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Ventura F, Drommi M, Barranco R, Vellone VG. Sudden death in a newborn from cerebral venous sinus thrombosis resulting from meningitis. Med Leg J 2024:258172241250193. [PMID: 39075857 DOI: 10.1177/00258172241250193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Septic cerebral venous sinus thrombosis is a rare but often fatal complication caused by bacterial meningitis and paranasal sinusitis.We report a particular case of the sudden and unexpected death of a six-day-old infant from unrecognised acute meningitis that caused a thrombotic occlusion of the venous sinuses (with the particular involvement of the torcular Herophili at the confluence of sinuses) resulting in subdural haemorrhage.This case report alerts paediatricians and neonatologists to the importance of promptly considering a possible diagnosis of meningitis without delay to avoid the fatal complications described here. As in all cases of sudden infant death our case study underlines the need for a thorough autopsy, accompanied by histological analysis, in order to identify the causes of the underlying pathological mechanisms causing death and to ensure an adequate differential diagnosis.
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Affiliation(s)
- Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Italy
- Legal Medicine Unit, IRCCS-Ospedale Policlinico San Martino Teaching Hospital, Genova, Italy
| | - Martina Drommi
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Valerio G Vellone
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Italy
- Fetal and Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Ordieres-Ortega L, Moragón-Ledesma S, Demelo-Rodríguez P. Cerebral venous thrombosis. Rev Clin Esp 2024; 224:237-244. [PMID: 38428733 DOI: 10.1016/j.rceng.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Cerebral venous thrombosis is part of the so-called thrombosis in unusual sites. It is defined as an occlusion in the cerebral venous territory. Its incidence is progressively increasing, especially in developing countries. It is more frequently observed in young women, with hormonal factors such as pregnancy or hormonal contraception being significant risk factors in the development of this condition. The clinical presentation will depend fundamentally on the topography of the thrombosis, with a confirmatory diagnosis based mainly on imaging tests. The treatment generally consists of anticoagulation, and other options may be considered depending on the severity of the case. Overall, the prognosis is better than that of other intracranial vascular disorders. This review describes the current evidence available regarding cerebral venous thrombosis.
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Affiliation(s)
- L Ordieres-Ortega
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - S Moragón-Ledesma
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - P Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Spain.
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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente-Fernández L, de la Torre-Colmenero JD, Tejada Meza H, Vesperinas-Castro A, Sánchez-Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2024; 39:226-234. [PMID: 37442428 DOI: 10.1016/j.nrleng.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/22/2021] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P = .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain.
| | | | | | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, Spain
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | | | | | - L Llul
- Hospital Clínic, Barcelona, Spain
| | - J Egido
- Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, Spain
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Calva-González M, Tello-Gerez TJ, Serrano-Arias F, Cano-Nigenda V, Ramírez-Bermúdez J. The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia. J Psychiatr Pract 2023; 29:493-498. [PMID: 37948175 DOI: 10.1097/pra.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
We report a patient with cerebral venous thrombosis who initially presented with psychosis and who then progressed to delirium and catatonia within a few days. Upon treatment and resolution of the thrombosis, she presented complete remission of the psychiatric disturbances. This case highlights a specific neuropsychiatric presentation of cerebral venous thrombosis involving psychosis, catatonia, and delirium, which, to our best knowledge, has not been reported in the neurological or psychiatric literature. However, it reminds us of mental status and behavioral abnormalities which are not infrequent features of cerebral venous thrombosis. This leads to a discussion regarding the psychopathology, etiology, and pathophysiology of the case.
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Mirza AM, Kulkarni GB, Ramakrishnan S, Mustare V, Yadav R, Gupta AK. Profile and Outcome of Prospective Non-Septic Lateral Sinus Thrombosis Patients from a Stroke Unit of a Developing Country. Neurol India 2023; 71:916-922. [PMID: 37929427 DOI: 10.4103/0028-3886.388114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Due to effective treatment of middle ear infections there is a change in etiologies causing lateral sinus thrombosis (LST) and outcome. There is a paucity of literature describing homogenous group of patients with nonseptic LST (NS-LST). Objective To describe the clinical profile, risk factors, outcome of patients of NS-LST seen at a single center from South India. Methods and Materials Prospective, observational study of 100 patients of NS-LST patients, diagnosed by magnetic resonance imaging (MRI) seen at the stroke unit. Results During 2 years, 100 patients of NS-LST (isolated: combined: 27:73) (male: female: 44:56), mean age: 31.45 ± 11.13 years, were seen. Subacute presentation (74%) with headache, seizures, focal deficits, and features of raised intracranial pressure were presenting features. Hyperhomocysteinemia (61%), anemia (57%), postpartum state (41%), OCP use (37%), and low VitB12 (32%) were commonly seen risk factors. Imaging with MRI compared withcomputerized tomography (CT) had better diagnostic sensitivity (100% vs. 67%), detection of parenchymal (81% vs. 67%)/hemorrhagic (79% vs. 74%) lesions, and cortical vein thrombosis (31% vs. 15.46%). Treatment with anticoagulation and supportive therapy resulted in good outcome (mRS (0-2)) at 3 months in 81%.There were four deaths, all during admission (one - isolated, three - combined) and 11 patients underwent decompressive surgery. Patients with low GCS level of sensoriumat admission, hemiparesis, combined LST, cerebellar involvement, and decompressive craniectomy had a poor outcome. Conclusion This single-center large cohort study of NS-LST patients brings out the clinical features, risk factors (peculiar to developing countries), and the superiority of MRI in the diagnosis. Majority of patients have good outcome, with low mortality with 10% requiring decompressive surgery.
