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Nguyen VN, Demetriou AN, Dallas J, Mack WJ. Cerebral Venous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:343-353. [PMID: 38782527 DOI: 10.1016/j.nec.2024.02.006] [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] [Indexed: 05/25/2024]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke indicated by the formation of blood clots within the dural venous sinuses. These are large venous conduits that are situated between the 2 layers of the dura mater which are responsible for draining blood from the brain and returning it to the systemic circulation. Cortical venous thrombosis refers to the blockage of veins on the brain's cortical surface. Cerebral venous thrombosis encompasses both dural and cortical vein occlusions.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Alexandra N Demetriou
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Jonathan Dallas
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA.
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2
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Arsovska AA, Venketasubramanian N. Use of MLC901 in cerebral venous sinus thrombosis: Three case reports. World J Clin Cases 2024; 12:346-353. [PMID: 38313657 PMCID: PMC10835695 DOI: 10.12998/wjcc.v12.i2.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVT) is rare cause of cerebrovascular disease. The incidence is 0.5% of all stroke. The majority of affected patients are young adults (mean age: 35-40 years) with mild to moderate disabilities. Poor outcome with severe disability is seen in 13% of cases. Early diagnosis and treatment are important for good outcomes and preventing complications. Treatment options are limited and mostly based on consensus. NeuroAiD II™ (MLC901; Moleac Pte, Ltd, Singapore) has a potential beneficial role in post-stroke recovery, by aiding the natural brain recovery process. CASE SUMMARY MLC901 consists of nine natural herbal ingredients. Studies have shown its safety profile and aid in post stroke recovery. The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis (CVST) who received MLC901 in addition to standard of care. The prescribed dose of MLC901 is 400 mg/cap two capsules, three times a day. Data from these patients were prospectively collected at baseline and at monthly visits, for a duration of 3 mo. Outcome measures included adherence to therapy, side effects, National Institutes of Health Stroke Scale, Glasgow Coma Scale, modified Rankin Scale, and the Short Orientation-Memory-Concentration Test. MLC901 was well tolerated and no side effects were reported. All patients were stable with improved condition. CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.
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Affiliation(s)
- Anita Ante Arsovska
- Department of Urgent Neurology, University Clinic of Neurology, University Ss. Cyril and Methodius-Faculty of Medicine, Skopje 1000, North Macedonia
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3
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Gurram S, Thambi M, Naik A, Gorthi SP. Critical Prognostic Factors in Cerebral Venous Sinus Thrombosis: An Observational Study. Ann Indian Acad Neurol 2024; 27:67-71. [PMID: 38495227 PMCID: PMC10941905 DOI: 10.4103/aian.aian_820_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 03/19/2024] Open
Abstract
Background Cerebral venous sinus thrombosis (CVST) presents with a wide variety of neurological symptoms in various combinations and has a high mortality rate of up to 50%. Recent advances in neuroimaging and therapeutic interventions have brought it down to 10%-20%. The study aims to identify critical prognostic factors associated with poor outcomes in patients with CVST. Materials and Methods All cases of CVST aged >18 years from July 2015 to July 2020 who were not terminally ill and bedridden before the illness were evaluated at the entry point for various risk factors and after 30 days for outcome assessment with the modified Rankin scale (mRS). The outcome was dichotomized, applying mRS <3 as a good outcome, and analyzed with the Chi-square test or the Fischer's exact test in a bivariate analysis to identify associated variables. Results A total of 149 subjects were studied. Glasgow Comma Scale (GCS) <9 (P<0.001), focal neurological deficits (P = 0.05), the presence of a mass effect (P<0.001), and the need for decompressive hemicraniectomy (P<0.001) were associated with poor outcomes. Age, gender, diagnostic delay, seizures at onset, papilledema, parenchymal lesions, deep sinus involvement, and multiple sinus thrombosis were not associated with a poor outcome. Conclusion In our study, early diagnosis and treatment of CVST is associated with an overall favorable outcome even in the presence of traditional poor prognostic factors such as age, seizures at onset, deep sinus involvement, and multiple sinus involvement in the face of conventional risk factors. A large country-wide prospective study might help in elucidating the poor prognostic factors.
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Affiliation(s)
- Sandeep Gurram
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
- Department of Neurology, Consultant Neurologist, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Magith Thambi
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
| | - Ashwini Naik
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
| | - Sankar Prasad Gorthi
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
- Department of Neurology, Bharti Vidyapeeth Medical College, Pune, Maharashtra, India
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Finsterer J. Alternative pathophysiologies must be ruled out before right middle cerebral artery ischemic stroke can be attributed to SARS-CoV-2 vaccination. J Family Med Prim Care 2023; 12:3007-3008. [PMID: 38186800 PMCID: PMC10771218 DOI: 10.4103/jfmpc.jfmpc_1090_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/02/2023] [Accepted: 07/17/2023] [Indexed: 01/09/2024] Open
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Tashiro T, Kira Y, Maeda N. Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension. Intern Med 2023; 62:3021-3025. [PMID: 36792193 PMCID: PMC10641184 DOI: 10.2169/internalmedicine.1113-22] [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: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
A 38-year-old woman with untreated Graves' disease was admitted to our hospital because of headache and diplopia for 3 months. A neuro-ophthalmic examination showed bilateral papilledema and abducens nerve paralysis. The cerebrospinal fluid pressure was extremely high. Brain magnetic resonance imaging showed cerebral venous thrombosis in the superior sagittal and right transverse and sigmoid sinuses. Laboratory investigations revealed elevated factor VIII and von Willebrand factor levels. The patient recovered after propylthiouracil and anticoagulation therapy. We herein report a rare case of cerebral venous thrombosis with hyperthyroidism presenting as chronic isolated intracranial hypertension. Hyperthyroidism can induce a hypercoagulable state and lead to venous thromboembolism.
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Affiliation(s)
- Takumi Tashiro
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Yuichi Kira
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
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Yang L, Zhang D. Case report: Coexistence of Labbe vein thrombosis and autoimmune encephalitis with two different antibodies. Front Neurol 2023; 14:1170169. [PMID: 37521281 PMCID: PMC10374307 DOI: 10.3389/fneur.2023.1170169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Anti-NMDA receptor encephalitis is an autoimmune encephalitis well- known to pediatric neurologists. The characteristic combination of symptoms and detection of NMDA receptor antibody can confirm the diagnosis. Most children respond well to immunosuppressive therapy. Anti-GABAB receptor encephalitis usually occurs in adult patients. Most patients present clinically with symptoms of limbic encephalitis. Cases in pediatric patients are rare. Cerebral venous thrombosis also has a very low incidence in children without underlying diseases. Patients usually present with headaches, convulsions, and focal deficits. Anticoagulants are the first choice treatment. We report a boy initially diagnosed with Labbe vein thrombosis and later tested positive for both NMDA and GABAB receptors. Anticoagulants did not relieve the boy's symptoms, and immunosuppressive therapy achieved good results. The antibody titers were significantly reduced or even turned negative. Although the Labbe vein was not recanalized at four months follow-up, the brain lesion was significantly absorbed. We learn from this case that a child can be inflicted with cerebral venous thrombosis and autoimmune encephalitis simultaneously. Child patients respond well to treatment.
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Madineni KU, Prasad SVN, Bhuma V. A study of the prognostic significance of platelet distribution width, mean platelet volume, and plateletcrit in cerebral venous sinus thrombosis. J Neurosci Rural Pract 2023; 14:418-423. [PMID: 37692829 PMCID: PMC10483190 DOI: 10.25259/jnrp-2021-1-3-r2-(1431)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Platelets play a key role in thrombus formation and propagation and are thus implicated in the pathogenesis and morbidity of cerebral venous sinus thrombosis (CVST). A whole blood count can be used to objectively measure platelet function through platelet indices, namely, platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit. This study examined how platelet indices (PDW,MPV, and plateletcrit) affect the CVST severity and functional outcome. Materials and Methods In this prospective, longitudinal, and observational study, 66 patients with CVST from a tertiary care referral center were enrolled. A complete blood count including platelet indices was obtained using an automated hematology analyzer. Patients with and without parenchymal abnormalities on brain imaging were classified as having severe and non-severe CVST, respectively. The modified Rankin Scale (mRS) was used to examine functional outcomes at admission and after 90 days. The patients were categorized into low mRS (0-1) and high mRS (2-6) functional groups. Results The patients with severe CVST were older (P < 0.05) and exhibited abnormally large PDW (P < 0.05) which were statistically significant. Severe CSVT also had poor functional outcome score both at admission (P < 0.05) and 90 days later (P < 0.05) which were statistically significant. Multiple logistic regression analysis concluded age and PDW as the independent predictors of severe CVST (P < 0.05). In receiver operating characteristic curve analysis, a cutoff value of 16.5 for PDW could predict CVST severity (P < 0.05). Patients with high mRS scores at admission had significantly larger PDW. At 90 days, no association was noted between PDW and mRS scores. MPV and plateletcrit levels were similar in both the severe and non-severe CVST groups and exerted no effect on functional outcomes. PDW was significantly and inversely related to plateletcrit (P < 0.05). Conclusion Severe CVST and PDW had a positive correlation. During the early phases of admission, PDW levels above a particular threshold were associated with poor functional outcomes; however, no such association was observed after 90 days. MPV and plateletcrit exerted no effect on CVST severity and prognosis.
