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Otufowora A, Lee C, Mohideen A, DeSena G, Pringle C, Guyer F, Sharma P, Baines T, Carr S. Cerebral venous sinus thrombosis and skull base osteomyelitis as manifestations of cat-scratch disease in a pediatric patient: A case report and literature review. Clin Case Rep 2023; 11:e7561. [PMID: 37361655 PMCID: PMC10288016 DOI: 10.1002/ccr3.7561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Cat-scratch disease (CSD) is caused by Bartonella henselae and usually presents with regional lymphadenopathy. Skull base osteomyelitis and cerebral venous sinus thrombosis are rarely reported, particularly in immunocompetent children. CSD should be considered in the differential diagnosis of any patient with persistent headaches in the setting of cat exposure.
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Affiliation(s)
- Ayodeji Otufowora
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Christine Lee
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Aneeb Mohideen
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Grace DeSena
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Charlene Pringle
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Freddie Guyer
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Priya Sharma
- Department of RadiologyCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Torrey Baines
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Silvana Carr
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
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Grigore I, Miron I, Gavrilovici C, Lupu VV, Antal DC, Schreiner TG, Prazaru C, Lupu A, Dragan F, Grigore E. SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature. Viruses 2023; 15:v15020405. [PMID: 36851619 PMCID: PMC9965073 DOI: 10.3390/v15020405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Cerebral venous thrombosis in pediatric patient has a varied etiology. The authors present the case of a teenager who, since the debut of SARS-CoV-2 infection, has accused intermittent right side hemicrania, which has become persistent in association with nausea and vomiting since the 5th day of quarantine. She was hospitalized in the 9th day since the debut. Neuroimaging revealed extended venous cerebral thrombosis affecting the right sigmoid sinus, the transverse sinus bilaterally, the confluence of the transverse sinuses and the right internal jugular vein. The evolution was favorable under anticoagulant and symptomatic treatment. Laboratory tests excluded other etiological causes for the cerebral venous thrombosis, thus the authors consider that cerebral thrombosis is a possible complication of SARS-CoV-2 infection in teenagers.
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Affiliation(s)
- Ioana Grigore
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ingrith Miron
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gavrilovici
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (V.V.L.); (A.L.)
| | - Dorin Cristian Antal
- Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Catalin Prazaru
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (V.V.L.); (A.L.)
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ecaterina Grigore
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Khan AN, Soh HJ, Emmanuel J, Andrews SL. Significant complications of RSV bronchiolitis: A case of severe hyponatraemia and central venous sinus thrombosis. J Paediatr Child Health 2022; 58:2297-2299. [PMID: 35972214 DOI: 10.1111/jpc.16156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Anika N Khan
- Department of General Paediatrics, Western Health, Melbourne, Victoria, Australia
| | - Han Jie Soh
- Department of General Paediatrics, Western Health, Melbourne, Victoria, Australia
| | - Jaiman Emmanuel
- Department of Medical Imaging, Western Health, Melbourne, Victoria, Australia
| | - Sarah L Andrews
- Department of General Paediatrics, Western Health, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Rodrigues SG, Vieira D, Bernardo F, Coelho J, Ribeiro JA, Palavra F, Robalo C, Levy A, Quintas S. Pediatric cerebral sinus venous thrombosis: clinical characterization of a Portuguese cohort. Acta Neurol Belg 2021; 122:1211-1218. [PMID: 34606070 DOI: 10.1007/s13760-021-01807-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pediatric cerebral sinus venous thrombosis (CSVT) is a rare entity. Risk factors differ from the adults, and treatment is not consensual. With this work, we aimed to characterize a pediatric cohort from two Portuguese tertiary centers. METHODS All patients under 18 years old with confirmed CSVT admitted between 2006 and 2019 were retrospectively included. Demographics, clinical presentation, workup, and follow-up were evaluated. RESULTS Fifty-three patients were included, 29 were male (54.7%). Median age was 5 years (IQR 11.08, range 0-17 years old). Headache, seizures and impairment of consciousness were the most frequent manifestations. A risk factor was identified in 90.6% (n = 48), mostly infections (43.8%; n = 21). CNS complications were comprised of hemorrhage, venous infarction, hydrocephalus and edema. Treatment included anticoagulation in 36 patients (67.9%), and there were no recurrences on follow-up. Prognosis was favorable, with most patients presenting no or only slight disability comparing to same age and sex children, on the follow-up. DISCUSSION In this cohort, impairment of consciousness was the most frequent clinical presentation and infections were the most frequent risk factors. The outcome was mainly favorable, with most patients presenting none or mild disability and without recurrences on follow-up. Studies are needed to define the criteria for anticoagulation and its recommended duration in children.
