1
|
Huang P. Rare cause of cerebral venous sinus thrombosis: Spontaneous intracranial hypotension syndrome: A case report. World J Clin Cases 2023; 11:4677-4683. [PMID: 37469739 PMCID: PMC10353506 DOI: 10.12998/wjcc.v11.i19.4677] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Spontaneous intracranial hypotension syndrome is a relatively uncommon neurological disorder of unknown etiology with a good prognosis. Cerebral venous sinus thrombosis is a specific type of cerebrovascular disease caused by multiple etiologies of cerebral venous sinus or vein thrombosis that obstructs cerebral venous return and is associated with impaired cerebrospinal fluid absorption; this entity is rarely seen clinically. Spontaneous intracranial hypotension syndrome is one of the causes of cerebral venous sinus thrombosis, and the probability of their combined occurrence is only 1%-2%. As such, it is easily overlooked clinically, thus increasing the difficulty of diagnosis and treatment.
CASE SUMMARY A 29-year-old young woman presented with postural headache. Lumbar puncture suggested a pressure of 50 mmH2O (normal 80 mmH2O-180 mmH2O), and magnetic resonance imaging cerebral venography suggested thrombosis of the supratentorial sinus. These findings were considered indicative of cerebral venous sinus thrombosis due to spontaneous intracranial hypotension syndrome after ruling out immunological causes, tumor, infection, abnormal coagulation mechanism, and hypercoagulable state, etc. She was treated with rehydration and low-molecular heparin anticoagulation for 15 d, and follow-up magnetic resonance imaging cerebral venography suggested resolution of the thrombus. The patient had complete improvement of her headache symptoms.
CONCLUSION Spontaneous intracranial hypotension syndrome is one of the rare causes of cerebral venous sinus thrombosis, which is frequently misdiagnosed or missed and deserves consideration by clinicians during differential diagnosis. Dehydration should be avoided in such patients, and early rehydration and anticoagulation therapy are effective treatment options.
Collapse
Affiliation(s)
- Pan Huang
- Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| |
Collapse
|
2
|
Chtara K, Bradai S, Baccouche N, Toumi N, Amar WB, Chelly H, Bahloul M, Bouaziz M. Post-traumatic cerebral venous sinus thrombosis in an intensive care unit: A case series of ten patients. J Med Vasc 2023; 48:62-68. [PMID: 37422329 DOI: 10.1016/j.jdmv.2023.04.001] [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] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/23/2023] [Indexed: 07/10/2023]
Abstract
Post-traumatic cerebral venous sinus thrombosis is one of the several causes of cerebral venous thrombosis, but its early diagnosis and management are still difficult in this traumatic context. Our objective is to describe clinical and radiological presentations and to report specific management and outcomes of this rare post-traumatic complication. We reported in this manuscript a case series of 10 patients hospitalized in the intensive care department with post-traumatic cerebral venous thrombosis. Demographic, clinical, and radiological data and their medical management are reported. The incidence of post-traumatic cerebral venous sinus thrombosis in our institution was 4.2%. Cerebral thrombophlebitis was diagnosed incidentally on the initial body scan, on ICU admission in five patients. The left or right lateral sinus was affected in four patients; the sigmoid sinus was affected in 6 patients. Five patients had a thrombosis in the jugular vein. Seven patients had 2 or 3 sites of occlusion. All patients had medical treatment. No hemorrhagic complications were reported. The total duration of anticoagulation was available in 5 cases. A follow-up of MRI or CT scan at 3 months revealed complete sinus recanalization in three patients. Post-traumatic cerebral venous sinus thrombosis in the intensive care department remains underdiagnosed because of the common clinical presentation of traumatic brain injury. Its incidence is increasing because of the increase in high-velocity accidents. And, it seems necessary to conduct prospective studies with a large cohort of patients in the intensive care department.
