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Murugaiyan S, Sivaji AR, Julin A. Alcohol Emergence: A Study on Various Risk Factors and Clinical Characteristics in Patients With Cerebral Venous Sinus Thrombosis From a Tertiary Care Hospital in South India. Cureus 2024; 16:e65528. [PMID: 39188469 PMCID: PMC11346587 DOI: 10.7759/cureus.65528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
Objective and aim Cerebral venous thrombosis (CVT) is a rare condition with significant morbidity and mortality risk involving the thrombosis of cerebral veins and dural sinuses. Its symptoms vary widely, ranging from headaches to focal neurological deficits, posing significant challenges to its diagnosis. Various contributing factors are involved in its etiology, some of which are gender specific. The clinical presentation varies widely and differs based on geographic distribution. This diversity makes CSVT challenging to diagnose, as it manifests in different ways and requires keen medical observation. Early detection is crucial for prognosis, as addressing the underlying cause can prevent further complications. This study aims to identify various causative factors and clinical presentations observed in individuals diagnosed with cerebral venous sinus thrombosis (CVST). Material and methods This prospective observational study was conducted at the Department of Neurology for a year, involving 55 patients admitted to the Neurology OPD/ER. Sample selection was done using non-probability convenience sampling. Patients aged 18 years or older presenting with symptoms indicative of CVST, confirmed by neuroimaging, were included in the study. Patients with arterial stroke, space-occupying lesions, and CVST related to pregnancy or puerperium were excluded. A detailed and structured medical history was obtained, and relevant blood investigations were conducted to find the underlying etiology. Results The study population had a mean age of 33 ± 2.04 years. The gender distribution is inclined towards 78.1% males due to the exclusion of pregnancy- or puerperium-related CVST to identify other predominant risk factors. 87.2% of the patients presented acutely, primarily with headaches (94.54%), and 67.2% had seizures within a week of admission. Prothrombotic conditions (45.4%) were the prevalent risk factor in the study group. Second, infections accounted for 21.8%. Alcoholism was seen in 52.7% of the study population, but its correlation with CVST remains unclear. The superior sagittal sinus (34.5%) and transverse sinus (20%) were commonly involved in neuroimaging, with multiple sinus involvement observed in some cases. Conclusion Cerebral venous sinus thrombosis (CVST) presents with a wide range of symptoms, making diagnosis challenging. However, with modern imaging and lab tests, we can detect and treat it effectively, often with positive outcomes and minimal long-term effects. This study seeks to understand the risk factors associated with CVST, contributing to its diagnosis and management.
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Affiliation(s)
- Sivaji Murugaiyan
- Neurology, Tamil Nadu Government Multi Super Specialty Hospital, Chennai, IND
| | - Akshaya Rathin Sivaji
- Internal Medicine, Panimalar Medical College Hospital & Research Institute, Chennai, IND
| | - Asir Julin
- Neurology, Tamil Nadu Government Multi Super Specialty Hospital, Chennai, IND
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2
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Amalia L, Ardo RT. Clinical Significance of D-dimer Level and Numeric Rating Scale with Amount of Sinus Involvement in Cerebral Sinus Thrombosis Patients. Int J Gen Med 2024; 17:2143-2149. [PMID: 38766601 PMCID: PMC11102121 DOI: 10.2147/ijgm.s460407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Cerebral venous sinus thrombosis (CVST) is a cerebral vascular disorder that currently occurs quite often and has very varied clinical symptoms. Headache is the main symptom most commonly found in patients with CVST and multiple sinus involvement often have a more severe prognosis and poor clinical outcome. This study aimed to learn the relationship between D-dimer level, numeric rating scale (NRS), and amount of sinus involvement in CVST patients. Methods This study was a retrospective observational analytic study with a cross-sectional approach using medical records and supporting data (D-dimer level and imaging finding) on patients diagnosed with CVST at Dr Hasan Sadikin Hospital Bandung. Results Sixty-five CVST patients met the study criteria with mean age of 47 years and mostly female (76.9%). Patients with single sinus involvement had a median initial NRS of 4 (range 2-6) and multiple sinus involvement was higher at 8 (range 5-9). Statistical test results showed a significant difference between D-dimer level, NRS and amount of sinus involvement (P<0.001). Conclusion D-dimer level, NRS, and amount of sinus involvement are associated with amount of sinus involvement in CVST patients. Involvement of multiple sinus will cause higher NRS with higher D-dimer level.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryan Tantri Ardo