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Affiliation(s)
- Komal Usha Madineni
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - S. V. Naveen Prasad
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Vengamma Bhuma
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Carletti F, Vilela P, Jäger HR. Imaging Approach to Venous Sinus Thrombosis. Radiol Clin North Am 2023; 61:501-519. [PMID: 36931766 DOI: 10.1016/j.rcl.2023.01.011] [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: 02/22/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease caused by an occlusion of the cerebral venous sinuses or cortical veins. It has a favorable prognosis if diagnosed and treated early. CVT can be difficult to diagnose on clinical grounds, and imaging plays a key role. We discuss clinical features and provide an overview of current neuroimaging methods and findings in CTV.
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Affiliation(s)
- Francesco Carletti
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Pedro Vilela
- Neuroradiology Department. Lisbon Western University Center (Centro Hospitalar Lisboa Ocidental -CHLO), Lisbon Portugal; Imaging Department, Hospital da Luz Lisbon, Portugal
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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9
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Asfaw YA, Huang H, Taimur M, Anand A, Poudel S, Garg T, Asfaw BA, Abebe BM, Akbariromani H, Lazovic G, Cueva W. Progressive Cerebral Venous Thrombosis with Cranial Nerve Palsies in an Adolescent African Girl & Associated Diagnostic Pitfalls: A Rare Case Report. Int Med Case Rep J 2023; 16:45-51. [PMID: 36660226 PMCID: PMC9842531 DOI: 10.2147/imcrj.s381748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a cerebrovascular disorder caused by complete or partial occlusion of the cerebral venous and sinus system. The etiology has been attributed to hypercoagulability and pro-thrombotic states, leading to raised intracranial pressures that often manifest as headaches and focal neurological deficits. However, the multifactorial nature of CVT can create a diagnostic conundrum for clinicians. We describe a unique case of a 16-year-old female who presented with convulsions, postictal confusion, and drowsiness followed by residual weakness of her extremities. She initially presented to the primary care center with headache, high-grade fever, and altered mental status and was empirically treated for pyogenic meningitis. The patient failed to improve with a week of antibiotics and was referred to the tertiary care center for urgent attention. On presentation, the patient developed VI and VII cranial nerve palsy. Subsequently, MRI images showed filling defects in the superior sagittal, right transverse, and sigmoid sinuses with right parietal gyral T1 hyperintensity and T2 hypo-intensity. She was diagnosed with septic CVT based on sinus venous thrombosis and venous infarction, probably secondary to meningococcal pneumonia. It can be challenging to distinguish between both conditions as their presentations overlap. Moreover, cranial nerve palsy is an infrequent manifestation of CVT, with unclear pathogenesis. We highlight the role of neuro-imaging in the early detection of CVT and bring to light the unfamiliar symptoms and a more varied clinical spectrum that may hinder the diagnosis in a limited-resource setting. Future research should be explicitly modeled to improve the diagnostic efficiency of CVT and improve outcomes in younger patient populations.
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Affiliation(s)
- Yonathan Aliye Asfaw
- Internal Medicine Department, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia,Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA,Correspondence: Yonathan Aliye Asfaw, Internal Medicine Department, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia, Email
| | - Helen Huang
- Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA,Internal Medicine Department, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muhammad Taimur
- Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA,Internal Medicine Department, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayush Anand
- Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA,Internal Medicine Department, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sujan Poudel
- Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
| | - Tulika Garg
- Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA,Internal Medicine Department, Government Medical College and Hospital, Chandigarh, India
| | - Bethlehem Aliye Asfaw
- Internal Medicine Department, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia,Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
| | - Befekadu Molalegn Abebe
- Internal Medicine Department, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia,Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
| | - Hanieh Akbariromani
- Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, FL, USA,Internal Medicine Department, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Gavrilo Lazovic
- Department of Emergency Medicine, Larkin Community Hospital, South Miami, FL, USA
| | - Wilson Cueva
- Department of Neurology, Larkin Community Hospital, South Miami, FL, USA
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Muacevic A, Adler JR. Rehabilitation of Post-Cerebral Venous Thrombosis. Cureus 2023; 15:e33512. [PMID: 36632374 PMCID: PMC9827895 DOI: 10.7759/cureus.33512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is rare and only accounts for 0.5% of all reported stroke cases. CVT includes severe headaches with neurological deficits, but the vague presentation of symptoms necessitates efficient clinical examination and imaging for a proper diagnosis. Here, we present a case of this rare type of stroke. Our patient exhibited continuous headaches, further complicated by other neurological deficits. We documented this case to aid in the diagnosis and rehabilitation management of CVT. We aim to demonstrate to physicians the importance of early rehabilitation in such stroke cases and improve the outcome for patients.
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11
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Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis. Neurol Sci 2022; 43:5229-5236. [PMID: 35639217 PMCID: PMC9153875 DOI: 10.1007/s10072-022-06148-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Abstract
Background Identifying
late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature to identify risk factors for LS due to CVT. Methods We systematically searched PubMed, Scholar, and Scopus databases (May 2021) to identify studies reporting data on prevalence and risk factors for CVT-LS. The methodological quality was assessed with the Ottawa-Newcastle Scale. The risk of developing CVT-LS was summarized in meta-analyses and expressed as odds ratio (OR) and corresponding 95% confidence intervals (CIs) using random-effects models. Results Out of the 332 records retrieved, four studies were eventually included with a total of 1309 patients with CVT and 142 (11%) with CVT-LS. The most relevant predictors of CVT-LS were symptomatic seizures (OR 5.66, 95% CI 3.83–8.35), stupor/coma (OR 6.81, 95% CI 1.18–39.20), focal neurologic signs (OR 6.81, 95% CI 1.18–39.2), hemorrhagic component (OR 3.52, 95% CI 2.45–5.06), and superior sagittal sinus involvement (OR 1.52, 95% CI 1.04–2.21). Conclusion There are several risk factors for CVT-LS that should be considered in clinical practice. Further high-quality studies are warranted to develop predictive models for individualized risk stratification and prediction of CVT-LS. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06148-y.
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Madineni KUC, Siddam Venkata NP, Bhuma V. A Study of the Prognostic Significance of Platelet Distribution Width, Mean Platelet Volume, and Plateletcrit in Cerebral Venous Sinus Thrombosis. J Neurosci Rural Pract 2022. [DOI: 10.1055/s-0042-1751240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Platelets play a vital role in thrombus formation and propagation and are thus implicated in the pathogenesis and morbidity of cerebral venous sinus thrombosis (CVST). A whole blood count can be used to objectively measure platelet function through platelet indices, namely platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit.
Objective This study examined how platelet indices (PDW, MPV, and plateletcrit) affect the CVST severity and functional outcome.
Methodology In this prospective, longitudinal, observational study, 66 patients with CVST from a tertiary care referral center were enrolled. A complete blood count including platelet indices was obtained using an automated hematology analyzer. Patients with and without parenchymal abnormalities on brain imaging were classified as having severe and nonsevere CVST, respectively. The modified Rankin Scale (mRS) was used to examine functional outcomes at admission and after 90 days. The patients were categorized into low mRS (0–1) and high mRS (2–6) functional groups.
Results The patients with severe CVST were older (p < 0.05) and exhibited abnormally large PDW (p < 0.05) which were statistically significant. Severe CSVT also had poor functional outcome score both at admission (p < 0.05) and 90 days later (p < 0.05) which were statistically significant. Multiple logistic regression analysis concluded age and PDW as the independent predictors of severe CVST (p < 0.05). In receiver operating characteristic curve analysis, a cut-off value of 16.5 for PDW could predict CVST severity (p < 0.05). Patients with high mRS scores at admission had significantly larger PDW. At 90 days, no association was noted between PDW and mRS scores. MPV and plateletcrit levels were similar in both the severe and nonsevere CVST groups and exerted no effect on functional outcomes. PDW was significantly and inversely related to plateletcrit (p < 0.05).
