High-dose-infliximab-associated Cerebral Venous Sinus Thrombosis: A Case Report and Review of the Literature

Homonymous hemianopia due to cerebral venous thrombosis: A case report

RATIONALE

Diagnosing cerebral venous thrombosis (CVT) can be difficult because of nonspecific symptoms, such as headache and homonymous hemianopia (HH). Herein, we present a case of delayed CVT diagnosis due to nonspecific neurological symptoms and nonprominent lesions in a patient with HH.

PATIENT CONCERN

A 65-year-old woman presented with a sudden onset headache accompanied by right HH that lasted for 1 day. Brain computed tomography and magnetic resonance imaging were initially performed due to suspicion of ischemic lesions or hemorrhage in the left postchiasmal visual pathway; however, no remarkable acute brain lesions were detected. Ophthalmological examinations revealed no notable findings, except for a definite field defect in the Humphrey visual field test. The headaches then waxed and waned but recurred 3 days after the initial symptom.A repeat brain magnetic resonance imaging was performed, which revealed left sectoral gyral swelling and vascular enhancement in the occipital lobe. To further evaluate venous drainage, additional 3-dimensional cerebral computed tomography angiography and 4-vessel angiography were conducted, revealing a partial filling defect in the left transverse sinus and superior venous drainage impairment. These findings suggested the presence of venous thrombosis in the left transverse sinus.

DIAGNOSIS

The patient was diagnosed with thrombosis of the left transverse sinus, which subsequently caused the right HH.

INTERVENTION

Anticoagulation therapy with parenteral heparin was started as soon as the diagnosis of CVT was confirmed. Eventually, the patient was solely managed with oral warfarin administration.

OUTCOMES

Following 3 days of treatment, her headache resolved, and a subsequent visual field testing conducted 2 weeks later revealed a definite improvement in the field defect.

LESSONS

Despite its favorable prognosis, CVT can be challenging to diagnose. CVT should be considered as a differential diagnosis when diagnosing patients who present with headaches accompanied by HH without prominent brain lesions.

Recent Developments in Blood-Compatible Superhydrophobic Surfaces

Superhydrophobic surfaces, as indicated in the name, are highly hydrophobic and readily repel water. With contact angles greater than 150° and sliding angles less than 10°, water droplets flow easily and hardly wet these surfaces. Superhydrophobic materials and coatings have been drawing increasing attention in medical fields, especially on account of their promising applications in blood-contacting devices. Superhydrophobicity controls the interactions of cells with the surfaces and facilitates the flowing of blood or plasma without damaging blood cells. The antibiofouling effect of superhydrophobic surfaces resists adhesion of organic substances, including blood components and microorganisms. These attributes are critical to medical applications such as filter membranes, prosthetic heart valves, extracorporeal circuit tubing, and indwelling catheters. Researchers have developed various methods to fabricate blood-compatible or biocompatible superhydrophobic surfaces using different materials. In addition to being hydrophobic, these surfaces can also be antihemolytic, antithrombotic, antibacterial, and antibiofouling, making them ideal for clinical applications. In this review, the authors summarize recent developments of blood-compatible superhydrophobic surfaces, with a focus on methods and materials. The expectation of this review is that it will support the biomedical research field by providing current trends as well as future directions.

Cerebral venous sinus thrombosis in patients with inflammatory bowel disease: a retrospective study

Cerebral venous sinus thrombosis (CVST) is a rare and devastating complication of inflammatory bowel disease (IBD). Early diagnosis and prompt treatment could improve prognosis. The aim of our study was to investigate the clinical data and predictive factors of inflammatory bowel disease in patients with a diagnosis of CVST. All IBD patient data were collected from July 2013 and September 2020. Clinical data, predictive factors and prognosis were compared between IBD patients with CVST and the IBD control group. The incidence of CVST in our study was 0.48%. The mean age of IBD patients with CVST was 34.9 years. The average duration of IBD was 4 years when cerebrovascular events occurred. The clinical presentation of CVST included headache (73.1%), vomiting (30.8%), limb dysmetria (26.9%), speech impairment (11.5%), blurred vision (7.7%), epileptic seizures (7.7%) and drowsiness (3.8%). The most common location for CVST was the transverse sinus (61.5%) followed by the superior sagittal sinus (30.8%). Anaemia, low albumin and elevated D-dimer were independent predictors of CVST in patients with IBD. Anticoagulation therapy was effective. The prognosis of IBD patients with CVST was worse than that of IBD patients without CVST. Early identification of the risk and clinical features of CVST in IBD patients is important. Prompt antithrombotic therapy is a safe and effective treatment.