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Shi W, Jiang D, Hu Z, Yedavalli V, Ge Y, Moghekar A, Lu H. VICTR: Venous transit time imaging by changes in T 1 relaxation. Magn Reson Med 2024; 92:158-172. [PMID: 38411277 PMCID: PMC11055660 DOI: 10.1002/mrm.30051] [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: 09/12/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Abnormalities in cerebral veins are a common finding in many neurological diseases, yet there is a scarcity of MRI techniques to assess venous hemodynamic function. The present study aims to develop a noncontrast technique to measure a novel blood flow circulatory measure, venous transit time (VTT), which denotes the time it takes for water to travel from capillary to major veins. METHODS The proposed sequence, venous transit time imaging by changes in T1 relaxation (VICTR), is based on the notion that as water molecules transition from the tissue into the veins, they undergo a change in T1 relaxation time. The validity of the measured VTT was tested by studying the VTT along the anatomically known flow trajectory of venous vessels as well as using a physiological vasoconstrictive challenge of caffeine ingestion. Finally, we compared the VTT measured with VICTR MRI to a bolus-tracking method using gadolinium-based contrast agent. RESULTS VTT was measured to be 3116.3 ± 326.0 ms in the posterior superior sagittal sinus (SSS), which was significantly longer than 2865.0 ± 390.8 ms at the anterior superior sagittal sinus (p = 0.004). The test-retest assessment showed an interclass correlation coefficient of 0.964. VTT was significantly increased by 513.8 ± 239.3 ms after caffeine ingestion (p < 0.001). VTT measured with VICTR MRI revealed a strong correlation (R = 0.84, p = 0.002) with that measured with the contrast-based approach. VTT was found inversely correlated to cerebral blood flow and venous oxygenation across individuals. CONCLUSION A noncontrast MRI technique, VICTR MRI, was developed to measure the VTT of the brain.
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Affiliation(s)
- Wen Shi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zhiyi Hu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vivek Yedavalli
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yulin Ge
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, United States
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Tan KS, Pandian JD, Liu L, Toyoda K, Leung TWH, Uchiyama S, Kuroda S, Suwanwela NC, Aaron S, Chang HM, Venketasubramanian N. Stroke in Asia. Cerebrovasc Dis Extra 2024; 14:58-75. [PMID: 38657577 PMCID: PMC11250668 DOI: 10.1159/000538928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a significant burden of stroke in Asia. Asia has the largest population in the world in 2023, estimated at 4.7 billion. Approximately 9.5-10.6 million strokes will be anticipated annually in the backdrop of a diverse group of well-developed and less developed countries with large disparities in stroke care resources. In addition, Asian countries are in varying phases of epidemiological transition. SUMMARY In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia, which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy, and cerebral venous thrombosis. KEY MESSAGES The review of selected literature and recent updates calls for attention to the different requirements for resources within Asia and highlights the breadth of cerebrovascular diseases still requiring further research and more effective therapies.
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Affiliation(s)
- Kay Sin Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Thomas Wai Hon Leung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Shinichiro Uchiyama
- Centre for Brain and Cerebral Vessels, Sanno Medical Centre, International University of Health and Welfare, Tokyo, Japan
| | - Sathoshi Kuroda
- Department of Neurosurgery, Toyama University, Toyama, Japan
| | - Nijasri C. Suwanwela
- Chulalongkorn Stroke Centre, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sanjith Aaron
- Department of Medicine, Christian Medical College, Vellore, India
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
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Leung HS, Choi CHJ, Lau EHL, Wong WYE, Cheung CY, Chan YYA. Eagle jugular syndrome presenting with intracranial hypertension - Diagnosis and illustration of pathophysiology by multi-modality imaging. Neuroradiol J 2024; 37:251-256. [PMID: 37385015 PMCID: PMC10973833 DOI: 10.1177/19714009231187347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Eagle jugular syndrome is an uncommon condition caused by compression of an elongated styloid process onto the internal jugular vein. Its presentation is non-specific but may represent in severe clinical consequences including venous thrombosis and intracranial haemorrhage. Thorough understanding of local anatomy is important in understanding the pathogenesis and establishing the diagnosis. Our case reported here illustrates the use of multimodality imaging, including dynamic Computer tomography manoeuvre, in identifying the site of obstruction and guidance towards successful surgical treatment.
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Affiliation(s)
- Ho Sang Leung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chun Ho Joseph Choi
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Eric Hui Lun Lau
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wai Yeung Eddy Wong
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chi Yan Cheung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Yin Yan Anne Chan
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Carrion AN, Allison TA, Samuel S. Is a minimum duration of 5 days of unfractionated heparin infusion necessary before transition to oral anticoagulation in cerebral venous thrombosis? a retrospective chart review. J Thromb Thrombolysis 2024; 57:691-698. [PMID: 38418744 DOI: 10.1007/s11239-024-02950-x] [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] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
In managing cerebral venous sinus thrombosis (CVT), the standard approach has been administering parenteral anticoagulation for at least five days, despite limited supporting evidence. This study aimed to determine the optimal duration of parenteral anticoagulation for CVT patients and its potential impact on their functional outcomes upon discharge. This retrospective observational cohort study was conducted across multiple healthcare centers and included adult CVT patients who received varying durations of parenteral anticoagulation: less than 5 days (n = 25) or 5 days or more (n = 16). The primary focus was on the duration of acute anticoagulation treatment, with secondary endpoints including hospital stay length and functional outcomes. The study found that a shorter duration of anticoagulation treatment (< 5 days) was linked to more favorable outcomes, as measured by the modified Rankin Scale (mRS) (68% vs. 25%, RR = 0.37, CI 0.15-0.90, p = 0.007). However, regression analysis showed non statistically significant associations for all variables except gender. Female patients were significantly more likely to receive a shorter duration of anticoagulation (Odds Ratio: 2.6, 95% CI: 2.2-3.1, P-Value: <0.001). These findings suggest a potential connection between shorter anticoagulation duration (< 5 days) and improved CVT patient outcomes, as indicated by their mRS scores at discharge. The observed relationship between female gender and shorter anticoagulation duration warrants further exploration. Nevertheless, caution is necessary when interpreting these findings due to the small sample size and specific patient characteristics. Further research in a larger and more diverse cohort is essential to validate these results and understand their implications fully.
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Affiliation(s)
- Ariel N Carrion
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA
| | - Teresa A Allison
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA
| | - Sophie Samuel
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA.