Conclusion Severe CVST and PDW had a positive correlation. During the early phases of admission, PDW levels above a particular threshold were associated with poor functional outcomes; however, no such association was observed after 90 days. MPV and plateletcrit exerted no effect on CVST severity and prognosis.
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Affiliation(s)
- K. Usha Chowdary Madineni
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | | | - Vengamma Bhuma
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Sarathchandran P, Farooq S, Dar J, Khan M, AlRukn S. Frequency of Cerebral Venous Thrombosis in Dubai, UAE-A Multicenter, Retrospective Study. Ann Neurosci 2022; 28:122-128. [PMID: 35341233 PMCID: PMC8948320 DOI: 10.1177/09727531211047413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose Cerebral venous thrombosis (CVT), also known as cerebral dural venous thrombosis, is not a very common cause of stroke. It has a diverse clinical presentation, with multiple predisposing factors and imaging findings. The incidence of CVT varies in different studies. We hypothesized that the incidence of CVT in Dubai is more than that reported in the West owing to dehydration caused by the high atmospheric temperature. Methods We retrospectively reviewed the medical records of all patients aged more than 13 years with appropriate International Classification of Diseases, 9th Revision, codes for the diagnosis of CVT from January 1, 2010 to December 31, 2018 from three major hospitals with an acute stroke service in Dubai, United Arab Emirates. Results We identified 138 patients who presented with CVT. The average frequency of CVT was 6.6 per 100,000 population. Fifty percent of the patients presented between May and September, which are considered the hottest months in the UAE. Headache was the most common presentation, followed by seizures. The most important risk factors were the use of oral contraceptive pills, anemia, and polycythemia. Our study showed a higher incidence of anemia, polycythemia, thrombophilia, and abnormal CT brain findings. Conclusion In our study, CVT was more common during the months of summer. Anemia and polycythemia were strongly associated with CVT. Public awareness about CVT, its higher incidence during summer months and strategies to avoid dehydration might be considered to reduce the incidence of CVT in summer months. However, larger studies are needed to confirm definite associations.
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Affiliation(s)
| | - Saba Farooq
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Javeed Dar
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Maria Khan
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Suhail AlRukn
- Consultant Rashid hospital, Saudi-German hospital& City Hospital, Dubai
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Aarju G, Birinder Singh P, Vipin K, Alisha S, Gunchan P. Neurological Predictors of Functional Outcome in Cortical Venous Sinus Thrombosis. J Neurosci Rural Pract 2022; 13:290-294. [PMID: 35694057 PMCID: PMC9187406 DOI: 10.1055/s-0042-1744123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Abstract
Objectives Cerebral venous sinus thrombosis (CVST) has a wide clinical spectrum. Despite favorable prognosis, identifying CVST patients with a possible poor functional outcome can be challenging. This study aims to establish the neurological predictors of outcome in CVST.
Materials and Methods We analyzed 70 patients of CVST and categorized them into three groups: Group I with isolated intracranial hypertension; Group II—focal syndrome of neurological deficit; Group III—subacute encephalopathy. Demographic, disease characteristics, and radiological parameters were also analyzed for prediction of hospital course. Functional outcome was assessed by modified Rankin scale (mRS) dichotomized as good (mRS: 0–2) or poor outcome (mRS ≥ 3).
Statistical Analysis Univariate and multivariate logistic regression analyses were performed to find out the independent effects of prognostic factors to be used for outcome prediction.
Results The mean age was 36.71 ± 14.9 years with 40 (68.8%) males. Most common presenting complaints were headache 35 (50%), hemiparesis 14 (20%), and seizures 12 (17.4%). Group I included 44 (62.9%), group II 17 (24.3%) and group III 12 (12.9%) patients. During hospitalization 28 (40%) patients needed intensive care unit (ICU) care, among them 7 (10%) required ventilation. There were eight times more chances of ICU care (odds ratio [OR]: 7.4; 2.5–24.4) and 23 times more need for ventilation (OR: 23; 2.5–88.9) whenever patients were in group II or III. Good outcome (mRS < 2) was noted in 52 (74.2%) patients. Headache was associated with good functional outcome, whereas hemiparesis with poor outcome. Neurological grouping was the independent predictor of functional outcome; patients with focal neurological deficit (group II) were 20 times more likely to have dependent life at the time of discharge (p < 0.05) with the mortality rate of 2.9%.
Conclusions Neurological grouping is a practical tool for prediction of function outcomes. Early anticipation of prognosis helps in decision-making in the clinical practice.
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Affiliation(s)
- Gagneja Aarju
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Paul Birinder Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kumar Vipin
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Saxena Alisha
- Department of Research and Development, Dayanand Medical College and Hospital, Ludhiana, India
| | - Paul Gunchan
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, India
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Moghaddam OM, Nasiripour M, Emam MH, Farasatinasab M. Cerebral Venous Sinus Thrombosis in a Young Body Builder Man With Androgen Use. Ann Pharmacother 2022; 56:1079-1081. [DOI: 10.1177/10600280211063883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Hassan M, Khan NU, Rajput HM, Shahzad W, Hassan T, Mushtaq HF, Badshah M. Clinical and radiological study profile of cerebral venous sinus thrombosis at a tertiary care center in Pakistan. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.01.004] [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] Open
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Anipindi M, Scott A, Joyce L, Wali S, Morginstin M. Case Report: Cerebral Venous Sinus Thrombosis and COVID-19 Infection. Front Med (Lausanne) 2021; 8:741594. [PMID: 34722579 PMCID: PMC8554241 DOI: 10.3389/fmed.2021.741594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease-2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). Coronavirus disease-2019 (COVID-19) was declared a pandemic in March 2020 and has changed our lives in many ways. This infection induces a hypercoagulable state leading to arterial and venous thrombosis, but the exact pathophysiology of thrombosis is unknown. However, various theories have been postulated including excessive cytokine release, endothelial activation, and disseminated intravascular coagulation (DIC). We present a patient diagnosed with cerebral venous sinus thrombosis (CVST) with COVID-19 infection. A 66-year-old man presented to a hospital for evaluation of persistent headaches. He tested positive for COVID-19, and MRI of the brain and CT venogram revealed CVST. He was started on heparin drip in the hospital and transitioned to oral anticoagulants at the time of discharge. His headaches improved with treatment. Even though headache is the most frequent and initial symptom of cerebral venous thrombosis, it is rarely the only symptom. A high index of suspicion is therefore required to diagnose CVST especially if the patient presents with a simple complaint like a headache. Common complaints can delay the diagnosis leading to disease progression. Considering the high mortality rates in patients diagnosed with CVST, we suggest the importance of knowing the association between COVID-19 infection and CVST, especially in susceptible patients.
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Affiliation(s)
- Manasa Anipindi
- Einstein Healthcare Network, Philadelphia, PA, United States
| | - Amanda Scott
- Einstein Healthcare Network, Philadelphia, PA, United States
| | - Li Joyce
- Einstein Healthcare Network, Philadelphia, PA, United States
| | - Salman Wali
- Einstein Healthcare Network, Philadelphia, PA, United States
| | - Mark Morginstin
- Einstein Healthcare Network, Philadelphia, PA, United States
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Gogineni S, Gupta D, Pradeep R, Mehta A, Javali M, Acharya PT, Srinivasa R. Deep Cerebral Venous Thrombosis-A Clinicoradiological Study. J Neurosci Rural Pract 2021; 12:560-565. [PMID: 34295112 PMCID: PMC8289541 DOI: 10.1055/s-0041-1730109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Stroke is a common neurological emergency. Almost 80% of strokes are due to arterial occlusion. Venous thrombosis comprises less than 1–2% of all strokes. Involvement of the deep cerebral venous system is still rare and accounts for about 10.9% of all cerebral venous thromboses (CVT). CVT diagnosis is often delayed or missed, because of its variable clinical manifestations. We retrospectively (2015–18) and prospectively (2018–20) reviewed all the cases of CVT in a tertiary care center in south India. Out of a total of 52 CVT cases, 12 were due to the involvement of deep cerebral venous system. Their clinical presentation, imaging characteristics, and outcomes were assessed. The most frequent presentation was headache followed by seizures. Hyperhomocysteinemia was the most common risk factor noted. Imaging characteristics were variable, and a high index of suspicion was required for early diagnosis. All patients had favorable outcome in our study, and except one, all were treated conservatively.