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Shlobin NA, LoPresti MA, Beestrum M, Lam S. Treatment of pediatric cerebral venous sinus thromboses: the role of anticoagulation. Childs Nerv Syst 2020; 36:2621-2633. [PMID: 32743709 DOI: 10.1007/s00381-020-04829-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/22/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cerebral venous sinus thromboses (CVST) occur in children with a variety of etiologies. However, no standard treatment paradigm is established. We sought to identify what treatments have been applied, their outcomes, and the role of anticoagulation in pediatric patients with CVST. METHODS A systematic review was conducted exploring all treatments of pediatric CVSTs using PubMed, Embase, Scopus, and Cochrane Library and Cochrane Central Register of Controlled Trials. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. RESULTS Of 2946 resultant articles, 51 full-text articles were included. Management of infectious CVST included broad-spectrum antibiotics, surgery, and anticoagulation. Neoplastic and traumatic CVST treatment included anticoagulation. Treatment of CVSTs associated with metabolic abnormalities centered on correction of metabolic derangements, or supplementation where appropriate, and anticoagulation. Autoimmune, congenital, and thrombotic pathway CVSTs were treated with anticoagulation and treatment of the underlying disorder. Unfractionated heparin and low molecular weight heparin were most commonly used and seen to be effective and safe. Uncommonly, endovascular interventions including venous thrombectomy and intravenous injection of thrombolytic therapy were used with varying success. CONCLUSIONS While conservative, medical, thombolytic, endovascular, and surgical treatment all have a role in in the treatment of pediatric CVSTs, anticoagulation is commonly applied and found to be safe and effective in pediatrics. Risks and benefits of anticoagulation must be considered on an individual basis as no randomized trials have established a standard of care. Based on our findings, we propose an approach to CVST treatment and look to future study aimed at more clearly delineating treatment dose, duration, and timing of re-evaluation in these patients.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Molly Beestrum
- Department of Library Services, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandi Lam
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA.
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Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon diagnosis associated with life-threatening and long-term neurological consequences in children. It is characterized by non-specific symptoms, including fever, altered mental status and focal neurological deficits. Etiologic factors include infection, trauma, prothrombotic disorders and importantly, iron-deficiency anemia. Iron-deficiency anemia is a preventable risk factor of CVST as it is commonly caused by excessive cow milk consumption in infants and toddlers. Diagnosis is mainly made with MRI and magnetic resonance venography (MRV). Prompt anticoagulation is a key therapeutic intervention, and in the case of associated iron deficiency, iron repletion and elimination or limitation of milk from diet are also required. Thus, it is essential for physicians to have a high level of suspicion to diagnose CVST, given its non-specific presentation. This is a case report of a two-year-old boy who presented to the pediatric emergency department with vomiting and altered mental status and was ultimately diagnosed with CVST.
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Affiliation(s)
- Prachi Shah
- Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Dan Nguyen
- Emergency Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, USA.,Emergency Medicine, William Beaumont Hospital, Royal Oak, USA
| | - Brian Berman
- Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, USA
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Abstract
Dural venous sinus thrombosis (DVST) is a rare disease associated with hypercoagulable states. Patients with sickle cell disease are known to be prothrombotic. We report a case of DVST presenting with anterior neck and facial pain in a 24-year-old female with sickle cell disease, found to have extensive thrombotic disease involving the internal jugular vein. A literature review of DVST in sickle cell disease consisting of 14 case reports was summarized. Headache was a presenting feature in two-thirds of patients. Nine cases were associated with vaso-occlusive crisis (VOC), transfusion, or acute respiratory illness. Most patients were treated with anticoagulation therapy. Over three-quarters either died or suffered from a serious neurological complication, including stroke, seizure, coma, or elevated intracranial pressure. Given its association with life-threatening complications, DVST should be considered when patients with sickle cell disease present with a VOC, especially in the context of headache or neurological deficits.