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Dias L, João Pinto M, Maia R, Albuquerque L, Carvalho M. Post cerebral venous thrombosis headache - Prevalence, mechanisms and risk factors. J Clin Neurosci 2024; 119:205-211. [PMID: 38141436 DOI: 10.1016/j.jocn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Headache after cerebral venous thrombosis (post-CVT headache [PCH]) is a common complaint during follow-up. Risk factors and their pathophysiology are not well known. We studied PCH prevalence in CVT patients, its pathophysiology, and possible risk factors. MATERIALS AND METHODS We performed a retrospective observational study of patients admitted to a tertiary hospital between 2006 and 2019 with CVT and at least one follow-up appointment. We diagnosed PCH when patients reported headaches during the follow-up visit. Recanalization was retrospectively assessed by two neuroradiologists using the first available follow-up MRI/ MRV, and the PRIORITy-CVT study classification. RESULTS Of 131 patients, sixty (60/131, 45.8 %) reported PCH at the 3-month follow-up. Of these PCH, 9 had previous migraine (9/60, 5.0 %) and 13 previous tension-type headaches (13/60, 21.6 %), before CVT. Forty-four (44/60, 73.3 %) PCH patients had de novo headache: 21 (21/60, 35.0 %) de novo tension-type headaches; 6 (6/60, 10.0 %) de novo migraine; 6 [(6/60, 10.0 %) secondary headache disorders: 3 due to dural arteriovenous fistula, 2 due to intracranial hypertension, and 1 recurrent CVT], and 11 other headache types. Most patients had at least partial recanalization, with no difference in PCH frequency amongst recanalization subgroups (p = 0.598). Premorbid depression (p = 0.009, OR 7.9, 95 % CI 1.6-31.4) increased the odds ratio of PCH, while superior sagittal sinus thrombosis (p = 0.005, OR 0.15, 95 % CI 0.03-0.56) decreased it. DISCUSSION Our study shows that PCH is a common finding after CVT and elucidates potential risk factors. PCH is common in patients with previous or de novo primary headache. In PCH patients without previous headache, secondary causes of headache, namely related to CVT complications, should be excluded. PCH is also increased in patients with premorbid depression. There was no statistically significant difference in PCH amongst the PRIORITy-CVT recanalization subgroups, but most patients had at least partial recanalization.
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Affiliation(s)
- Leonor Dias
- Neurology Department, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Porto Medical Faculty (FMUP), 4200-319, Porto, Portugal.
| | - Maria João Pinto
- Neurology Department, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Porto Medical Faculty (FMUP), 4200-319, Porto, Portugal.
| | - Rúben Maia
- Neurorradiology Department, Centro Hospitalar Vila Nova de Gaia/ Espinho, 4434-502, Vila Nova de Gaia, Portugal.
| | - Luís Albuquerque
- Neuroradiology Department, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.
| | - Marta Carvalho
- Neurology Department, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Porto Medical Faculty (FMUP), 4200-319, Porto, Portugal.
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Dinkin MJ, Patsalides A. Idiopathic Intracranial Venous Hypertension: Toward a Better Understanding of Venous Stenosis and the Role of Stenting in Idiopathic Intracranial Hypertension. J Neuroophthalmol 2023; 43:451-463. [PMID: 37410913 DOI: 10.1097/wno.0000000000001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Venous sinus stenosis, typically at the junction of the transverse and sigmoid sinus, is increasingly recognized as a contributor to the pathophysiology of idiopathic intracranial hypertension (IIH), whether it be the intrinsic type that does not reverse with normalization of intracranial pressure or the extrinsic type, which does. Efforts to treat the stenosis and reduce the associated transstenotic gradient through placement of a stent at the site of stenosis have been studied over the past 2 decades, primarily through retrospective studies, with variable emphasis on formal visual testing and direct assessment of poststent opening pressure. Most studies have presented evidence for utilization of stenting as an alternative to cerebrospinal fluid shunting or optic nerve sheath fenestration in patients with IIH who harbor the stenosis and are refractory to or intolerant of intracranial pressure-lowering medications, but an assessment of the current data is needed to better understand the role of stenting for this patient population. EVIDENCE ACQUISITION A search in PubMed was made for "IIH," "papilledema," and "venous stenting." Data pre and post stenting, including symptoms attributable to IIH, intracranial pressure, papilledema, retinal nerve fiber layer thickening on optical coherence tomography, and visual field assessment (mean deviation), were collected. Need for retreatment and complications were assessed among all studies. Studies using stenting for special circumstances, such as cerebrospinal leaks or for stenosis along anomalous vessels, were reviewed. RESULTS In total, 49 studies (45 retrospective and 4 prospective) and 18 case reports (with 3 or less patients) were found and included in the analysis, for a total of 1,626 patients. In 250 patients in whom poststent intracranial pressure was measured, the mean value was 19.7 cm H 2 O, reduced from a mean of 33 cm H 2 O. Transient visual obscurations resolved in 79.6% of 201 patients who complained of it, pulsatile tinnitus resolved in 84.7% of 515, diplopia resolved in 93% of 86 patients, and nonspecific visual symptoms such as "blurry vision" improved in 76.2% of 537 patients. Headaches resolved in 36% and improved in a further 40.7% of 1,105 patients in whom they were documented before stenting. Of 1,116 with papilledema, 40.8% demonstrated resolution and 38.2% improvement. The mean retinal nerve fiber layer thickness improved from 170.2 µm to 89.2 µm among 402 eyes in which optical coherence tomography was used to measure it. Among 135 eyes in which formal visual fields were performed pre and post stenting, the prestent average mean deviation of -7.35 dB improved to -4.72 dB after stenting. Complications associated with stenting included in-stent stenosis or thrombosis, subdural hematoma, intracerebral hematoma, cerebral edema, stent migration, and death. A recurrence of symptoms requiring a follow-up surgical intervention occurred in 9%. CONCLUSIONS A growing body of evidence supports the use of venous sinus stenting as a viable option for medically refractory IIH, especially when papilledema threatens visual function. Complication and failure rates seem to be similar to alternative surgical approaches, although serious neurological sequalae can rarely occur. Emerging studies evaluating stent type, including novel stents designed for use in the venous system, may help improve ease of the procedure and long-term success rates. Prospective head-to-head studies are needed to better understand the performance of stenting compared with other interventions.
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Affiliation(s)
- Marc J Dinkin
- Department of Ophthalmology and Neurology (MJD), Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY; and Department of Neurosurgery (AP), North Shore University Hospital, Northwell Health, Great Neck, NY
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Moreno-Cortez KM, Chujfi-Zamora M, Reyes-Vaca JG, Rodriguez-Leyva I. Facial pain associated with vein of Trolard thrombosis Case report Neurology. BMJ Case Rep 2023; 16:e256545. [PMID: 37973537 PMCID: PMC10661060 DOI: 10.1136/bcr-2023-256545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Cerebral venous thrombosis is a rare condition, with identified and described risk factors mainly associated with prothrombotic states, with a wide variety of symptomatology based on the site affected, the most common being intracranial hypertensive syndrome, focal or encephalopathy. Cortical veins of the superficial system are among the least frequently affected veins. The following describes a case of painful facial symptoms progressing to a focal syndrome associated with a history of chronic oral contraceptive use, with thrombosis of vein of Trolard detected and successfully treated with oral anticoagulants.
