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Borhani-Haghighi A, Hooshmandi E. Cerebral venous thrombosis: a practical review. Postgrad Med J 2024; 100:68-83. [PMID: 37978050 DOI: 10.1093/postmj/qgad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.
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Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
- Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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Aboul Fotouh AM, Helmy SM, Mourad HS, Abdelbaky HA, Hatem G. Clinical, radiological profile and prognostic role of transcranial color-coded duplex in cerebral venous thrombosis: a case-control study. BMC Neurol 2023; 23:295. [PMID: 37550633 PMCID: PMC10405461 DOI: 10.1186/s12883-023-03342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis is a rare type of stroke, occurring more among young individuals. The presentation is highly variable, and this can delay diagnosis and management, thereby affecting outcome. The aim is to study the clinical, radiological profile, risk factors for cerebral venous thrombosis (CVT) and the role of transcranial color-coded duplex (TCCD) in CVT prognosis among Egyptian patients. METHODS Eighty CVT patients and 80 normal healthy individuals were included. Magnetic resonance imaging, magnetic resonance venography, and genetic thrombophilia tests were done for patients. Deep cerebral venous system was evaluated using B-mode transcranial color-coded duplex (TCCD) for both groups. RESULTS Showed female predominance with gender specific risk factors being the most common etiology. The most common hereditary thrombophilia was homozygous factor V Leiden mutation and anti-thrombin III (AT III). Headache was the most common presentation. Forty-three patients had transverse sinus thrombosis. Regarding TCCD, there was an increase in mean blood flow velocities, peak flow velocities and end diastolic flow velocities in deep middle cerebral vein and basal veins in CVT group compared to control group. There was a positive correlation not reaching statistical significance between flow velocities in the deep venous system and modified Rankin Scale. CONCLUSION Clinical presentation is extremely variable. In our population, homozygous factor V Leiden mutation and AT III deficiency were the most common. Increased deep cerebral venous system flow velocities using TCCD in patients with CVT reflect their venous hemodynamic state.
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Affiliation(s)
- Alshaimaa M Aboul Fotouh
- Department of Neurology, Faculty of medicine, Cairo University, Al-Saraya Street, Al Manial, Cairo, Egypt
| | - Sadek Mohamed Helmy
- Department of Neurology, Faculty of medicine, Cairo University, Al-Saraya Street, Al Manial, Cairo, Egypt
| | - Husam S Mourad
- Department of Neurology, Faculty of medicine, Cairo University, Al-Saraya Street, Al Manial, Cairo, Egypt
| | - Hadeel Ahmed Abdelbaky
- Department of Neurology, Faculty of medicine, Cairo University, Al-Saraya Street, Al Manial, Cairo, Egypt
| | - Ghada Hatem
- Department of Neurology, Faculty of medicine, Cairo University, Al-Saraya Street, Al Manial, Cairo, Egypt.
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Lv B, Jing F, Tian CL, Liu JC, Wang J, Cao XY, Liu XF, Yu SY. Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Cerebral Venous Thrombosis : A Meta-Analysis. J Korean Neurosurg Soc 2021; 64:418-426. [PMID: 33993690 PMCID: PMC8128531 DOI: 10.3340/jkns.2020.0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 12/26/2022] Open
Abstract
Objective A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not wellunderstood. This study evaluates the effectiveness of DWI in the diagnosis of CVT.
Methods Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue.
Results Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference−0.33×10-3 mm2/s [95% CI, −0.44 to −0.23]; p<0.00001).
Conclusion DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.
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Affiliation(s)
- Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Feng Jing
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cheng-Lin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jian-Chao Liu
- Department of Medical Statistics, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-Yu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin-Feng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Liao CC, Chen YF, Xiao F. Brain Midline Shift Measurement and Its Automation: A Review of Techniques and Algorithms. Int J Biomed Imaging 2018; 2018:4303161. [PMID: 29849536 PMCID: PMC5925103 DOI: 10.1155/2018/4303161] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Midline shift (MLS) of the brain is an important feature that can be measured using various imaging modalities including X-ray, ultrasound, computed tomography, and magnetic resonance imaging. Shift of midline intracranial structures helps diagnosing intracranial lesions, especially traumatic brain injury, stroke, brain tumor, and abscess. Being a sign of increased intracranial pressure, MLS is also an indicator of reduced brain perfusion caused by an intracranial mass or mass effect. We review studies that used the MLS to predict outcomes of patients with intracranial mass. In some studies, the MLS was also correlated to clinical features. Automated MLS measurement algorithms have significant potentials for assisting human experts in evaluating brain images. In symmetry-based algorithms, the deformed midline is detected and its distance from the ideal midline taken as the MLS. In landmark-based ones, MLS was measured following identification of specific anatomical landmarks. To validate these algorithms, measurements using these algorithms were compared to MLS measurements made by human experts. In addition to measuring the MLS on a given imaging study, there were newer applications of MLS that included comparing multiple MLS measurement before and after treatment and developing additional features to indicate mass effect. Suggestions for future research are provided.
