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Deep cerebral venous system involvement in patients with cerebral sinus thrombosis. A proposal of neuroradiological score systems useful for clinical assessment. Neurol Sci 2023; 44:2049-2060. [PMID: 36746845 PMCID: PMC9901835 DOI: 10.1007/s10072-023-06656-5] [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: 05/25/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To develop a neuroradiological score in patients with deep cerebral venous thrombosis (DCVT), capable of assessing extension of intracranial changes and venous occlusion at diagnosis; to assess the relationship between neuroradiological and clinical features at follow-up. MATERIAL AND METHODS In 14 patients with DCVT, we developed 2 score systems on non-enhanced and contrast-enhanced CT: Intracranial Imaging Score (IIS) and Venous Occlusion Imaging Score (VOIS). ISS considers parenchymal venous strokes, hemorrhage, mass effect, and hydrocephalus; VOIS evaluates unilateral or bilateral venous occlusion extension. Modified Rankin Scale (mRS) and vessel recanalization status were assessed at follow-up. RESULTS At diagnosis, higher IIS was related to bilateral venous thrombosis involvement (p 0,02; r:0,60), but parenchymal strokes were not related to venous occlusion extension (unilateral or bilateral) (p > 0,05). Moreover, the symptoms' onset time did not correlate with the severity scores (p > 0,05). At follow-up, 8 out of 14 patients showed good clinical outcomes with complete recanalization and neurological improvement, 1 patient showed a poor neurological outcome, whereas 5 patients died within 1 week. Positive correlations were found between IIS and mRS (p 0,003, r = 0,73), between IIS and vessels' recanalization status (p 0,002, r = 0,75), and between vessels' recanalization status and mRS (p < 0,001, r = 0,98). CONCLUSION Neuroradiological scores may enhance diagnostic accuracy, and they may have a predictive significance. In patients with DCVT, although intracranial involvement was not influenced by symptoms' onset time or extension of venous occlusion, clinical outcome was related to both intracranial involvement and venous recanalization state. Collateral venous drainage status may counterbalance the thrombotic process improving prognosis.
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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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3
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Isolated thrombosis of cortical veins - Clinical and radiological correlation. J Clin Neurosci 2021; 91:369-377. [PMID: 34373054 DOI: 10.1016/j.jocn.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Isolated cortical venous thrombosis (ICVT) is a relatively rare clinical entity with non-specific clinical presentations. Anatomical variations in cortical veins and the lack of a gold standard imaging feature make the diagnosis of ICVT challenging. Headache and seizures were the most common presentations. The Vein of Trolard followed by superficial middle cerebral vein (SMCV) were the most commonly involved. Susceptibility Weighted Imaging (SWI) cord sign was observed in 100% of the cases. CT cord sign and filling defects on contrast enhanced CT were evident in 46.7% and 10% of the cases, respectively. Notably, in the absence of filling defect visualized on contrast CT, MRI, replacement of flow void was the surrogate marker for the ICVT. A high index of clinical suspicion, a thorough understanding of neurovascular anatomy, multiparametric, multiplanar MRI protocol is required to diagnose this rare entity. A serpiginous blooming structure within the subarachnoid space identifiable in less than two contiguous sections on SWI in the vicinity of haemorrhagic infarction should alert the clinician to the imaging possibility of ICVT.
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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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Sahu A, Sankhe S, Mittal K, Kamath N, Pg N, Sahu A. A Pictorial Review on Reversible Splenial Lesions. Indian J Radiol Imaging 2021; 31:3-9. [PMID: 34316105 PMCID: PMC8299498 DOI: 10.1055/s-0041-1729127] [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
Splenium of corpus callosum can be involved in a variety of pathologies causing reversible or irreversible damage. Magnetic resonance imaging (MRI) is a useful investigation to evaluate the same. In spite of the differing etiologies implicated, MRI findings can be quite common. We review the reversible causes of diffusion restriction involving the splenium of corpus callosum and highlight the etiopathologic mechanisms implicated in these pathologies. We further discuss these pathologies in entirety with relevant clinical and laboratory findings helping make definitive diagnosis and guiding appropriate management.