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Affiliation(s)
- Katia Mabiael Moreno-Cortez
- Neurology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Manir Chujfi-Zamora
- Neurology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Jorge Guillermo Reyes-Vaca
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Radiology and Image, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Ildefonso Rodriguez-Leyva
- Neurology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
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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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Mirza AM, Kulkarni GB, Ramakrishnan S, Mustare V, Yadav R, Gupta AK. Profile and Outcome of Prospective Non-Septic Lateral Sinus Thrombosis Patients from a Stroke Unit of a Developing Country. Neurol India 2023; 71:916-922. [PMID: 37929427 DOI: 10.4103/0028-3886.388114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Due to effective treatment of middle ear infections there is a change in etiologies causing lateral sinus thrombosis (LST) and outcome. There is a paucity of literature describing homogenous group of patients with nonseptic LST (NS-LST). Objective To describe the clinical profile, risk factors, outcome of patients of NS-LST seen at a single center from South India. Methods and Materials Prospective, observational study of 100 patients of NS-LST patients, diagnosed by magnetic resonance imaging (MRI) seen at the stroke unit. Results During 2 years, 100 patients of NS-LST (isolated: combined: 27:73) (male: female: 44:56), mean age: 31.45 ± 11.13 years, were seen. Subacute presentation (74%) with headache, seizures, focal deficits, and features of raised intracranial pressure were presenting features. Hyperhomocysteinemia (61%), anemia (57%), postpartum state (41%), OCP use (37%), and low VitB12 (32%) were commonly seen risk factors. Imaging with MRI compared withcomputerized tomography (CT) had better diagnostic sensitivity (100% vs. 67%), detection of parenchymal (81% vs. 67%)/hemorrhagic (79% vs. 74%) lesions, and cortical vein thrombosis (31% vs. 15.46%). Treatment with anticoagulation and supportive therapy resulted in good outcome (mRS (0-2)) at 3 months in 81%.There were four deaths, all during admission (one - isolated, three - combined) and 11 patients underwent decompressive surgery. Patients with low GCS level of sensoriumat admission, hemiparesis, combined LST, cerebellar involvement, and decompressive craniectomy had a poor outcome. Conclusion This single-center large cohort study of NS-LST patients brings out the clinical features, risk factors (peculiar to developing countries), and the superiority of MRI in the diagnosis. Majority of patients have good outcome, with low mortality with 10% requiring decompressive surgery.
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Affiliation(s)
- Abbas M Mirza
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Arun K Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
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Aaron S, Arthur A. Visual Impairment in Cerebral Venous Thrombosis: The Various Shades of Gray. Ann Indian Acad Neurol 2023; 26:629-630. [PMID: 38022438 PMCID: PMC10666876 DOI: 10.4103/aian.aian_449_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: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anupriya Arthur
- Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Nirhale S, Rohatgi S, Rao P, Naphade P, Hatekar KS. Acute Subdural Hematoma: A Rare Manifestation of Cerebral Venous Sinus Thrombosis. Cureus 2023; 15:e45519. [PMID: 37868383 PMCID: PMC10585420 DOI: 10.7759/cureus.45519] [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: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Cerebral venous sinus thrombosis (CVST) usually presents with headaches, seizures, and signs and symptoms of raised intracranial pressure (ICP). Risk factors for CVST commonly include hypercoagulable states such as pregnancy and the peripartum period, dehydration, vitamin B12 deficiency, hyper-homocysteinemia, coagulation factor deficiency, antiphospholipid antibody disease, oral contraceptive pill intake, etc. CVST with venous hemorrhagic infarction is commonly reported, but only a few cases have been reported in the literature of CVST presenting as SDH. Here, we present a case of a 28-year-old female who presented with an acute onset of severe headache, vomiting, and bilateral papilledema on fundus examination. She had a prior history of oral contraceptive pill intake. An MRI brain venogram suggested CVST involving the superior sagittal sinus, right transverse, and a few cortical vein thromboses with subdural hematoma (SDH) in the frontal-parieto-temporo-occipital region on the right side. The patient was treated with anticoagulants and antiepileptics and had significant improvement in symptoms with the resolving SDH on subsequent scans.
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Affiliation(s)
- Satish Nirhale
- Neurology, Dr. D.Y. Patil Medical College and Research Center, Pune, IND
| | - Shalesh Rohatgi
- Neurology, Dr. D.Y. Patil Medical College and Research Center, Pune, IND
| | - Prajwal Rao
- Neurology, Dr. D.Y. Patil Medical College and Research Center, Pune, IND
| | - Pravin Naphade
- Neurology, Dr. D.Y. Patil Medical College and Research Center, Pune, IND
| | - Khushboo S Hatekar
- Neurology, Dr. D.Y. Patil Medical College and Research Center, Pune, IND
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Kashyap PV, Kashyap M, Dhiran A, Yadav A. Missed Cerebral Venous Thrombosis: A Diagnostic Challenge. Ann Neurosci 2023; 30:197-204. [PMID: 37779553 PMCID: PMC10540759 DOI: 10.1177/09727531231183242] [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: 06/29/2022] [Accepted: 05/12/2023] [Indexed: 10/03/2023] Open
Abstract
Rates of cerebral venous sinus thrombosis (CVT) misdiagnosis or at times delayed diagnosis and related outcomes have remained underexplore, and also there is less knowledge about the long-term outcome of patients with untreated cerebral venous sinus thrombosis (CVT). Long-term presentations of untreated CVT are rare. We hereby presenting series of four interesting patients of chronic CVT whose diagnosis was missed and how varied chronic presentations of untreated CVT appeared to neurology and how subtle radiologic features helped with correct diagnosis.
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Affiliation(s)
| | - Manshi Kashyap
- Department of Neurology, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Arpit Dhiran
- Department of Neurology, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Akanxa Yadav
- Department of Neurology, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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Jain V, Pilania J, Agarwal M, Thokchom N, Pathania M. Prolonged Corticosteroid Use Leading to Cerebral Venous Sinus Thrombosis: A Rare Association. Cureus 2023; 15:e41104. [PMID: 37519533 PMCID: PMC10382212 DOI: 10.7759/cureus.41104] [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: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Partial or complete obstruction of blood flow in venous sinuses of the brain leads to a clinical condition termed cerebral venous sinus thrombosis (CVST). In most diagnosed cases, CVST has at least one risk factor identified among many postulated, and it most commonly includes acquired or inherited prothrombotic conditions. Steroid intake for intentional weight gain is prevalent in the general population, especially among new-generation bodybuilders and athletes. Excess exogenous steroids have many adverse effects, and increasing the risk of venous thromboembolism is one of them. The role of these steroids in developing CVST among such individuals has not been reported frequently in the literature. We report a case of a young male with a history of chronic exogenous steroid intake to increase his body weight, who presented with clinical features of CVST.
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Affiliation(s)
- Vikram Jain
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Jaideep Pilania
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Mayank Agarwal
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Nonita Thokchom
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Monika Pathania
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND
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14
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Jianu DC, Jianu SN, Iacob N, Dan TF, Munteanu G, Gogu AE, Sadik R, Motoc AGM, Axelerad A, Sirbu CA, Petrica L, Ionita I. Diagnosis and Management of Cerebral Venous Thrombosis Due to Polycythemia Vera and Genetic Thrombophilia: Case Report and Literature Review. Life (Basel) 2023; 13:life13051074. [PMID: 37240720 DOI: 10.3390/life13051074] [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: 02/24/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Cerebral venous and dural sinus thrombosis (CVT) rarely appears in the adult population. It is difficult to diagnosis because of its variable clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. (2) Case presentation: A 41-year-old male patient presented with an acute isolated intracranial hypertension syndrome. The diagnosis of acute thrombosis of the left lateral sinus (both transverse and sigmoid portions), the torcular Herophili, and the bulb of the left internal jugular vein was established by neuroimaging data from head-computed tomography, magnetic resonance imaging (including Contrast-enhanced 3D T1-MPRAGE sequence), and magnetic resonance venography (2D-TOF MR venography). We detected different risk factors (polycythemia vera-PV with JAK2 V617F mutation and inherited low-risk thrombophilia). He was successfully treated with low-molecular-weight heparin, followed by oral anticoagulation. (3) Conclusions: In the case of our patient, polycythemia vera represented a predisposing risk factor for CVT, and the identification of JAK2 V617F mutation was mandatory for the etiology of the disease. Contrast-enhanced 3D T1-MPRAGE sequence proved superior to 2D-TOF MR venography and to conventional SE MR imaging in the diagnosis of acute intracranial dural sinus thrombosis.