Collapse
Affiliation(s)
- Kamilia Chtara
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia.
| | - Sabrine Bradai
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Najeh Baccouche
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Nozha Toumi
- Department of Radiology, Habib-Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Wiem Ben Amar
- Department of Forensic Medicine, Habib-Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Mabrouk Bahloul
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| |
Collapse
|
3
|
Peng C, Liu X, Wu K, Lang H, He L, Chen N. Nitrous oxide inhalation-induced cerebral venous sinus thrombosis in a 20-year-old man: A case report. Heliyon 2023; 9:e13473. [PMID: 36825186 PMCID: PMC9941988 DOI: 10.1016/j.heliyon.2023.e13473] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/06/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
Nitrous oxide is increasingly abused in the young population and has been verified to induce neuropathy, myelopathy, encephalopathy, and thrombosis. Nitrous oxide-related thrombosis was identified in the coronary artery, ascending aorta, pulmonary artery, and deep vein in the lower extremities. Cases with nitrous oxide abuse-related thrombosis in cerebral veins or cerebral venous sinus have rarely been reported, and confounding risk factors for thrombosis other than nitrous oxide exist in previous cases. Here, we report a case of probable nitrous oxide abuse-related cerebral venous sinus thrombosis without common confounding risk factors for thrombosis except for nitrous oxide.
Collapse
Affiliation(s)
- Cheng Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, China
| | - Kongyuan Wu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Hui Lang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China,Corresponding author.
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China,Corresponding author.
| |
Collapse
|
4
|
Medhi G, Parida S, Nicholson P, Senapati SB, Padhy BP, Pereira VM. Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis: A Case Series and Technical Note. World Neurosurg 2020; 140:148-61. [PMID: 32389866 DOI: 10.1016/j.wneu.2020.04.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis is a rare cause of acute stroke. It may lead to hemorrhagic venous infarctions, brain swelling, or raised intracranial pressure and can be associated with significant mortality and morbidity. Low-molecular-weight heparin is the mainstay of treatment. Endovascular treatment is reserved for patients who deteriorate despite medical management. METHODS Retrospective evaluation of our institutional databases from 2018-2019 revealed 7 patients who underwent aspiration thrombectomy using large-bore aspiration catheters for recanalization of the dural sinuses with or without intrasinus thrombolysis during the procedure. Their clinical, imaging findings, endovascular technique, and outcome are discussed. RESULTS We treated 7 patients who did not respond to best medical management. Aspiration thrombectomy was the primary mode of endovascular treatment. Adjuvant low-dose (10 mg recombinant tissue plasminogen activator), short-duration (20-minute) intrasinus thrombolysis was used in 4 patients only during the procedure. Headache was the most common symptom, followed by seizures, focal neurologic deficits, and vomiting. There was improvement in clinical condition within 24 hours of procedure in all patients. The 30-day modified Rankin Scale score was 0 in 6 patients. One patient had residual hemiparesis and aphasia. There were no procedure-related complications. CONCLUSIONS The described technique appears to be simple, safe, and effective and results in a relatively short procedure time in achieving complete or partial recanalization of the dural sinuses in patients who deteriorate despite clinical management. Endovascular thrombectomy along with conventional medical management restores the final drainage pathway of the brain with good clinical outcome.
Collapse
|
5
|
Alshoabi SA. Cerebral venous sinus thrombosis: A diagnostic challenge in a rare presentation. Brain Circ 2017; 3:227-230. [PMID: 30276329 PMCID: PMC6057707 DOI: 10.4103/bc.bc_27_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/22/2017] [Revised: 11/05/2017] [Accepted: 11/25/2017] [Indexed: 11/23/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon, life-threatening condition with a variable clinical presentation that makes it a challenge of diagnosis. A 39-year-old male patient presented to the hospital with complete loss of conscious and admitted to Medical Intensive Care Unit for investigation without any obvious history that was difficult for diagnosis. In this case, the patient presented with coma that is a rare presentation of CVST with no obvious clinical history and he was male patient that means he is free of all gender-specific risk factors of CVST. The brain computed tomography (CT) scan showed hypodense lesion in the left upper parietal region with no hemorrhage. The lesion was low-signal intensity (SI) on T1WIs and high SI on T2WIs and restricted on diffusion-weighted images like arterial infarctions, but magnetic resonance angiography (MRA) was normal that excluded arterial infarction. Gadolinium-enhanced MR venography (MRV) showed the filling defect of CVST. CVST can be present by a mysterious clinical presentation that makes it as a challenge of diagnosis even by medical imaging by CT and MR imaging (MRI). A combination of MRI and MRV is the best, noninvasive, and nonionizing imaging modality for the diagnosis of CVST.