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Affiliation(s)
- Arpita Sahu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shilpa Sankhe
- Department of Radiodiagnosis and Imaging, King Edward Memorial Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Kartik Mittal
- Department of Radiodiagnosis and Imaging, King Edward Memorial Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Namita Kamath
- Department of Radiodiagnosis and Imaging, King Edward Memorial Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Nandakumar Pg
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Sahu
- Department of Radiodiagnosis and Imaging, King Edward Memorial Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
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Yeo LLL, Lye PPS, Yee KW, Cunli Y, Ming TT, Ho AFW, Sharma VK, Chan BPL, Tan BYQ, Gopinathan A. Deep Cerebral Venous Thrombosis Treatment. Clin Neuroradiol 2020; 30:661-670. [DOI: 10.1007/s00062-020-00920-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
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7
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van Dam LF, van Walderveen MAA, Kroft LJM, Kruyt ND, Wermer MJH, van Osch MJP, Huisman MV, Klok FA. Current imaging modalities for diagnosing cerebral vein thrombosis - A critical review. Thromb Res 2020; 189:132-139. [PMID: 32220779 DOI: 10.1016/j.thromres.2020.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022]
Abstract
Cerebral vein thrombosis (CVT) is a rare presentation of venous thromboembolism. Prompt and accurate diagnosis is essential as delayed recognition and treatment may lead to permanent disability or even death. Since no validated diagnostic algorithms exist, the diagnosis of CVT mainly relies on neuroimaging. Digital subtraction angiography (DSA) is the historical diagnostic standard for CVT, but is rarely used nowadays and replaced by computed tomography (CT) and magnetic resonance imaging (MRI). High quality studies to evaluate the diagnostic test characteristics of state of the art imaging modalities are however unavailable to date. This review provides an overview of the best available evidence regarding the diagnostic performance of CT and MRI for the diagnosis of CVT. Notably, available studies are observational, mostly small, outdated, and with a high risk of bias. Therefore, direct comparison between studies is difficult due to large diversity in study design, imaging method, reference standard, patient selection and sample size. In general, contrast-enhanced techniques are more accurate for the diagnosis of CVT then non-contrast-enhanced techniques. CT venography and MRI have been both reported to be adequate for establishing a final diagnosis of CVT, but choice of modality as used in clinical practice depends on availability, local preference and experience, as well as patient characteristics. Our review underlines the need for high-quality diagnostic studies comparing CT venography and MRI in specific settings, to improve clinical care and standardize clinical trials.
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Affiliation(s)
- Lisette F van Dam
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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Shimizu Y, Tsuchiya K, Fujisawa H. Cerebral swelling caused by deep venous thrombosis immediately after cranioplasty. Br J Neurosurg 2020:1-4. [DOI: 10.1080/02688697.2020.1716948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yu Shimizu
- Department of Neurosurgery, Kanazawa Medical Center, Kanazawa, Japan
| | | | - Hironori Fujisawa
- Department of Neurosurgery, Kanazawa Medical Center, Kanazawa, Japan
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Bello L, Silva M, Triana J, Zabaleta M, Anzola K, Abrajim S, Palacios E. Infarto bitalámico por trombosis venosa cerebral profunda hallazgos clínicos y radiológicos. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La enfermedad cerebrovascular es un problema de salud pública mundial, considerada dentro de las primeras causas de mortalidad. La trombosis venosa cerebral (TVC) es una de sus patologías, que a pesar de ser infrecuente puede llevar a severas complicaciones en el paciente. Es por eso que se presentan dos casos de infartos bitalámicos secundarios a trombosis venosa cerebral profunda, con hallazgos clínicos e imagenológicos inusuales que hicieron aún más difícil su diagnóstico. Debido a las diferentes funciones que posee el tálamo además de la infrecuencia de la trombosis venosa cerebral profunda, la presentación clínica sigue siendo atípica y es usual que se consideren otros diagnósticos al inicio del evento, por lo tanto, consideramos importante proyectar estudios con muestras de mayor tamaño para definir con claridad la clínica y los hallazgos radiológicos de esta patología.
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Shimizu Y, Tsuchiya K, Fujisawa H. Deep Venous Thrombosis with Decreased Cerebral Blood Flow to the Thalamus was Completely Restored by Factor Xa Inhibitor. J Stroke Cerebrovasc Dis 2019; 28:e39-e43. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022] Open
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Lal D, Gujjar AR, Ramachandiran N, Obaidi A, Kumar S, El-Tigani M, Al-Azri F, Al-Asmi AR. Spectrum of Cerebral Venous Thrombosis in Oman. Sultan Qaboos Univ Med J 2018; 18:e329-e337. [PMID: 30607274 DOI: 10.18295/squmj.2018.18.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.
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Affiliation(s)
- Darshan Lal
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Arunodaya R Gujjar
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nandagopal Ramachandiran
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ammar Obaidi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Sunil Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mortada El-Tigani
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Faizal Al-Azri
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Abdullah R Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Zheng H, Xu W, Chen Y, Gai S, Chen G. A rare case of deep cerebral venous thrombosis secondary to traumatic epidural hematoma: Case report. Medicine (Baltimore) 2018; 97:e11587. [PMID: 30200060 PMCID: PMC6133577 DOI: 10.1097/md.0000000000011587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Deep cerebral venous thrombosis (DCVT) is a rare disease, but always results in poor prognosis. PATIENT CONCERNS We reported a 79-year-old female with coma after traumatic brain injury (TBI). DIAGNOSIS The epidural hematoma was first diagnosed on non-contrast computerized tomography (CT). The hypodense areas in bilateral thalami and basal ganglia on reexamination CT highly indicated the suspicion of DCVT. Finally, the appearance of thrombosis of the vein of Galen on the computed tomography venography (CTA) and digital subtraction angiography (DSA) confirmed the diagnosis. INTERVENTIONS The patients received surgery to remove the epidural hematoma. After that, she was treated with oral anticoagulation agent (low molecular weight heparin (LMWH), 180 Axal U/kg 24 h) for 4 weeks, shifted by oral warfarin (2.5 mg qd) for 4 weeks. OUTCOMES The hypodense areas in bilateral thalami and basal ganglia have been largely reversed. At the time of 6 months after surgery, the patient could take care of herself. LESSONS If the CT shows hypodense areas in bilateral thalami and basal ganglia, a diagnosis of DCVT should be suspected once the patients could not recover from the treatment of primary diseases.
