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Chakkera P, Gupta M, Marasakatla S, Ramakrishnan S, Kulkarni GB. Cerebral Venous Sinus Thrombosis Associated Subdural Hematoma: A Case Series on Clinical Presentation and Management. Ann Indian Acad Neurol 2023; 26:778-781. [PMID: 38022435 PMCID: PMC10666864 DOI: 10.4103/aian.aian_346_23] [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: 04/20/2023] [Revised: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 12/01/2023] Open
Abstract
Diagnosis and treatment of cerebral venous sinus thrombosis (CVT) associated with subdural hematoma (SDH) is challenging with an increased risk of rebleeding on using anticoagulation. There are no guidelines at present due to its rare presentation. In this report we describe three patients who presented with non-traumatic SDH and CVT over the last 3 years. Clinical assessment, investigations including neuroimaging, and management were reviewed both at time of admission and follow-up. These patients presented with varied CVT syndromes -isolated raised intracranial pressure (ICP), focal and diffuse encephalopathy. Neuroimaging helped in diagnosing CVT and SDH. Cases 1 and 3 had SDH alone, while case 2 had SDH along with intraparenchymal hemorrhage. Management of these patients was tailored individually as per mechanism of CVT. Case 1 was clinically stable, however, she had rebleeding after starting anticoagulation, requiring its discontinuation. Cases 2 and 3 underwent immediate neurosurgical intervention in view of deteriorated sensorium. Although CVT manifesting as SDH is rare, clinicians should have a high index of suspicion to accurately diagnose and manage these challenging cases. The decision regarding use of anticoagulation and apt time for neurosurgical intervention needs to be individualized depending on patients condition and response to treatment.
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Affiliation(s)
- Priyanka Chakkera
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manisha Gupta
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sandeep Marasakatla
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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2
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Burtard C, Panks J, Silverman LB, Lindberg DM, Stence NV, Neuberger I, Maloney J, White C, Mirsky DM. Prevalence of cerebral sinovenous thrombosis in abusive head trauma. Pediatr Radiol 2023; 53:78-85. [PMID: 36074163 DOI: 10.1007/s00247-022-05462-z] [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: 01/11/2022] [Revised: 04/28/2022] [Accepted: 07/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cerebral sinovenous thrombosis (CSVT) has been proposed in legal settings to be an atraumatic mimic of abusive head trauma (AHT). OBJECTIVE The objective of this study was to determine the prevalence of CSVT and subdural hemorrhage (SDH) in a large AHT population. MATERIALS AND METHODS This retrospective cohort study measured the prevalence of CSVT and SDH on magnetic resonance venograms in 243 patients diagnosed with AHT at a single center. We also reported additional intra- and extracranial injuries, head injury severity and length of hospital stay. RESULTS Among 243 patients diagnosed with AHT, 7% (16/243) had CSVT. SDH was present in 94% (15/16) of the CSVT cases. Cytotoxic edema and subarachnoid hemorrhage were in 88% (14/16) and 69% (11/16) of the CSVT cases, respectively. Extracranial signs of abuse were also in 100% (16/16) of the patients with CSVT. Critical to maximal head injury severity (abbreviated injury scale >=5) was in 75% (12/16) of the CSVT population vs. 33% (82/243) in the total AHT population. Length of hospital and pediatric intensive care unit stay was greater in those with CSVT (10 vs. 21.9 and 3.5 vs. 7.3 days). CONCLUSION These findings suggest that CSVT is uncommon in AHT and is associated with additional traumatic injuries and greater injury severity.
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Affiliation(s)
- Colt Burtard
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA
| | - Jessica Panks
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | | | - Daniel M Lindberg
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA
- Department of Emergency Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Nicholas V Stence
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA
| | - Ilana Neuberger
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA
| | - John Maloney
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA
| | - Christina White
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA
| | - David M Mirsky
- Department of Radiology, Anschutz Medical Campus, Children's Hospital Colorado, 13123 East 16th Ave. Box B125, Aurora, CO, 80045, USA.
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Lim EYT, Pai V, Sitoh YY, Purohit B. Acute subdural haemorrhage complicating cerebral venous thrombosis in a patient with protein C deficiency. BMJ Case Rep 2020; 13:e236745. [PMID: 33257369 PMCID: PMC7705573 DOI: 10.1136/bcr-2020-236745] [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: 10/26/2020] [Indexed: 12/27/2022] Open
Abstract
Cerebral venous thrombosis (CVT) directly causing subdural haemorrhage (SDH) is a rare entity. We present a case of an 18-year-old female patient who presented with severe occipital headache. Neuroimaging showed acute SDH and CVT. She was eventually discovered to have underlying protein C deficiency. She was treated with anticoagulation and made an uneventful recovery. We aim to highlight the epidemiology, risk factors and aetiopathogenesis of CVT. We have included a literature review of previously described 13 case studies/reports describing SDH associated with CVT and a brief discussion of the dilemmas associated with management.