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Affiliation(s)
- Sujana Gogineni
- Department of Neurology, Ramaiah Medical College, Bengaluru, India
| | - Dhananjay Gupta
- Department of Neurology, Ramaiah Medical College, Bengaluru, India
| | - R Pradeep
- Department of Neurology, Ramaiah Medical College, Bengaluru, India
| | - Anish Mehta
- Department of Neurology, Ramaiah Medical College, Bengaluru, India
| | - Mahendra Javali
- Department of Neurology, Ramaiah Medical College, Bengaluru, India
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Bano S, Farooq MU, Nazir S, Aslam A, Tariq A, Javed MA, Rehman H, Numan A. Structural Imaging Characteristic, Clinical Features and Risk Factors of Cerebral Venous Sinus Thrombosis: A Prospective Cross-Sectional Analysis from a Tertiary Care Hospital in Pakistan. Diagnostics (Basel) 2021; 11:diagnostics11060958. [PMID: 34073620 PMCID: PMC8229012 DOI: 10.3390/diagnostics11060958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that accounts for 0.5-1.0% of all strokes. Clinical presentation, predisposing factors, neuroimaging findings, and outcomes of CVST are extremely diverse, which causes a high index of suspicion in diagnosis. Therefore, early diagnosis of CVST is crucial for prompt treatment to prevent morbidity and mortality. OBJECTIVE The purpose of this prospective study is aimed at assessing the clinical characteristics, potential risk factors, and neuro-radiological features along with the topography of venous sinus involved in CVST patients in a tertiary care hospital, Lahore, Pakistan. MATERIAL AND METHODS Consecutive patients enrolled in this study had a computed tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) along with a clinical presentation to confirm the diagnosis of CVST. Categorical data were presented as percentages. Continuous variable and categorical data were compared (parenchymal lesions vs. non-parenchymal lesions) using the Student's t-test and Chi-square test, respectively. RESULTS A total of 3261 patients with stroke were presented during the study period. Out of all patients, 53 confirmed patients with CVST (1.6%) were recruited; the predominant population was female (84.91%), having a male to female ratio of 1:4. Mean age of the cohort was 28.39 ± 7.19 years. Most frequent symptoms observed were headache (92.45%) followed by vomiting (75.47%), seizures (62.26%), papilledema (54.72%), visual impairment (41.51%), and altered consciousness disturbance (52.83%). The presumed risk factors associated with CVST were puerperium (52.83%), use of oral contraceptives (13.21%), antiphospholipid syndrome (7.55%), elevated serum levels of protein C and S (5.66%), and CNS infection (3.77%). On cranial CT scans, 50 patients (94.33%) showed abnormalities while 32 patients exhibited various parenchymal lesions. Seizures were more frequent in CVST patients with parenchymal lesions compared with subjects lacking parenchymal lesions. Seventy-two sinuses, either single or in combination, were involved in CVST patients, being more common in patients with parenchymal lesions than those without parenchymal lesions. The most frequent locations of CVST were the superior sagittal and transverse sinus. CONCLUSION In short, non-contrast CT brain may be used as a first line investigation in suspected cases of CVST. Our study also demonstrates some regional differences in the clinical features, risk factors, and neuroimaging details of CVST as described by some other studies. Therefore, care must be taken while diagnosing and predicting the outcome of the CVST.
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Affiliation(s)
- Safia Bano
- Department of Neurology, King Edward Medical University, Lahore 54000, Pakistan; (S.B.); (M.U.F.); (A.A.); (A.T.); (M.A.J.)
| | - Muhammad Umer Farooq
- Department of Neurology, King Edward Medical University, Lahore 54000, Pakistan; (S.B.); (M.U.F.); (A.A.); (A.T.); (M.A.J.)
| | - Sarwat Nazir
- Department of Gynecology and Obstetrics, Fatima Jinnah Medical University, Lahore 54000, Pakistan;
| | - Ayesha Aslam
- Department of Neurology, King Edward Medical University, Lahore 54000, Pakistan; (S.B.); (M.U.F.); (A.A.); (A.T.); (M.A.J.)
| | - Adnan Tariq
- Department of Neurology, King Edward Medical University, Lahore 54000, Pakistan; (S.B.); (M.U.F.); (A.A.); (A.T.); (M.A.J.)
| | - Muhammad Athar Javed
- Department of Neurology, King Edward Medical University, Lahore 54000, Pakistan; (S.B.); (M.U.F.); (A.A.); (A.T.); (M.A.J.)
| | - Habib Rehman
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Ahsan Numan
- Department of Neurology, King Edward Medical University, Lahore 54000, Pakistan; (S.B.); (M.U.F.); (A.A.); (A.T.); (M.A.J.)
- Correspondence:
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Abstract
Headache has been consistently reported as the most common symptom of cerebral venous thrombosis and as the most frequent presenting feature. It is often the heralding symptom, preceding other manifestations of the disease by days or even weeks. This aspect highlights the importance of recognizing headache due to cerebral venous thrombosis, as early recognition of the disease can lead to a rapid diagnosis with appropriate imaging techniques and as early treatment with heparin can dramatically change the course of the disease and alter the prognosis. Unfortunately, although common, the headache has no specific features, and the clinical presentation of CVT is highly variable, making the correct diagnosis in the emergency setting a challenging task for clinicians, even in the case of highly specialized ones such as neurologists. In this review, we will briefly summarize the epidemiology and physiopathology of CVT, and then we will discuss in more details the causes, features, and course of headache, focusing on its relevance for differential diagnosis and on red flags that should suggest the possibility of CVT as the cause of the headache.
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Nonabducent Cranial Neuropathies in Cerebral Venous Sinus Thrombosis: A Case Report and Literature Review. Neurologist 2021; 26:90-97. [PMID: 33942790 DOI: 10.1097/nrl.0000000000000310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) can rarely present with cranial neuropathies other than abducent nerve palsy. The authors report a case and review the literature for nonabducent cranial neuropathies in CVST. CASE REPORT A 22-year-old woman with a history of oral contraceptive use developed right-sided headache, blurred vision, and dizziness for 4 days. Magnetic resonance venogram showed complete thrombosis of the right transverse sinus, sigmoid sinus, and internal jugular vein, and partial thrombosis of the superior sagittal sinus, left transverse sinus, and superior part of the left internal jugular vein. Hypercoagulable workup revealed heterozygous factor V Leiden mutation. About 2 weeks after symptom onset, she developed right facial droop and left eye ptosis. Examination revealed bilateral papilledema, partial left ptosis, complete right abducent, and right peripheral facial palsies. Acetazolamide 250 mg 2 times per day was initiated for the treatment of headache. Three days after starting acetazolamide left ptosis, right facial and abducent palsies improved that continued to get better with only slight deficits at discharge 4 weeks from symptom onset. Follow-up computed tomography venogram on day 24 showed partial recanalization of CVST. CONCLUSION A systematic review identified 26 patients from 21 articles with nonabducent cranial neuropathies. Seven patients had lower motor neuron facial palsy, 13 patients had hearing loss or vertigo with vestibulocochlear involvement, and 6 patients had other mixed cranial nerve palsies with CVST. They are usually associated with transverse sinus and/or sigmoid sinus thrombosis. They have a good prognosis with improvement and complete resolution of cranial neuropathies in most cases usually in 1 month.
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Abouhashem S, Eldawoody H, Taha MM. Cerebral venous sinus thrombosis in patients with COVID-19 infection. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021; 24:101091. [PMID: 33520667 PMCID: PMC7834014 DOI: 10.1016/j.inat.2021.101091] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/20/2020] [Accepted: 01/01/2021] [Indexed: 12/28/2022]
Abstract
Background Despite the COVID-19 infection is more frequently related to acute respiratory distress but there is an increasing evidence of a heterogeneous spectrum of multi-system involvement including the central nervous system. Thromboembolic events after COVID-19 infection have been reported mainly in the pulmonary vasculature however; thromboembolic complications of the nervous system with subsequent cerebrovascular stroke have been increasingly reported. The most common cerebrovascular complication after COVID-19 infection is ischemic stroke however there is also reported cases of cerebral venous sinus thrombosis in such patients as well. In the current report we present two cases with extensive cerebral venous sinus thrombosis as a potential complication for COVID-19 infection. Objective Increase the awareness of neurological complications in patient with COVID-19 virus disease. Methods Reporting two cases with confirmed cerebral venous sinus obstruction in patient with confirmed COVID-19 infection. Results Two young adult males less than 30 years old have no other risk factors of hypercoagulable state apart from being COVID-19 infection victims complicated by CVST. Both of them had progressive course of deterioration in conscious level, right hemiplegia and only one seizures attack has been reported in (Case-1). Both patients in the current report died within one week of their initial symptoms in spite the aggressive medical and surgical treatment. Conclusion CVST is a devastating complication when associated with COVID-19 infection and early investigations for cerebrovascular integrity by using MRA, MRV whenever there are unexplained neurological manifestations in patient with COVID-19 disease.