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Affiliation(s)
- Haiyan Zheng
- Department of Neurosurgery, Fourth Affiliated Hospital, Yiwu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weilin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yili Chen
- Department of Neurosurgery, Fourth Affiliated Hospital, Yiwu
| | - Shiying Gai
- Department of Neurosurgery, Fourth Affiliated Hospital, Yiwu
| | - Gao Chen
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Preliminary data on utility of subcutaneous unfractionated heparin in patients with deep cerebral venous thrombosis. J Thromb Thrombolysis 2018. [PMID: 28620756 DOI: 10.1007/s11239-017-1518-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Subcutaneous unfractionated heparin (SCUFH) has been proved effective in puerperal cerebral venous thrombosis (CVT), but its efficacy in the more serious form of the disease such as deep CVT patients (DCVT) unreported. We describe the outcomes of 37 (isolated:combined: 11:26) patients of DCVT diagnosed by MRI, treated with SCUFH in a tertiary care stroke unit. It was a prospective observational cohort study using 5000 U of SCUFH every 6 hourly for 10 days with oral Acenocoumarol started on day 7, with monitoring. The outcome was assessed by modified Rankin scale (mRS), National Institute of Health Stroke Scale (NIHSS) and Barthel's activities of daily life (BADL) at 3 months. The mean age of the cohort was 27.9 ± 9.7 years, females (n = 24) outnumbering the males (n = 13). Mean duration of symptoms being 10.2 ± 15.9 days. MRI showed vein of Galen and straight sinus involvement in 36 (97.3%) patients, with sparing of the basal vein of Rosenthal in 28 (75%). Thalamus 27 (73%) basal ganglia 21 (56.7%) were commonly involved areas with hemorrhagic lesions in 18 (48.6%) patients. The median NIHSS score at presentation was 11 (1-21). Mean duration of SCUFH treatment was 9.3 ± 1.3 days and the mean aPTT on day 7 was 49.3 ± 9.8 s (control 32-39 s), mean PT INR on day 13 was 1.5 ± 0.45. All the patients improved with no mortality in the study group. At 3 months, good functional outcome (mRS: 0-2) was observed in 94.6% (n = 35) of patients. Two patients had mRS-3. The median mRS (3{1-5} to 0{0-3}) and BADL (8{0-20} to 20{8-20}) improved at 3 months. Complications seen were thrombocytopenia-1, infection-6 and deep vein thrombosis of leg-4. Our preliminary data suggests that SCUFH is safe, effective treatment option in patients with DCVT in a stroke unit with minimal monitoring.
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Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornello R, Raffaelli B, Terrin A, Reuter U, Mitsikostas DD. Headache and pregnancy: a systematic review. J Headache Pain 2017; 18:106. [PMID: 29052046 PMCID: PMC5648730 DOI: 10.1186/s10194-017-0816-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/11/2017] [Indexed: 02/06/2023] Open
Abstract
This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify “red flag symptoms” suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.
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Affiliation(s)
- A Negro
- Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sapienza University of Rome, Sant'Andrea Hospital, 00189, Rome, Italy.
| | - Z Delaruelle
- Department of Neurology, Ghent University Hospital, 9000, Ghent, Belgium
| | - T A Ivanova
- Institute of Professional Education, Chair of Neurology. I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S Khan
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, -2600, Glostrup, DK, Denmark
| | - R Ornello
- Department of Neurology, University of L'Aquila, 67100, L'Aquila, Italy
| | - B Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - A Terrin
- Department of Neurosciences, Headache Centre, University of Padua, 35128, Padua, Italy
| | - U Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - D D Mitsikostas
- Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, 11528, Athens, Greece
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Santos-Soares PC, Oliveira-Filho J. Thrombosis of the Vein of Galen: Pitfalls, Metamorphosis, and Paroxysmal Sympathetic Hyperactivity. Case Rep Neurol 2017; 9:168-172. [PMID: 28868029 PMCID: PMC5567064 DOI: 10.1159/000447119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
Isolated thrombosis of the vein of Galen is a rare and serious entity with few cases reported in the literature. We report the case of a previously healthy 18-year-old male who was admitted after developing headache and subsequently worsening mental status, requiring endotracheal intubation for airway protection. During his admission he developed symptoms of severe paroxysmal sympathetic hyperactivity and posturing. The computed tomography and magnetic resonance imaging of the brain showed bilateral thalamic lesions. The magnetic resonance angiography and digital arteriography revealed a thrombosis of the deep cerebral venous system (vein of Galen). We call attention to a case with rapid symptom progression and specific radiological findings, with atypical clinical course, characterized by paroxysmal sympathetic hyperactivity, but with good clinical functional outcome.
