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Trevizan-Baú P, Stanić D, Furuya WI, Dhingra RR, Dutschmann M. Neuroanatomical frameworks for volitional control of breathing and orofacial behaviors. Respir Physiol Neurobiol 2024; 323:104227. [PMID: 38295924 DOI: 10.1016/j.resp.2024.104227] [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: 12/07/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
Breathing is the only vital function that can be volitionally controlled. However, a detailed understanding how volitional (cortical) motor commands can transform vital breathing activity into adaptive breathing patterns that accommodate orofacial behaviors such as swallowing, vocalization or sniffing remains to be developed. Recent neuroanatomical tract tracing studies have identified patterns and origins of descending forebrain projections that target brain nuclei involved in laryngeal adductor function which is critically involved in orofacial behavior. These nuclei include the midbrain periaqueductal gray and nuclei of the respiratory rhythm and pattern generating network in the brainstem, specifically including the pontine Kölliker-Fuse nucleus and the pre-Bötzinger complex in the medulla oblongata. This review discusses the functional implications of the forebrain-brainstem anatomical connectivity that could underlie the volitional control and coordination of orofacial behaviors with breathing.
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Affiliation(s)
- Pedro Trevizan-Baú
- The Florey Institute, University of Melbourne, Victoria, Australia; Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Davor Stanić
- The Florey Institute, University of Melbourne, Victoria, Australia
| | - Werner I Furuya
- The Florey Institute, University of Melbourne, Victoria, Australia
| | - Rishi R Dhingra
- The Florey Institute, University of Melbourne, Victoria, Australia; Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mathias Dutschmann
- The Florey Institute, University of Melbourne, Victoria, Australia; Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA.
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2
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Kalita J, Sachan A, Dubey AK, Jain N, Kumar S. A clinico-radiological study of deep cerebral venous thrombosis. Neuroradiology 2022; 64:1951-1960. [DOI: 10.1007/s00234-022-02938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
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3
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Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral Venous Thrombosis: A Comprehensive Review. Eur Neurol 2020; 83:369-379. [PMID: 32877892 DOI: 10.1159/000509802] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword "Cerebral sinus venous thrombosis" was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease. SUMMARY The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment. CONCLUSION CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.
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Affiliation(s)
| | - Dhineshreddy Gurala
- Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
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4
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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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Al-Sulaiman A. Clinical Aspects, Diagnosis and Management of Cerebral Vein and Dural Sinus Thrombosis: A Literature Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:137-145. [PMID: 31543733 PMCID: PMC6734737 DOI: 10.4103/sjmms.sjmms_22_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/10/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022]
Abstract
Cerebral vein and dural sinus thrombosis (CVST) is an uncommon cause of stroke, but its delayed diagnosis carries significant morbidity and mortality. Several studies have reported higher incidence of CVST than that previously reported. The clinical presentation of CVST varies and can be atypical. Advancement in neuroimaging modalities has made it possible to make an early diagnosis and initiate management with a wide range of therapeutic options, including direct oral anticoagulants and endovascular treatment. This narrative review summarizes the epidemiology, clinical aspects, diagnosis and management of CVST.
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Affiliation(s)
- Abdulla Al-Sulaiman
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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6
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Godfrey M, Gillis MM, Khurana D, Poletto E, Tarazi RA. Neuropsychological outcome following thalamic stroke in adolescence: an identical twin comparison. Clin Neuropsychol 2018; 33:905-927. [DOI: 10.1080/13854046.2018.1533997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mary Godfrey
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Divya Khurana
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Department of Pediatrics, Drexel University, Philadelphia, PA, USA
| | - Erica Poletto
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Department of Pediatrics, Drexel University, Philadelphia, PA, USA
- Department of Radiologic Sciences, Drexel University, Philadelphia, PA, USA
| | - Reem A. Tarazi
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Department of Psychiatry, Drexel University, Philadelphia, PA, USA
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7
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Saigal G, Ezuddin NS, Vega GDL. Neurologic Emergencies in Pediatric Patients Including Accidental and Nonaccidental Trauma. Neuroimaging Clin N Am 2018; 28:453-470. [DOI: 10.1016/j.nic.2018.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Chukanova EI, Chukanova AS, Mamaeva HI. [Cerebral venous thrombosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:4-10. [PMID: 27845308 DOI: 10.17116/jnevro20161161014-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is ample evidence that arterial and venous links of the vascular bed are interrelated, with the venous part, as the highly organized reflexogenic zone, responsible for the development of complex reactions providing the stability of the cerebral blood flow. There is few publications devoted to the venous pathology of the brain however the prevalence of cerebral venous thrombosis (CVT) is relatively high. The annual prevalence of CVT is 4-7 per 1 million of population. Timely recognition and early diagnosis of CVT are most important for successful treatment of patients. It can lead to effective therapy, decrease the consequences of this disease and the fatal outcomes. The review and systematization of the literature on the epidemiology, etiology, risk factors, clinical presentations, diagnosis and treatment of CVT are presented.