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Affiliation(s)
- Safwat Abouhashem
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt.,Department of Neurosurgery, Saudi German Hospital, Riyadh, Saudi Arabia
| | - Hany Eldawoody
- Department of Neurosurgery, Mansoura University Hospital, Mansoura, Egypt.,Prince Mohamed Bin Abdul-Aziz Hospital Riyadh, Saudi Arabia
| | - Mahmoud M Taha
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
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Abstract
Introduction Cerebral venous sinus thrombosis (CVST) is an acute cerebrovascular disease diagnosed nowadays more frequently. Magnetic resonance venogram (MRV) is the modality of choice for accurate diagnosis. Young females in their childbearing age are prone to develop CVST. Clinical presentation is mainly with headache, focal neurologic deficits, and seizures. Around one third of the patients have altered sensorium at presentation. Prognosis of CVST is good if diagnosed and treated early. Long-term deficits may remain in one quarter of patients. The aim of our study was to do clinical profiling and prognosis of CVST patients. Materials and methods This is a descriptive study conducted at the department of Neurology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Study duration was one year. Patients fulfilling inclusion and exclusion criteria were included in the study. Patients confirmed to have CVST on magnetic resonance imaging (MRI)/MRV were included in final analysis. Ethical approval was taken from the Institutional Review Board. Results Thirty three out of 54 patients were included in the final analysis. Out of them, 29 (87.8%) were females and four (12.1%) were males. The mean age at the time of presentation was 31.36 ± 9.61. Of the 29 females, only three were pregnant and 26 were in the postpartum period at the time of presentation. Twelve (41.4%) females were primigravida. Focal deficits were present in 30 (90.9%) patients; headache was present in 26 (78.8%) patients; seizures were present in 24 (72.7%) patients on presentation; and anemia was present in 20 (60.6%) patients. Conclusion CVST is an important cause of intracranial hypertension, seizures, and stroke in young people. Clinical presentation is extremely variable, and a high index of suspicion is needed. Magnetic resonance imaging brain with MRV is the current diagnostic modality of choice. Medical management with anticoagulants and supportive measures has excellent clinical outcomes.
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Affiliation(s)
| | | | - Sehar Iqbal
- Department of Obstetrics and Gynecology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, PAK
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Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study. Stroke Res Treat 2020; 2020:8610903. [PMID: 32953038 PMCID: PMC7481993 DOI: 10.1155/2020/8610903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34 ± 9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 ± 9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). Conclusion The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.
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Bolaji P, Kukoyi B, Ahmad N, Wharton C. Extensive cerebral venous sinus thrombosis: a potential complication in a patient with COVID-19 disease. BMJ Case Rep 2020; 13:13/8/e236820. [PMID: 32784243 PMCID: PMC7418679 DOI: 10.1136/bcr-2020-236820] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 63-year-old man was admitted with left-sided weakness and subsequent focal seizures following a recent diagnosis of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in a nearby hospital. He developed status epilepticus and became comatose, requiring intensive care unit admission for invasive ventilation. Imaging done at admission confirmed extensive cerebral venous sinus thrombosis (CVST) with bilateral venous cortical infarcts and acute cortical haemorrhage. No known risk factor for CVST could be identified. He improved with anticoagulation and antiepileptic therapy. He was subsequently transferred to an inpatient rehabilitation facility. Although Coronavirus disease 19 (COVID-19) infection has been previously associated with thrombotic complications, these mostly relate to the pulmonary vasculature. We present this case as a potential association between CVST and COVID-19 infection.
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Affiliation(s)
- Paul Bolaji
- Stroke Medicine, New Cross Hospital, Wolverhampton, UK
| | | | - Nasar Ahmad
- Stroke Medicine, New Cross Hospital, Wolverhampton, UK
| | - Chris Wharton
- Stroke Medicine, New Cross Hospital, Wolverhampton, UK
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Sellers A, Meoded A, Quintana J, Jallo G, Amankwah E, Nguyen ATH, Betensky M, Mills K, Goldenberg N, Shimony N. Risk factors for pediatric cerebral sinovenous thrombosis: A case-control study with case validation. Thromb Res 2020; 194:8-15. [PMID: 32554256 DOI: 10.1016/j.thromres.2020.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/09/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cerebral sinovenous thrombosis (CSVT) represents the second most common type of venous thromboembolism (VTE) in children. Current literature includes limited evidence on risk factors for CSVT, particularly in the pediatric population. We sought to determine risk factors for CSVT in pediatric patients through a single-institutional case-control study. In addition, we evaluated thrombophilias, treatments and outcomes in CSVT among cases. METHODS A case-control study was performed at Johns Hopkins All Children's Hospital on patients admitted from March 31, 2006 through April 1, 2018. Cases were identified using diagnostic codes and confirmed based on electronic health record (EHR) and neuroimaging review. Controls were matched in a 2:1 fashion accounting for the month and year of admission. RESULTS A total of 60 CSVT cases and 120 controls were identified. Median (range) age was 4.8 years (0-21.3 years) for cases and 5.6 years (0-20.0 years) for controls. Factors putatively associated with CSVT in unadjusted analyses were: corticosteroid use, presence of a central venous catheter, mechanical ventilation, systemic infection, head/neck infection, head/neck trauma, and chronic inflammatory disease. In the multivariable model, head/neck infection (OR: 13.8, 95% CI: 4.87-38.7; P < 0.01), head/neck trauma (OR: 12.7, 95% CI: 2.88-56.2; P < 0.01), and mechanical ventilation (OR: 9.32, 95% CI: 2.35-36.9; P = 0.01) remained independent, statistically-significant risk factors. 61% of patients were subacutely treated with anticoagulants and of those, only two developed relevant bleeding after initiation of therapy. CONCLUSIONS This single-institutional case-control study reveals that head/neck infection, head/neck trauma, and mechanical ventilation are independent risk factors for pediatric CSVT. These findings will be further investigated via a cooperative registry of pediatric hospital-acquired VTE, by which a risk model for pediatric CSVT will be developed and validated, in order to inform future preventive strategies in at-risk pediatric patients.
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Affiliation(s)
- Austin Sellers
- Office of Medical Education, Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA; Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Avner Meoded
- Department of Radiology, Division of Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Javier Quintana
- Department of Radiology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins All Children's Stroke Program, St. Petersburg, FL, USA
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL, USA
| | - Ernest Amankwah
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Department of Oncology, Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Epidemiology and Biostatistics Unit, Johns Hopkins All Children's Health Informatics, St. Petersburg, FL, USA
| | - Anh Thy H Nguyen
- Epidemiology and Biostatistics Unit, Johns Hopkins All Children's Health Informatics, St. Petersburg, FL, USA
| | - Marisol Betensky
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Katie Mills
- Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Neil Goldenberg
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins All Children's Stroke Program, St. Petersburg, FL, USA; Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL, USA; Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL, USA; Department of Medicine, Division of Hematology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins Children's Center, Baltimore, MD, USA.
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL, USA; Department of Neurosurgery, Geisinger Medical Center, Danville, PA, USA; Department of Neuroscience, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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Lv B, Tian CL, Cao XY, Liu XF, Wang J, Yu SY. Role of diffusion-weighted imaging in the diagnosis of cerebral venous thrombosis. J Int Med Res 2020; 48:300060520933448. [PMID: 32589072 PMCID: PMC7323280 DOI: 10.1177/0300060520933448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/20/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the hyperintense signal (HIS) performance on diffusion-weighted imaging (DWI) in diagnosing cerebral venous thrombosis (CVT). METHODS Seventy-eight patients with CVT hospitalized from January 2004 to January 2015 were retrospectively studied alongside 78 controls without intracranial organic diseases. Diagnostic accuracy indices of HIS on DWI or T2-weighted imaging (T2WI) to diagnose CVT at different sites and states were analyzed. RESULTS The overall sensitivity of HIS on DWI for the diagnosis of CVT was significantly lower than that of HIS on T2WI (34.6% vs. 79.5%). HIS on T2WI was more sensitive than HIS on DWI in detecting thrombosis, especially in the superior sagittal sinus and transverse sinus. HIS on DWI was inversely related to the time between disease onset and imaging. Compared with HIS on T2WI, combining HIS on DWI and T2WI did not increase the sensitivity for detecting CVT. HIS on DWI was not detected in the control group, but HIS on T2WI was detected in 26.3% of control individuals. The specificity of HIS on DWI for CVT was higher than that of HIS on T2WI (97.4% vs. 76.9%). CONCLUSION HIS on DWI has a lower sensitivity, but a higher specificity, than HIS on T2WI for diagnosing CVT.