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Affiliation(s)
- Michael K Wang
- Division of General Internal Medicine, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Ravi Shergill
- Department of Radiology, McMaster University , Hamilton , ON , Canada
| | - Matthew Jefkins
- Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Jason Cheung
- Division of General Internal Medicine, Department of Medicine, McMaster University , Hamilton , ON , Canada
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dmytriw AA, Song JSA, Yu E, Poon CS. Cerebral venous thrombosis: state of the art diagnosis and management. Neuroradiology 2018; 60:669-685. [PMID: 29752489 DOI: 10.1007/s00234-018-2032-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This review article aims to discuss the pathophysiology, clinical presentation, and neuroimaging of cerebral venous thrombosis (CVT). Different approaches for diagnosis of CVT, including CT/CTV, MRI/MRV, and US will be discussed and the reader will become acquainted with imaging findings as well as limitations of each modality. Lastly, this exhibit will review the standard of care for CVT treatment and emerging endovascular options. METHODS A literature search using PubMed and the MEDLINE subengine was completed using the terms "cerebral venous thrombosis," "stroke," and "imaging." Studies reporting on the workup, imaging characteristics, clinical history, and management of patients with CVT were included. RESULTS The presentation of CVT is often non-specific and requires a high index of clinical suspicion. Signs of CVT on NECT can be divided into indirect signs (edema, parenchymal hemorrhage, subarachnoid hemorrhage, and rarely subdural hematomas) and less commonly direct signs (visualization of dense thrombus within a vein or within the cerebral venous sinuses). Confirmation is performed with CTV, directly demonstrating the thrombus as a filling defect, or MRI/MRV, which also provides superior characterization of parenchymal abnormalities. General pitfalls and anatomic variants will also be discussed. Lastly, endovascular management options including thrombolysis and mechanical thrombectomy are discussed. CONCLUSIONS CVT is a relatively uncommon phenomenon and frequently overlooked at initial presentation. Familiarity with imaging features and diagnostic work-up of CVT will help in providing timely diagnosis and therapy which can significantly improve outcome and diminish the risk of acute and long-term complications, optimizing patient care.
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Affiliation(s)
- Adam A Dmytriw
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, M5T 1W7, Canada.
| | - Jin Soo A Song
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, M5T 1W7, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, M5T 1W7, Canada
| | - Colin S Poon
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
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Basse I, Diagne/Gueye NR, Ndiaye N, Mbengue M, Obambi DC, Ba A, Fall AL, Ndongo AA, Boiro D, Ba A. [Difficulties in the management of cerebral venous thrombosis (CVT) complicated by subarachnoid hemorrhage (SAH) in infants: about a case]. Pan Afr Med J 2018; 28:206. [PMID: 29610644 PMCID: PMC5878859 DOI: 10.11604/pamj.2017.28.206.11639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/28/2017] [Indexed: 12/27/2022] Open
Abstract
La TVC est rare en général et particulièrement chez l’enfant. La survenue d’une HSA dans ce contexte est une situation très peu fréquente et seuls quelques cas sont rapportés dans la littérature. Sa symptomatologie est variable et souvent trompeuse. Non traitée ou en cas de traitement tardif l’issue peut être fatale ou conduire à des séquelles potentiellement graves. Nous rapportons l’observation d’un nourrisson de 22 mois reçu pour des convulsions avec coma stade II, syndrome d’hypertension intracrânienne et syndrome infectieux. Une septicémie à Pseudomonas spp a était retrouvée à la biologie et le scanner cérébral a permis de poser le diagnostic. Le traitement a été basé sur l’antibiothérapie mais surtout l’anticoagulation. Une nette amélioration clinique a été ainsi notée et le scanner cérébral de contrôle montrait une disparition de la thrombose avec images hémorragiques séquellaires droites. La TVC est une pathologie grave d’origine généralement infectieuse. Le traitement anticoagulant est aujourd’hui sujet à controverse notamment en cas d’hémorragie associée, mais l’expérience clinique serait en faveur de l’efficacité et de l’innocuité de ce traitement.