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Affiliation(s)
- E I Chukanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A S Chukanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - H I Mamaeva
- Pirogov Russian National Research Medical University, Moscow, Russia
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Cerebral Venous Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation after Hemicraniectomy. J Stroke Cerebrovasc Dis 2016; 25:2312-6. [PMID: 27321968 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a rare cerebrovascular event that can present with headache, seizure, and focal neurological deficits. Approximately 30%-40% of patients with CVT also present with intracranial hemorrhage. Current guidelines recommend anticoagulation after CVT even in the setting of intracranial hemorrhage, but the timing of initiation is unclear. We present a case of CVT where timing of anticoagulation was unclear by current guidelines. METHODS We conducted a literature search with search terms of "cerebral venous thrombosis," "intracranial hemorrhage," and "anticoagulation." Abstracted information included anticoagulation status and time of initiation of anticoagulation. We present a 30-year-old woman with sudden onset of right hemiplegia, global aphasia, and new-onset seizures diagnosed with left transverse and sigmoid sinus thrombosis with intraparenchymal hemorrhage. The patient was treated with endovascular thrombectomy and decompressive hemicraniectomy due to hemorrhage expansion, and anticoagulation was restarted 8 days after hemicraniectomy. RESULTS The literature review demonstrated a wide variation of timing for anticoagulation initiation in patients with CVT and intracranial hemorrhage. Most started anticoagulation within 24 hours of admission with similar functional neurological recovery. Current guidelines on the treatment of CVT, even with intracranial hemorrhage, recommend anticoagulation. Most reports in the literature state initiation of anticoagulation within 24 hours. However, the literature does not definitively state when to initiate anticoagulation in a patient with CVT, intracranial hemorrhage, thrombectomy, and decompressive hemicraniectomy. CONCLUSION This case illustrates the challenge of determining when to resume anticoagulation for CVT.
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10
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Corrales-Medina FF, Grant L, Egas-Bejar D, Valdivia-Ascuna Z, Rodriguez N, Mancias P. Cerebral sinovenous thrombosis associated with iron deficiency anemia secondary to severe menorrhagia: a case report. J Child Neurol 2014; 29:NP62-4. [PMID: 24056151 DOI: 10.1177/0883073813500715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral sinovenous thrombosis is a rare condition presenting with a wide spectrum of nonspecific symptoms that can make early diagnosis difficult. Cerebral sinovenous thrombosis has been associated with various etiologies. Iron deficiency anemia associated with cerebral sinovenous thrombosis in teenagers is rare. We present a teenage patient with complete thrombosis of the vein of Galen, straight sinus, and left internal cerebral vein associated with iron deficiency anemia due to severe menorrhagia. Mechanisms that can explain the association between iron deficiency anemia and thrombosis are discussed.
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Affiliation(s)
- Fernando F Corrales-Medina
- Department of Pediatrics, Children's Cancer Hospital, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Leon Grant
- Department of Pediatrics, The University of Texas Health Science Center, Houston, TX, USA
| | - Daniela Egas-Bejar
- Department of Pediatrics, Children's Cancer Hospital, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | | | - Nidra Rodriguez
- Department of Pediatrics, Children's Cancer Hospital, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA Department of Pediatrics, The University of Texas Health Science Center, Houston, TX, USA
| | - Pedro Mancias
- Department of Pediatrics, The University of Texas Health Science Center, Houston, TX, USA
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11
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McAndrew S, Listernick R, Kuntz N. Cerebellar mutism in acute disseminating encephalomyelitis. Pediatr Neurol 2014; 50:511-4. [PMID: 24656209 DOI: 10.1016/j.pediatrneurol.2014.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/20/2013] [Accepted: 01/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebellar mutism in children occurs after posterior fossa tumor resection and can have lasting effects on cognition, language, and behavior. Cerebellar mutism in acute disseminated encephalomyelitis is rare. PATIENT A 7-year-old boy with a 3-day history of fever, vomiting, and diarrhea presented with altered mental status and expressive aphasia. Magnetic resonance imaging showed new diffusion restriction in the bilateral dentate nuclei and right cerebellum. With treatment, he began to verbalize again but had long-term cognitive and language difficulties. CONCLUSION Acute disseminated encephalomyelitis is commonly a benign process, but its effect on the cerebellum can be long-lasting.