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Affiliation(s)
- Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cheng-lin Tian
- 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
| | - Jun Wang
- 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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Ghoneim A, Straiton J, Pollard C, Macdonald K, Jampana R. Imaging of cerebral venous thrombosis. Clin Radiol 2020; 75:254-264. [DOI: 10.1016/j.crad.2019.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022]
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Uluduz D, Midi I, Duman T, Yayla V, Karahan AY, Afsar N, Goksu EO, Mengulluoglu N, Aytac E, Sungur MA, Yesilot N, Ince B, Yalin OO, Oruc S, Senol MG, Yilmaz A, Gokce M, Demirci S, Kusbeci OY, Uzuner G, Caglayan HZB, Acikgoz M, Kurucu H, Ozdag F, Baybas S, Ekmekci H, Cabala M, Yaman M, Yürekli VA, Tekeli H, Genc H, Utku U, Sahin S, Tokuc FEU, Uzuner N, Bektas H, Kablan Y, Goksel BK, Milanlioglu A, Orken DN, Aluclu U, Colakoglu S, Tufekci A, Bakar M, Nazliel B, Tascilar N, Goksan B, Kozak HH, Demir S, Mısırli CH, Kucukoglu H, Cinar N, Domac FM, Ozturk S, Gunes T. Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study. Seizure 2020; 78:113-117. [PMID: 32353818 DOI: 10.1016/j.seizure.2020.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). METHOD VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. RESULTS The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. CONCLUSIONS In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.
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Affiliation(s)
- Derya Uluduz
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ipek Midi
- Department of Neurology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Taskin Duman
- Department of Neurology, Mustafa Kemal University, School of Medicine, Hatay, Turkey.
| | - Vildan Yayla
- Clinic of Neurology, Saglik Bilimleri University, Bakirkoy Sadi Konuk Research and Training, Hospital, Istanbul, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University, School of Medicine, Usak, Turkey
| | - Nazire Afsar
- Department of Neurology, Acıbadem Mehmet Aydinlar University, Istanbul, Turkey
| | - Eylem Ozaydin Goksu
- Clinic of Neurology, Antalya Research and Training Hospital, Antalya, Turkey
| | | | - Emrah Aytac
- Department of Neurology, Firat University, School of Medicine, Elazig, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, Duzce University, School of Medicine, Duzce, Turkey
| | - Nilufer Yesilot
- Department of Neurology, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Birsen Ince
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Osman Ozgur Yalin
- Clinic of Neurology, Saglik Bilimleri University, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Serdar Oruc
- Department of Neurology, Kocatepe University, School of Medicine, Afyon, Turkey
| | - Mehmet Guney Senol
- Clinic of Neurology, Sisli Hamidiye Research and Training Hospital, Istanbul, Turkey; Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Arda Yilmaz
- Department of Neurology, Mersin University, School of Medicine, Mersin, Turkey
| | - Mustafa Gokce
- Department of Neurology, Sütçü İmam University, School of Medicine, Kahramanmaraş, Turkey
| | - Seden Demirci
- Department of Neurology, Aspendos Anatolian Hospital, Antalya, Turkey; Department of Neurology, Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | | | - Gulnur Uzuner
- Department of Neurology, Osmangazi University, School of Medicine, Eskisehir, Turkey
| | | | - Mustafa Acikgoz
- Department of Neurology, Bülent Ecevit University, School of Medicine, Zonguldak, Turkey
| | - Hatice Kurucu
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fatih Ozdag
- Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Sevim Baybas
- Clinic of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Hakan Ekmekci
- Department of Neurology, Selçuk University, School of Medicine, Konya, Turkey
| | - Murat Cabala
- Clinic of Neurology, Saglik Bilimleri University, Bakirkoy Sadi Konuk Research and Training, Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Department of Neurology, Kocatepe University, School of Medicine, Afyon, Turkey
| | - Vedat Ali Yürekli
- Department of Neurology, Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Hakan Tekeli
- Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey; Clinic of Neurology, Sancaktepe Research and Training Hospital, Istanbul, Turkey
| | - Hamit Genc
- Department of Neurology, Mersin University, School of Medicine, Mersin, Turkey
| | - Uygar Utku
- Department of Neurology, Sütçü İmam University, School of Medicine, Kahramanmaraş, Turkey
| | - Sevki Sahin
- Department of Neurology, Maltepe University, School of Medicine, Istanbul, Turkey
| | | | - Nevzat Uzuner
- Department of Neurology, Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Hesna Bektas
- Clinic of Neurology, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Yuksel Kablan
- Department of Neurology, Inonu University, School of Medicine, Malatya, Turkey
| | | | - Aysel Milanlioglu
- Department of Neurology, Yüzüncü Yıl University, School of Medicine, Van, Turkey
| | | | - Ufuk Aluclu
- Department of Neurology, Dicle University, School of Medicine, Diyarbakir, Turkey
| | - Sena Colakoglu
- Department of Neurology, Mustafa Kemal University, School of Medicine, Hatay, Turkey
| | - Ahmet Tufekci
- Department of Neurology, Recep Tayyip Erdoğan University, School of Medicine, Rize, Turkey
| | - Mustafa Bakar
- Department of Neurology, Uludağ University, School of Medicine, Bursa, Turkey
| | - Bijen Nazliel
- Department of Neurology, Gazi University, School of Medicine, Ankara, Turkey
| | - Nida Tascilar
- Department of Neurology, Bülent Ecevit University, School of Medicine, Zonguldak, Turkey; Department of Neurology, Medipol University, Istanbul, Turkey
| | - Baki Goksan
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Hasan Huseyin Kozak
- Department of Neurology, Necmettin Erbakan University, School of Medicine, Konya, Turkey
| | - Serkan Demir
- Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey; Clinic of Neurology, Sancaktepe Research and Training Hospital, Istanbul, Turkey
| | - Cemile Handan Mısırli
- Clinic of Neurology, Saglik Bilimleri University, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Hayriye Kucukoglu
- Clinic of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Nilgun Cinar
- Department of Neurology, Maltepe University, School of Medicine, Istanbul, Turkey
| | - Fusun Mayda Domac
- Clinic of Neurology, Erenkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Serefnur Ozturk
- Department of Neurology, Selçuk University, School of Medicine, Konya, Turkey
| | - Taskin Gunes
- Clinic of Neurology, Saglik Bilimleri University, Istanbul Research and Training Hospital, Istanbul, Turkey
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Alami B, Boujraf S, Quenum L, Oudrhiri A, Alaoui Lamrani MY, Haloua M, Boubbou M, Maâroufi M. [Cerebral venous thrombosis: Clinical and radiological features, about 62 cases]. JOURNAL DE MEDECINE VASCULAIRE 2019; 44:387-399. [PMID: 31761306 DOI: 10.1016/j.jdmv.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
UNLABELLED The work's purpose is to make a general review on the various clinical-radiological aspects and the management of cerebral venous thrombosis (CVT) in our hospital and compare them to those described in the literature. MATERIAL AND METHOD Our series included 62 patients aged over 18 years, collected over 7 years (2009-2016) in the radiology department of the CHU Hassan II of Fez (Morocco), in which the radiological diagnosis of TVC was retained. Our patients have benefited from a brain CT scan and brain MRI. Clinical and radiological characteristics and post-treatment progression were described. RESULTS The average age was 35 years with a female predominance; sex ratio 3.76 (49F/13H). The symptomatology was non-specific, made mainly of headaches, comic crises, disturbances of consciousness and focal signs. The upper longitudinal sinus was dominant topography (51.61%). The etiological factors were varied: infectious (sinusitis, chronic otitis media, oto-mastoiditis, bacterial meningitis, and septicemia), gyneco-obstetrical (oral contraception, pregnancy, and postpartum), systemic (Behçet diseases, polycythemia of Vaquez, paraneoplastic syndrome, antiphospholipid syndrome), local (head trauma), undetermined etiological factors. The CT scan, but especially the cerebral MRI, made it possible to make the diagnosis but also to direct towards the etiology. CONCLUSION Cerebral MRI is currently the best imaging in the diagnosis of CTV, allowing an accurate assessment of its location, extent and impact on the cerebral parenchyma. Multiple conditions are responsible for CTVs. Therapeutic management is based on heparinotherapy and etiological treatment.