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Affiliation(s)
- Dragos Catalin Jianu
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Silviana Nina Jianu
- Department of Ophthalmology, "Dr. Victor Popescu" Military Emergency Hospital, 7 G. Lazar Ave., 300080 Timisoara, Romania
| | - Nicoleta Iacob
- Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, 300218 Timisoara, Romania
| | - Traian Flavius Dan
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Georgiana Munteanu
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Anca Elena Gogu
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Raphael Sadik
- Department of Geriatrics-Rehabilitation, Riviera-Chablis Hospital, 3 Prairie Ave., 1800 Vevey, Switzerland
| | - Andrei Gheorghe Marius Motoc
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
| | - Any Axelerad
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania
| | - Carmen Adella Sirbu
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Department of Neurology, Central Military Emergency University Hospital, Clinical Neuroscience Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ligia Petrica
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Division of Nephrology, Department of Internal Medicine II, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
| | - Ioana Ionita
- Division of Hematology, Department V, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Multidisciplinary Research Center for Malignant Hemopathies (CMCHM), "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
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15
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Liberman AL. Diagnosis and Treatment of Cerebral Venous Thrombosis. Continuum (Minneap Minn) 2023; 29:519-539. [PMID: 37039408 DOI: 10.1212/con.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cerebral venous thrombosis (CVT), thrombosis of the dural sinus, cerebral veins, or both, is a rare cerebrovascular disease. Although mortality rates after CVT have declined over time, this condition can result in devastating neurologic outcomes. This article reviews the latest literature regarding CVT epidemiology, details new factors associated with the development of CVT, and describes advances in CVT treatment. It also contains a discussion of future directions in the field, including novel diagnostic imaging modalities, and potential strategies to reduce the risks associated with CVT. LATEST DEVELOPMENTS The incidence of CVT may be as high as 2 per 100,000 adults per year. It remains a difficult condition to diagnose given its variable clinical manifestations and the necessity of neuroimaging for confirmation. The COVID-19 pandemic has revealed a novel CVT trigger, vaccine-induced immune thrombotic thrombocytopenia (VITT), as well as an association between COVID-19 infection and CVT. Although VITT is a very rare event, timely diagnosis and treatment of CVT due to VITT likely improves patient outcomes. Direct oral anticoagulants are currently being used to treat CVT and emerging data suggest that these agents are as safe and effective as vitamin K antagonists. The role of endovascular therapy to treat CVT, despite a recent clinical trial, remains unproven. ESSENTIAL POINTS The incidence of CVT has increased, outcomes have improved, and the use of direct oral anticoagulants to treat CVT represents an important advance in the clinical care of these patients. Rates of CVT as a complication of COVID-19 vaccines using adenoviral vectors are very low (<5 per million vaccine doses administered), with the benefits of COVID-19 vaccination far outweighing the risks.
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16
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Schuchardt F, Demerath T, Lützen N, Elsheikh S, Lagrèze W, Reich M, Küchlin S, Urbach H, Meckel S, Harloff A. Risk factors for the development of secondary intracranial hypertension in acute cerebral venous thrombosis. Neuroradiology 2023; 65:463-477. [PMID: 36445465 DOI: 10.1007/s00234-022-03091-9] [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: 07/25/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intracranial hypertension (IH) can complicate cerebral venous thrombosis (CVT), potentially causing permanent visual loss. Current knowledge on risk factors for the development of IH following CVT is scarce. We applied a compound classifier (CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI) as a surrogate for IH and studied the predictive value of thrombus location, the number of thrombosed segments, and thrombus volume. METHODS We prospectively included 26 patients with acute CVT and complete MRI data. IH was defined by CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI. Using high-resolution contrast-enhanced venography, we determined the thrombus location, number of thrombosed segments, and thrombus volume. We analyzed their association with IH by logistic regression, their predictive power by the area under the receiver operating characteristic curve, and their association with CSF opening pressure by linear regression. RESULTS IH occurred in 46% of CVT patients and was associated with higher thrombus volume (AUC 0.759, p = 0.025) and superior sagittal sinus thrombosis both alone (OR 2.086, p = 0.049) and combined with transverse sinus thrombosis (OR 2.014, p = 0.028). Effects in patients presenting CSF opening pressure > 25 cm H2O and the compound classifier were consistent. Thrombus volume > 4 ml was the single most important predictor of higher CSF opening pressure (ß = 0.566, p = 0.035), increasing IH risk. CONCLUSION Larger thrombus volume, dominant transverse sinus occlusion, and extensive superior sagittal combined with transverse sinus thrombosis were associated with IH. Thrombus volumetry might identify patients at risk for IH and direct further clinical evaluation.
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Affiliation(s)
- Florian Schuchardt
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
| | - T Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Lützen
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Elsheikh
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - W Lagrèze
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Küchlin
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Meckel
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Diagnostic and Interventional Neuroradiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - A Harloff
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
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17
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Stroke in Pregnancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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18
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Muacevic A, Adler JR, Kronen T, Fahad A, Crooks R. Evaluating the Safety of Ultra-Low-Dose Estrogen Contraception in Sickle Cell Trait With Focus on Cerebral Venous Sinus Thrombosis. Cureus 2023; 15:e34163. [PMID: 36843802 PMCID: PMC9949882 DOI: 10.7759/cureus.34163] [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: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Ultra-low-dose combination estrogen-progestin contraceptive pills (OCP) have been marketed as being safer to use than previously higher estrogen-containing OCPs. While multiple large studies have shown a dose-dependent association between estrogen and deep vein thrombosis, there remains sparse guidance or data as to whether patients with sickle cell trait should avoid estrogen-containing OCPs regardless of the dosage. We present a case of a 22-year-old female with a history of sickle cell trait who had recently been started on an ultra-low-dose norethindrone-ethinyl estradiol-iron (1-20 mcg) that presented with headache, nausea, vomiting, and obtunded. Initial neuroimaging was significant for an extensive superior sagittal sinus thrombosis with extension into the confluence of dural venous sinuses, right transverse sinus, right sigmoid sinus, and right internal jugular vein which ultimately required systemic anti-coagulation. Her symptoms largely resolved within four days after starting anti-coagulation. She was discharged on day six to complete a six-month course of oral anti-coagulation. At her neurology follow-up three months later, the patient reported resolution of all symptoms. This study evaluates the safety of ultra-low-dose estrogen-containing contraceptive pills in the sickle cell trait population with special focus on cerebral sinus thrombosis.