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Affiliation(s)
| | - Jamary Oliveira-Filho
- Neurology Service and Neurocritical Care Unit, Hospital Santa Isabel, Salvador, Brazil
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16
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Hafed BM, Houcem R, Wassim S, Taieb G, Waddah M, Mohamed L, Ridha FM. [Clinical and therapeutic aspects of post-partum cerebral thrombophlebites]. Pan Afr Med J 2017; 25:248. [PMID: 28293364 PMCID: PMC5337296 DOI: 10.11604/pamj.2016.25.248.9576] [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: 04/10/2016] [Accepted: 05/02/2016] [Indexed: 11/23/2022] Open
Abstract
Les thrombophlébites cérébrales sont des pathologies rares (1/5000 naissances) mais redoutables. La grossesse et le post-partum en sont des circonstances favorisantes: leur symptomatologie clinique est divertie et variée dominée par les céphalées, les convulsions et les déficits neurologiques mais aucun signes n’est spécifique. L’examen physique est souvent pauvre et prêt à confusion avec de nombreuses autres affections. Le diagnostic de certitude ne peut être que neuroradiologique. L’IRM cérébrale est actuellement la méthode de référence, elle permet la visualisation du thrombus veineux et le suivie de son évolution. Le traitement de ces TPC est essentiellement médical basé sur les anticoagulants. A l’occasion de quatre observations de TPC, du post-partum et d’une revue de la littérature, nous allons mettre le point sur l’importance d’un diagnostic précoce et d’une prise en charge thérapeutique adéquate.
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Affiliation(s)
| | - Ragmoun Houcem
- Service de Gynécologie Obstétrique- CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Saidi Wassim
- Service de Gynécologie Obstétrique- CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Guizani Taieb
- Service d'Anesthésie Réanimation, CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Manssouri Waddah
- Service de Gynécologie Obstétrique- CHU Ibn El Jazzar, Kairouan, Tunisie
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Cerebral venous sinus thrombosis in pregnancy and puerperium: A pooled, systematic review. J Clin Neurosci 2017; 39:9-15. [PMID: 28274514 DOI: 10.1016/j.jocn.2017.02.046] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/13/2017] [Indexed: 12/15/2022]
Abstract
Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST); however studies describing diagnosis and management in this population are limited. The objective of this study was to amalgamate published case reports and series regarding diagnosis and management of CVST in pregnancy and puerperium. Searches of PubMed and the Cochrane library were performed using search terms "pregnancy"/"puerperium" and "sinus occlusion"/"sinus thrombosis". Studies were included in our pooled analysis if they included individual patient symptoms, management approach and follow-up condition. Multivariate regression was utilized to assess the effect of non-modifiable factors on excellent outcome (mRS 0). Sixty-six patients were included. Mean duration of symptom onset to diagnosis was 5.9days (95% CI 4.2-7.6). Clot involvement of the superior sagittal sinus was seen in 67% of cases, the transverse/sigmoid in 64% and of the deep venous system in 15% of cases. Management approaches included anticoagulation (91% of patients), IA (intra-arterial) thrombolysis alone (26%), and IA thrombectomy with IA thrombolysis (8%). Fifty-nine percent of patients were mRS 0 at follow-up; 94% were mRS 0-2. Presentation with headache alone was associated with excellent outcome on multivariate analysis (p=0.04); coma/obtundation predicted against excellent outcome (p=0.03). As compared to IA thrombolysis alone, patients undergoing IA thrombolysis with IA thrombectomy demonstrated a trend toward better outcome (p=0.10).
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18
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Coagulation is more affected by quick than slow bleeding in patients with massive blood loss. Blood Coagul Fibrinolysis 2017; 28:121-125. [DOI: 10.1097/mbc.0000000000000552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deep Cerebral Venous Thrombosis: An Illustrative Case with Reversible Diencephalic Dysfunction. Can J Neurol Sci 2017. [DOI: 10.1017/s0317167100052872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT:Objectives:Meige syndrome is a movement disorder that includes blepharospasm and oromandibular dystonias. Its etiology may be idiopathic (primary) or it may arise secondary to focal brain injury. Acute respiratory distress as a feature of such dystonias occurs infrequently. A review of the literature on Meige syndrome and the relationship between dystonias and respiratory compromise is presented.Methods:A 60-year-old woman suffered a cerebral anoxic event secondary to manual strangulation. She developed progressive blepharospasm combined with oromandibular and cervical dystonias. Neuroimaging demonstrated bilateral damage localized to the globus pallidus. Years later, she presented to the emergency department in intermittent respiratory distress associated with facial and cervical muscle spasms.Results and conclusions:Increasing frequency and severity of the disorder was noted over years. The acute onset of respiratory involvement required intubation and eventual tracheotomy. A partial therapeutic benefit of tetrabenazine was demonstrated.