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Affiliation(s)
| | - Vivek Pai
- Neuroradiology, National Neuroscience Institute, Singapore
| | - Yih Yian Sitoh
- Neuroradiology, National Neuroscience Institute, Singapore
| | - Bela Purohit
- Neuroradiology, National Neuroscience Institute, Singapore
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4
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Akins PT, Axelrod YK, Ji C, Ciporen JN, Arshad ST, Hawk MW, Guppy KH. Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review. Surg Neurol Int 2013; 4:85. [PMID: 23869285 PMCID: PMC3709281 DOI: 10.4103/2152-7806.113651] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/13/2013] [Indexed: 12/02/2022] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to the neurointensive care unit. A 38-year-old woman had both SDH and a hemorrhagic venous infarct associated with a transverse sinus thrombosis. She was managed conservatively with long-term anticoagulation. A 68-year-old woman presented with an acute SDH requiring craniotomy and a thrombosed cortical vein was noted intraoperatively. Computed tomography venography showed thrombosis of the superior sagittal sinus. She had polycythemia vera with the V617 Jak2 gene mutation and was managed with aspirin and hydroxyurea. A 60-year-old male had recurrence of a spontaneous convexity SDH requiring reoperation. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. There have been limited reports of SDH complicating CVST in the literature. Conclusion: This case series and literature review demonstrates that CVST can also present with spontaneous SDH with or without associated venous infarctions. Treatment must be individualized. This is the first published description of endovascular thrombectomy for recurrent symptomatic SDH due to CVST.
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Affiliation(s)
- Paul T Akins
- Department of Neurosurgery, Permanente Medical Group, Kaiser Sacramento Medical Center, Sacramento, CA 95825
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5
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Cerebral sinovenous thrombosis in pediatric practice. Pediatr Radiol 2013; 43:173-88. [PMID: 23212594 DOI: 10.1007/s00247-012-2486-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/09/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
Cerebral sinovenous thrombosis (CSVT) in the pediatric population is a relatively uncommon yet under-appreciated and potentially life-threatening neurological condition. Early symptoms and signs are often vague and the clinician requesting a cranial imaging study might not even suspect sinovenous thrombosis. If left undiagnosed, or if the diagnosis of CSVT is delayed, progressive neurological deterioration, coma and death can follow. The purpose of this review is to highlight pertinent development of the cerebral venous system, discuss the causal factors of cerebral sinovenous thrombosis in the pediatric population, review practical imaging strategies using cranial sonography augmented with color and pulsed Doppler, unenhanced brain CT, CT venography, cerebral MRI, and MR venography (MRV). Finally, this review will illustrate the imaging features of sinovenous thrombosis, including a discussion of the common causes of false-positive and false-negative CT and MRI studies.
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Sánchez Medina Y, Pérez del Rosario PA, Domínguez J, Millán A. [Venous angioma with associated cerebellar haemorrhage]. Neurocirugia (Astur) 2012; 24:88-92. [PMID: 23218501 DOI: 10.1016/j.neucir.2011.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 09/15/2011] [Indexed: 10/27/2022]
Abstract
Venous angiomas are a developmental anomaly in which embryonic venous drainage is still present into adulthood. They are usually asymptomatic and benign course but they can cause seizures and less commonly bleeding, usually associated to cavernous malformation. Normally, treatment is not necessary although bleeding, severe clinical and lesions in which it is possible a favourable approach, we can consider treatment. We show a case of a 11 years old boy with acute decrease level of consciousness. We observed hematoma in the right cerebellar hemisphere with radial tubular structures consistent with developmental venous anomaly. The hematoma was evacuated without a demonstrable other reason justifying the bleeding.