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Affiliation(s)
- Idrissa Basse
- Service de Pédiatrie, Hôpital pour Enfants de Diamniadio, Université de Thiès, Sénégal
| | | | - Ndiémé Ndiaye
- Service de Pédiatrie, Hôpital pour Enfants de Diamniadio, Université de Thiès, Sénégal
| | - Marie Mbengue
- Service de Radiologie, Hôpital pour Enfants de Diamniadio, Sénégal
| | - Dina Cyrienne Obambi
- Service de Pédiatrie, Hôpital pour Enfants de Diamniadio, Université de Thiès, Sénégal
| | - Aïssatou Ba
- Hôpital d'Enfants Albert Royer, Université Cheikh Anta Diop (CAD) de Dakar, Sénégal
| | - Amadou Lamine Fall
- Hôpital d'Enfants Albert Royer, Université Cheikh Anta Diop (CAD) de Dakar, Sénégal
| | | | - Djibril Boiro
- Service de Pédiatrie, Centre Hospitalier National Abass Ndao, Université CAD de Dakar, Sénégal
| | - Abou Ba
- Hôpital d'Enfants Albert Royer, Université Cheikh Anta Diop (CAD) de Dakar, Sénégal
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Cox M, Epelman M, Chandra T, Meyers AB, Johnson CM, Podberesky DJ. Non–Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe. Radiographics 2017; 37:1753-1774. [DOI: 10.1148/rg.2017170036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mougnyan Cox
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Monica Epelman
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Tushar Chandra
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Arthur B. Meyers
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Craig M. Johnson
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Daniel J. Podberesky
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
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Abstract
PURPOSE OF REVIEW To evaluate the feasibility of 4-dimensional (4D) flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease. RECENT FINDINGS 4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intraaneurysmal and parent artery blood flow after flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy individuals over a broad age range. SUMMARY 4D flow MRI is a useful tool for the noninvasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultrahigh-field strengths to achieve higher spatial resolution and streamlined postprocessing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.
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Affiliation(s)
- Susanne Schnell
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Can Wu
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A. Ansari
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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13
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Boon IS, Starkey KJ, Samsonova O, Johnston AM. In the thick of it: cerebral venous sinus thrombosis precipitated by iron-deficiency anaemia and sickle cell trait. BMJ Case Rep 2016; 2016:bcr-2016-215399. [PMID: 27190121 DOI: 10.1136/bcr-2016-215399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ian S Boon
- Department of Clinical Decision Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kerry Jo Starkey
- Department of Clinical Decision Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Army Medical Directorate, Surrey, UK
| | - Oksana Samsonova
- Department of Elderly Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew McDonald Johnston
- Department of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK
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14
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Torres RA, Torres BR, de Castilho ASR, Honorato R. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review. Rev Bras Ter Intensiva 2016; 26:430-4. [PMID: 25607275 PMCID: PMC4304474 DOI: 10.5935/0103-507x.20140066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/15/2014] [Indexed: 11/20/2022] Open
Abstract
Nephrotic syndrome is associated with a hypercoagulable state and an increased risk
of thromboembolic complications. Cerebral venous sinus thrombosis is a rare
complication of nephrotic syndrome, with few cases described in the literature,
although the disease may be under-diagnosis. The true incidence of cerebral venous
sinus thrombosis may be underestimated because many events are asymptomatic or are
not diagnosed in time. Here, we describe the case of a male child, 2 years and 10
months old, with nephrotic syndrome presenting with headache, epileptic seizures and
sensory inhibition who was diagnosed with superior sagittal and transverse sinuses
thrombosis. An international literature review was performed with a defined search
strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic
syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis
should be considered in any patient with nephrotic syndrome who presents with
neurological signs and symptoms, as early clinical diagnosis promotes favorable
outcomes.
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Affiliation(s)
- Ronaldo Afonso Torres
- Unidade de Terapia Intensiva Neonatal e Pediátrica, Hospital Santa Isabel, Ubá, MG, Brasil
| | - Bruna Ribeiro Torres
- Curso Acadêmico de Medicina, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
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Wu C, Honarmand AR, Schnell S, Kuhn R, Schoeneman SE, Ansari SA, Carr J, Markl M, Shaibani A. Age-Related Changes of Normal Cerebral and Cardiac Blood Flow in Children and Adults Aged 7 Months to 61 Years. J Am Heart Assoc 2016; 5:JAHA.115.002657. [PMID: 26727967 PMCID: PMC4859381 DOI: 10.1161/jaha.115.002657] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Cerebral and cardiac blood flow are important to the pathophysiology and development of cerebro‐ and cardiovascular diseases. The purpose of this study was to investigate the age dependence of normal cerebral and cardiac hemodynamics in children and adults over a broad range of ages. Methods and Results Overall, 52 children (aged 0.6–17.2 years) and 30 adults (aged 19.2–60.7 years) without cerebro‐ and cardiovascular diseases were included in this study. Intracranial 4‐dimensional flow and cardiac 2‐dimensional phase‐contrast magnetic resonance imaging were performed for all participants to measure flow parameters in the major intracranial vessels and aorta. Total cerebral blood flow (TCBF), cardiac and cerebral indexes, brain volume, and global cerebral perfusion (TCBF/brain volume) were evaluated. Flow analysis revealed that TCBF increased significantly from age 7 months to 6 years (P<0.001) and declined thereafter (P<0.001). Both cardiac and cerebral indices declined with age (P<0.001). The ratio of TCBF to ascending aortic flow declined rapidly until age 18 years (P<0.001) and remained relatively stable thereafter. Age‐related changes of cerebral vascular peak velocities exhibited a trend similar to TCBF. By comparison, aortic peak velocities maintained relatively high levels in children and declined with age in adults (P<0.001). TCBF significantly correlated with brain volume in adults (P=0.005) and in 2 pediatric subgroups, aged <7 years (P<0.001) and 7 to 18 years (P=0.039). Conclusions Cerebral and cardiac flow parameters are highly associated with age. The findings collectively highlight the importance of age‐matched control data for the characterization of intracranial and cardiac hemodynamics.
