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Ellwood SJ, Mootz AA, Carabuena JM, Farber MK, Reale SC. Management of sporadic intracranial vascular malformations in pregnancy: a retrospective analysis. Int J Obstet Anesth 2024; 58:103989. [PMID: 38614896 DOI: 10.1016/j.ijoa.2024.103989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Sporadic intracranial vascular malformations can pose significant risk to parturients, and additional reports of management may inform patient care. Here we describe the peripartum management of parturients with intracranial vascular malformations. METHODS After Institutional Review Board approval, we performed a retrospective analysis of parturients with a known sporadic intracranial vascular malformation including cavernous malformation, developmental venous anomaly, or arteriovenous malformation who delivered at our institution between 2007 and 2020. RESULTS We identified 10 parturients (five cavernous malformations, three developmental venous anomalies, and two arteriovenous malformations) with 16 deliveries. Among all deliveries, 13 (81.3%) were cesarean deliveries without trial of labor; 11 of these (84.6%) received a single-shot spinal and two (15.4%) received an epidural for surgical anesthesia. Two deliveries (12.5%) began with attempted trial of labor but ultimately required cesarean delivery for failure to progress; one of these cases received epidural anesthesia and the other received combined spinal-epidural anesthesia. One delivery was via spontaneous vaginal delivery with epidural analgesia. Overall, our study's cesarean delivery rate was 93.8% and spontaneous vaginal delivery rate was 6.2%. Three of 16 pregnancies were complicated by seizure, obstructive hydrocephalus, or intracranial hemorrhage. There were no intensive care unit admissions or maternal deaths. CONCLUSIONS In our case series of 16 deliveries, there were no complications directly resulting from neuraxial procedures. It remains unclear whether intracranial developmental venous anomalies or unruptured arteriovenous malformations impart increased risk during pregnancy. Antepartum planning with a multidisciplinary team approach enables risk stratification and optimal management.
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Affiliation(s)
- S J Ellwood
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
| | - A A Mootz
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - J M Carabuena
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - M K Farber
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - S C Reale
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Findlay MC, Kim RB, Putnam AR, Couldwell WT. Management of Symptomatic Hemorrhage From a Developmental Venous Anomaly. Cureus 2024; 16:e58130. [PMID: 38738135 PMCID: PMC11088928 DOI: 10.7759/cureus.58130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/14/2024] Open
Abstract
Developmental venous anomalies (DVAs) are clinically benign, low-flow vascular malformations that classically hemorrhage only when associated with a cerebral cavernous malformation. It is very rare for an isolated DVA to hemorrhage. Resection of the DVA is generally contraindicated because of the high risk of venous infarct. We present the case of a large symptomatic hemorrhage stemming from an isolated DVA. The hematoma was evacuated and the hemorrhagic portion of the DVA was resected. This case demonstrates that in rare circumstances, careful resection can successfully treat hemorrhagic DVAs.
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Affiliation(s)
| | - Robert B Kim
- Department of Neurosurgery, University of Utah, Salt Lake City, USA
| | | | - William T Couldwell
- Department of Neurosurgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, USA
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Popa SL, Barsan M, Caziuc A, Pop C, Muresan L, Popa LC, Perju-Dumbrava L. Life-threatening complications of hyperemesis gravidarum. Exp Ther Med 2021; 21:642. [PMID: 33968173 PMCID: PMC8097228 DOI: 10.3892/etm.2021.10074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Hyperemesis gravidarum (HG) refers to severe nausea and emesis noted during pregnancy. However, no consensus exists on the specific diagnostic criteria that can be used for this condition. The aim of the present systematic review was to summarize the available evidence regarding the severe complications observed during HG with a heightened risk of fatality. A systematic search was conducted on PubMed, Cochrane Library, EMBASE and WILEY databases for the relevant publications regarding the severe and life-threatening complications of HG. The search terms were as follows: '(Hyperemesis gravidarum)' AND ('complications' OR 'severe' OR 'adverse pregnancy outcomes' OR 'stroke' OR 'seizures' OR 'Wernicke's encephalopathy' OR 'arrhythmias' OR 'pneumomediastinum' OR 'coagulopathy' OR 'electrolytic imbalance'). Abstracts, conference presentations, letters to the editor, studies written in languages other than English and editorials were all excluded. This search identified 43 studies analyzing life-threatening complications of HG, of which 11, seven, eight and 17 articles analyzed neurological, cardiovascular, thoracic and systemic complications, respectively. Reports on life-threatening complications were exceptionally rare in HG. The most frequent severe complications noted were Wernicke's encephalopathy, electrolyte imbalance and vitamin K deficiency. The low mortality rate for patients with HG over the last decade could be explained by the high efficiency of modern therapy, and the precise management of every complication according to current guidelines.