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Affiliation(s)
- B Alami
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc; Laboratoire de biophysique et méthodes IRM, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, Fès, Maroc
| | - S Boujraf
- Laboratoire de biophysique et méthodes IRM, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, Fès, Maroc
| | - L Quenum
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc.
| | - A Oudrhiri
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Y Alaoui Lamrani
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Haloua
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Boubbou
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Maâroufi
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
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Wang MK, Shergill R, Jefkins M, Cheung J. A sickle cell disease patient with dural venous sinus thrombosis: a case report and literature review. Hemoglobin 2019; 43:193-197. [PMID: 31414933 DOI: 10.1080/03630269.2019.1651734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dural venous sinus thrombosis (DVST) is a rare disease associated with hypercoagulable states. Patients with sickle cell disease are known to be prothrombotic. We report a case of DVST presenting with anterior neck and facial pain in a 24-year-old female with sickle cell disease, found to have extensive thrombotic disease involving the internal jugular vein. A literature review of DVST in sickle cell disease consisting of 14 case reports was summarized. Headache was a presenting feature in two-thirds of patients. Nine cases were associated with vaso-occlusive crisis (VOC), transfusion, or acute respiratory illness. Most patients were treated with anticoagulation therapy. Over three-quarters either died or suffered from a serious neurological complication, including stroke, seizure, coma, or elevated intracranial pressure. Given its association with life-threatening complications, DVST should be considered when patients with sickle cell disease present with a VOC, especially in the context of headache or neurological deficits.
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Affiliation(s)
- Michael K Wang
- Division of General Internal Medicine, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Ravi Shergill
- Department of Radiology, McMaster University , Hamilton , ON , Canada
| | - Matthew Jefkins
- Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Jason Cheung
- Division of General Internal Medicine, Department of Medicine, McMaster University , Hamilton , ON , Canada
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Management of Cerebral Venous Thrombosis in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Elnekeidy AE, Yehia A, Elfatatry A. Importance of susceptibility weighted imaging (SWI) in management of cerebro-vascular strokes (CVS). ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Abd Elaziz Elnekeidy
- Department of Radio-Diagnosis, Faculty of Medicine, Alexandria University, Egypt
| | - Ahmed Yehia
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Egypt
| | - Amr Elfatatry
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
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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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Renjen P, Garg S, Chaudhari D, Ahmad K, Kumar A, Pradhan R, Mishra A. Cortical venous thrombosis – A case series and review of recent updates. APOLLO MEDICINE 2019. [DOI: 10.4103/am.am_60_19] [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] Open
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Diacinti D, Cartocci G, Colonnese C. Cerebral venous thrombosis: A case series and a neuroimaging review of the literature. J Clin Neurosci 2018; 58:142-147. [DOI: 10.1016/j.jocn.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/04/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
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Mehvari Habibabadi J, Saadatnia M, Tabrizi N. Seizure in cerebral venous and sinus thrombosis. Epilepsia Open 2018; 3:316-322. [PMID: 30187001 PMCID: PMC6119760 DOI: 10.1002/epi4.12229] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/08/2022] Open
Abstract
Many conflicting issues exist about seizure in the setting of cerebral venous and sinus thrombosis (CVST). In this article we aimed to address the existing data regarding incidence, characteristics, predictors, treatment, and prognosis of acute and late seizures in patients with CVST and to prepare more practical information for clinicians. PubMed, Embase, Web of science and Cochrane databases were searched within 1966–2016 using relevant keywords. A total of 63 papers met the inclusion criteria. Seizures are classified as acute symptomatic seizures (ASS; first 14 days) and post‐CVST epilepsy (PCE; after 14 days). The incidence had been reported in a wide range of 6.9–76% for ASS and 4–16% for PCE. Focal and generalized seizures were observed with different predominance. ASS commonly occurred in patients with loss of consciousness, focal neurological deficits, supratentorial lesions and thrombosis in superior sagittal sinus, straight sinus, and cortical veins. PCE had been predisposed by occurrence of ASS, motor deficit, and supratentorial lesions, particularly hemorrhage. Most experts believe that primary prophylaxis with antiepileptic drugs in the acute phase is not indicated. However, the initiation of prophylaxis after the first seizure in patients with supratentorial lesions or focal neurological deficit should be recommended. The quality of current evidence is low and most conclusions are based on expert opinions. More accurate reports of seizure semiology, detailed antiepileptic treatment plans, and outcomes are necessary to answer the existing questions.
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Affiliation(s)
| | - Mohammad Saadatnia
- Isfahan Neuroscience Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Nasim Tabrizi
- Department of Neurology Mazandaran University of Medical Sciences Sari Iran
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Lee SK, Mokin M, Hetts SW, Fifi JT, Bousser MG, Fraser JF. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2018; 10:803-810. [DOI: 10.1136/neurintsurg-2018-013973] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 11/03/2022]
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Rezoagli E, Martinelli I, Poli D, Scoditti U, Passamonti SM, Bucciarelli P, Ageno W, Dentali F. The effect of recanalization on long-term neurological outcome after cerebral venous thrombosis. J Thromb Haemost 2018; 16:718-724. [PMID: 29341411 DOI: 10.1111/jth.13954] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Indexed: 12/01/2022]
Abstract
Essentials The role of cerebral venous thrombosis (CVT) recanalization on neurologic outcome is still debated. We studied a large cohort of 508 CVT patients with 419 patient years of radiological follow-up. Recanalization rate is high during the first months after CVT and neurologic outcome is favorable. High recanalization grade of CVT independently predicts good neurological outcome. SUMMARY Background Studies with limited sample size and with discordant results described the recanalization time-course of cerebral venous thrombosis (CVT). The neurological outcome after a first episode of CVT is good, but the role of recanalization on neurological dependence is still debated. Objectives The aim of the study is to assess the recanalization rate after cerebral venous thrombosis (CVT) and its prognostic role in long-term neurological outcome. Patients/Methods In a retrospective observational multicenter cohort study, patients with an acute first episode of CVT with at least one available imaging test during follow-up were enrolled. Patency status of the vessels was categorized as complete, partial or not recanalized. Neurological outcome was defined using the modified Rankin scale (mRS) as good (mRS = 0-1) or poor (mRS = 2-6). Results Five-hundred and eight patients (median [IQR] age, 39 [28.5-49] years; 26% male) were included. Complete or partial recanalization was not differently represented in patients undergoing scans at different periods of time (from 28-day to 3 month-period up to a 1-3 year-period). mRS at the time of follow-up imaging was available in 483 patients; 92.8% of them had a mRS of 0-1. CVT recanalization (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.59-4.13) was positively associated, whereas cancer (OR, 0.29; 95% CI, 0.09-0.88), and personal history of venous thromboembolism (VTE) (OR, 0.36; 95% CI, 0.14-0.92) were negatively associated as independent predictors of favorable (mRS = 0-1) outcome at follow-up. Conclusions Most patients with a first CVT had complete or partial recanalization at follow-up. Recanalization was independently associated with a favorable neurological outcome.
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Affiliation(s)
- E Rezoagli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Anesthesia Center for Critical Care Research, Boston, USA
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Poli
- Thrombosis Centre, Department of Heart and Vessels, University of Florence, Florence, Italy
| | - U Scoditti
- Thrombosis Centre, Department of Heart and Vessels, University of Florence, Florence, Italy
- Department of Neurology, University of Parma, Parma, Italy
| | - S M Passamonti
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Bucciarelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - W Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Perry A, Graffeo CS, Brinjikji W, Copeland WR, Rabinstein AA, Link MJ. Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report. J Neurosurg Spine 2018; 28:669-678. [PMID: 29600909 DOI: 10.3171/2017.10.spine17806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia. CT venography confirmed CVT, and therapeutic heparin was initiated. He suffered a generalized seizure due to left parietal hemorrhage, which subsequently expanded. He developed signs of mass effect and herniation, heparin was discontinued, and he was taken to the operating room for clot evacuation and external ventricular drain placement. Intraoperatively, the dura was deflated, suggesting underlying SIH. Ventral T-1 CSF leak was identified, which failed multiple epidural blood patches and required primary repair. The patient ultimately made a complete recovery. Systematic review identified 29 publications describing 36 cases of SIH-associated CVT. Among 31 patients for whom long-term neurological outcome was reported, 25 (81%) recovered completely. Underlying coagulopathy/risk factors were identified in 11 patients (31%). CVT is a rare and potentially lethal sequela occurring in 2% of SIH cases. Awareness of the condition is poor, risking morbid complications. Evaluation and treatment should be directed toward identification and treatment of occult CSF leaks. Encouragingly, good neurological outcomes can be achieved through vigilant multidisciplinary neurosurgical and neurocritical care.