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Esin OR, Esin RG, Khairullin IK. Headache in pregnancy. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro201711721136-142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roncallo F, Turtulici I, Arena E, Bisio N, Inglese M, Assini A, Gasparetto B, Bartolini A. Cerebral Venous Sinus Thrombosis: Prognostic and Therapeutic Significance of an Early Radiologic Diagnosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099801100409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the CT and MRI patterns of cerebral venous sinus thrombosis (CVST) on the basis of the venous angioarchitecture and the underlying pathophysiological mechanism. We also investigated if any radiologic data exist to establish which patients can be followed conservatively and which warrant endovascular treatment. The clinical, CT-CTA and MRI-MRA findings of 11 patients (2 men; 9 women; 24 to 69 years-old) with CVST were reviewed. The morphological patterns of CVST were divided into two major groups: Vascular signs: spontaneous sinusal hyperdensity (9); spontaneous all-sequences hyperintensity (4); venous engorgement (9); empty delta sign (4); lack of sinusal contrast-enhancement (3); delayed sinusal transit-time (11); lack of flow-related signal (3). Parenchymal signs: mass effect and cortical sulcal effacement (8), white matter edema (7), venous ischemia (6), haemorrhagic infarct (3), breakdown of the blood-brain barrier (4), hydrocephalus (2). The clinical and radiologic pictures are related to cerebral venous angioarchitecture and underlying pathophysiologic mechanism of venous thrombosis. Reversibility of clinical symptoms and parenchymal lesions is far more frequent, because vessel damage slowly and progressively develops, whereas damage to brain tissue occurs later. Consequently, a prompt CT-MRI diagnosis may allow a good prognosis. Treatment using selective sinusal instillation of urokinase is considered only when the patient clinically and radiologically does not improve within the first two weeks after heparinization.
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Affiliation(s)
| | | | | | | | | | | | - B. Gasparetto
- CNR - Centro di Studio per la Neurofisiologia Cerebrale; Genova
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22
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Holekamp TF, Mollman ME, Murphy RKJ, Kolar GR, Kramer NM, Derdeyn CP, Moran CJ, Perrin RJ, Rich KM, Lanzino G, Zipfel GJ. Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases. J Neurosurg 2016; 124:1752-65. [DOI: 10.3171/2015.5.jns15473] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.
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Affiliation(s)
| | | | | | | | | | - Colin P. Derdeyn
- Departments of 1Neurological Surgery,
- 4Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; and
- 5Neurology, and
| | - Christopher J. Moran
- Departments of 1Neurological Surgery,
- 4Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; and
| | | | - Keith M. Rich
- Departments of 1Neurological Surgery,
- 4Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; and
| | - Giuseppe Lanzino
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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Saadatnia M, Mousavi SA, Haghighi S, Aminorroaya A. Cerebral Vein and Sinus Thrombosis in Isfahan-Iran: A Changing Profile. Can J Neurol Sci 2014; 31:474-7. [PMID: 15595250 DOI: 10.1017/s0317167100003656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives:This study was performed to investigate the clinical presentation and predisposing factors for cerebral vein and sinus thrombosis (CVST) in Isfahan, Iran.Methods:Data from the records of all patients with CVSTreferred to the largest tertiary-care hospital of Isfahan during a five-year period (1997 to 2001) were extracted and reviewed.Results:The number of cases with CVST diagnosed annually was 6, 9, 11, 14 and 15 patients, respectively. Thirteen men and 42 women were diagnosed to have CVST with the mean age of 35.1± 3.8 and 28.7±1.3 years, respectively. Headache was the most frequent complaint (95%) and 63% of patients had focal neurological symptoms, including seizure (58%). Among possible predisposing factors, oral contraceptive pill was the most prevalent one, which was used by 38.1% of affected women for a period of as short as 1-3 months. Anticardiolipin antibodies were detected in 14% of patients.Conclusion:It seems that the annual incidence of CVST is increasing in Isfahan, perhaps due to more extensive intake of oral contraceptive pills and usage of more accurate modern diagnostic tools. The use of oral contraceptive pills was the most frequent predisposing factor; infections and postpartum factors were infrequently observed. Despite other reports from the Middle East, Behçet's disease is not a principal risk factor for CVST in Isfahani patients.
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Affiliation(s)
- Mohammad Saadatnia
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Kazi AZ, Joshi PC, Kelkar AB, Mahajan MS, Ghawate AS. MRI evaluation of pathologies affecting the corpus callosum: A pictorial essay. Indian J Radiol Imaging 2013; 23:321-32. [PMID: 24604936 PMCID: PMC3932574 DOI: 10.4103/0971-3026.125604] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The corpus callosum is a midline cerebral structure and has a unique embryological development pattern. In this article, we describe the pathophysiology and present imaging findings of various typical/atypical conditions affecting the corpus callosum. Since many of these pathologies have characteristic appearances on magnetic resonance imaging (MRI) and their therapeutic approaches are poles apart, ranging from medical to surgical, the neuroradiologist should be well aware of them.
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Affiliation(s)
- Aamish Z Kazi
- Bharati Hospital and Research Centre, Pune, Maharashtra, India
| | | | | | | | - Amit S Ghawate
- Bharati Hospital and Research Centre, Pune, Maharashtra, India
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Hassan KM, Kumar D. Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a case. J Neurosci Rural Pract 2013; 4:193-6. [PMID: 23914104 PMCID: PMC3724306 DOI: 10.4103/0976-3147.112767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 45-year-old man presented with global headache, vomiting and abnormal behavior after cross-country run at high altitude. There was no seizure, loss of consciousness, fever or head injury. He was conscious, abulic and uncooperative with normal vitals. There was no focal neurological deficit. Non contrast computed tomography scan of head was normal. Magnetic resonance imaging of brain showed venous infarct in bilateral thalami, left basal ganglia and periventricular white matter. Magnetic resonance venography revealed thrombosis involving internal cerebral veins, septal veins, thalamostriate veins, vein of Galen and proximal portion of straight sinus. His condition steadily improved on low molecular weight heparin bridged with oral anticoagulation for one year. At two months, serum homocysteine was 31.51 μmol/l (5.46-16.2 μmol/l) and protein S was 49.00% (77-143.00%). He received methylcobalamin, pyridoxine and folic acid. After 16 months, he was asymptomatic with partially recanalized deep cerebral veins and serum homocysteine falling to 16.50 μmol/l (5.46-16.2 μmol/l).