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Affiliation(s)
- Sarah McAndrew
- Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Robert Listernick
- Academic General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nancy Kuntz
- Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
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12
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Abstract
Medically ill adolescents are at increased risk for psychological distress and/or functional impairment. However, there are few research studies examining the optimal psychiatric treatments for this population. Psychiatric medication recommendations are largely based on studies of youth with a primary psychiatric disorder, adult studies, hypothesized mechanisms of action, and/or clinical experience. This paper provides evidence-informed recommendations for the psychopharmacological treatment of acutely medically ill adolescents suffering from significant psychological distress and/or functional impairment. Representing the most common problems among medically ill adolescents that are treated with psychiatric medications, recommendations are provided for anxiety and depression; iatrogenic medical trauma, inadequate sleep and insomnia; and, delirium.
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13
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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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14
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Pluchon C, Jaafari N, Loiseau-Corvez MN, Parizel A, Vandermarcq P, Hankard R, Gil R. A child with mutism after bilateral thalamic infarction. J Clin Neurosci 2011; 18:1738-40. [PMID: 22001246 DOI: 10.1016/j.jocn.2011.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 04/22/2011] [Indexed: 11/24/2022]
Abstract
The occurence of mutism after thalamic lesions has rarely been observed before adulthood. We report a 6.5-year-old girl who presented with sudden mutism with a decreased level of alertness. Her MRI revealed a T2-fluid attenuated inversion recovery hyperintensity in both thalami, which suggested bithalamic infarction in the territory of the thalamo-perforating arteries and, more specifically, the para-median territories. Mutism was followed by a deficit of speech initiation with slow and slurred speech. Her speech returned to normal at 3 months after the onset of symptoms. Thus mutism could be the equivalent of akinetic mutism limited to the speech sphere.
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Affiliation(s)
- C Pluchon
- Service de Neurologie, Unité de Neuropsychologie et Rééducation du Langage, Centre Hospitalier Universitaire (CHU) de Poitiers, Université de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
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15
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Saposnik G, Barinagarrementeria F, Brown RD, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:1158-92. [PMID: 21293023 DOI: 10.1161/str.0b013e31820a8364] [Citation(s) in RCA: 1116] [Impact Index Per Article: 85.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The purpose of this statement is to provide an overview of cerebral venous sinus thrombosis and to provide recommendations for its diagnosis, management, and treatment. The intended audience is physicians and other healthcare providers who are responsible for the diagnosis and management of patients with cerebral venous sinus thrombosis. METHODS AND RESULTS Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represent different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 1966 and used the American Heart Association levels-of-evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. CONCLUSIONS Evidence-based recommendations are provided for the diagnosis, management, and prevention of recurrence of cerebral venous thrombosis. Recommendations on the evaluation and management of cerebral venous thrombosis during pregnancy and in the pediatric population are provided. Considerations for the management of clinical complications (seizures, hydrocephalus, intracranial hypertension, and neurological deterioration) are also summarized. An algorithm for diagnosis and management of patients with cerebral venous sinus thrombosis is described.
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16
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Dlamini N, Billinghurst L, Kirkham FJ. Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am 2011; 21:511-27. [PMID: 20561500 PMCID: PMC2892748 DOI: 10.1016/j.nec.2010.03.006] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cerebral venous sinus (sinovenous) thrombosis (CSVT) in childhood is a rare, but underrecognized, disorder, typically of multifactorial etiology, with neurologic sequelae apparent in up to 40% of survivors and mortality approaching 10%. There is an expanding spectrum of perinatal brain injury associated with neonatal CSVT. Although there is considerable overlap in risk factors for CSVT in neonates and older infants and children, specific differences exist between the groups. Clinical symptoms are frequently nonspecific, which may obscure the diagnosis and delay treatment. While morbidity and mortality are significant, CSVT recurs less commonly than arterial ischemic stroke in children. Appropriate management may reduce the risk of recurrence and improve outcome, however there are no randomized controlled trials to support the use of anticoagulation in children. Although commonly employed in many centers, this practice remains controversial, highlighting the continued need for high-quality studies. This article reviews the literature pertaining to pediatric venous sinus thrombosis.