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Affiliation(s)
- Abbas M Mirza
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Arun K Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
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Ruiz AM, Acelas GE, Patiño HM, Vergara JP, Silva MA, Camargo MD. Characteristics of cerebral venous thrombosis in patients from two university hospitals in Colombia between 2018-2020. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:213-221. [PMID: 37433161 PMCID: PMC10532268 DOI: 10.7705/biomedica.6877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Cerebral venous thrombosis is an uncommon cause of cerebrovascular disease, which has been increasing worldwide. In Colombia, there are not enough recent studies that allow us to determine epidemiological characteristics of the disease in our population to identify more frequent risk factors and complications according to our living conditions. OBJETIVE To describe clinical, demographic, and radiographic characteristics, and risk factors in a cohort of patients with cerebral venous thrombosis attended at two hospitals in Colombia. MATERIALS AND METHODS Retrospective descriptive study with patients treated in the hospitalization neurology service of two hospitals in Bogotá, Colombia from December 2018 to December 2020. RESULTS Thirty-three patients were included. There was a higher incidence of cerebral venous thrombosis in women of childbearing age in the puerperium (n=7; 33.3%) and associated with autoimmune diseases (n=10; 30.3%). The most common initial symptom was headache (n=31; 93.9 %), followed by neurological focal signs (n=9; 27.2%) and seizures (n=8; 24.2%). Fifty-one percent (n=17) of the patients had a normal physical examination. Cerebral venous infarction occurred in 21.1 % (n=7), subarachnoid hemorrhage in 12.1 % (n=4), and intraparenchymal hematoma in 9 % (n=3) of all the patients. Sixty-point six percent (n=20) of the patients had a total independent Barthel functional scale. None of those died. CONCLUSIONS We found similar sociodemographic, clinical, and radiography characteristics to those reported in the world literature. Regarding the differences, deep cerebral venous circulation was higher than that described in previous studies but without complications increase or mortality.
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Affiliation(s)
| | - Gabriel Esteban Acelas
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C..
| | - Hernán Mauricio Patiño
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia; Sección Neurología, Hospital Universitario San José Infantil, Bogotá, D. C., Colombia.
| | - Jean Paul Vergara
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
| | - Miguel Arturo Silva
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
| | - María Daniela Camargo
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C..
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Pin JN, Leonardi L, Nosadini M, Pelizza MF, Capato L, Piretti L, Cavicchiolo ME, Simioni P, Baraldi E, Perilongo G, Luciani M, Sartori S. Deep Medullary Vein Thrombosis in Newborns: A Systematic Literature Review. Neonatology 2023; 120:539-547. [PMID: 37379822 DOI: 10.1159/000530647] [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: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Deep medullary vein (DMV) thrombosis is a rare cause of brain damage in both preterm and full-term neonates. In this study, we aimed to collect data on clinical and radiological presentation, treatment, and outcome of neonatal DMV thrombosis. METHODS Systematic literature review on neonatal DMV thrombosis was carried out in PubMed, ClinicalTrial.gov, Scopus, and Web of Science up to December 2022. RESULTS Seventy-five published cases of DMV thrombosis were identified and analysed (preterm newborns were 46%). Neonatal distress, respiratory resuscitation, or need for inotropes were present in 34/75 (45%) of patients. Signs and symptoms at presentation included seizures (38/75, 48%), apnoea (27/75, 36%), lethargy or irritability (26/75, 35%). At magnetic resonance imaging (MRI), fan-shaped linear T2 hypointense lesions were documented in all cases. All had ischaemic injuries, most often involving the frontal (62/74, 84%) and parietal lobes (56/74, 76%). Signs of haemorrhagic infarction were present in 53/54 (98%). Antithrombotic treatment was not mentioned in any of the studies included. Although mortality was low (2/75, 2.6%), a large proportion of patients developed neurological sequelae (intellectual disability in 19/51 [37%] and epilepsy in 9/51 [18%] cases). CONCLUSIONS DMV thrombosis is rarely identified in the literature, even if it is possibly under-recognized or under-reported. Presentation in neonatal age is with seizures and non-specific systemic signs/symptoms that often cause diagnostic delay, despite the pathognomonic MRI picture. The high rate of morbidity, which determines significant social and health costs, requires further in-depth studies aimed at earlier diagnosis and evidence-based prevention and therapeutic strategies.
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Affiliation(s)
- Jacopo Norberto Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Letizia Leonardi
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza,", Padua, Italy
| | - Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Capato
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Piretti
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University Hospital of Padua, Padua, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Giorgio Perilongo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Matteo Luciani
- Department of Paediatric Hematology Oncology, Bambino Gesù Children Hospital IRCSS, Roma, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza,", Padua, Italy
- Department of Neuroscience, University Hospital of Padua, Padua, Italy
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Zhang B, Wu H, Kim H, Welch PJ, Cornett A, Stocker G, Nogueira RG, Kim J, Owens G, Dayton PA, Xu Z, Shi C, Jiang X. A Model of High-Speed Endovascular Sonothrombolysis with Vortex Ultrasound-Induced Shear Stress to Treat Cerebral Venous Sinus Thrombosis. RESEARCH (WASHINGTON, D.C.) 2023; 6:0048. [PMID: 37040522 PMCID: PMC10078321 DOI: 10.34133/research.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
This research aims to demonstrate a novel vortex ultrasound enabled endovascular thrombolysis method designed for treating cerebral venous sinus thrombosis (CVST). This is a topic of substantial importance since current treatment modalities for CVST still fail in as many as 20% to 40% of the cases, and the incidence of CVST has increased since the outbreak of the coronavirus disease 2019 pandemic. Compared with conventional anticoagulant or thrombolytic drugs, sonothrombolysis has the potential to remarkably shorten the required treatment time owing to the direct clot targeting with acoustic waves. However, previously reported strategies for sonothrombolysis have not demonstrated clinically meaningful outcomes (e.g., recanalization within 30 min) in treating large, completely occluded veins or arteries. Here, we demonstrated a new vortex ultrasound technique for endovascular sonothrombolysis utilizing wave-matter interaction-induced shear stress to enhance the lytic rate substantially. Our in vitro experiment showed that the lytic rate was increased by at least 64.3% compared with the nonvortex endovascular ultrasound treatment. A 3.1-g, 7.5-cm-long, completely occluded in vitro 3-dimensional model of acute CVST was fully recanalized within 8 min with a record-high lytic rate of 237.5 mg/min for acute bovine clot in vitro. Furthermore, we confirmed that the vortex ultrasound causes no vessel wall damage over ex vivo canine veins. This vortex ultrasound thrombolysis technique potentially presents a new life-saving tool for severe CVST cases that cannot be efficaciously treated using existing therapies.