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Missori P, Domenicucci M, Sassun TE, Tarantino R, Peschillo S. Alterations in the intracranial venous sinuses in spontaneous nontraumatic chronic subdural hematomas. J Clin Neurosci 2012; 20:389-93. [PMID: 23219821 DOI: 10.1016/j.jocn.2012.02.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/10/2012] [Accepted: 02/14/2012] [Indexed: 11/26/2022]
Abstract
Occlusion of the cerebral venous system is frequently associated with intraparenchymal or subarachnoid hemorrhage. There are few reports of cerebral venous thrombosis associated with nontraumatic chronic subdural hematoma (CSH). We aimed to evaluate the intracranial venous system in patients with spontaneous nontraumatic CSH and to identify alterations in their venous sinuses. In this study, eight patients with spontaneous, nontraumatic CSH were followed for a 7-year period (mean: 2.2 years, range: 1-7 years). Neuroradiological images were taken at the onset of symptoms and during follow-up. Venous angiography or magnetic resonance venography was used to evaluate the cerebral venous system of patients. In all patients, medical or surgical treatments were based on clinical symptoms. In seven of the eight patients, the CSH was in the left hemisphere, whereas one patient had bilateral CSH. In one of the eight patients, thrombosis of the transverse sinus and sigmoid sinus was found, but recanalization was observed at follow-up. In a further three patients, the superior sagittal sinus, the straight sinus, and the vein of Galen were markedly reduced in diameter compared to normal or were not visible at presentation, but normal flow was observed at follow-up. In the remaining four patients, the transverse sinus was not observed at symptom onset or during long-term follow-up. A nontraumatic CSH can occur secondary to a venous thrombosis or it can be associated with the inability to image some of the venous sinuses. Venous flow was restored at long-term follow-up. Increased intravenous pressure is thought to be the pathogenic factor that causes a nontraumatic CSH.
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Affiliation(s)
- Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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8
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McLean LA, Frasier LD, Hedlund GL. Does intracranial venous thrombosis cause subdural hemorrhage in the pediatric population? AJNR Am J Neuroradiol 2012; 33:1281-4. [PMID: 22345498 DOI: 10.3174/ajnr.a2967] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Unexplained SDH in infants and children is an accepted marker for AHT. It has been proposed that IVT may be the initiating event leading to the development of acute SDH, mimicking the appearance of traumatic SDH. Our study aims to investigate if nontraumatic IVT causes SDH in the pediatric population. We retrospectively identified 36 patients with IVT and reviewed neuroimaging studies for the concurrent presence of SDH. In our 36 patients with IVT, no associated SDH was observed. Even with extensive IVT, no SDH was present. Three false-positive diagnoses of IVT were identified in the setting of mastoiditis and traumatic SDH, demonstrating pitfalls in imaging. In conclusion, our findings do not support the previous AHT literature stating that IVT is associated with, or leads to, SDH in neonates, infants, or children.
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Affiliation(s)
- L A McLean
- Department of Radiology, University of Utah, Salt Lake City, Utah 84132-2140, USA.
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9
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Cerebral Venous Sinus Thrombosis in an Adult Patient Presenting as Headache and Acute Subdural Hematoma. J Stroke Cerebrovasc Dis 2012; 21:338-40. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 12/11/2009] [Accepted: 12/19/2009] [Indexed: 11/23/2022] Open
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10
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Sirin NG, Yesilot N, Ekizoglu E, Keles N, Tuncay R, Coban O, Bahar SZ. A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma. Case Rep Neurol 2010; 2:37-45. [PMID: 20671855 PMCID: PMC2905579 DOI: 10.1159/000313953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease.
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Affiliation(s)
| | - Nilufer Yesilot
- Edip Aktin Stroke Unit, Department of Neurology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
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Muttikkal T, Shaikh R, Nakhi AB, Gupta R, Sheikh M. Cerebral Venous Sinus Thrombosis: Unusual Imaging Appearance. Neuroradiol J 2009; 22:413-7. [DOI: 10.1177/197140090902200409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 07/19/2009] [Indexed: 11/17/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) has widely varied clinical and radiological manifestations ranging from asymptomatic minimal brain oedema to severe haemorrhagic infarcts associated with focal deficits, coma and even death. Cerebral venous sinus thrombosis presenting with lobar or subdural hematomas are rare and the cause may easily be overlooked. We present a case of CVST with an atypical radiological picture of intra-arenchymal, subdural and subarachnoid haemorrhage.
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Affiliation(s)
| | - R. Shaikh
- Department of Radiology, Chest Hospital; Farwaniya, Kuwait
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12
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Knopman J, Tsiouris AJ, Souweidane MM. Atraumatic epidural hematoma secondary to a venous sinus thrombosis: a novel finding. J Neurosurg Pediatr 2008; 2:416-9. [PMID: 19035688 DOI: 10.3171/ped.2008.2.12.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Venous sinus thrombosis is a rare entity that usually arises secondary to underlying thrombophilia, neoplasm, head injury, or infection. Tympanic infection accounts for the majority of infectious etiologies, and the sigmoid sinus becomes the likely anatomical site of thrombosis. The authors report a case involving a child with recurrent otitis media who presented with an atraumatic epidural hematoma secondary to sigmoid sinus thrombosis. Intraoperative evaluation revealed epidural hemorrhage that originated from the venous sinus, with hemorrhagic products of varying ages. To the authors' knowledge, this is the first reported case of a venous sinus thrombosis resulting in an epidural hematoma.