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Affiliation(s)
- Can Wu
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL (C.W., M.M.) Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.)
| | - Amir R Honarmand
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.)
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.)
| | - Ryan Kuhn
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, IL (R.K., S.E.S., A.S.)
| | - Samantha E Schoeneman
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, IL (R.K., S.E.S., A.S.)
| | - Sameer A Ansari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.) Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.A.A., A.S.) Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.A.A.)
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.)
| | - Michael Markl
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL (C.W., M.M.) Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.)
| | - Ali Shaibani
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (C.W., A.R.H., S.S., S.A.A., J.C., M.M., A.S.) Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.A.A., A.S.) Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, IL (R.K., S.E.S., A.S.)
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Bosemani T, Poretti A, Huisman TA. Susceptibility-weighted imaging in pediatric neuroimaging. J Magn Reson Imaging 2013; 40:530-44. [DOI: 10.1002/jmri.24410] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/22/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Thierry A.G.M. Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
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Abstract
Venous thromboembolism (VTE) is an important cause of in-hospital mortality. A local understanding of disease burden, occurrence, etiology and successful preventive and therapeutic interventions is of vital import. We aimed to review the current literature of VTE originating from Pakistan to determine gaps in knowledge in order to prioritize future research. An electronic search was performed using Pakmedinet, Pubmed and Google Scholar to retrieve research articles on thrombosis, deep vein thrombosis and pulmonary thromboembolism in Pakistan. The search included all years and no limits were applied. All original research articles presenting primary data from Pakistan were selected. Full texts were reviewed and information synthesized and summarized in our review. Eighty-one studies were found, out of which we were able to retrieve and review 77 (95%) full texts. A total of 6,501 patients are included in this review. Among the studies, we found 25 case reports/series, 1 case-control, 3 cohort, 20 cross-sectional, 1 quasi-experimental, 2 randomized controlled trials, 4 retrospective file reviews and 21 review articles. Most of these were small studies with only eight having a patient population above 100. Six studies presented incidence of DVT which ranged from 2.6 to 12.82% depending on the population under study. Two articles studied risk factors for DVT. Six looked at different treatment modalities, often comparing one modality to the other, while another 15 articles assessed diagnostic strategies. Preventive aspects of VTE were addressed by only three studies and all found the rates of thrombo-prophylaxis grossly inadequate. There is a dearth of quality research on venous thromboembolism in Pakistan. We describe key areas of neglect and recommend prioritizing research on epidemiological and preventive aspects.
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Presicci A, Garofoli V, Simone M, Campa MG, Lamanna AL, Margari L. Cerebral venous thrombosis after lumbar puncture and intravenous high dose corticosteroids: a case report of a childhood multiple sclerosis. Brain Dev 2013; 35:602-5. [PMID: 23044052 DOI: 10.1016/j.braindev.2012.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 11/28/2022]
Abstract
The association between cerebral venous thrombosis (CVT) and multiple sclerosis (MS) has already been reported in several adult patients with clinically definite MS, in a suspected relation to i.v. corticosteroids or previously performed lumbar puncture (LP). We are reporting a case, which is, to our knowledge, the first one concerning a child patient with a MS, who developed multiple CVT after LP and during high-dose i.v. corticosteroid. Our conclusions are that the sequence LP followed by high dose corticosteroids may be a contributory factor for the development of CVT when associated with other risk factors.
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Affiliation(s)
- Anna Presicci
- Child Neuropsychiatry Unit, Department of Neurological Science and Sense Organs, University Aldo Moro of Bari, Italy
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