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Affiliation(s)
- Bohua Zhang
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Huaiyu Wu
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Howuk Kim
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
- Department of Mechanical Engineering, Inha University, Incheon, Republic of Korea
| | - Phoebe J. Welch
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ashley Cornett
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Greyson Stocker
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Raul G. Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jinwook Kim
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
| | - Gabe Owens
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Paul A. Dayton
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Chengzhi Shi
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Xiaoning Jiang
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
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Neonatal Cerebral Sinovenous Thrombosis and the Main Perinatal Risk Factors—A Retrospective Unicentric Study. CHILDREN 2022; 9:children9081182. [PMID: 36010072 PMCID: PMC9406898 DOI: 10.3390/children9081182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Neonatal cerebral sinovenous thrombosis (CSVT) is a rare disorder, associated with long-term neurological sequelae. The aim of this study was to retrospectively evaluate the most commonly encountered perinatal risk factors for this disease in a cohort of newborns from Romania. (2) Methods: The medical records of neonatal CSVT patients treated between January 2017 and December 2021 were descriptively assessed. (3) Results: The study included nine neonates, five males (55.56%) and four females (44.44%), who were born at term. The most commonly presented clinical manifestations were feeding difficulties, lethargy, respiratory distress, loss of consciousness, and seizures. Maternal-inherited thrombophilia, male sex, complicated delivery, perinatal asphyxia, and mechanical ventilation were frequently identified as potential risk factors for developing CSVT. The lesions were more frequently localized in the superior sagittal sinus (n = 7; 77.78%), followed by the transverse (n = 4; 44.44%), sigmoid (n = 2; 22.22%), and cavernous (n = 1; 11.11%) sinuses. Low-molecular-weight heparin was administered to all patients, and two of them died from thrombotic complications. (4) Conclusions: Recognition of potential risk factors and a prompt diagnosis of neonatal CSVT could lead to better patient management and to a reduction of severe complications.
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Cerebral angiography as a tool for diagnosis and management of idiopathic intracranial hypertension syndrome. Clin Imaging 2022; 88:53-58. [DOI: 10.1016/j.clinimag.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
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Forst DA, Restrepo JA, Gonzalez RG, Jones PS, Marshall MS. Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for Herself. N Engl J Med 2022; 386:977-986. [PMID: 35263523 DOI: 10.1056/nejmcpc2115853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Deborah A Forst
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Judith A Restrepo
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Pamela S Jones
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Michael S Marshall
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
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Fallah Arzpeyma S, Kazemnezhad-Leili E, Rashidi H, Ghorbani-Shirkouhi S, Saberi A. Factors Contributing to Attenuation of Cerebral Venous Sinus in Brain Noncontrast Computed Tomography Scan. Indian J Radiol Imaging 2022; 31:882-887. [PMID: 35136500 PMCID: PMC8817799 DOI: 10.1055/s-0041-1741048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Aim
In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT.
Material and Methods
Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05.
Results
Hematocrit (B = 0.251,
p
< 0.001), hemoglobin (B = 0.533,
p
< 0.001), and creatinine (B = − 0.270,
p
= 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit (
p
< 0.001) and hemoglobin (
p
< 0.001) were determined as positive predictors, and creatinine (
p
< 0.001) and BUN (
p
< 0.002) were determined as negative and positive predictors, respectively.
Conclusion
Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases.
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Affiliation(s)
- Sima Fallah Arzpeyma
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad-Leili
- Clinical Statistics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hosna Rashidi
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghorbani-Shirkouhi
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alia Saberi
- Neuroscience Research Center, Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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13
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Cerebral Venous Thrombosis: A Challenging Diagnosis; A New Nonenhanced Computed Tomography Standardized Semi-Quantitative Method. Tomography 2021; 8:1-9. [PMID: 35076628 PMCID: PMC8788512 DOI: 10.3390/tomography8010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) on non-contrast CT (NCCT) is often challenging to detect. We retrospectively selected 41 children and 36 adults with confirmed CVST and two age-matched control groups with comparable initial symptoms. We evaluated NCCT placing four small circular ROIs in standardized regions of the cerebral dural venous system. The mean and maximum HU values were considered from each ROI, and the relative percentage variations were calculated (mean % variation and maximum % variation). We compared the highest measured value to the remaining three HU values through an ad-hoc formula based on the assumption that the thrombosed sinus has higher attenuation compared with the healthy sinuses. Percentage variations were employed to reflect how the attenuation of the thrombosed sinus deviates from the unaffected counterparts. The attenuation of the affected sinus was increased in patients with CVST, and consequently both the mean % and maximum % variations were increased. A mean % variation value of 12.97 and a maximum % variation value of 10.14 were found to be useful to distinguish patients with CVST from healthy subjects, with high sensitivity and specificity. Increased densitometric values were present in the site of venous thrombosis. A systematic, blind evaluation of the brain venous system can assist radiologists in identifying patients who need or do not need further imaging.
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14
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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente Fernández L, de la Torre Colmenero JD, Tejada Meza H, Vesperinas Castro A, Sánchez Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2021:S0213-4853(21)00116-X. [PMID: 34511275 DOI: 10.1016/j.nrl.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/29/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España.
| | | | - C Aguirre
- Hospital La Princesa, Madrid, España
| | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, España
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, España
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, España
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | | | | | - L Llul
- Hospital Clínic, Barcelona, España
| | - J Egido
- Hospital Clínico San Carlos, Madrid, España
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, España
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15
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Patiño Arboleda M, Muñoz JF, Ocampo JM, Calzada MT, Cárdenas Prieto JM. Trombosis bilateral del seno cavernoso en un paciente con enfermedad periodontal y diabetes mellitus. descripción de un caso. DUAZARY 2021. [DOI: 10.21676/2389783x.4239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La trombosis de los senos cavernosos (TSC) corresponde a una entidad vascular poco usual, asociada con alta morbimortalidad y secuelas neurológicas. La etiología más frecuente son los procesos infecciosos a nivel de cabeza y cuello, que sirven como puerta de entrada para diferentes microorganismos, generando una respuesta inflamatoria que desencadena el evento trombótico. La enfermedad periodontal caracterizada por inflamación gingival, pérdida de tejido conectivo circundante y eventual del diente está asociada con el desarrollo de enfermedades sistémicas secundarias a los patógenos periodontales y mediadores inflamatorios producidos en la cavidad oral. Estos pueden diseminarse y producir complicaciones por contigüidad como eventos trombóticos a nivel del sistema nervioso central. A continuación, se presenta el caso clínico de un paciente que desarrolló una TSC bilateral después de ser sometido a un procedimiento periodontal.