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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3
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Khoromi S. Secondary headaches in pregnancy and the puerperium. Front Neurol 2023; 14:1239078. [PMID: 37840942 PMCID: PMC10569305 DOI: 10.3389/fneur.2023.1239078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Headache during pregnancy can be due to primary causes such as migraine but can also be a presenting symptom of secondary causes including life threatening conditions. This is a minireview of secondary causes of headache during pregnancy and the puerperium. Unique alterations in physiological and vascular functions as well as in the coagulation pathway which occur during pregnancy increase the risk of most of these secondary conditions which include preeclampsia, eclampsia, hemorrhagic stroke, cerebral venous, sinus thrombosis, reversible cerebral vascular syndrome, and posterior reversible encephalopathy. Marked increase in progesterone level in pregnancy is also associated with the growth of tumors such as meningiomas, as 70% of these tumors are positive for progesterone receptors and increase in size can lead to headache along with other neurological symptoms. Hemodynamic changes can lead to the growth of meningiomas as well. Although hormone producing pituitary tumors are usually not conducing to pregnancy, women with known pituitary tumors who do get pregnant may become symptomatic during pregnancy and develop secondary headache. Another rare cause of secondary headache during pregnancy is pituitary apoplexy. Although its occurrence is uncommon, it needs to be properly recognized and treated to avoid endocrine and visual complications. Other rare entities with increased incidence during the puerperium such postdural puncture headache will be also discussed. In summary, new onset headache during pregnancy deserves special attention because in the absence of proper recognition and treatment, secondary headache disorders can endanger the life of the mother and the fetus.
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Affiliation(s)
- Suzan Khoromi
- University of California, San Diego, La Jolla, CA, United States
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4
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Mishra AK, Shukla R, Chaurasia RN, Verma A. Descriptive Study of Headache as the Most Common Presenting Feature of Cerebral Venous Thrombosis. Cureus 2023; 15:e43007. [PMID: 37674961 PMCID: PMC10477085 DOI: 10.7759/cureus.43007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To study the etiology and clinical characteristics of cerebral venous thrombosis (CVT) patients with a detailed description of headache as a presenting feature. INTRODUCTION CVT is an infrequent type of stroke with protean clinical manifestations. The most common presenting symptom in CVT is headache (>85%), followed by seizures and focal neurological deficits. METHODS A total of 32 consecutive and confirmed patients of CVT were recruited after obtaining informed consent. CVT was diagnosed based on clinical and imaging parameters. Data regarding etiology, clinical symptoms, and signs with special mention of headache pattern, onset, site, character, severity (based on the visual analog scale), aggravating and relieving factors, as well as sinus involvement were recorded. RESULTS A total of 32 patients (16 males and 16 females) with a mean age of 31.56 (SD = 14.31) years were recruited, out of which 31 patients (96.87%) presented with headaches. The mode of onset of headache was acute in 19.35%, sub-acute in 67.75%, and chronic in 12.9% of patients. Location was holocranial in 38.71%, hemicranial in 29.03%, frontal in 22.58%, and occipital in 9.68% of patients. Headache was severe in 38.7% and moderate in 61.3% of patients. Character was throbbing in 67.74%, heaviness in 25.8%, and band-like in 6.46% of patients. Headache was aggravated on bending forward in 58.06%, movement in 35.48%, coughing in 32.26%, straining in 25.8%, and standing in 16.12% of patients. The relieving factors of headache were lying down in 45.16%, sleeping in 45.16%, and sitting quietly in 9.86% of patients. CONCLUSION CVT should be suspected in patients presenting with new-onset holocranial or hemicranial headaches of increasing intensity, thereby requiring early imaging and appropriate management.