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19
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Emekli AS, Doğan FU, Gündüz T, Sezgin M, Ekizoğlu E, Yeşilot N, Çoban O, Akman G, Kürtüncü M. Lesion probability map in cerebral vein thrombosis due to Behçet's disease. Int J Rheum Dis 2023; 26:145-150. [PMID: 36210482 DOI: 10.1111/1756-185x.14455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 01/03/2023]
Abstract
AIM Behçet's disease (BD) is a multisystemic inflammatory disease. Cerebral venous sinus thrombosis (CVST) is the second most common form of neuro-BD after parenchymal central nervous system involvement. The purpose of this study was to construct flow-void probability maps of patients with CVST with and without BD to visually illustrate the impacted cerebral venous sinuses, to compare the subgroups of patients, and investigate the effect of thrombus localization on clinical findings. METHODS Seventeen patients with a diagnosis of BD-related CVST (CVST-BD) and 23 patients with a diagnosis of CVST related to other etiologies (CVST-O) were included. We collected data including gender, age at onset of BD and CVST, presenting symptoms, neurological findings, and the etiology. High-resolution magnetic resonance venographies obtained during CVST were used to mark and digitalize thrombosed areas. Thrombus probability and subtraction maps were created to reveal the differences between the subgroups. RESULTS Remarkably, all patients with CVST-BD had thrombosis in the transverse sinus (TS). However, TS was affected in 73.9% of the CVST-O patients (17/17 in CVST-BD vs 17/23 in CVST-O, P = .03). Thrombosis developed mostly in the superior sagittal sinus (SSS) and TS in the CVST-O group (11/23, 47.8% and 17/23, 73.9%, respectively). The frequency of SSS thrombosis tended to be higher in the CVST-O (47.8% vs 23.5%, P = .19). CONCLUSION Venous infarction and hemorrhage were less common in patients with CVST-BD. The only clinical symptom in most of the CSVT patients with BD was headache due to elevated intracranial pressure. TS thrombosis was more common in patients with BD.
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Affiliation(s)
- Ahmed Serkan Emekli
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Faruk Uğur Doğan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mine Sezgin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esme Ekizoğlu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nilüfer Yeşilot
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Oğuzhan Çoban
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gülşen Akman
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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20
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Sigmoid Venous Thrombosis in JAK2 V617F Mutated Polycythemia Vera. Case Rep Hematol 2022; 2022:4948115. [DOI: 10.1155/2022/4948115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
A 60-year-old female presented with headaches, blurry vision, diplopia, and dizziness for six weeks. Her workup revealed an elevated hematocrit, thrombocytosis, high ferritin, and normal erythropoietin. She was diagnosed with polycythemia vera with the JAK2 V617F mutation. The patient underwent magnetic resonance venography, which showed left-sided sigmoid venous thrombosis. She was placed on low-molecular-weight heparin, with a plan to transition to oral anticoagulation after four weeks and repeat imaging in three months to assess for resolution. Thrombotic events may occur in patients with polycythemia vera, and a JAK2 mutation further heightens that risk. Even so, intracranial venous thrombosis is not among the most common events, and it should be kept in the differential for any patient with myeloproliferative neoplasms presenting with new neurological symptoms.
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21
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Friedman SA, Masters-Israilov A, Robbins MS. Secondary Headache Disorders: Approach, Workup, and Special Considerations for Select Populations. Semin Neurol 2022; 42:418-427. [PMID: 36220127 DOI: 10.1055/s-0042-1757753] [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]
Abstract
Headache is one of the most common diagnoses in neurology. A thorough understanding of the clinical presentation of secondary headache, which can be life-threatening, is critical. This review provides an overview of the diagnostic approach to a patient with headache, including discussion of "red," "orange," and "green" flags. We emphasize particular scenarios to help tailor the clinical workup to individual circumstances such as in pregnant women, when particular attention must be paid to the effects of blood pressure and hypercoagulability, as well as in older adults, where there is a need for higher suspicion for an intracranial mass lesion or giant cell arteritis. Patients with risk factors for headache secondary to alterations in intracranial pressure, whether elevated (e.g., idiopathic intracranial hypertension) or decreased (e.g., cerebrospinal fluid leak), may require more specific diagnostic testing and treatment. Finally, headache in patients with COVID-19 or long COVID-19 is increasingly recognized and may have multiple etiologies.
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Affiliation(s)
- Sarah A Friedman
- Department of Neurology, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Alina Masters-Israilov
- Department of Neurology, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medicine and New York Presbyterian, New York, New York
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22
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Kow CS, Ramachandram DS, Hasan SS. The use of corticosteroids in patients with COVID-19 vaccine–related cerebral venous thrombosis. Neurol Sci 2022; 43:5183-5184. [PMID: 35650457 PMCID: PMC9159644 DOI: 10.1007/s10072-022-06177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/26/2022] [Indexed: 10/25/2022]
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23
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Danis F, Rabani AE, Subhani F, Yasmin S, Koul SS. COVID‐19: Vaccine‐induced immune thrombotic thrombocytopenia (VITT). Eur J Haematol 2022; 109:619-632. [PMID: 36030503 PMCID: PMC9538855 DOI: 10.1111/ejh.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Salman Shafi Koul
- Pakistan Institute of Medical Sciences, Ibn‐e‐Sina Road, G‐8/3 G 8/3 G‐8 Islamabad Pakistan
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Harrison H, Rezaei H, Dalal N. A Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia. Cureus 2022; 14:e27204. [PMID: 36039236 PMCID: PMC9395908 DOI: 10.7759/cureus.27204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
This report discusses a case of a 37-year-old female who developed vaccine-induced thrombotic thrombocytopenia (VITT) after receiving the Johnson and Johnson COVID-19 vaccination. The patient first presented to the ED with complaints of a worsening headache. Labs were significant for thrombocytopenia with a platelet count of 22,000, and the patient was admitted to the inpatient unit for monitoring. The day after admission, the patient was found to have a right common femoral artery embolus, left distal popliteal trifurcation embolism, a small pulmonary embolism in the right lower lobe, and a mural thrombus of the infrarenal abdominal aorta. Following these findings, the patient underwent emergent thrombectomy of the common and superficial femoral arteries. Over the hospital course of six days, the patient received steroids and IV immunoglobulin (IVIG), which led to the resolution of the thrombocytopenia. The patient was given argatroban followed by apixaban for anticoagulation. She was instructed to follow up with hematology within one to two weeks post-discharge for monitoring of anticoagulation and thrombus surveillance. This case report outlines the clinical course, diagnosis, and treatment of a case of VITT, which will assist physicians in early recognition and adequate treatment of this condition as the COVID-19 pandemic continues.
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25
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An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis. Life (Basel) 2022; 12:life12050717. [PMID: 35629384 PMCID: PMC9145675 DOI: 10.3390/life12050717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.
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Cerebral angiography as a tool for diagnosis and management of idiopathic intracranial hypertension syndrome. Clin Imaging 2022; 88:53-58. [DOI: 10.1016/j.clinimag.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
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27
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Alghamdi SR, Cho A, Lam J, Al-Saadi T. Cerebral Venous Sinus Thrombosis in Closed Head Injury: Systematic Review and Meta-analysis. J Clin Neurosci 2022; 98:254-260. [PMID: 35247707 DOI: 10.1016/j.jocn.2022.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 09/08/2021] [Accepted: 01/22/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CSVT) is a rare condition, causing 0.5% of all strokes only, several mechanisms might be involved in forming the thrombosis, including closed head injury. METHODS Systematic review was done by using the following databases: PubMed, Google Scholar, Microsoft Academic, Clinical Trials, Cochrane Library, and Web of Science. RESULTS 25 articles met our criteria out of 152 articles, average and standard deviation of the age was 38.2 ± 16.8 years with an age range of 18-82. The majority of cases presented with loss of consciousness or decreased GCS (41%), followed by headache (26%), scalp abrasions/lacerations (21%), paralysis (18%), visual disturbance (18%), nystagmus (15%), and agitation (15%). The most commonly used diagnostic method was angiography. Thrombosis was the most frequently reported radiological finding among all the cases (26/34, 76%). Comparisons of outcomes between patients who underwent surgical intervention and those who did not undergo surgery revealed a significant difference in outcome favoring non-surgical treatment (p < 0.005, odds ratio (OR) 0.04, (95% CI) 0.003 - 0.30). CONCLUSION Non-surgical outcomes were better than the surgical outcomes. However, no significant difference was seen comparing anti-coagulation versus conservative management (supportive without anticoagulation), single versus multi-sinuses (≥2 sinuses) involvement, and between any of the sinuses involved.