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Affiliation(s)
| | - Dheeraj Kumar
- Department of Neurology, Command Hospital, Alipore, Kolkata, India
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Pukenas BA, Kumar M, Stiefel M, Smith M, Hurst R. Solitaire FR device for treatment of dural sinus thrombosis. J Neurointerv Surg 2013; 6:e2. [DOI: 10.1136/neurintsurg-2012-010543.rep] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Chung SW, Hwang SN, Min BK, Kwon JT, Nam TK, Lee BH. Unilateral thrombosis of a deep cerebral vein associated with transient unilateral thalamic edema. J Cerebrovasc Endovasc Neurosurg 2012; 14:233-6. [PMID: 23210053 PMCID: PMC3491220 DOI: 10.7461/jcen.2012.14.3.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/14/2012] [Accepted: 08/20/2012] [Indexed: 02/02/2023] Open
Abstract
Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.
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Affiliation(s)
- Sang Won Chung
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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Agarwal N, Tolia A, Hansberry DR, Duffis EJ, Barrese JC, Gandhi CD, Prestigiacomo CJ. Current differential diagnoses and treatment options of vascular occlusions presenting as bilateral thalamic infarcts: a review of the literature. J Neurointerv Surg 2012; 5:419-25. [DOI: 10.1136/neurintsurg-2012-010352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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A study of factors associated with cerebral venous thrombosis. Neurol Sci 2012; 34:321-6. [PMID: 22395946 DOI: 10.1007/s10072-012-0997-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 02/21/2012] [Indexed: 12/11/2022]
Abstract
Cerebral venous thrombosis (CVT) is an uncommon but important cause of stroke. Since there are few number of studies about the factors associated with CVT, we aimed to perform a study on Iranian patients, during a 12-year period (1997-2010) and assessed the risk factors, mortality rate, symptoms and signs, imaging and seasonal distribution. This study was a retrospective cross sectional study conducted in Rasul-e-Akram Hospital of Tehran University of Medical Sciences. The hospital is a referral neurology center for west, south and east parts of the capital city. The patients' data were extracted from the documents and entered to a self-designed checklist including probable risk factors, sequels, involved venous and also demographic characteristics. From 62 patients, 85.5% of the patients were female. Most of the patients were between 25 and 35 years old. Superior sagittal sinus was involved in 35 patients. Generalized seizure in the expired group (7 patients) was significantly more than the alive group (P = 0.017). There was a significant relationship between intracranial hemorrhage and mortality rate and between the site of thrombosis and level of consciousness. There was also a significant relationship between fasting and pregnancy with seizure in these patients. Although most of the patients presented in spring and autumn, majority of the expired cases were reported in autumn. This study can help defining risk factors, symptoms, and predicting risk factors of seizure in patients with CVT. We suggest future studies based on gathering data for meta-analysis.
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Hegde AN, Mohan S, Lath N, Lim CCT. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics 2011; 31:5-30. [PMID: 21257930 DOI: 10.1148/rg.311105041] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The basal ganglia and thalamus are paired deep gray matter structures that may be involved by a wide variety of disease entities. The basal ganglia are highly metabolically active and are symmetrically affected in toxic poisoning, metabolic abnormalities, and neurodegeneration with brain iron accumulation. Both the basal ganglia and thalamus may be affected by other systemic or metabolic disease, degenerative disease, and vascular conditions. Focal flavivirus infections, toxoplasmosis, and primary central nervous system lymphoma may also involve both deep gray matter structures. The thalamus is more typically affected alone by focal conditions than by systemic disease. Radiologists may detect bilateral abnormalities of the basal ganglia and thalamus in different acute and chronic clinical situations, and although magnetic resonance (MR) imaging is the modality of choice for evaluation, the correct diagnosis can be made only by taking all relevant clinical and laboratory information into account. The neuroimaging diagnosis is influenced not only by detection of specific MR imaging features such as restricted diffusion and the presence of hemorrhage, but also by detection of abnormalities involving other parts of the brain, especially the cerebral cortex, brainstem, and white matter. Judicious use of confirmatory neuroimaging investigations, especially diffusion-weighted imaging, MR angiography, MR venography, and MR spectroscopy during the same examination, may help improve characterization of these abnormalities and help narrow the differential diagnosis.
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Affiliation(s)
- Amogh N Hegde
- Department of Neuroradiology, National Neuroscience Institute, Singapore.