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Affiliation(s)
- Ashutosh K Mishra
- Department of Neurology, All India Institute of Medical Sciences, Raebareli, IND
| | - Ruchi Shukla
- Department of Ophthalmology, All India Institute of Medical Sciences, Raebareli, IND
| | - Rameshwar N Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Archana Verma
- Department of Neurology, All India Institute of Medical Sciences, Raebareli, IND
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5
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Zenobia E, Lailiyya N, Dian S, Juli C, Nugraha Hermawan A, Amalia L. Platelet Selectin Levels in Patients with Cerebral Venous Sinus Thrombosis: Preliminary Findings. J Blood Med 2023; 14:359-365. [PMID: 37284611 PMCID: PMC10239894 DOI: 10.2147/jbm.s405975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
Background Cerebral Venous Sinus Thrombosis (CVST) is a cerebrovascular disease with an estimated annual incidence of 3-4 cases per 1 million population with an 8% mortality rate caused by hypercoagulable conditions and hyper aggregation and also Platelet Selectin (P-Selectin) as one of coagulation biomarker for both of them. This study aimed to describe the levels of P-selectin in CVST patients at RSHS Bandung. Objective This study aimed to describe the levels of P-selectin in CVST patients at RSHS Bandung. Methods This is a descriptive observational study on patients ≥18 years old diagnosed with CVST at the Neurology outpatient polyclinic of RSUP Dr. Hasan Sadikin Bandung for March-May 2022. All samples that meet the inclusion criteria will be included as research subjects. Results There were 55 research subjects with a median age of 48 (range 22-69 years), the majority were women (80%), the most complaints were headaches (92.7%), the majority onset was chronic (96.4%) with a length of treatment ≥12 months (61.8%). P-selectin levels were found to increase in the group of subjects with subacute onset (mean 5.20 ± 2.977), infectious etiology (mean 5.26 ± 3.561), duration of treatment <3 Months (mean 3.79 ± 3.065), history of hyper aggregation (mean 3.89±2.805), hypercoagulation (mean 3.50±2.719), increased D-dimer (mean 3.93±2.710), normal fibrinogen (mean 3.38±2.693), and in the group with multiple affected sinuses (mean 6.08±2.681). Conclusion P-selectin could be a diagnostic marker for hyper aggregation and hypercoagulable state in patients with CVST, but it still needs further research to prove it.
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Affiliation(s)
- Eswi Zenobia
- Neurology Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nushrotul Lailiyya
- Neurology Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Sofiati Dian
- Neurology Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Cep Juli
- Neurology Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Asep Nugraha Hermawan
- Neurology Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Lisda Amalia
- Neurology Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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6
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Zhou Y, Jiang H, Wei H, Liu L, Zhou C, Ji X. Venous stroke–a stroke subtype that should not be ignored. Front Neurol 2022; 13:1019671. [PMID: 36277910 PMCID: PMC9582250 DOI: 10.3389/fneur.2022.1019671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Based on the etiology, stroke can be classified into ischemic or hemorrhagic subtypes, which ranks second among the leading causes of death. Stroke is caused not only by arterial thrombosis but also by cerebral venous thrombosis. Arterial stroke is currently the main subtype of stroke, and research on this type has gradually improved. Venous thrombosis, the particular type, accounts for 0.5–1% of all strokes. Due to the lack of a full understanding of venous thrombosis, as well as its diverse clinical manifestations and neuroimaging features, there are often delays in admission for it, and it is easy to misdiagnose. The purpose of this study was to review the pathophysiology mechanisms and clinical features of arterial and venous thrombosis and to provide guidance for further research on the pathophysiological mechanism, clinical diagnosis, and treatment of venous thrombosis. This review summarizes the pathophysiological mechanisms, etiology, epidemiology, symptomatology, diagnosis, and treatment heterogeneity of venous thrombosis and compares it with arterial stroke. The aim is to provide a reference for a comprehensive understanding of venous thrombosis and a scientific understanding of various pathophysiological mechanisms and clinical features related to venous thrombosis, which will contribute to understanding the pathogenesis of intravenous stroke and provide insight into diagnosis, treatment, and prevention.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Wei
- School of Engineering Medicine, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Chen Zhou
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xunming Ji
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7
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Rivas Ruvalcaba F, Moreno-Cortez KM, Badial-Ochoa S, Rodriguez-Leyva I. Optic ataxia in a patient with HaNDL syndrome. BMJ Case Rep 2022; 15:e252055. [PMID: 36192033 PMCID: PMC9535137 DOI: 10.1136/bcr-2022-252055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
We present a woman in her 40s who arrived at the emergency room with hypertension and optic ataxia. Her medical history is only relevant for obesity. Her lumbar puncture revealed high intracranial pressure and lymphocytic pleocytosis, and her neuroimaging tests, including angiography and venography, were normal. The patient improved after a cerebrospinal fluid drainage with a lumbar puncture, and her clinical manifestations resolved in parallel to the lymphocytic pleocytosis.The patient was diagnosed with a syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis and fully recovered 21 days after her discharge.