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16
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Khan F, Seyam M, Sharma N, Ud Din M, Bansal V. New Horizons for Diagnostic Pitfalls of Cerebral Venous Thrombosis: Clinical Utility of a Newly Developed Cerebral Venous Thrombosis Diagnostic Score: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932123. [PMID: 34224551 PMCID: PMC8274363 DOI: 10.12659/ajcr.932123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Male, 35-year-old Final Diagnosis: Cerebral venous Symptoms: Bloody diarrhea • throbbing persistent headache • weight loss Medication: — Clinical Procedure: — Specialty: Neurology
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Affiliation(s)
- Faisal Khan
- Department fo Neurology, Sam Houston State University College of Osteopathic Medicine, Huntsville, TX, USA
| | - Muhannad Seyam
- Department of Internal Medicine, Rheinfelden Hospital, Rheinfelden, Switzerland
| | - Neha Sharma
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Vivek Bansal
- Radiology Partners Gulf Coast, University of Houston College of Medicine, Houston, TX, USA
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17
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Abuserewa ST, Duff R. Transverse Sinus Thrombosis Secondary to Internal Jugular Vein Abnormalities. Cureus 2021; 13:e15747. [PMID: 34285853 PMCID: PMC8286797 DOI: 10.7759/cureus.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/03/2022] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a rare disorder that presents with highly variable neurological manifestations ranging from headache, confusion, seizures, coma to stroke-like symptoms. It predominantly affects young adults and children, with female predilection. We are presenting a case of 59-year-old female with left-sided transverse and sigmoid sinus thrombosis most likely secondary to dehydration on top of chronically diminutive left transverse sinus and internal jugular vein.
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Affiliation(s)
| | - Richard Duff
- Pulmonary and Critical Care Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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18
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Lv B, Jing F, Tian CL, Liu JC, Wang J, Cao XY, Liu XF, Yu SY. Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Cerebral Venous Thrombosis : A Meta-Analysis. J Korean Neurosurg Soc 2021; 64:418-426. [PMID: 33993690 PMCID: PMC8128531 DOI: 10.3340/jkns.2020.0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 12/26/2022] Open
Abstract
Objective A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not wellunderstood. This study evaluates the effectiveness of DWI in the diagnosis of CVT.
Methods Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue.
Results Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference−0.33×10-3 mm2/s [95% CI, −0.44 to −0.23]; p<0.00001).
Conclusion DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.
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Affiliation(s)
- Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Feng Jing
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cheng-Lin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jian-Chao Liu
- Department of Medical Statistics, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-Yu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin-Feng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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19
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Thrombocytopenia and Intracranial Venous Sinus Thrombosis after "COVID-19 Vaccine AstraZeneca" Exposure. J Clin Med 2021; 10:jcm10081599. [PMID: 33918932 PMCID: PMC8069989 DOI: 10.3390/jcm10081599] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena.
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20
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Benmelouka A, Meshref M, Masoud A. Otogenic Cerebral Venous Sinus Thrombosis: A Case Report and Literature Review. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_205_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Lal A, Hui ACF. Cerebral Venous Thrombosis: A Critical Appraisal. Ann Indian Acad Neurol 2020; 23:582-583. [PMID: 33623252 PMCID: PMC7887505 DOI: 10.4103/aian.aian_814_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, MN, United States
| | - Andrew C F Hui
- Department of Medicine, Division of Neurology, Ng Teng Fong General Hospital, National University Hospital Cluster, Singapore
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22
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Medicherla CB, Pauley RA, de Havenon A, Yaghi S, Ishida K, Torres JL. Cerebral Venous Sinus Thrombosis in the COVID-19 Pandemic. J Neuroophthalmol 2020; 40:457-462. [PMID: 33186264 DOI: 10.1097/wno.0000000000001122] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recent studies have noted concern for increased thromboembolic events in the setting of Coronavirus Disease 2019 (COVID-19). Cerebral venous sinus thrombosis (CVST) is a form of thromboembolism that has been observed as a neuro-ophthalmologic complication of COVID-19. METHODS Review of the scientific literature. RESULTS In this article, we report an overview of CVST epidemiology, clinical presentation, diagnostics, disease pathophysiology, and management in the setting of COVID-19. CONCLUSION CVST is an uncommon thromboembolic event with variable phenotypes and multiple etiologies. Neurologic complications can be severe, including significant visual deficits and death. Current observations suggest that the risk of CVST may be profoundly impacted by this novel COVID-19 pandemic, thus prompting increased attention to disease presentation, pathogenesis, and management.
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Affiliation(s)
- Chaitanya B Medicherla
- Department of Neurology (CM, RAP, SY, KI, JT), New York University Langone Medical Center, New York, New York; and Department of Neurology (AdH), University of Utah School of Medicine, Salt Lake City, Utah
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23
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Cavernous sinus thrombosis after follow-up cerebral angiography. Porto Biomed J 2020; 5:e097. [PMID: 33283067 PMCID: PMC7710207 DOI: 10.1097/j.pbj.0000000000000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
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24
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Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral Venous Thrombosis: A Comprehensive Review. Eur Neurol 2020; 83:369-379. [PMID: 32877892 DOI: 10.1159/000509802] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword "Cerebral sinus venous thrombosis" was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease. SUMMARY The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment. CONCLUSION CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.
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Affiliation(s)
| | - Dhineshreddy Gurala
- Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
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25
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Cerebral Venous Thrombosis in Patient with Metastatic Carcinoma Breast: Mimicking Brain Metastasis—a Case Report and Review of Literature. Indian J Surg Oncol 2020; 11:244-246. [DOI: 10.1007/s13193-020-01101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022] Open
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26
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Jacob MS, Gunasekaran K, Miraclin AT, Sadiq M, Kumar CV, Oommen A, Koshy M, Mishra AK, Iyadurai R. Clinical Profile and Outcome of Patients with Cerebral Venous Thrombosis Secondary to Bacterial Infections. Ann Indian Acad Neurol 2020; 23:477-481. [PMID: 33223663 PMCID: PMC7657302 DOI: 10.4103/aian.aian_341_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/03/2020] [Accepted: 06/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology. Methods: This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study. Results: Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was Staphylococcus aureus. At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%. Conclusion: Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial.