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34
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Cerebral Venous Thrombosis. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Philpott C, Brotchie P. Unilateral internal cerebral vein thrombosis: Review of literature and case illustration at 3T. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2010.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Suppurative intracranial thrombophlebitis. HANDBOOK OF CLINICAL NEUROLOGY 2010. [PMID: 20109678 DOI: 10.1016/s0072-9752(09)96008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Vyas S, Singh P, Kumar R, Singhi PD, Khandelwal N. "Cord sign" in deep cerebral venous thrombosis. J Emerg Med 2010; 42:60-1. [PMID: 20045603 DOI: 10.1016/j.jemermed.2009.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/19/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Sameer Vyas
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Liu GT, Volpe NJ, Galetta SL. Optic disc swelling. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00006-8] [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] Open
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Eom KS, Kim DW, Kang SD. Bilateral diffuse intracerebral hemorrhagic infarction after cranioplasty with autologous bone graft. Clin Neurol Neurosurg 2009; 112:336-40. [PMID: 19896762 DOI: 10.1016/j.clineuro.2009.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 08/21/2009] [Accepted: 10/10/2009] [Indexed: 11/30/2022]
Abstract
We present the first case of a bilateral diffuse intracerebral hemorrhagic infarction following cranioplasty using an autologous bone graft. The case is that of a 63-year-old man who had undergone previous decompressive craniectomy due to right middle cerebral artery and posterior cerebral artery territory infarction. In order to avoid this extremely rare complication, the possible pathogenic mechanism underlying the deleterious cascade following cranioplasty is discussed.
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Affiliation(s)
- Ki Seong Eom
- Department of Neurosurgery, Institute of Wonkwang Medical Science, 344-2 Shinyong-dong, Iksan 570-749, Republic of Korea
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40
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Lim CCT. Magnetic Resonance Imaging Findings in Bilateral Basal Ganglia Lesions. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n9p795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction: Radiologists may encounter bilaterally symmetrical abnormalities of the basal ganglia on magnetic resonance imaging (MRI), typically in the context of diffuse systemic, toxic or metabolic diseases. A systematic approach and broad knowledge of pathology causing this uncommon group of conditions would be useful.
Materials and Methods: This review uses illustrative images to highlight metabolic conditions, such as Leigh’s syndrome, citrullinaemia, hypoglycaemia or carbon monoxide poisoning, as well as other causes of bilateral basal ganglia lesions such as osmotic myelinolysis, deep cerebral venous thrombosis and Creutzfeldt-Jakob disease.
Results: Careful assessment of radiological findings outside the basal ganglia, such as involvement of the cortex, white matter, thalamus and pons, together with clinical correlation, may be helpful in narrowing the differential diagnosis, and directing further radiological, biochemical or genetic investigations. Recent advances in MR technology have resulted in newer techniques including diffusion-weighted (DW) MR imaging and MR spectroscopy (MRS); these may be helpful if appropriately used.
Conclusions: Abnormal MRI findings in the basal ganglia should not be interpreted in isolation. A systematic approach including DW MR imaging, MRS, and a broad knowledge of diffuse systemic, toxic or metabolic diseases is helpful.
Key Words: Basal ganglia, Metabolic disorders
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Pfefferkorn T, Crassard I, Linn J, Dichgans M, Boukobza M, Bousser MG. Clinical features, course and outcome in deep cerebral venous system thrombosis: an analysis of 32 cases. J Neurol 2009; 256:1839-45. [DOI: 10.1007/s00415-009-5206-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 05/31/2009] [Accepted: 06/02/2009] [Indexed: 11/29/2022]
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Palena LM, Toni F, Piscitelli V, Maffei M, Leonardi M. CT Diagnosis of Cerebral Venous Thrombosis: Importance of the First Examination for Fast Treatment. Neuroradiol J 2009; 22:137-49. [PMID: 24207031 DOI: 10.1177/197140090902200201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 04/24/2009] [Indexed: 11/15/2022] Open
Abstract
This study is a retrospective investigation of the role of non contrast-enhanced CT (NCCT) in the diagnosis of cerebral venous thrombosis (CVT) in clinical practice. We retrospectively identified 24 patients discharged with a diagnosis of CVT between January 2002 and December 2008 who had undergone NCCT as the first imaging modality. NCCT had been evaluated by a general radiologist and subsequently by a neuroradiologist in five cases. Final diagnosis was established by CT angiography (CTA), magnetic resonance (MR) and digital subtraction angiography (DSA). NCCT diagnosis was defined as "positive" when the neuroradiologist suggested the diagnosis of CVT on the report, as opposed to the "negative" diagnosis group. All NCCT examinations were reviewed by a neuroradiologist experienced in cerebrovascular pathology. We compared his evaluation and analysed the location and number of direct signs found on NCCT. The neuroradiologist strongly suggested an NCCT diagnosis of CVT in 63% (15/24) of patients: 80% (4/5) with deep venous thrombosis (DVT) and 57% (11/19) with sinus venous thrombosis (SVT). The general radiologist's NCCT evaluation was incorrect in four cases, subsequently diagnosed at NCCT by the neuroradiologist. After reviewing the NCCT examination the experienced neuroradiologist identified the CVT direct sign in two that belonged to the NCCT negative diagnosis group. Thus the direct sign was present in 71% (17/24) of the cases: all the patients with DVT and 63% (12/19) of the patients with SVT. NCCT still plays an important role for fast and accurate diagnosis of CVT in the emergency setting. NCCT displayed the CVT direct sign more frequently than previously thought and it was correctly interpreted in most cases. Neuroradiological consultation adds value to the general radiologist's evaluation.