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Affiliation(s)
- Jared Knopman
- Department of Neurological Surgery and, Weill Medical College of Cornell University, New York, New York 10021, USA.
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13
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Zhao X, Rizzo A, Malek B, Fakhry S, Watson J. Basilar skull fracture: a risk factor for transverse/sigmoid venous sinus obstruction. J Neurotrauma 2008; 25:104-11. [PMID: 18260793 DOI: 10.1089/neu.2007.0351] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In trauma practice, basilar skull fracture is an extremely common finding while transverse/sigmoid venous sinus thrombosis is generally considered quite a rare complication. During evaluation of cervical computed tomography (CT) angiography after trauma, we identified five patients in just three months with unexpected transverse/sigmoid venous sinus obstruction ipsilateral to a basilar skull fracture. This number represented a surprisingly high percentage of our neurosurgical trauma consults for the study period (31%). Three of the five patients were found to have sinus thrombosis: two with right transverse/sigmoid sinus thrombosis experienced significant neurological deficits and prolonged hospital courses even with anti-coagulation therapy; one patient with a left transverse/sigmoid sinus thrombosis had a good outcome with anti-coagulation therapy. The other two of the five patients had outflow obstruction, likely from focal epidural bleeding and extrinsic compression: one patient with partial obstruction in the right transverse-sigmoid junction, due to epidural bleeding, experienced a difficult recovery; one patient with a right sigmoid sinus obstruction presented and remained asymptomatic and experienced a benign hospital course. Two of the five patients had a posterior temporal hemorrhagic area ipsilateral to the affected sinus, suggesting that this finding may have represented hemorrhagic venous infarction rather than traumatic contusion. We propose that a basilar skull fracture in the region of temporal or occipital bone should be considered as a significant risk factor for the development of transverse/sigmoid venous sinus obstruction and may be an under-recognized and treatable cause of increased intracranial pressure. Failure to detect this complication may explain, in part, unexpected clinical outcomes.
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Affiliation(s)
- Xueren Zhao
- Inova Regional Neurosurgery Service, Department of Neuroscience, Inova Fairfax Hospital, Falls Church, Virginia, USA
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Singh S, Kumar S, Joseph M, Gnanamuthu C, Alexander M. Cerebral venous sinus thrombosis presenting as subdural haematoma. ACTA ACUST UNITED AC 2005; 49:101-3. [PMID: 15845043 DOI: 10.1111/j.1440-1673.2005.01348.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors report a 39-year-old woman who presented with intermittent, excruciating nuchal and occipital headache. Magnetic resonance imaging and magnetic resonance angiography scans showed bilateral subdural haematomas with veno-occlusive disease of the superficial and deep venous systems. There were bridging collaterals with scalp veins, bleeds from which could explain the subdural haematoma. There was acute on chronic veno-occlusive disease with an acute rise in intracranial pressure and a bleed from the vein of Galen.
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Affiliation(s)
- S Singh
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India
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Marquardt G, Weidauer S, Lanfermann H, Seifert V. Cerebral venous sinus thrombosis manifesting as bilateral subdural effusion. Acta Neurol Scand 2004; 109:425-8. [PMID: 15147467 DOI: 10.1111/j.1600-0404.2004.00250.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Three patients with bilateral subdural effusion, an exclusive manifestation of cerebral venous sinus thrombosis (CVST), are presented. A possible explanation of this rare occurrence is provided, and the differential therapeutic strategies are discussed. We propose to consider CVST in cases of subdural effusions of obscure origin. Appropriate imaging studies should not be delayed if there is suspicion of sinus thrombosis to enable adequate therapy to be started as soon as possible.
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Affiliation(s)
- G Marquardt
- Neurosurgical Clinic, Johann Wolfgang Goethe-University, Schleusenweg, Frankfurt am Main, Germany.
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Marquardt G, Weidauer S, Lanfermann H, Seifert V. Cerebral venous sinus thrombosis manifesting as bilateral subdural effusion. Acta Neurol Scand 2003. [DOI: 10.1046/j.1600-0404.2003.00250.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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