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Affiliation(s)
- Francisco Rivas Ruvalcaba
- Neurology Department, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Department of the Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Katia Mabiel Moreno-Cortez
- Neurology Department, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Department of the Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Sandra Badial-Ochoa
- Neurology Department, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Department of the Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Ildefonso Rodriguez-Leyva
- Neurology Department, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Department of the Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
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8
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Foschi M, Pavolucci L, Rondelli F, Amore G, Spinardi L, Rinaldi R, Favaretto E, Favero L, Russo M, Pensato U, Benini M, Barone V, Guarino M. Clinicoradiological Profile and Functional Outcome of Acute Cerebral Venous Thrombosis: A Hospital-Based Cohort Study. Cureus 2021; 13:e17898. [PMID: 34532197 PMCID: PMC8435069 DOI: 10.7759/cureus.17898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction Acute cerebral venous thrombosis (CVT) may result in a variety of clinical presentations, with headache being the most common. The relationship between clinical and neuroradiological characteristics in acute CVT patients is still not univocally characterized. Materials and methods We enrolled 32 consecutive acute CVT patients admitted to our emergency department from January 1, 2012, to June 30, 2019. Clinicoradiological associations and their relationship with the functional outcome at the discharge were tested. Results Headache was the presenting symptom in 85% of patients, more frequently subacute (82%), new-onset (67%), with unusual features in respect to prior headache episodes (100%), and associated with concomitant neurological symptoms/signs (74%). Patients with holocranial headache showed more frequent venous ischemia (VI) compared to those with bilateral and unilateral headache (50% vs. 20% vs. 0%, respectively; p=0.027). Patients with concomitant neurological defects had a higher prevalence of VI (50.0% vs. 15.0%; p=0.049) and superior sagittal sinus thrombosis (67% vs. 30%; p=0.043) than those without. Vomit was more frequently observed in patients with straight sinus thrombosis (67% vs. 8%; p=0.005). Increasing age and VI were independently associated with poor (modified Rankin scale (mRS) 2-5) functional outcome (odds ratio (OR) = 1.081, 95% confidence interval (CI) 1.004-1.165; p=0.038 and OR = 12.089, 95% CI 1.141-128.104; p=0.039, respectively). Conclusions Our study confirms and enriches available data on the clinicoradiological profile of patients with acute CVT and suggests that increasing age and venous ischemia are independently associated with poor outcomes.
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Affiliation(s)
- Matteo Foschi
- Department of Neuroscience, Neurology Unit, S.Maria delle Croci Hospital of Ravenna - AUSL Romagna, Ravenna, ITA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, ITA
| | - Lucia Pavolucci
- Department of Neuroscience, Neurology Unit, S.Maria delle Croci Hospital of Ravenna - AUSL Romagna, Ravenna, ITA
| | - Francesca Rondelli
- Neurology Unit, S.Orsola-Malpighi University Hospital of Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
| | - Giulia Amore
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITA
| | - Luca Spinardi
- Department of Experimental Diagnostic and Specialty Medicine, Neuroradiology Unit, S.Orsola-Malpighi University Hospital of Bologna, Bologna, ITA
| | - Rita Rinaldi
- Neurology Unit, S.Orola-Malpighi University Hospital of Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
| | - Elisabetta Favaretto
- Department of Angiology and Blood Coagulation, Angiology and Blood Coagulation Unit, S.Orsola-Malpighi University Hospital of Bologna, Bologna, ITA
| | - Luca Favero
- Department of Health Management, S.Orsola-Malpighi University Hospital of Bologna, Bologna, ITA
| | - Michele Russo
- Department of Cardiovascular Diseases, Division of Cardiology, S.Maria delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, ITA
| | - Umberto Pensato
- Department of Biomedical and Neuromotor Sciences, Univesity of Bologna, Bologna, ITA
| | - Matteo Benini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITA
| | - Valentina Barone
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITA
| | - Maria Guarino
- Neurology Unit, S.Orsola-Malpighi University Hospital of Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
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9
