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Zhou Y, Jiang H, Wei H, Xiao X, Liu L, Ji X, Zhou C. Cerebral venous thrombosis in patients with autoimmune disease, hematonosis or coronavirus disease 2019: Many familiar faces and some strangers. CNS Neurosci Ther 2023; 29:2760-2774. [PMID: 37365966 PMCID: PMC10493677 DOI: 10.1111/cns.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis, a rare stroke, is characterized by neurological dysfunction caused by bleeding and/or infarction resulting from venous sinus thrombosis, the so-called venous stroke. Current guidelines recommend anticoagulants as first-line therapy in the treatment of venous stroke. With complicated causes of cerebral venous thrombosis, treatment is difficult, especially when combined with autoimmune diseases, blood diseases, and even COVID-19. AIMS This review summarizes the pathophysiological mechanisms, epidemiology, diagnosis, treatment, and clinical prognosis of cerebral venous thrombosis combined with autoimmune diseases, blood diseases, or infectious diseases such as COVID-19. CONCLUSION A systematic understanding of particular risk factors that should not be neglected when unconventional cerebral venous thrombosis occurs and for a scientific understanding of pathophysiological mechanisms, clinical diagnosis, and treatment, thus contributing to knowledge on special types of venous stroke.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Xuechun Xiao
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Lu Liu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
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Malikov A, Saylak FB, Ertugrul Y, Ocal O, Daglioglu E. An Illustrative Case of Vein of Labbe Thrombosis Presented as a Glioma. Asian J Neurosurg 2023; 18:180-183. [PMID: 37056895 PMCID: PMC10089761 DOI: 10.1055/s-0043-1761236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
AbstractCerebral vein thrombosis is a unique and rare type of cerebrovascular disease. The main challenge in identifying cerebral vein thrombosis is the presence of vague signs and symptoms that can resemble a variety of other intracranial pathologies. Our goal is to present the unique case of a young patient whose MRI scan revealed an abnormally enhancing tumor-like brain lesion that was heterogeneous in intensity and whose intraoperative view and histopathological findings were consistent with the vein of Labbe thrombosis, with ipsilateral transverse and sigmoid sinus involvement.
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Linley-Adams S, Halpin S, Hughes T. Unilateral thalamic oedema secondary to venous sinus thrombosis. BMJ Case Rep 2022; 15:e250711. [PMID: 36123005 PMCID: PMC9486235 DOI: 10.1136/bcr-2022-250711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Serena Linley-Adams
- Department of Neurology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Shawn Halpin
- Department of Radiology, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Tom Hughes
- Department of Neurology, Cardiff and Vale University Health Board, Cardiff, UK
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Hosur B, Sinha R, Jain NK, Muthanna BA. Isolated unilateral thalamic venous infarct in a toddler. BMJ Case Rep 2022; 15:e249336. [PMID: 35361669 PMCID: PMC8971799 DOI: 10.1136/bcr-2022-249336] [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] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
Abstract
Isolated deep cerebral venous thrombosis (CVT), especially involving only the right thalamus, is one of the rarest forms of intracranial venous thrombosis in a child. The anatomy and flow patterns of the deep cerebral venous system are complex and usually, the thrombosis of the internal cerebral veins (ICV) results in thalamic infarction bilaterally. The focal infections, thalamic tumours and vascular malformations may have overlapping clinicoradiological patterns. The treating team should be able to recognise the atypical phenotypes of the deep CVT at the earliest, which can facilitate apt treatment and obviate the need for unnecessary investigations and interventions. We present a rare case of an isolated right thalamic acute venous infarct secondary to bilateral ICV thrombosis in a toddler who was successfully managed by timely diagnosis and with only conservative therapy.
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Affiliation(s)
- Bharat Hosur
- Radiodiagnosis, Command Hospital Panchkula, Panchkula, India
| | - Rahul Sinha
- Department of Pediatrics and Pediatric Neurology, Command Hospital Panchkula, Panchkula, India
| | | | - B A Muthanna
- Radiodiagnosis, Command Hospital Panchkula, Panchkula, India
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HIT in the head: a systematic review of cerebral venous sinus thrombosis in classical and autoimmune heparin-induced thrombocytopenia. J Thromb Thrombolysis 2021; 52:952-961. [PMID: 34089462 DOI: 10.1007/s11239-021-02484-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) causes thrombosis and thrombocytopenia, usually due to prior heparin exposure, so-called classical HIT. However, in the autoimmune form, the signs and symptoms of HIT occur without prior heparin exposure. Development of cerebral venous sinus thrombosis (CVST) secondary to HIT is a rare occurrence, with relatively few reports in the literature. There is a need to better understand the clinical presentation and treatment paradigms in these rare cases. Therefore, we present the first systematic review of CVST occurring in classical and autoimmune HIT. Cases of HIT-induced CVST were identified through a systematic search of Pubmed from the date of inception to March 2021. Literature search revealed 21 cases of HIT and associated CVST with six cases (28.6%) of autoimmune HIT. Patients presented with signs and symptoms consistent with increased intracranial pressure, intracerebral hemorrhage (ICH), and/or focal neurologic deficits. Headache was the most common symptom with 12 patients (60.0%) presenting as such. 10 patients (47.6%) included in the study developed ICH. Non-heparin anticoagulants, especially direct thrombin inhibitors, were the first-line treatment for the majority of patients (55.6%). Intravenous immunoglobulin (IVIG) was used as treatment for select patients (16.7%) with autoimmune HIT. Few patients received surgical intervention for CVST (14.3%) or ICH (30.0%). Four patients had a full recovery, four patients had residual deficits, and seven patients ultimately expired. Symptoms of HIT-induced CVST are often related to CNS dysfunction. Non-heparin anticoagulants are important to treat CVST, even when patients have concomitant ICH, and may be supplemented with IVIG if treating autoimmune HIT. Rapid identification and treatment of HIT-induced CVST is imperative in order to prevent morbidity and mortality.