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Affiliation(s)
| | | | | | - William R Copeland
- 3Division of Neurosurgery, Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | | | - Michael J Link
- Departments of1Neurologic Surgery.,5Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota; and
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Luo Y, Tian X, Wang X. Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. Front Aging Neurosci 2018; 10:2. [PMID: 29441008 PMCID: PMC5797620 DOI: 10.3389/fnagi.2018.00002] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/08/2018] [Indexed: 12/13/2022] Open
Abstract
Cerebral venous thrombosis (CVT), also called cerebral venous sinus thrombosis (CVST), is a cerebrovascular disease with diverse clinical manifestations that often affects young adults, women of childbearing age, and children. It's most common clinical manifestations are headache, seizures, altered consciousness, and neurological focal signs on physical examination. CVT can manifest as a single symptom, or it can present as a syndrome consisting of multiple symptoms. This non-specific clinical picture makes diagnosing CVT difficult. Although the mortality rate of CVT has been significantly reduced by improvements in treatment and diagnostic techniques, the mortality rate of severe CVT remains as high as 34.2%. Survivors of this type of CVT have varying degrees of residual symptoms and are not able to return to their previous work. Hence, we performed a comprehensive literature search in the PubMed, EMBASE, and Medline databases to review the diagnosis and treatment of CVT.
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Affiliation(s)
- Yaxi Luo
- Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Tian
- Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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Anadure RK, Wilson V, Sahu S, Singhal A, Kota S. A study of clinical, radiological and etiological profile of cerebral venous sinus thrombosis at a tertiary care center. Med J Armed Forces India 2017; 74:326-332. [PMID: 30449917 DOI: 10.1016/j.mjafi.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 11/17/2017] [Indexed: 11/28/2022] Open
Abstract
Background A prospective, observational study was done at a tertiary care hospital in Western Maharashtra to describe the etiologies, clinical features, diagnosis and prognosis of cerebral venous sinus thrombosis in an Indian population. Methods 54 patients with clinical and MRI features suggestive of cerebral venous sinus thrombosis (CVST), were studied with detailed clinical evaluation and pro-thrombotic work up. All were followed up monthly for 6 months, to assess the response to therapy and clinical outcomes. Results The mean age of presentation was 35 years. Headache was the most common presenting symptom (94%) and hemi paresis (22%) was the most common neurological sign. The most common sinus involved was transverse sinus in 77% of cases. In the unprovoked CVST subset (n = 29), elevated factor VIII (72%) and protein C deficiency (24%) were the common prothrombotic states identified. In the provoked CVST subset (n = 18), puerperium (44%) and para-infectious (22%) accounted for majority cases. Idiopathic CVST accounted for 13% (7/54) in this study. A Modified Rankin Scale (MRS) of 0-1 was achieved in 96% of patients at the end of 6 months follow up with no mortality in this study. Conclusion CVST is an important yet under recognized cause of intracranial hypertension and stroke in young. Clinical presentation is extremely varied and a high index of suspicion is needed. Magnetic Resonance Imaging (MRI) brain with Magnetic Resonance Venography (MRV) is the current diagnostic modality of choice. Elevated factor VIII and puerperium are the common etiologies in an Indian population. Management with anticoagulants is safe and has excellent clinical outcomes.
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Affiliation(s)
- R K Anadure
- Senior Adviser (Medicine & Neuro), Command Hospital (Air Force), Bengaluru, India
| | - Vinny Wilson
- Classified Specialist (Medicine & Neuro), INHS Asvini, Mumbai, India
| | - Samaresh Sahu
- Senior Adviser (Radiology), INHS Asvini, Mumbai, India
| | - Anuj Singhal
- Associate Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - Satish Kota
- Resident (Medicine), INHS Asvini, Mumbai, India
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Facial Nerve Palsy from Cerebral Venous Sinus Thrombosis: An Effect of Increased ICP. Can J Neurol Sci 2017; 44:624-625. [DOI: 10.1017/cjn.2016.446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chandra A, Li WA, Stone CR, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: Anatomy. Brain Circ 2017; 3:45-56. [PMID: 30276305 PMCID: PMC6126264 DOI: 10.4103/bc.bc_10_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Abstract
In this paper, which is the first in a three-part series that reviews cerebrovascular anatomy, pathogenesis, and stroke, we lay the anatomical foundation for the rest of the series. Beginning with its origin in the branches of the aorta, we start by describing the arterial system. This system is partitioned into two major divisions (anterior and posterior circulations) that differ significantly in features and pathogenic potential. The systems, and the major branches that comprise them, are described. Description of the arterial system proceeds to the point of the fulfillment of its function. This function, the exchange of gases and nutrients with the cerebral parenchyma, is the subject of a subsequent section on the microcirculation and blood-brain barrier. Finally, the cerebral venous system, which is composed of cerebral veins and dural venous sinuses, is described. Thus, an anatomical context is supplied for the discussion of cerebrovascular disease pathogenesis provided by our second paper.
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Affiliation(s)
- Ankush Chandra
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - William A Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher R Stone
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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Cerebral venous sinus thrombosis in pregnancy and puerperium: A pooled, systematic review. J Clin Neurosci 2017; 39:9-15. [PMID: 28274514 DOI: 10.1016/j.jocn.2017.02.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/13/2017] [Indexed: 12/15/2022]
Abstract
Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST); however studies describing diagnosis and management in this population are limited. The objective of this study was to amalgamate published case reports and series regarding diagnosis and management of CVST in pregnancy and puerperium. Searches of PubMed and the Cochrane library were performed using search terms "pregnancy"/"puerperium" and "sinus occlusion"/"sinus thrombosis". Studies were included in our pooled analysis if they included individual patient symptoms, management approach and follow-up condition. Multivariate regression was utilized to assess the effect of non-modifiable factors on excellent outcome (mRS 0). Sixty-six patients were included. Mean duration of symptom onset to diagnosis was 5.9days (95% CI 4.2-7.6). Clot involvement of the superior sagittal sinus was seen in 67% of cases, the transverse/sigmoid in 64% and of the deep venous system in 15% of cases. Management approaches included anticoagulation (91% of patients), IA (intra-arterial) thrombolysis alone (26%), and IA thrombectomy with IA thrombolysis (8%). Fifty-nine percent of patients were mRS 0 at follow-up; 94% were mRS 0-2. Presentation with headache alone was associated with excellent outcome on multivariate analysis (p=0.04); coma/obtundation predicted against excellent outcome (p=0.03). As compared to IA thrombolysis alone, patients undergoing IA thrombolysis with IA thrombectomy demonstrated a trend toward better outcome (p=0.10).
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Abstract
The chapter describes the epidemiology of cerebrovascular diseases, anatomy of the cerebral blood vessels, pathophysiology of ischemia, hypoxia, hypoxemia, anemic hypoxia, histotoxic hypoxia, carbon monoxide damage, hyperoxid brain damage and decompression sickness, and selective cell and regional vulnerability; diseases of the blood vessels including atherosclerosis, hypertensive angiopathy, small vessel disease, inflammatory vascular diseases, cerebral amyloid angiopathies, CADASIL, CARASIL and other diseases that can lead to cerebrovascular occlusion; intracranial and intraspinal aneurysms and vascular malformations; hematologic disorders that can cause cerebral infarct or hemorrhage; brain ischemic damage; and spontaneous intracranial bleeding. Within ischemic brain damage, focal cerebral ischemia, hemorrhagic infarct, brain edema, penumbra, global cerebral ischemia, venous thrombosis, lacunas and lacunar state, status cribosus, granular atrophy of the cerebral cortex, hippocampal sclerosis, vascular leukoencephalopathy Binswanger type and multi-infarct encephalopathy are discussed in detail. Cognitive impairment of vascular origin deserves an individual section.
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Affiliation(s)
- Isidro Ferrer
- Pathologic Anatomy Service, Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
| | - Noemi Vidal
- Pathologic Anatomy Service, Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Kraut E, Sarkar R, Houlden RL. Cerebral Venous Thrombosis Associated With Graves Hyperthyroidism. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161269.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cerebral Venous Sinus Thrombosis during Everest Expedition: A Case Report and Review of the Literature. Case Rep Neurol Med 2016; 2016:8314040. [PMID: 27872776 PMCID: PMC5107850 DOI: 10.1155/2016/8314040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare but serious disorder that is associated with a poor clinical outcome. We report a 35-year-old man who had a severe headache and diplopia while climbing Mount Everest. His MR venography showed right transverse and right sigmoid sinus thrombosis. He improved on anticoagulant and symptomatic measures. Cerebral venous sinus thrombosis at high altitude is discussed.
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