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Affiliation(s)
- Saad R Alghamdi
- Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Jack Lam
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Tariq Al-Saadi
- Department of Neurology and Neurosurgery- Montreal Neurological Institute- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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Ferro JM, de Sousa DA, Canhão P. Cerebral Venous Thrombosis. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sachdeva V, Nalawade R, Kannam M, Kapoor R, Chattannavar G, Kale SB, Sheth J, Badakere A, Majhi D, Warkad VU, Chougule P, Kekunnaya R. Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis. Indian J Ophthalmol 2021; 69:3598-3606. [PMID: 34827003 PMCID: PMC8837335 DOI: 10.4103/ijo.ijo_96_21] [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] [Indexed: 11/29/2022] Open
Abstract
Purpose: To report clinical profile, diagnostic challenges, and outcomes in cases of subacute/chronic cerebral sinus venous thrombosis (CSVT) presenting to neuro-ophthalmologists/neurologists. Methods: This was a multicentric, retrospective, observational study. Records of patients with neuroimaging proven subacute/chronic CSVT seen the from January 1, 2016 to March 31, 2020 were analyzed. Data collected included duration of symptoms, diagnosing physician, ophthalmological vs. focal/generalized neurological symptoms, optic disc examination, perimetry, and neuroimaging findings. Statistical analysis was performed using STATA software. Results: Forty-three patients with subacute (30)/chronic (13) CSVT were identified (32 males, 11 females). Median age was 37 (IQR 27–47) years. The presenting complaints were blurred vision 34 (79%), headaches in 25 (58%), vomiting 12 (28%), and diplopia 11 (26%). Eleven patients had associated sixth cranial nerve palsy. All but two patients had either disc edema/optic atrophy; four had unilateral disc edema at presentation. Ophthalmologists and neurologists diagnosed/suspected CSVT correctly in 13/29 (45%) and 11/14 (78.5%) patients, respectively. Most common initial alternate diagnosis was idiopathic intracranial hypertension in 12 (28%). Female gender, age ≤36, unilateral papilledema, not obtaining venogram at initial workup increased chances of initial alternate diagnosis. Median follow-up duration was 21 days. Average visual function remained stable in majority of patients at last follow-up. In total, 47.6% of patients had best-corrected visual acuity ≥20/30 at the final follow-up. Conclusion: In our series, subacute or chronic CSVT presented presented primarily with symptoms of intracranial hypertension. Unilateral papilledema, middle-aged patients, female gender, lack of focal/generalized neurological symptoms created diagnostic dilemma. Visual function remained stable in majority of patients.
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Affiliation(s)
- Virender Sachdeva
- Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| | - Rohan Nalawade
- Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| | - Mohan Kannam
- Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| | - Rajat Kapoor
- Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| | - Goura Chattannavar
- Academy of Eye Care Education, Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Sheetal Bajirao Kale
- Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| | - Jenil Sheth
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Akshay Badakere
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Debasmita Majhi
- Child Sight Institute, Miriyam Hyman Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L V Prasad Eye Institute, MTC Campus, Bhubaneshwar, Odisha, India
| | - Vivekanand Uttamrao Warkad
- Child Sight Institute, Miriyam Hyman Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L V Prasad Eye Institute, MTC Campus, Bhubaneshwar, Odisha, India
| | - Pratik Chougule
- Child Sight Institute, David Brown Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L V Prasad Eye Institute, KVC Campus, Vijayawada, Andhra Pradesh, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
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Thakur KT, Tamborska A, Wood GK, McNeill E, Roh D, Akpan IJ, Miller EC, Bautista A, Claassen J, Kim CY, Guekht A, Pardo CA, Williams O, García-Azorín D, Prasad K, Schmutzhard E, Michael BD, Chou SHY, Winkler AS, Solomon T, Elkind MS. Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions. J Neurol Sci 2021; 427:117532. [PMID: 34134058 PMCID: PMC8178065 DOI: 10.1016/j.jns.2021.117532] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaccine induced immune mediated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers. METHODS A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists. FINDINGS Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation.
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Affiliation(s)
- Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
| | - Arina Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK
| | - Greta K Wood
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK
| | - Emily McNeill
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Imo J Akpan
- Department of Hematology/Oncology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Eliza C Miller
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Alyssa Bautista
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Carla Y Kim
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry & Russian National Research Medical University, Moscow, Russia
| | - Carlos A Pardo
- Divisions of Neuroimmunology and Neuroinfectious Disorders & Advanced Clinical Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olajide Williams
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Kameshwar Prasad
- Rajendra Institute of Medical Sciences, Ranchi 834009, Jharkhand, India
| | - Erich Schmutzhard
- Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Benedict D Michael
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital/Harvard University, Boston, MA, USA
| | - Sherry H-Y Chou
- Department of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Mitchell S Elkind
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
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31
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Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous thrombosis: a practical guide. Pract Neurol 2021; 20:356-367. [PMID: 32958591 DOI: 10.1136/practneurol-2019-002415] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/04/2022]
Abstract
All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from 'conventional' stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research.
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Affiliation(s)
- Leonardo Ulivi
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK
| | - Martina Squitieri
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK
| | - Hannah Cohen
- Haemostasis Research Unit, University College London, London, UK.,Haematology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Peter Cowley
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK.,Lysholm Department of Neuroradiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - David J Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK .,Lysholm Department of Neuroradiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
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Abstract
Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and gestational hypercoagulability are important contributors to obstetric stroke. Preeclampsia and eclampsia confer risk for future cardiovascular disease. Hemorrhagic stroke is the most common type of obstetric stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy.
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Affiliation(s)
- Erica C Camargo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA.