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Chambers DJ, Bhatia K, Columb M. Postpartum cerebral venous sinus thrombosis following obstetric neuraxial blockade: a literature review with analysis of 58 case reports. Int J Obstet Anesth 2021; 49:103218. [PMID: 34598860 DOI: 10.1016/j.ijoa.2021.103218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/17/2021] [Accepted: 09/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a rare complication of pregnancy. It usually presents with a headache and may mimic a post-dural puncture headache (PDPH) in women who receive a neuraxial block. METHODS Medline, CINAHL and EMBASE databases were searched to identify postpartum cases of CVST following neuraxial block. The aim was to delineate the characteristics, presentation, investigations, and outcomes of postpartum women who presented with CVST. RESULTS Forty-nine articles with 58 case reports were identified. Forty-two women (72.4%) had an epidural attempted whilst 16 women (27.6%) received a spinal anaesthetic. Accidental dural puncture (ADP) was reported in 17 women (40.5%). Headache was the presenting symptom in 57 women (98.3%); 26 women (44.8%) also experienced seizures. Post-dural puncture headache was reported in 46 (79.3%) and an epidural blood patch was performed in 26 women (44.8%). Superior sagittal sinus, transverse sinus, and cortical veins were the most common sites of thrombosis. The median time to diagnosis was 6.5 days from delivery. Magnetic resonance imaging was the most common diagnostic neuro-imaging modality. Full neurological recovery was reported in 48 (82.8%), whilst neurological deficits were reported in six (10.3%) women. DISCUSSION The diagnosis of CVST may be overlooked in women who present with headache following neuraxial block. A change in character of headache with loss of postural element, and focal neurological signs are the key clinical features that could help anaesthetists differentiate headache of CVST from PDPH. The high reported rates of ADP and PDPH lend support to their possible association with CVST.
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Affiliation(s)
| | - K Bhatia
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - M Columb
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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10
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Petrović J, Švabić T, Zidverc-Trajković J, Stanarčević P, Jovanović D, Mijajlović M. Cerebral venous thrombosis: a retrospective unicentric analysis of clinical and neuroimaging characteristics. Neurol Sci 2021; 43:1839-1847. [PMID: 34347215 DOI: 10.1007/s10072-021-05514-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 01/30/2023]
Abstract
Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of stroke, usually affecting young individuals. It has a variable clinical presentation ranging from mild cases presenting only headaches, to severe cases featuring encephalopathy, coma or status epilepticus. A retrospective cross-sectional study of patients treated in the outpatient department and in-hospital during the period from 2014 to 2020 at the Neurology Clinic-University Clinical Centre of Serbia was conducted. Forty-nine patients (24 men; 25 women) were included in the study. Twenty-three patients (46.9%) suffered a subacute form of CVT (48 h-4 weeks), 19 (38.8%) presented with an acute form (< 48 h) and 7 (14.3%) with a chronic form (> 4 weeks). Around 75% of patients reported headaches during disease course. Focal neurological deficit (FND) was observed in 27 (55.1%) patients. Patients who did not report headaches (22.4%) presented with more severe symptoms (seizures and coma). More than 70% of patients had no radiologically evident brain parenchymal lesion. The most frequent locations of CVT were transverse sinus (79.6%), sigmoid sinus (44.9%) and superior sagittal sinus (36.7%). Thrombosis of more than one sinus/vein occurred in 33 (67.3%) patients. Hereditary thrombophilia was observed in 9 (18.4%) patients, 11 (22.4%) patients had some type of infection and 20% of women reported OCT usage. As much as 25% of cases remained without evident risk factors. The most common symptom in our cohort was acute unilateral throbbing headache of high intensity, while patients without headaches had more severe symptoms.
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Affiliation(s)
- Jovan Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Švabić
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Zidverc-Trajković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Dejana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milija Mijajlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia.
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11
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Tshering S, Youden S, Pema D. Eclampsia and postpartum onset of subarachnoid hemorrhage in dual setting of cerebral venous thrombosis and posterior reversible encephalopathy syndrome: A case report. Clin Case Rep 2021; 9:2210-2213. [PMID: 33936666 PMCID: PMC8077395 DOI: 10.1002/ccr3.3985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) can be an initial presentation of cerebral venous thrombosis. Eclampsia and postpartum onset of SAH should prompt physicians to identify possible causes and institute prompt management to avert irreversible cerebrovascular sequelae.
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Affiliation(s)
- Sangay Tshering
- Department of Obstetrics & GynecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Sonam Youden
- Faculty of Post Graduate MedicineKhesar Gyalpo University of Medical Sciences of BhutanThimphuBhutan
| | - Dechen Pema
- Department of RadiologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
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