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Affiliation(s)
- Manna S Jacob
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Angel T Miraclin
- Department of Neurological Science, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mohammad Sadiq
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - C Vignesh Kumar
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajoy Oommen
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maria Koshy
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Kumar Mishra
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Canedo-Antelo M, Baleato-González S, Mosqueira AJ, Casas-Martínez J, Oleaga L, Vilanova JC, Luna-Alcalá A, García-Figueiras R. Radiologic Clues to Cerebral Venous Thrombosis. Radiographics 2019; 39:1611-1628. [DOI: 10.1148/rg.2019190015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Bello L, Silva M, Triana J, Zabaleta M, Anzola K, Abrajim S, Palacios E. Infarto bitalámico por trombosis venosa cerebral profunda hallazgos clínicos y radiológicos. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La enfermedad cerebrovascular es un problema de salud pública mundial, considerada dentro de las primeras causas de mortalidad. La trombosis venosa cerebral (TVC) es una de sus patologías, que a pesar de ser infrecuente puede llevar a severas complicaciones en el paciente. Es por eso que se presentan dos casos de infartos bitalámicos secundarios a trombosis venosa cerebral profunda, con hallazgos clínicos e imagenológicos inusuales que hicieron aún más difícil su diagnóstico. Debido a las diferentes funciones que posee el tálamo además de la infrecuencia de la trombosis venosa cerebral profunda, la presentación clínica sigue siendo atípica y es usual que se consideren otros diagnósticos al inicio del evento, por lo tanto, consideramos importante proyectar estudios con muestras de mayor tamaño para definir con claridad la clínica y los hallazgos radiológicos de esta patología.
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Avanali R, Gopalakrishnan MS, Devi BI, Bhat DI, Shukla DP, Shanbhag NC. Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis. Front Neurol 2019; 10:511. [PMID: 31156540 PMCID: PMC6529953 DOI: 10.3389/fneur.2019.00511] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/29/2019] [Indexed: 12/31/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively reduce intracranial pressure just like it works for malignant middle cerebral artery infarcts and traumatic brain injury. But because of the relative rarity of this type of stroke, strong evidence from randomized controlled trials that DC is a life-saving procedure is not available unlike in the latter two conditions. There is a possibility that other forms of interventions like endovascular recanalization, thrombectomy, thrombolysis, and anticoagulation, which cannot be used in established middle cerebral artery infarcts and TBI, can reverse the ongoing pathology of increasing edema in CVST. Such interventions, although presently unproven, could theoretically obviate the need for DC when used in early stages. However, in the absence of such evidence, we recommend that DC be considered early as a life-saving measure whenever there are large hemorrhagic infarcts, expanding edema, radiological, and clinical features of impending herniation. This review gives an overview of the etiology and risk factors of CVST in different patient populations and examines the effectiveness of DC and other forms of interventions.
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Affiliation(s)
- Raghunath Avanali
- Department of Neurosurgery, Government T. D. College, Allapuzha, India
| | - M S Gopalakrishnan
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Dhananjaya I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhaval P Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nagesh C Shanbhag
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
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Abstract
Cerebral sinovenous thrombosis (CSVT) is a focal or diffuse disruption of cerebral blood flow secondary to occlusion of cerebral veins and/or sinuses. The challenge of CSVT during the neonatal age has led to a great interest in this condition among neonatologists, child neurologists, and pediatric neuroradiologists. The highly variable clinical spectra, etiologies, and prognosis require fine medical skills and a high level of suspicion. Nevertheless, the diagnosis is often delayed or missed altogether. Differences in brain vulnerability at different stages of maturation may explain the spectrum of associated brain lesions, which varies with gestational age. Treatment is controversial and reported clinical outcomes vary widely. The controversial treatment of CSVT with anticoagulant therapy is based only on case series and expert consensus, there is lack of safety data.
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Affiliation(s)
- Luca A Ramenghi
- Neonatal Intensive Care Unit, Giannina Gaslini Children's Hospital, Genova, Italy.
| | - Valentina Cardiello
- Neonatal Intensive Care Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Andrea Rossi
- Neonatal Intensive Care Unit, Giannina Gaslini Children's Hospital, Genova, Italy
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Diplopia-an unheralded consequence of neck dissection: case report. Oral Maxillofac Surg 2018; 22:341-343. [PMID: 30078114 DOI: 10.1007/s10006-018-0711-0] [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: 06/09/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Neck dissection is a part of the standard surgical procedure in the management of head and neck malignancy. Diplopia following neck dissection is a rare entity; hence, its diagnosis and management strategies needed to be discussed for prevention of its grave consequences. CASE REPORT A 30-year-old male patient presented with binocular horizontal diplopia following total thyroidectomy and neck dissection. On evaluation, there was internal jugular vein (IJV) thrombosis followed by cerebral venous sinus thrombosis (CVST). After meticulous medical management with diuretics and antiplatelet drugs, diplopia resolved completely and normal vision was restored. CONCLUSION Therapeutic ligation of internal jugular vein during neck dissection may result in IJV thrombosis followed by CVST leading to raised intracranial tension (ICT). It has to be anticipated and addressed as early as possible to prevent its grave consequences like blindness and death.
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Preliminary data on utility of subcutaneous unfractionated heparin in patients with deep cerebral venous thrombosis. J Thromb Thrombolysis 2018. [PMID: 28620756 DOI: 10.1007/s11239-017-1518-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Subcutaneous unfractionated heparin (SCUFH) has been proved effective in puerperal cerebral venous thrombosis (CVT), but its efficacy in the more serious form of the disease such as deep CVT patients (DCVT) unreported. We describe the outcomes of 37 (isolated:combined: 11:26) patients of DCVT diagnosed by MRI, treated with SCUFH in a tertiary care stroke unit. It was a prospective observational cohort study using 5000 U of SCUFH every 6 hourly for 10 days with oral Acenocoumarol started on day 7, with monitoring. The outcome was assessed by modified Rankin scale (mRS), National Institute of Health Stroke Scale (NIHSS) and Barthel's activities of daily life (BADL) at 3 months. The mean age of the cohort was 27.9 ± 9.7 years, females (n = 24) outnumbering the males (n = 13). Mean duration of symptoms being 10.2 ± 15.9 days. MRI showed vein of Galen and straight sinus involvement in 36 (97.3%) patients, with sparing of the basal vein of Rosenthal in 28 (75%). Thalamus 27 (73%) basal ganglia 21 (56.7%) were commonly involved areas with hemorrhagic lesions in 18 (48.6%) patients. The median NIHSS score at presentation was 11 (1-21). Mean duration of SCUFH treatment was 9.3 ± 1.3 days and the mean aPTT on day 7 was 49.3 ± 9.8 s (control 32-39 s), mean PT INR on day 13 was 1.5 ± 0.45. All the patients improved with no mortality in the study group. At 3 months, good functional outcome (mRS: 0-2) was observed in 94.6% (n = 35) of patients. Two patients had mRS-3. The median mRS (3{1-5} to 0{0-3}) and BADL (8{0-20} to 20{8-20}) improved at 3 months. Complications seen were thrombocytopenia-1, infection-6 and deep vein thrombosis of leg-4. Our preliminary data suggests that SCUFH is safe, effective treatment option in patients with DCVT in a stroke unit with minimal monitoring.