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33
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Elnahry AG, Talbet JH, El Mahgoub IR, Elnahry GA. Optic Nerve Sheath Fenestration for Papilledema Due to Cerebral Venous Sinus Thrombosis Associated with Antiphospholipid Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930497. [PMID: 34029308 PMCID: PMC8164882 DOI: 10.12659/ajcr.930497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 21-year-old Final Diagnosis: Antiphospholipid antibody syndrome • cerebral venous sinus thrombosis Symptoms: Blurring of vision • confusion • fever • headache Medication: — Clinical Procedure: Laboratory • magnetic resonance imaging Specialty: Neurology • Ophthalmology
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Iman R El Mahgoub
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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34
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Geisbüsch C, Herweh C, Gumbinger C, Ringleb PA, Möhlenbruch MA, Nagel S. Chronic intracranial hypertension after cerebral venous and sinus thrombosis - frequency and risk factors. Neurol Res Pract 2021; 3:28. [PMID: 33993881 PMCID: PMC8127194 DOI: 10.1186/s42466-021-00127-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) can infrequently lead to chronical intracranial hypertension (IH) due to the altered venous drainage. The aim of this study was to ascertain the risk of IH after CVST and to stratify underlying risk factors. METHODS We performed a retrospective cohort analysis of all cases treated for acute CVST at our department between 2013 and 2019. IH was diagnosed at follow-up according to the modified Dandy criteria. CVST-patients with and without IH were descriptively compared conforming to available clinical and radiological data as well as outcomes. RESULTS Our study included 102 patients with acute CVST. In 70 cases complete follow-up data was available (68.6%). Seven of these patients developed symptomatic intracranial hypertension (10%; N = 7, n = 70) within a median follow-up of 6 months. Four of these patients (57.1% (N = 4, n = 7) vs. 3.2% (N = 2, n = 63); p < 0.001) presented recurrent sinus thrombosis in the further course. There were no significant differences between patients with or without IH concerning gender, age, risk factors, occluded vessels and treatment for their CVST. However the presence of visual deterioration at initial admission was higher in patients who developed IH afterwards (57.1% (N = 4, n = 7) vs. 20.6% (N = 13, n = 63); p = 0.03). Patients with chronic IH after CVST showed significantly less likely recanalization of the occluded vessel on follow-up MRI (no recanalization in 28.6% (N = 2, n = 7) vs. 4.8% (N = 3, n = 63); p = 0.02). All patients with IH had a good outcome (mRS 0-2) at discharge and follow-up. CONCLUSION IH occurred in around 10% after CVST. Insufficient recanalization status may facilitate IH. Patients with visual disturbances seem to develop more likely IH afterwards. Patients who present IH after CVST may develop recurrent cerebral venous thrombosis.
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Affiliation(s)
- Christina Geisbüsch
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Herweh
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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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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36
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Furie KL, Cushman M, Elkind MSV, Lyden PD, Saposnik G. Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia. Stroke 2021; 52:2478-2482. [PMID: 33914590 DOI: 10.1161/strokeaha.121.035564] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Karen L Furie
- Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Mary Cushman
- Larner College of Medicine, University of Vermont, Burlington (M.C.)
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons, Columbia University, NY (M.S.V.E.)
| | | | - Gustavo Saposnik
- St. Michael's Hospital, University of Toronto, ON, Canada (G.S.)
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Sutraye J, Kannam M, Ponnapalli SP, Sachdeva V. Disc Oedema in A Patient with Chronic Kidney Disease: A Diagnostic Conundrum. Neuroophthalmology 2021; 46:34-40. [DOI: 10.1080/01658107.2020.1867872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Jagadeesh Sutraye
- Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
| | - Mohan Kannam
- Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
| | | | - Virender Sachdeva
- Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
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38
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Medicherla CB, Pauley RA, de Havenon A, Yaghi S, Ishida K, Torres JL. Cerebral Venous Sinus Thrombosis in the COVID-19 Pandemic. J Neuroophthalmol 2020; 40:457-462. [PMID: 33186264 DOI: 10.1097/wno.0000000000001122] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recent studies have noted concern for increased thromboembolic events in the setting of Coronavirus Disease 2019 (COVID-19). Cerebral venous sinus thrombosis (CVST) is a form of thromboembolism that has been observed as a neuro-ophthalmologic complication of COVID-19. METHODS Review of the scientific literature. RESULTS In this article, we report an overview of CVST epidemiology, clinical presentation, diagnostics, disease pathophysiology, and management in the setting of COVID-19. CONCLUSION CVST is an uncommon thromboembolic event with variable phenotypes and multiple etiologies. Neurologic complications can be severe, including significant visual deficits and death. Current observations suggest that the risk of CVST may be profoundly impacted by this novel COVID-19 pandemic, thus prompting increased attention to disease presentation, pathogenesis, and management.
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Affiliation(s)
- Chaitanya B Medicherla
- Department of Neurology (CM, RAP, SY, KI, JT), New York University Langone Medical Center, New York, New York; and Department of Neurology (AdH), University of Utah School of Medicine, Salt Lake City, Utah
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39
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Magnetic resonance or computed tomography venography in the evaluation of young overweight women with papilledema. Eye (Lond) 2020; 35:2241-2245. [PMID: 33106608 DOI: 10.1038/s41433-020-01242-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare the yield of magnetic resonance venography (MRV)/computed tomography venography (CTV) in a group of overweight women with incidentally-discovered papilledema and symptomatic intracranial hypertension (IC-HTN) patients without risk factors for dural venous sinus thrombosis (DVST). DESIGN Retrospective cohort study. METHODS Retrospective cohort study of female patients between ages 16 and 50 with papilledema, body mass index >25 kg/m2 and MRV/CTV imaging. Patients were excluded if they had risk factors for DVST. The incidence of DVST and clinical features were retrieved. Patients were divided into those with incidentally-discovered papilledema (Group-1) and those who presented due to symptoms of IC-HTN (Group-2). RESULTS One hundred three patients (45 Group-1, 58 Group-2) were included in the study. Group-2 patients were more likely to have pulsatile tinnitus (p = 0.017), transient visual obscurations, and showed a trend towards increased headache (p = 0.058). Group-2 was also more likely to have been treated with acetazolamide (p < 0.01) and undergo lumbar puncture (p = 0.02). DVST was initially reported in four patients (one in Group-1, three in Group-2), but after further review, two cases (one from Group-1, one from Group-2) were found to be false positives. The final two DVST diagnoses were in Group-2 and presented with significant neurological symptoms. CONCLUSIONS DVST was not found among a group of 45 young, overweight women with incidentally-discovered papilledema and without DVST risk factors. We therefore believe it is reasonable practice to perform MRI alone, without dedicated MRV/CTV, in the investigation of young, overweight women with incidentally-discovered papilledema without risk factors for DVST.
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40
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Virdee J, Larcombe S, Vijay V, Sinclair AJ, Dayan M, Mollan SP. Reviewing the Recent Developments in Idiopathic Intracranial Hypertension. Ophthalmol Ther 2020; 9:767-781. [PMID: 32902722 PMCID: PMC7708542 DOI: 10.1007/s40123-020-00296-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Indexed: 02/07/2023] Open
Abstract
There is increasing evidence and appreciation of idiopathic intracranial hypertension (IIH) in medicine. The pathological processes underlying raised intracranial pressure are being studied, with new insights found in both hormonal dysregulation and the metabolic neuroendocrine axis. These will potentially lead to novel therapeutic targets for IIH. The first consensus guidelines have been published on the investigation and management of adult IIH, and the International Headache Society criteria for headache attributable to IIH have been modified to reflect our evolving understanding of IIH. Randomized clinical trials have been published, and a number of studies in this disease area are ongoing.