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Affiliation(s)
- Stefan L Popa
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Maria Barsan
- Department of Occupational Health, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Alexandra Caziuc
- Department of Surgery, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Cristina Pop
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400349, Romania
| | - Lucian Muresan
- Department of Cardiology, 'Emile Muller' Hospital, Mulhouse, 68200 Mulhouse, France
| | - Luminita Celia Popa
- Department of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Romania
| | - Lacramioara Perju-Dumbrava
- Department of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Romania
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Kurt G, Aslan A, Kara E, Erol G, Şahin MB, Uçar M. Different Aspects on Clinical Presentation of Developmental Venous Anomalies: Are They as Benign as Known? A Single Center Experience. Clin Neurol Neurosurg 2020; 201:106443. [PMID: 33388660 DOI: 10.1016/j.clineuro.2020.106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebral developmental venous anomalies (DVAs) are frequently diagnosed incidentally owing to the advances in neuroimaging. They are regarded as clinically insignificant due to their supposed quiescent existence which the authors aimed to contradict in this paper. AIM In the aim of constituting a better understanding of clinical presentation of DVAs and making an estimation regarding the probability of resulting in a hemorrhage, the authors presented their experiences with a case series of DVAs. METHODS A retrospective analysis was carried out among patients who underwent brain MRI in a radiology department of a university between January of 2019 and January of 2020. RESULTS A total of 101 patients with DVA were extracted. 38 patients had isolated DVAs, while 63 patients had various accompanying cerebral pathologies, mostly cavernomas (39 patients) and AVMs (11 patients). The main complaints leading investigation were headache, dizziness, ataxia, nausea\vomiting, seizures and focal neurological deficits. 41 patients were truly symptomatic with indicative findings of seizures, neurological deficits or intracranial hemorrhages, and 12 of them had solitary DVAs. 22 patients presented with hemorrhages, and of them, 10 had only DVA, while the rest had some associated lesions, most often cavernoma. Of 22 patients with hemorrhage, 5 were operated, 5 were applied radiosurgery; while the rest were followed without any intervention. CONCLUSION Although the symptoms in patients with DVA are generally charged on other associated pathologies, the fact that isolated DVAs may occasionally be problematic in the range of minor symptoms and severe hemorrhage should not be underestimated.
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Affiliation(s)
- Gökhan Kurt
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayfer Aslan
- Department of Neurosurgery, Faculty of Medicine Hitit University, Çorum, Turkey.
| | - Enes Kara
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gökberk Erol
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Merve Büke Şahin
- Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Uçar
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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Nonaka Y, Yasuda S, Kumagai N, Kakino Y, Nakagawa J, Takenaka K. Successful Cesarean Section Deliveries in a Patient with a History of Developmental Venous Anomaly-Induced Hemorrhage. J Stroke Cerebrovasc Dis 2019; 28:104461. [PMID: 31662240 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/21/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022] Open
Abstract
While hemorrhage can occur because of developmental venous anomalies (DVAs), there is no established opinion concerning their association with pregnancy and childbirth. In the present report, we discuss the case of a now 39-year-old woman with DVA in whom pregnancy and childbirth were successful. When she was 28, she experienced disturbance of consciousness and paralysis on the left side of the body, and brain computed tomography revealed cerebral hemorrhage coupled with subarachnoid hemorrhage. Cerebral angiography revealed a DVA with an arteriovenous shunt, with superficial drainage surrounding the hematoma. No associated cavernous hemangiomas were observed, and the patient was diagnosed with DVA-induced hemorrhage and treated via conservative therapy. Later, at the ages of 32 and 35, she gave birth via Caesarean section under general anesthesia. At the age of 37, she experienced sudden headache and nausea, following which she was again diagnosed with DVA-induced hemorrhage. Fortunately, she experienced no exacerbation of symptoms such as paralysis. However, she currently has mild, residual paralysis on the left side of the body, and she regularly walks to the hospital using a cane for follow-up examinations.