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Baishya PP, Lanka V, Kulanthaivelu K, Saini J, Vengalil S. Outflow-Restricted Developmental Venous Anomaly Masquerading as a Tumefactive Lesion on Imaging. World Neurosurg 2020; 141:261-266. [PMID: 32461173 DOI: 10.1016/j.wneu.2020.05.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Developmental venous anomalies (DVA) are rarely symptomatic. We report an unusual case of outflow-restricted DVA presenting with seizures. CASE DESCRIPTION Expansile signal changes due to a hemorrhagic venous infarction in the draining territory of collector vein of DVA simulated a neoplasm. Follow-up imaging showed regression of mass effect and asymptomatic thrombosis of another distant vein. Investigation for prothrombotic conditions returned negative. CONCLUSIONS Atypical imaging findings in the draining territory of DVA ought to raise the possibility of outflow restriction.
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Affiliation(s)
- Priyanka Priyadarshini Baishya
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Lanka
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Shimizu Y, Tsuchiya K, Fujisawa H. Deep Venous Thrombosis with Decreased Cerebral Blood Flow to the Thalamus was Completely Restored by Factor Xa Inhibitor. J Stroke Cerebrovasc Dis 2019; 28:e39-e43. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022] Open
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Özyörük D, Karakurt N, Yazal Erdem A, Emir S, Tunç B, Yaralı N, Özbek N. Cerebral Sinovenous Thrombosis Mimicking Intracranial Mass. Turk J Haematol 2016; 33:255-6. [PMID: 27604041 PMCID: PMC5111475 DOI: 10.4274/tjh.2016.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Derya Özyörük
- Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey, Phone : +90 505 633 52 74, E-mail:
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Frassanito P, Tamburrini G, Massimi L, Caldarelli M, Di Rocco C. Ghost Tumors of the Central Nervous System: Definition, Clinical Implications, and Proposal of Classification. World Neurosurg 2015; 84:663-70. [DOI: 10.1016/j.wneu.2015.03.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
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Leclercq D, Trunet S, Bertrand A, Galanaud D, Lehéricy S, Dormont D, Drier A. Cerebral tumor or pseudotumor? Diagn Interv Imaging 2014; 95:906-16. [PMID: 25260711 DOI: 10.1016/j.diii.2014.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pseudotumoral lesions are uncommon but important to identity lesions. They can occur during inflammatory diseases (systemic diseases, vasculitis, demyelinating diseases), infectious, and vascular diseases. Also, in a patient with a treated tumor, pseudo-progression and radionecrosis must be differentiated from the tumoral development. Diagnosis can be difficult on an MRI scan, but some MRI aspects in conventional sequences, diffusion, perfusion and spectroscopy can suggest the pseudotumoral origin of a lesion. Imaging must be interpreted according to the context, the clinic and the biology. The presence of associated intracranial lesions can orientate towards a systemic or infectious disease. A T2 hyposignal lesion suggests granulomatosis or histiocytosis, especially if a meningeal or hypothalamic-pituitary involvement is associated. Non-tumoral lesions are generally not hyperperfused. In the absence of a definitive diagnosis, the evolution of these lesions, whether under treatment or spontaneous, is fundamental.
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Affiliation(s)
- D Leclercq
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - S Trunet
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Bertrand
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Galanaud
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Lehéricy
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Dormont
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Drier
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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12
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Desai PK. Letter to the editor. Unilateral thalamic infarction in vein of galen and straight sinus thrombosis. Neuroradiol J 2010; 23:763-4. [PMID: 24148734 DOI: 10.1177/197140091002300619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/27/2010] [Indexed: 11/15/2022] Open
Abstract
Deep cerebral venous thrombosis is an uncommon event. It usually involves the halami and adjacent areas on both sides. Unilateral thalamic infarction is extremely rare subsequent to deep cerebral venous thrombosis. Imaging findings of a female in the postpartum period with unilateral thalamic infarction and basal ganglia edema are presented.
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Affiliation(s)
- P K Desai
- Department of Radiology, Goa Medical College; Canacona, India -
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Philpott C, Brotchie P. Unilateral internal cerebral vein thrombosis: Review of literature and case illustration at 3T. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2010.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mariotti P, Iorio R, Frisullo G, Plantone D, Colantonio R, Tartaglione T, Batocchi AP, Valentini P. Acute necrotizing encephalopathy during novel influenza A (H1N1) virus infection. Ann Neurol 2010; 68:111-4. [PMID: 20582943 DOI: 10.1002/ana.21996] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A novel swine-origin influenza A (H1N1) virus was recently identified in Mexico. Some cases of infection with neurological complications have been reported to date. We report a case of acute necrotizing encephalopathy associated with the novel H1N1 virus in a 2-year-old European girl who suddenly developed fever, seizures, and altered mental status. Brain and spinal cord magnetic resonance imaging showed bilateral symmetrical lesions of the insulae, thalami, geniculate bodies, and pons tegmentum suggestive of an acute necrotizing encephalopathy. An involvement of meninges and spinal cord was observed configuring an acute necrotizing meningoencephalomyelitis.
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Affiliation(s)
- Paolo Mariotti
- Department of Medical and Surgical Pediatric Sciences and Developmental Neurosciences, Unit of Child Neuropsychiatry, Catholic University, Largo Gemelli 8, Rome, Italy
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