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Affiliation(s)
- Jasvir Virdee
- Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vivek Vijay
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Alex J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Margaret Dayan
- Newcastle Eye Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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41
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Lounici A, Bensefia A, Tabti E, Bestaoui M. A descriptive monocentric study in Algeria of adults with cerebral venous thrombosis. Rev Neurol (Paris) 2020; 176:614-618. [DOI: 10.1016/j.neurol.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
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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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Simon S, Volpe NJ. Implications of a Swollen Optic Nerve. JAMA Netw Open 2020; 3:e207159. [PMID: 32484550 DOI: 10.1001/jamanetworkopen.2020.7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shira Simon
- Department of Neurology, Feinberg School of Medicine, Northwestern Medicine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern Medicine
| | - Nicholas J Volpe
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern Medicine
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Long CP, Ediriwickrema LS, Liu CY. Severe Progressive Bilateral Vision Loss With Headaches. JAMA Ophthalmol 2020; 138:582-583. [PMID: 32191266 DOI: 10.1001/jamaophthalmol.2020.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher P Long
- Shiley Eye Institute, Division of Oculofacial Plastic and Reconstructive Surgery, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Lilangi S Ediriwickrema
- Shiley Eye Institute, Division of Oculofacial Plastic and Reconstructive Surgery, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Catherine Y Liu
- Shiley Eye Institute, Division of Oculofacial Plastic and Reconstructive Surgery, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
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Mainoli B, Carvalho Dias M, Canhão P, Rosa MM. Suspected adverse reaction to compounded preparations prescribed for weight loss: two cases of cerebral venous thrombosis. BMJ Case Rep 2020; 13:e233746. [PMID: 32234856 PMCID: PMC7167426 DOI: 10.1136/bcr-2019-233746] [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] [Accepted: 03/13/2020] [Indexed: 11/04/2022] Open
Abstract
We report two cases of cerebral venous thrombosis associated with the use of compounded preparations containing several active substances prescribed for weight loss. In both cases there is suspicion of additive/synergic interaction with oral contraceptives. The adverse drug reactions were considered serious, being life-threatening and causing hospitalisation for days.
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Affiliation(s)
- Beatrice Mainoli
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Unidade de Farmacovigilância de Lisboa, Sistema Nacional de Farmacovigilância, Lisboa, Portugal
| | - Mariana Carvalho Dias
- Stroke Unit, Neurology Department, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Patricia Canhão
- Stroke Unit, Neurology Department, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Miguel Rosa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Unidade de Farmacovigilância de Lisboa, Sistema Nacional de Farmacovigilância, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Neurology Department, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Sun WYL, Switzer NJ, Dang JT, Gill R, Shi X, de Gara C, Birch D, Nataraj A, Karmali S. Idiopathic intracranial hypertension and bariatric surgery: a systematic review. Can J Surg 2020; 63:E123-E128. [PMID: 32195557 DOI: 10.1503/cjs.016616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a rare condition typically affecting women with obesity who are of child-bearing age. Patients commonly present with headaches, visual disturbances, pulsatile tinnitus and papilledema. The association between IIH and obesity has been well established in the literature, suggesting that weight loss may contribute to improving IIH. For patients with severe obesity for whom conservative management is not successful, bariatric surgery is an effective modality for weight loss. We aimed to systematically review the literature to determine the efficacy of bariatric surgery in the treatment of IIH Methods We conducted a comprehensive search of MEDLINE, Embase, Scopus, the Cochrane Library and Web of Science (limited to studies in humans published in English between January 1946 and July 2015). Results Twelve primary studies (n = 39 patients) were included in the systematic review. All patients had a preoperative diagnosis of IIH. Preoperative body mass index (BMI) was 47.4 ± 3.6 kg/m2 ; BMI improved to 33.7 ± 2.1 kg/m2 and 33.9 ± 11.6 kg/m2 at 6 and 12 months postoperatively, respectively. Lumbar puncture opening pressures decreased from 34.4 ± 6.9 cmH2O to 14.0 ± 3.6 cmH2O after surgery. Common symptoms of IIH improved after bariatric surgery: headaches (100% preoperatively v. 10% postoperatively), visual complaints (62% v. 44%), tinnitus (56% v. 3%) and papilledema (62% v. 8%). Conclusion Bariatric surgery appears to lead to considerable improvement in IIH. Idiopathic intracranial hypertension is not a well-publicized comorbidity of obesity, but its presence may be considered as an indication for bariatric surgery.
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Affiliation(s)
- Warren Y. L. Sun
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Noah J. Switzer
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Jerry T. Dang
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Richdeep Gill
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Xinzhe Shi
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Christopher de Gara
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Daniel Birch
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Andrew Nataraj
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Shahzeer Karmali
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
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Abstract
PURPOSE OF REVIEW Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unclear etiology that most often occurs in obese women of childbearing age but can also occur in men, children, and older adults. This article reviews the diagnostic criteria, clinical features, neuroimaging findings, differential diagnosis, and management options for this condition. RECENT FINDINGS Recent population studies have found that the annual incidence of idiopathic intracranial hypertension is increasing in association with obesity rates, whereas recent scientific studies indicate a possible role for androgen sex hormones and adipose tissue in the pathogenesis of the disease. Prospective clinical trials have demonstrated a role for weight loss, acetazolamide, and topiramate in the management of mild disease. A recently begun randomized multicenter trial of surgical interventions will provide insight into the indications for surgical intervention, optimal timing and choice of intervention, and long-term outcomes. SUMMARY Idiopathic intracranial hypertension is a disorder producing symptoms and signs of increased intracranial pressure in the absence of an alternative cause. The main goals of treatment are to preserve visual function and alleviate symptoms, which can usually be achieved with a combination of weight loss, medical therapies, and surgical interventions depending on the severity of symptoms and vision loss, response to treatment, and subsequent clinical course.
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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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Perez FA. Imaging of Nontraumatic Orbital and Neuro-ophthalmological Emergencies. Semin Roentgenol 2019; 55:132-149. [PMID: 32438976 DOI: 10.1053/j.ro.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Emergency department (ED) visits for eye and vision-related concerns are common. In most cases, accurate diagnosis is made using clinical history and physical exam findings without the need for emergent imaging. When orbital imaging is performed in the ED, it is often in patients with orbital trauma where CT is used to assess for orbital fractures and associated injuries. However, CT or MR imaging can also be critical to appropriately diagnose and manage certain ED patients with nontraumatic eye and vision-related conditions. The purpose of this article is to review the imaging findings and differential diagnoses for nontraumatic orbital and neuro-ophthalmological emergencies from a practical, clinical perspective, based on a patient's typical presenting symptoms. The more commonly imaged clinical indications will be discussed including periorbital swelling, proptosis, eye pain, diplopia, and visual disturbances. In addition, rare but easily overlooked and clinically important diagnoses for the emergency radiologist to recognize will be highlighted.
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Affiliation(s)
- Francisco A Perez
- Department of Radiology, Seattle Children's Hospital and University of Washington, Seattle, WA.
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50
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Abstract
Summary. Thromboses of cerebral veins and/or sinuses (CVT) encompass a clinically rather heterogenous, relatively rare entity, which is nonetheless an important cause of stroke in the young. While until the mid of the last century the prognosis of CVT was thought to be poor or even fatal in the majority of cases, the advance and wider use of modern imaging technology since the early 1980s, together with the results of registries and population-based studies, revealed that CVT is more frequent and less life-threatening than previously assumed. However, because headache is frequently the only symptom, many oligosymptomatic cases might be overlooked. Both, CT- and MR-venography are suitable methods to confirm or rule out CVT, while the sensitivity of laboratory tests (D-dimer) alone is too low to rely on. Despite low evidence anticoagulation remains the treatment of choice during the acute phase and for secondary prevention.
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