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Affiliation(s)
- L M Palena
- Neuroradiology Department, University of Bologna, Bellaria Hospital; Bologna Italy -
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Downer J, Pretorius P. Symmetry in computed tomography of the brain: the pitfalls. Clin Radiol 2009; 64:298-306. [DOI: 10.1016/j.crad.2008.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/04/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
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Linn J, Pfefferkorn T, Ivanicova K, Müller-Schunk S, Hartz S, Wiesmann M, Dichgans M, Brückmann H. Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. AJNR Am J Neuroradiol 2009; 30:728-35. [PMID: 19213820 DOI: 10.3174/ajnr.a1451] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE With its highly variable clinical presentation, the diagnosis of cerebral venous sinus thrombosis (SVT), and especially of deep venous thrombosis (DVT), as rare but important causes of stroke is challenging. Because noncontrast cranial CT (NCCT) is still the imaging technique of choice in most emergency departments, we aimed to investigate its value in the diagnosis of SVT and DVT. MATERIALS AND METHODS Screening our patient data base, we identified 8 patients with DVT and 25 patients with SVT. We also included a control group of 36 patients who had presented with clinical signs of DVT or SVT but in whom thrombosis was subsequently excluded. MR imaging, multidetector row CT angiography (MDCTA), and/or digital subtraction angiography (DSA) were used as the reference standard. Three independent readers assessed the NCCTs for the presence of direct and indirect signs of DVT or SVT. Direct signs included the presence of hyperattenuated sinuses (ie, cord sign) or veins (ie, attenuated vein sign), whereas parenchymal edema and hemorrhage were indirect signs. RESULTS The sensitivity and specificity of the attenuated vein sign for the diagnosis of DVT were 100%, and 99.4%, respectively, whereas the sensitivity and specificity of the cord sign for SVT were 64.6% and 97.2%, respectively. The sensitivity and specificity values of NCCT were 93.7% and 98% for intracerebral edema and 94.8% and 98.7% for intracerebral hemorrhages, respectively. CONCLUSIONS Although NCCT is insufficient to exclude a SVT, its value in the emergency diagnosis of DVT seems to be very high.
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Affiliation(s)
- J Linn
- Department of Neuroradiology, University Hospital Munich, Munich, Germany.
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Wieshmann NH, Amin S, Hodgson R. A case of unilateral thalamic hemorrhagic infarction as a result of the vein of Galen and straight sinus thrombosis. J Stroke Cerebrovasc Dis 2009; 18:28-31. [PMID: 19110141 DOI: 10.1016/j.jstrokecerebrovasdis.2008.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 07/04/2008] [Accepted: 07/14/2008] [Indexed: 12/21/2022] Open
Abstract
Straight sinus vein thrombosis represents 15% of all diagnosed sinus vein thrombosis. Thrombotic occlusion of the deep cerebral venous system, the straight sinus, and the vein of Galen causes centrally located and usually bilateral thalamic infarcts. Unilateral thalamic venous infarction is extremely rare. The clinical and radiologic findings can be nonspecific and diagnostically challenging. We report a patient with this unusual condition and review the available literature.
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Affiliation(s)
- Nuribe Hulya Wieshmann
- University Hospital Aintree, Department of Radiology, Longmoore Lane, Liverpool L97AL, UK.
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The diencephalon. Clin Neuroradiol 2008. [DOI: 10.1017/cbo9780511551925.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cerebral venous thrombosis. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18804681 DOI: 10.1016/s0072-9752(08)93040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Soda T, Edagawa K, Tsuji K, Dehara M, Nakajima Y, Ito M. [Case of deep cerebral venous thrombosis associated with breast cancer]. Rinsho Shinkeigaku 2008; 48:646-650. [PMID: 19048947 DOI: 10.5692/clinicalneurol.48.646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 69-year-old woman was admitted to our hospital because of disturbed consciousness. She awoke to a solid mass in her left breast, but it had been present for about 20 years. On arrival to our hospital, she was comatose, and Babinski's reflexes were present bilaterally. She had no paresis or neck stiffness. Her left breast contained a 10 cm x 12 cm node with multiple ulcers. Blood analysis showed she was in a hypercoagulative state. Computed tomography of the brain demonstrated bilateral hypodensities in the thalamus and hyperdensities at the vein of Galen and at the straight sinus. Angiography showed an absence of flow in the inferior sagittal sinus, in the vein of Galen, and in the straight sinus. Thus, she was diagnosed as having a deep cerebral venous thrombosis. She was treated by continuous heparin infusion, and her consciousness improved gradually. The biopsy of her left breast confirmed the presence of a mucinous carcinoma. The hypercoagulative state associated with the carcinoma was considered to be the cause of her deep cerebral venous thrombosis. It is very rare to diagnose deep cerebral venous thrombosis in a cancer patient while the patient is still alive. In this case, computed tomography of the brain was useful for the diagnosis.
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Affiliation(s)
- Takao Soda
- Department of Neurology, Rinku General Medical Center
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Day 2 — September 11, 2007. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Posters. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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