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Affiliation(s)
- Nomazulu Dlamini
- The Hospital For Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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17
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Kanaan ZM, Mahfouz R, Taher A, Sawaya RA. Bilateral Transverse Sinus Thrombosis Secondary to a Homozygous C677T MTHFR Gene Mutation. ACTA ACUST UNITED AC 2008; 12:363-5. [DOI: 10.1089/gte.2007.0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ziad M. Kanaan
- Department of Internal Medicine, Faculty of Medicine, Wayne State University, Detroit, Michigan
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Taher
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Raja A. Sawaya
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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18
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Affiliation(s)
- Jan Stam
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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19
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Wu YW, Hamrick SEG, Miller SP, Haward MF, Lai MC, Callen PW, Barkovich AJ, Ferriero DM. Intraventricular hemorrhage in term neonates caused by sinovenous thrombosis. Ann Neurol 2003; 54:123-6. [PMID: 12838529 DOI: 10.1002/ana.10619] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The cause of intraventricular hemorrhage in term neonates is poorly understood. Among 29 neonates of at least 36 weeks' gestation with intraventricular hemorrhage, 9 (31%) had cerebral sinovenous thrombosis. Of the 26 neonates who underwent computed tomography or magnetic resonance studies, those with thalamic hemorrhage were more likely to have sinovenous thrombosis than those without thalamic involvement (4/5 vs 5/21, p = 0.03). Term neonates with intraventricular hemorrhage should undergo neuroimaging to evaluate the presence of sinovenous thrombosis. Ann Neurol 2003
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Affiliation(s)
- Yvonne W Wu
- Department of Neurology, University of California, San Francisco, CA 94143-0136, USA.
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Buoni S, Molinelli M, Mariottini A, Rango C, Medaglini S, Pieri S, Strambi M, Fois A. Homocystinuria with transverse sinus thrombosis. J Child Neurol 2001; 16:688-90. [PMID: 11575612 DOI: 10.1177/088307380101600913] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of cerebral venous thrombosis caused by undiagnosed homocystinuria is reported. The pitfalls regarding the diagnosis of a potentially medically treatable condition are discussed. Cerebral venous thrombosis in children has a variable type of onset and a multiplicity of causes. This type of pathology, although not frequent, is more common than previously thought. Among the different etiologies, undiagnosed homocystinuria is not routinely considered. We report a case of venous thrombosis of the left transverse cerebral sinus in a girl with drug-resistant partial epilepsy and homocystinuria. This diagnosis was considered and confirmed after the appearance of acute cerebral symptoms caused by venous thrombosis.
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Affiliation(s)
- S Buoni
- Institute of Clinical Pediatrics, University of Siena, Italy
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Abstract
Cerebral venous thrombosis is an important cause of stroke in children. Understanding the natural history of the disease is essential for rational application of new interventions. We retrospectively identified 31 children with cerebral venous thrombosis confirmed by head computed tomography (4 patients) or by magnetic resonance imaging (27 patients). Risk factors, clinical and radiographic features, and neurologic outcomes were analyzed. There were 21 males and 10 females aged 1 day to 13 years (median 14 days). Nineteen (61%) were neonates. The most common risk factors included mastoiditis, persistent pulmonary hypertension, cardiac malformation, and dehydration. The chief clinical features were seizures, fever, respiratory distress, and lethargy. Fifteen patients had infarctions (8 hemorrhagic, 7 ischemic). Protein C and antithrombin III deficiency were the most common coagulopathies among 14 tested patients. On discharge, 11 patients were normal, 17 had residual deficits, and 2 patients died. Twenty-seven patients were followed from 1 month to 12 years (mean 22 months). At follow-up, 11 patients were normal, and 13 patients had development delay. One had residual hemiparesis and cortical visual impairment. Two had other deficits. Neonatal cerebral venous thrombosis is probably more common than previously thought, and outcomes are worse in this group. All children with cerebral venous thrombosis should be tested for coagulation disorders.
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Affiliation(s)
- K S Carvalho
- Division of Pediatric Neurology, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, USA
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