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Affiliation(s)
- Chun-Chih Liao
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Renai Rd., Taipei City 10051, Taiwan
- Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, No. 127, Siyuan Rd., New Taipei City 24213, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan
| | - Furen Xiao
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Renai Rd., Taipei City 10051, Taiwan
- Department of Neurosurgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan
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Gadient P, Archer D, Asdaghi N. Pearls & Oy-sters: Delayed progression of isolated cortical vein thrombosis despite therapeutic INR. Neurology 2018; 90:e727-e730. [PMID: 29459455 DOI: 10.1212/wnl.0000000000004994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paul Gadient
- From the Department of Neurology (P.G., N.A.), University of Miami Miller School of Medicine, FL; and Universidad Ibero-Americana School of Medicine (D.A.), Santo Domingo, Dominican Republic
| | - Dimitri Archer
- From the Department of Neurology (P.G., N.A.), University of Miami Miller School of Medicine, FL; and Universidad Ibero-Americana School of Medicine (D.A.), Santo Domingo, Dominican Republic
| | - Negar Asdaghi
- From the Department of Neurology (P.G., N.A.), University of Miami Miller School of Medicine, FL; and Universidad Ibero-Americana School of Medicine (D.A.), Santo Domingo, Dominican Republic.
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Salottolo K, Wagner J, Frei DF, Loy D, Bellon RJ, McCarthy K, Jensen J, Fanale C, Bar-Or D. Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients. J Am Heart Assoc 2017; 6:JAHA.117.005480. [PMID: 28611097 PMCID: PMC5669171 DOI: 10.1161/jaha.117.005480] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis. Methods and Results This was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in (AOR: 7.06 [95% CI, 2.27–21.96], interaction P=0.03) and who had migraine history (AOR: 4.87 [95% CI, 1.01–23.50], P=0.05), whereas negative predictors of full recovery were cerebral edema (AOR: 0.11 [95% CI, 0.04–0.34], P<0.001) and motor weakness (AOR: 0.28 [95% CI, 0.09–0.96], P=0.04). Conclusions As one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.
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Affiliation(s)
| | - Jeffrey Wagner
- Neurology Department, Swedish Medical Center, Englewood, CO
| | - Donald F Frei
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | - David Loy
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | - Richard J Bellon
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | | | - Judd Jensen
- Neurology Department, Swedish Medical Center, Englewood, CO.,Blue Sky Neurology, Englewood, CO
| | - Christopher Fanale
- Neurology Department, Swedish Medical Center, Englewood, CO.,Blue Sky Neurology, Englewood, CO
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, Englewood, CO
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El Tecle NE, Patel BM, El Ahmadieh TY, Daou MR, Hamade YJ, Zammar SG, Shaibani A, Bendok BR. Novel use of a double lumen balloon catheter for venous sinus thrombolysis and venoplasty. J Clin Neurosci 2015; 22:1018-20. [DOI: 10.1016/j.jocn.2014.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/24/2014] [Accepted: 12/26/2014] [Indexed: 10/23/2022]
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Alvis-Miranda HR, Milena Castellar-Leones S, Alcala-Cerra G, Rafael Moscote-Salazar L. Cerebral sinus venous thrombosis. J Neurosci Rural Pract 2014; 4:427-38. [PMID: 24347950 PMCID: PMC3858762 DOI: 10.4103/0976-3147.120236] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
| | | | | | - Luis Rafael Moscote-Salazar
- Department of Neurological Endovascular Therapy, Instituto Nacional de Neurologia y Neurocirugía; Stroke Unit, Hospital Ángeles del Pedregal, Mexico City, Mexico
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