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Victorio-Meza H, Mejía-Lavalle M, Martínez Rebollar A, Ortega AB, Lagunas OP, Sidorov G. Searching for Cerebrovascular Disease Optimal Treatment Recommendations Applying Partially Observable Markov Decision Processes. INT J PATTERN RECOGN 2018. [DOI: 10.1142/s0218001418600157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Partially observable Markov decision processes (POMDPs) are mathematical models for the planning of action sequences under conditions of uncertainty. Uncertainty in POMDPs is manifested in two ways: uncertainty in the perception of model states and uncertainty in the effects of actions on states. The diagnosis and treatment of cerebral vascular diseases (CVD) present this double condition of uncertainty, so we think that POMDP is the most suitable method to model them. In this paper, we propose a model of CVD that is based on observations obtained from neuroimaging studies such as computed tomography, magnetic resonance and ultrasound. The model is designed as a POMDP because the health status of the patient is not directly observable, and only can be deduced, with some probability, from the observations in the cerebral images. The components of the model (states, observations, actions, etc.) were defined based on specialized literature. A diagnosis of the patient’s health status is made and the most appropriate action for the recovery of health is recommended after introducing the observations when operating the model. Consultation of the probable state of health of the patient and alternative actions is also allowed.
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Affiliation(s)
- Hermilo Victorio-Meza
- Tecnológico Nacional de México/Centro Nacional de, Investigación y Desarrollo Tecnológico, Interior Internado Palmira S/N, Col. Palmira, Cuernavaca, Morelos 62490, México
| | - Manuel Mejía-Lavalle
- Tecnológico Nacional de México/Centro Nacional de, Investigación y Desarrollo Tecnológico, Interior Internado Palmira S/N, Col. Palmira, Cuernavaca, Morelos 62490, México
| | - Alicia Martínez Rebollar
- Tecnológico Nacional de México/Centro Nacional de, Investigación y Desarrollo Tecnológico, Interior Internado Palmira S/N, Col. Palmira, Cuernavaca, Morelos 62490, México
| | - Andrés Blanco Ortega
- Tecnológico Nacional de México/Centro Nacional de, Investigación y Desarrollo Tecnológico, Interior Internado Palmira S/N, Col. Palmira, Cuernavaca, Morelos 62490, México
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Sevilla Martinez M, Lorente Conesa M, Silvente Fernandez S, García Bautisita E, Guerrero López F. Trombosis venosa cerebral: una misma enfermedad con diferentes abordajes. Med Intensiva 2017; 41:377-379. [DOI: 10.1016/j.medin.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/16/2016] [Accepted: 05/03/2016] [Indexed: 11/16/2022]
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Duman T, Uluduz D, Midi I, Bektas H, Kablan Y, Goksel BK, Milanlioglu A, Necioglu Orken D, Aluclu U. A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: The VENOST Study. J Stroke Cerebrovasc Dis 2017; 26:1848-1857. [PMID: 28583818 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.020] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/03/2017] [Accepted: 04/13/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. METHODS All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. RESULTS Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. CONCLUSIONS Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome.
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Affiliation(s)
- Taskin Duman
- Department of Neurology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Derya Uluduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ipek Midi
- Department of Neurology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Hesna Bektas
- Clinic of Neurology, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Yuksel Kablan
- Department of Neurology, School of Medicine, Inonu University, Malatya, Turkey
| | - Basak K Goksel
- Department of Neurology, School of Medicine, Baskent University, Adana, Turkey
| | - Aysel Milanlioglu
- Department of Neurology, School of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Dilek Necioglu Orken
- Clinic of Neurology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Ufuk Aluclu
- Department of Neurology, School of Medicine, Dicle University, Diyarbakır, Turkey
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Le signe du triangle dense. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Cerebral venous thrombosis (CVT) is a severe multifactorial condition with various clinical manifestations that may include headache, papilledema, seizures, focal deficits, coma and death. The mortality rate of untreated CVT is up to 50%, but it drops to 10% when CVT is properly treated. Prevention of CVT is feasible through healthy lifestyle, genetic counseling, molecular genetic analysis for common thrombophilia-related mutations, and prophylactic anticoagulative medication.
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Gu JJ, Chen JB, Zhang JH, Zhang H, Wang SS. Recombinant human soluble thrombomodulin protects against brain injury in a CVST rat model, via downregulation of the HMGB1-RAGE axis. Mol Med Rep 2016; 14:5217-5222. [PMID: 27840921 DOI: 10.3892/mmr.2016.5891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a distinct cerebrovascular disorder, and ~50% of CVST patients progress to cerebral venous infarction, resulting in elevation of cerebral venous pressure. Anticoagulation is the standard initial treatment and is associated with a reduced relative risk of mortality and dependency. Recombinant human soluble thrombomodulin (rhs‑TM) is a promising therapeutic natural anticoagulant comparable to antithrombin, tissue factor pathway inhibitor, and activated protein C. The present study aimed to investigate the protective effects of rhs‑TM in a CVST rat model, and identify any underlying mechanisms. Rats were treated with rhs‑TM intravenously prior to CVST. Following neurological function evaluation, animals were sacrificed and brain water content and infarct volume were assessed. Brain tissue was collected from the infarcted segments and mRNA and protein expression levels of high mobility group box 1 (HMGB1), receptor for advanced glycation end products (RAGE), tumor necrosis factor (TNF)‑α, interleukin (IL)‑1β, IL‑6, caspase‑3, B‑cell lymphoma‑2 and Bcl‑2 associated X were analyzed by reverse transcription-quantitative polymerase chain reaction and western blot analysis. rhs‑TM significantly prevented neurological deficits in locomotor function and reduced infarct volume. The expression levels of HMGB1‑RAGE were upregulated in the infarcted segments of rat brains following CVST. Pretreatment with rhs‑TM inhibited the HMGB1‑RAGE axis, alleviating the expression levels of the proinflammatory cytokines, TNF‑α, IL‑1β and IL‑6; however, expression levels of the apoptosis-associated genes and proteins remained unaffected. The results of the present study indicated that rhs‑TM protects against CVST in the rat model via inhibition of the HMGB1‑RAGE axis and inflammation, but not via apoptosis.
