padding:0in 5.4pt 0in 5.4pt;height:26.2pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003ci\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003e\u0026nbsp;P \u003c/span\u003e\u003c/i\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=158 valign=top style='width:1.65in;border:none;padding:0in 5.4pt 0in 5.4pt'\u003e\n \u003cp class=MsoNormal style='line-height:normal'\u003e\u003cspan style='font-size:9.0pt;\n font-family:\"Times New Roman\",serif'\u003eD-dimer\u0026gt;1134\u003c/span\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New Roman\",serif'\u003e\u0026micro;\u003c/span\u003e\u003cspan\n style='font-size:9.0pt;font-family:\"Times New 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Headache, D-dimer","lastPublishedDoi":"10.21203/rs.2.111/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.111/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\n\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cerebral venous sinus thrombosis (CVST) is a rare and serious complication during pregnancy and puerperium with a variety of clinical features. Little is known about the prognostic factors of CVST during the acute phase, subsequent pregnancy outcomes, and the risk of recurrence of CVST. The purpose of the study is to investigate the clinical features and prognosis of pregnancy-related CVST in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We retrospectively analyzed the clinical data of 41 patients diagnosed with CVST during pregnancy or puerperium from January 2007 through March 2018 in Shengjing Hospital. Poor outcome was defined as modified Rankin Scale (mRS) ³3 at discharge. Independent prognostic factors for CVST outcome were identified via multivariate logistic regression analysis. Long-term outpatient interview was followed to know the next pregnancies outcome and CVST relapse rate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e CVST occurred about 2.4 times (29 vs. 12) during puerperium than in pregnancy. Headache (90%) was found the most common clinical feature, followed by focal neurologic deficits (61%), seizure (59%), visual disorder (37%) and impaired consciousness (29%). The multivariate analysis revealed D-dimer levels \u0026gt;1134 µg/L (OR=18.67, 95% CI:1.79-194.84) and impaired consciousness (OR=33.85, 95% CI: 3.14-365.45) were independent prognostic factors of a poor outcome during acute phase. Twenty-eight (68%) patients underwent a long-term interview. Only three women had multiple pregnancies (six pregnancies, two in each women), but no birth occurred from these. One patient had a relapse of CVST three years later, which had no relationship with pregnancy or puerperium.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e CVST occurred mostly during puerperium. D-dimer levels \u0026gt;1134µg/L and impaired consciousness could predict poor outcomes of pregnancy-related CVST. The subsequent pregnancy rate and CVST relapse rate was low in this Chinese population.\u003c/p\u003e","manuscriptTitle":"Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2018-12-19 12:10:34","doi":"10.21203/rs.2.111/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3f15dc1-c11d-4cc2-988c-f8f7bb7d18f6","owner":[],"postedDate":"December 19th, 2018","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":273,"name":"Internal Medicine Specialties"}],"tags":[],"updatedAt":"","versionOfRecord":[],"versionCreatedAt":"2018-12-19 12:10:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-111","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-111","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}