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Affiliation(s)
- Yuko Nonaka
- Department of Neurosurgery, Japanese Red Cross Takayama Hospital, Takayama, Gifu, Japan.
| | - Shoji Yasuda
- Department of Neurosurgery, Japanese Red Cross Takayama Hospital, Takayama, Gifu, Japan
| | - Nobutoshi Kumagai
- Department of Neurosurgery, Japanese Red Cross Takayama Hospital, Takayama, Gifu, Japan
| | - Yoshinori Kakino
- Department of Emergency Medicine, Japanese Red Cross Takayama Hospital, Takayama, Gifu, Japan
| | - Jiro Nakagawa
- Department of Neurosurgery, Japanese Red Cross Takayama Hospital, Takayama, Gifu, Japan
| | - Katsunobu Takenaka
- Department of Neurosurgery, Japanese Red Cross Takayama Hospital, Takayama, Gifu, Japan
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Zhang NN, Zhao KT, Zhao ZA, Chen WL, Xu HB, Chen HS. A novel rat model of cerebral artery occlusion complicated with prior venous stagnation. J Neurosci Methods 2019; 318:100-103. [PMID: 30703390 DOI: 10.1016/j.jneumeth.2019.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND To establish a novel rat model of middle cerebral artery occlusion (MCAO) complicated with prior venous stagnation, and to investigate the role of cerebral venous drainage in neural injury after acute cerebral infarction. NEW METHOD Eighteen SD rats were randomly divided into two groups: control group and jugular vein ligation group. The left jugular vein ligation was performed to produce the jugular venous stagnation. In the control group, the jugular vein was exposed but not ligated. Cerebral blood flow (CBF) was measured through laser speckle imaging before and after the surgery. At 1 week after the surgery, CBF was again measured and then a left MCAO was performed in both groups. At 24 h after MCAO, neurological deficit scoring was performed and the infarct volume was measured by 2,3,5-triphenyltetrazolium chloride staining. RESULTS Compared with the control group, a significant decrease in the CBF level was observed immediately after the ligation. A moderate recovery in CBF level was observed at 1 week after the ligation. The neurological deficit scores were significantly higher in the ligation group than in the control group at 24 h after the MCAO. Additionally, the volume of cerebral infarction increased significantly in the ligation group compared with that in the control group at the 24 h after MCAO. COMPARISON WITH EXISTING METHOD(S) AND CONCLUSIONS The novel rat model of cerebral artery occlusion complicated with long-term unilateral venous stagnation indicates cerebral venous drainage impairment may aggravate behavioral impairment and increase infarct volume after cerebral infarction.
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Affiliation(s)
- Nan-Nan Zhang
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang, 110840, PR China
| | - Kai-Tao Zhao
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang, 110840, PR China
| | - Zi-Ai Zhao
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang, 110840, PR China
| | - Wan-Li Chen
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang, 110840, PR China
| | - Hai-Bin Xu
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang, 110840, PR China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang, 110840, PR China.
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Entezami P, Boulos A, Yamamoto J, Adamo M. Paediatric presentation of intracranial haemorrhage due to thrombosis of a developmental venous anomaly. BMJ Case Rep 2019; 12:12/1/bcr-2018-227362. [PMID: 30659007 DOI: 10.1136/bcr-2018-227362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Developmental venous anomalies (DVAs) are the most commonly encountered cerebral malformations. While generally asymptomatic and discovered as incidental findings, there is a small number that can cause intracranial haemorrhage, usually attributed to associated cavernomas; however, venous thrombosis of the draining vein is a rare cause. A 10-year-old woman presented with seizure episodes. Angiographic evaluation revealed a collection of vessels draining into the superior sagittal sinus via the vein of Trolard, concerning for a DVA. The patient improved clinically with supportive care and antiepileptic treatment. Anatomically, DVAs represent dysplasia of primary capillary beds and smaller cerebral veins, resulting in abnormal venous drainage of the affected parenchyma. Several distinguishing radiological findings can help differentiate a DVA from other pathologies. Early radiological identification can help in the initiation of appropriate therapy and prevent incorrect surgical management leading to further neurological demise.