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Affiliation(s)
- Jian-Jun Gu
- Department of Neurosurgery, Fuzhou General Hospital, Xiamen University Medical College, Fuzhou, Fujian 350025, P.R. China
| | - Jie-Bin Chen
- Department of Pediatrics, Taizhou People's Hospital Affiliated to the Medical College of Nantong University, Taizhou, Jiangsu 225300, P.R. China
| | - Jian-He Zhang
- Department of Neurosurgery, Fuzhou General Hospital, Xiamen University Medical College, Fuzhou, Fujian 350025, P.R. China
| | - Hao Zhang
- Department of Neurosurgery, Fuzhou General Hospital, Xiamen University Medical College, Fuzhou, Fujian 350025, P.R. China
| | - Shou-Sen Wang
- Department of Neurosurgery, Fuzhou General Hospital, Xiamen University Medical College, Fuzhou, Fujian 350025, P.R. China
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Chukanova EI, Mamaeva KI, Chukanova AS. [Treatment of chronic cerebral venous insufficiency: a study on an effect of L-lysine aescinat]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:37-41. [PMID: 27500874 DOI: 10.17116/jnevro20161167137-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study an effect of L-lysine aescinat on the dynamics of complaints, severity of neurological syndromes and parameters of cerebral blood flow estimated by transcranial doppler and duplex scanning in patients with chronic cerebral venous insufficiency (CCVI). MATERIAL AND METHODS Eighty patients with ultrasound-confirmed CCVI were examined. The basic group included 40 patients who received two treatment courses (intravenous drop-by-drop/stream introductions of L-lysine aescinat in the dose of 5ml during 7 days in 2nd and 30th days of examination). The comparison group consisted of 40 patients. RESULTS AND CONCLUSION Treatment with L-lysine aescinat led to the significant decrease in complaints and improved the scores on the scales used in the study. There was an improvement in the cerebral hemodynamics (an increase of hemodynamic reserve and normalization of the linear blood flow velocity in deep veins) in the patients with CCVI. The safe profile of L-lysine aescinat used in recommended doses was confirmed.
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Affiliation(s)
- E I Chukanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Kh I Mamaeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A S Chukanova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Factors Affecting Attenuation of Dural Sinuses on Noncontrasted Computed Tomography Scan. J Stroke Cerebrovasc Dis 2016; 25:2559-65. [PMID: 27492944 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/18/2016] [Accepted: 07/02/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Noncontrasted computed tomography (NCCT) is used as the initial neuroimaging test of choice for patients who present with new-onset neurological symptoms. An apparently hyperattenuated venous sinus may lead to the suspicion of cerebral venous sinus thrombosis (CVST). Improved understanding of all factors that can affect attenuation of dural sinuses can guide triage of patients to or from further investigations of suspected CVST. The purpose of this retrospective study was to assess the effect of different factors including hematocrit (HCT), hemoglobin (Hb), age, BUN/Cr ratio (blood urea nitrogen-to-creatinine ratio), and gender on the attenuation of dural sinuses on brain NCCT. METHODS A total of 1293 patients with neurological symptoms who presented to the emergency department were included in this study. For each patient, clinical assessment, laboratory investigations, and brain NCCT were reviewed. For each brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. RESULTS Positive significant correlations were found between average attenuation of dural sinuses on one hand and each of age, Hb, and HCT on the other hand. No significant correlation was found between average attenuation and BUN/Cr ratio. Gender discrepancy was also significant as higher attenuation was found in men. CONCLUSION Age, gender, and Hb levels are the main factors that should be taken into account upon the assessment of dural sinuses on brain NCCT. The highest normal attenuation is predicted in an elderly polycythemic man and the lowest is predicted in a young anemic woman.
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Nephrotic Syndrome May Be One of the Important Etiologies of Cerebral Venous Sinus Thrombosis. J Stroke Cerebrovasc Dis 2016; 25:2415-22. [PMID: 27350124 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/28/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Thrombosis is a common complication of nephrotic syndrome (NS). However, cerebral venous sinus thrombosis (CVST) secondary to NS is rarely reported. Here we report a case series study of 5 cases of CVST with NS, so as to make a better understanding and management of this disorder. METHODS A retrospective study was performed in 5 consecutive patients with CVST in combination with NS between 2009 and 2015. The clinical manifestations, laboratory and radiological findings, treatment, and clinical outcomes were analyzed. RESULTS This cohort of case series consists of 1 woman and 4 men, aged 16-49 years. All patients complained initially of an acute or subacute headache. CVST attacked during NS occurrence in 3 patients, and during NS recurrence in 2 patients. The median duration of signs and symptoms prior to clinical diagnosis and treatment was 12.80 ± 7.53 days. In all patients, it was magnetic resonance venography that detected the thrombosis in the cerebral venous sinus, with the most common site of CVST to be the superior sagittal sinus (5 of 5 patients). Two or more segments of sinus were involved simultaneously in 4 patients. The treatment of CVST in NS involved therapy of CVST in the general population. All the 5 patients had full recovery, and no one relapsed with a follow-up of 26.60 ± 29.75 months. CONCLUSIONS NS may be one of the important etiologies of CVST. When patients with NS had progressing headache, seizure, or other unexplained neurological symptoms, CVST should be considered.
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Guenifi W, Boukhrissa H, Gasmi A, Rais M, Ouyahia A, Hachani A, Diab N, Mechakra S, Lacheheb A. Thromboses veineuses cérébrales au cours de la méningo-encéphalite tuberculeuse. ACTA ACUST UNITED AC 2016; 41:210-4. [DOI: 10.1016/j.jmv.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/28/2016] [Indexed: 11/27/2022]
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Thrombophlébite cérébrale compliquant une sinusite. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alvis-Miranda HR, Milena Castellar-Leones S, Alcala-Cerra G, Rafael Moscote-Salazar L. Cerebral sinus venous thrombosis. J Neurosci Rural Pract 2014; 4:427-38. [PMID: 24347950 PMCID: PMC3858762 DOI: 10.4103/0976-3147.120236] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
| | | | | | - Luis Rafael Moscote-Salazar
- Department of Neurological Endovascular Therapy, Instituto Nacional de Neurologia y Neurocirugía; Stroke Unit, Hospital Ángeles del Pedregal, Mexico City, Mexico
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Shindo A, Wada H, Ishikawa H, Ito A, Asahi M, Ii Y, Ikejiri M, Tomimoto H. Clinical features and underlying causes of cerebral venous thrombosis in Japanese patients. Int J Hematol 2014; 99:437-40. [PMID: 24599415 DOI: 10.1007/s12185-014-1550-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 01/08/2023]
Abstract
The clinical symptoms, causative factors, and prognosis in Japanese patients with cerebral venous thrombosis have not been adequately characterized. The present study describes these features in patients in Japan. Twenty-two patients with cerebral venous thrombosis were retrospectively identified. Diagnosis was confirmed by either digital subtraction angiography, magnetic resonance venography, or contrast-enhanced computed tomography. Demographic data and clinical and radiological features were recorded and analyzed for each patient. Prognosis was evaluated by the modified Rankin scale (mRS) at the time of hospital discharge. The most frequent symptom of cerebral venous thrombosis was headache (59.1 %). Causative factors included congenital thrombophilia (31.8 %), acquired thrombophilia (27.3 %), and iron-deficiency anemia (13.6 %). Of seven patients with congenital thrombophilia, four had mutations in the protein S gene, two had mutations in the protein C gene, and one had mutations in the antithrombin gene. All patients were alive at discharge from hospital. Nineteen of the 22 patients (86.4 %) recovered completely or exhibited only mild residual symptoms (mRS 0-2). However, three patients (13.6 %) had a poor prognosis (mRS 3-5). Cerebral venous thrombosis in Japanese patients is frequently associated with congenital thrombophilia and protein S gene mutation.
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Affiliation(s)
- Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan,
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Alonso de Leciñana M, Egido J, Casado I, Ribó M, Dávalos A, Masjuan J, Caniego J, Martínez Vila E, Díez Tejedor E, Fuentes (Secretaría) B, Álvarez-Sabin J, Arenillas J, Calleja S, Castellanos M, Castillo J, Díaz-Otero F, López-Fernández J, Freijo M, Gállego J, García-Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Martí-Fábregas J, Martínez-Sánchez P, Molina C, Morales A, Nombela F, Purroy F, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J, Vivancos J. Guidelines for the treatment of acute ischaemic stroke. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2011.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
Current advances in nanotechnology have paved the way for the early detection, prevention and treatment of various diseases such as vascular disorders and cancer. These advances have provided novel approaches or modalities of incorporating or adsorbing therapeutic, biosensor and targeting agents into/on nanoparticles. With significant progress, nanomedicine for vascular therapy has shown significant advantages over traditional medicine because of its ability to selectively target the disease site and reduce adverse side effects. Targeted delivery of nanoparticles to vascular endothelial cells or the vascular wall provides an effective and more efficient way for early detection and/or treatment of vascular diseases such as atherosclerosis, thrombosis and Cerebrovascular Amyloid Angiopathy (CAA). Clinical applications of biocompatible and biodegradable polymers in areas such as vascular graft, implantable drug delivery, stent devices and tissue engineering scaffolds have advanced the candidature of polymers as potential nano-carriers for vascular-targeted delivery of diagnostic agents and drugs. This review focuses on the basic aspects of the vasculature and its associated diseases and relates them to polymeric nanoparticle-based strategies for targeting therapeutic agents to diseased vascular site.
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Affiliation(s)
- Edward Agyare
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL ; Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Karunyna Kandimalla
- Department of Pharmaceutics and Brain Barriers Research Center, University of Minnesota, Minneapolis, MN, USA
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Rodríguez de Mingo E, Riofrío Cabeza S, Villa Albuger T, Velasco Blanco M. Arteritis de Takayasu y trombosis venosa cerebral: a propósito de un caso. Semergen 2014; 40:e18-22. [DOI: 10.1016/j.semerg.2012.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/04/2012] [Accepted: 10/19/2012] [Indexed: 11/25/2022]
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Wang WH, Lin JM, Luo F, Hu LS, Li J, Huang W. Early diagnosis and management of cerebral venous flow obstruction secondary to transsinus fracture after traumatic brain injury. J Clin Neurol 2013; 9:259-68. [PMID: 24285968 PMCID: PMC3840137 DOI: 10.3988/jcn.2013.9.4.259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral venous flow obstruction (CVFO) is a fatal complication of traumatic brain injury. To compare the outcomes of patients with CVFO secondary to traumatic-brain-injury-induced transsinus fracture who were diagnosed early versus those diagnosed late in the therapeutic course. METHODS In total, 403 patients with transsinus fracture were reviewed retrospectively. The patients were divided into an early-diagnosis group (n=338) and a delayed-diagnosis group (n=65). The patients submitted to 2D time-of-flight magnetic resonance venography (2D-TOF MRV) and/or CT venography (CTV), depending upon the findings of intracranial pressure monitoring, in order to identify potentially complicated CVFO. These examinations took place within 3 days of the onset of malignant intracranial hypertension symptoms in the early-diagnosis group, and after an average of 7 days in the delayed-diagnosis group. Once diagnosed, patients received intravenous thrombolytic therapy with low-dose urokinase. Patients with massive transsinus epidural hematoma, depressed fracture, or cerebral hernia were treated surgically to relieve the compression and repair any damage to the venous sinuses. RESULTS Cerebral venous flow obstruction was much more severe in the delayed-diagnosis group than in the early-diagnosis group (p<0.001), and hence patients in the former group were given a higher dose of urokinase (p<0.001) for thrombolytic therapy. They were also significantly more likely to need surgery (48.1% vs. 20.6%, p=0.003) and had a higher mortality rate (37.0% vs. 4.1%, p<0.001). However, patients in both groups experienced a similarly favorable prognosis, not only with regard to functional outcome but also with respect to neuroradiological improvement, as evaluated by 2D-TOF MRV/CTV at the final follow-up (p=0.218). CONCLUSIONS Delayed diagnosis can result in increased risk of surgery and death in the acute phase. Thrombolytic therapy with low-dose urokinase resulted in promising improvements in both functional and neuroradiological outcomes in all of the patients in this study, regardless of the time to diagnosis.
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Affiliation(s)
- Wen-Hao Wang
- Department of Neurosurgery, 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China
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Abstract
Ulcerative colitis has been reported to show hyper coagulation leading to peripheral and rarely central thrombosis. A 35-year-old female was admitted with chief complaints of increased frequency of bloody diarrhea, abdominal pain, and weight loss for 2 months. The patient was diagnosed to have ulcerative colitis after sigmoidoscopy and biopsy and she was started on treatment. Two days later, the patient developed headache and seizures. Magnetic resonance imaging of brain showed cerebral venous thrombosis with venous infarcts. A high index of clinical suspicion is needed to diagnose this uncommon condition so that appropriate treatment can be initiated.
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Affiliation(s)
- Bindu Menon
- Department of Neurology, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, India
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