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Affiliation(s)
- Pouya Entezami
- Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Alan Boulos
- Neurosurgery, Albany Medical Center, Albany, New York, USA
| | | | - Matthew Adamo
- Neurosurgery, Albany Medical Center, Albany, New York, USA
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Kang K, Ju Y, Wang D, Li H, Sun L, Ma K, Zhao X, Lu J. Cerebral Venous Malformations in a Chinese Population: Clinical Manifestations, Radiological Characteristics, and Long-Term Prognosis. World Neurosurg 2018; 120:e472-e479. [PMID: 30149153 DOI: 10.1016/j.wneu.2018.08.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We elucidated the clinical and radiological characteristics and analyzed the risk factors for hemorrhage and poor outcomes of cerebral venous malformations (CVMs) in a northern Chinese population. METHODS We included 60 consecutive patients with CVM patients in Beijing Tiantan Hospital from January 2011 to February 2018. The clinical manifestations, radiological characteristics, management, and outcomes were elucidated and analyzed. The patients were followed up for 5-64 months (median, 26). Poor outcomes included repeat bleeding, secondary infarction, severe disability (modified Rankin scale score ≥3), and death. RESULTS Infratentorial CVMs were more prone to intracranial hemorrhage (75% vs. 28.6%; P < 0.001), dizziness (37.5% vs. 10.7%; P = 0.017), and focal neurological deficits (65.6% vs. 25%; P = 0.002) than were supratentorial CVMs. Supratentorial CVMs were more prone to seizure (32.1% vs. 0%; P = 0.001) than were infratentorial CVMs. Multivariate logistic regression revealed that the major risk factors for intracranial hemorrhage in CVMs were infratentorial lesions (P = 0.003) and complicated cavernous angiomas (P = 0.016). Compared with conservative treatment, resection of hematoma or cavernous angiomas with CVM preservation did not increase the risk of poor outcomes (P = 0.646). However, CVM resection significantly increased that risk (odds ratio, 44.0; P = 0.003). CONCLUSIONS Our results have shown that conservative treatment of CVMs results in a relatively good prognosis. For those complicated by hemorrhage or cavernous angiomas requiring surgical interventions, the integrity of the CVM should be preserved, irrespective of the treatment. In exceptional cases, before CVM resection, the CVM drainage should be comprehensively evaluated.
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Affiliation(s)
- Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dandan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Huan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liqian Sun
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kaiqiang Ma
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
| | - Jingjing Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Monique B, Sandra C, Marie-Cécile HF, Jean-Pierre L. Serial imaging and SWAN sequence of developmental venous anomaly thrombosis with hematoma: Diagnosis and follow-up. J Clin Neurosci 2017. [PMID: 28624141 DOI: 10.1016/j.jocn.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Developmental venous anomalies (DVAs) are usually asymptomatic. We report a case of DVA thrombosis with recurrent tiny frontal hematoma in a 24-year-old man. The contribution of T2-GRE and SWAN sequences are discussed. Follow-up attested complete recanalization after anticoagulation.
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Affiliation(s)
- Boukobza Monique
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, 75018, France.
| | - Calvez Sandra
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | - Laissy Jean-Pierre
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France
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Agarwal N, Zuccoli G, Murdoch G, Jankowitz BT, Greene S. Developmental venous anomaly presenting as a spontaneous intraparenchymal hematoma without thrombosis. Neuroradiol J 2016; 29:465-469. [PMID: 27613246 DOI: 10.1177/1971400916665387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Developmental venous anomalies (DVAs) are cited as the most common cerebral vascular malformations. Still, intracerebral hematomas are rarely thought to be caused by DVAs. In this report, the authors present a unique case of a DVA that hemorrhaged spontaneously, rather than hemorrhaging into a venous infarction following DVA thrombosis as has been more commonly reported. CLINICAL PRESENTATION A 22-year-old previously healthy male presented to the emergency department with a severe headache, confusion, and progressive hemiparesis. A computed tomography (CT) scan demonstrated a spontaneous left parietal intraparenchymal hemorrhage (IPH), with intraventricular extension and acute hydrocephalus. CT angiography did not demonstrate an underlying vascular malformation. The patient was taken emergently to the operating room for a left parietal craniotomy for evacuation of the hematoma. Intraoperative pathology was consistent with a DVA Postoperative magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) did not demonstrate a mass lesion, ischemic stroke, or underlying vascular malformation. An MRI obtained three years previously for headaches was normal. A postoperative diagnostic cerebral angiogram was normal. An MRI/MRA performed six months postoperatively demonstrated two foci of abnormal vessels on susceptibility-weighted imaging (SWI), suggesting the presence of a venous vascular malformation. A diagnostic cerebral angiogram obtained six months postoperatively was again normal, including delayed imaging. CONCLUSION Few reports have cited DVA as the sole cause of intracerebral hemorrhage. While very rare, these reports suggest hemorrhagic conversion of a venous infarction secondary to a thrombosed DVA as a possible etiology, and several provide imaging consistent with this diagnosis. This case study demonstrates a unique presentation of a hemorrhagic DVA in the absence of thrombosis or stroke.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
| | - Giulio Zuccoli
- Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, USA
| | - Geoffrey Murdoch
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Brian T Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, USA
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