Collapse
Affiliation(s)
- Sultan AbdulWadoud Alshoabi
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| |
Collapse
|
6
|
Liang J, Chen H, Li Z, He S, Luo B, Tang S, Shang W, Zeng J. Cortical vein thrombosis in adult patients of cerebral venous sinus thrombosis correlates with poor outcome and brain lesions: a retrospective study. BMC Neurol 2017; 17:219. [PMID: 29246198 DOI: 10.1186/s12883-017-0995-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cortical vein thrombosis (CVT) receives little attention in adult patients with cerebral venous sinus thrombosis (CVST). This study aimed to investigate the clinical and radiological features of adult CVST patients with concomitant CVT. METHODS From May 2009 to May 2016, we recruited 44 adult CVST patients (diagnosed within 1 month of onset; 33.8 ± 14.0 years of age, 28 males). CVT was primarily confirmed using computed tomography venography and magnetic resonance imaging sequence of contrast enhanced three dimensions magnetization prepared rapid acquisition with gradient echo. Patients with concomitant CVT were divided into the CVT group; otherwise, the patients were placed into the non-CVT group. The clinico-radiological characteristics were compared between the two groups. RESULTS The CVT group included 27 patients (61.4%), and the non-CVT group included 17 patients (38.6%). Seizure (63.0% versus 11.8%), focal neurological deficits (44.4% versus 5.9%), and consciousness disorders (33.3% versus 0) occurred more frequently in the patients in the CVT group than in those of the non-CVT group (P < 0.05). The modified Rankin Scale (mRS) score at discharge was higher for the CVT group patients (median 2, range 1-4) than for the non-CVT group patients (median 0, range 0-4) (P < 0.001). Venous infarction (63.0% versus 11.8%), parenchymal hemorrhage (40.7% versus 5.9%), and subarachnoid hemorrhage (22.2% versus 0) were identified more frequently in the CVT group than in the non-CVT group (P < 0.05). CONCLUSIONS This study demonstrates that concomitant CVT is a common finding in adult patients with CVST and is associated with severe clinical manifestations, poor short-term outcomes, and brain lesions.
Collapse
|
7
|
Mahale R, Mehta A, John AA, Buddaraju K, Shankar AK, Javali M, Srinivasa R. Acute seizures in cerebral venous sinus thrombosis: What predicts it? Epilepsy Res 2016; 123:1-5. [PMID: 27023399 DOI: 10.1016/j.eplepsyres.2016.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 10/11/2015] [Revised: 12/01/2015] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Seizures are the presenting feature of cerebral venous sinus thrombosis (CVST) in 12-31.9% of patients. 44.3% of patients have seizures in the early stage of the disease. Acute seizures (AS), refers to seizures which take place before the diagnosis or during the first 2 weeks afterward. OBJECTIVE To report the predictors of acute seizures in cerebral venous sinus thrombosis (CVST). METHODS 100 patients with CVST were included in the study. The occurrence of acute seizures was noted. The predictors of acute seizure were evaluated by univariate analysis including the demographic (gender, age), clinical (headache, focal neurological deficit, papilloedema, GCS score), type and number of risk factors, MRI findings (Type of lesion: hemorrhagic infarction or hematoma, location of lesion) and MRV findings (superficial or deep sinus, cortical veins). RESULTS A total of 46 patients had acute seizures. On univariate analysis, altered mental status (p<0.001), paresis (p=0.03), GCS score <8 (p=0.009), hemorrhagic infarct on imaging (p=0.04), involvement of frontal lobe (p=0.02), superior sagittal sinus (p=0.008), and high D-dimer levels (p=0.03) were significantly associated with acute seizure. On multivariate analysis, the hemorrhagic infarct on MRI and high D-dimer was independently predictive for early seizure. CONCLUSION The predictive factors for the acute seizures are altered mental status (GCS<8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels.
Collapse
Affiliation(s)
- Rohan Mahale
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| | - Aju Abraham John
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| | - Kiran Buddaraju
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| | - Abhinandan K Shankar
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| | - Mahendra Javali
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| | - Rangasetty Srinivasa
- Department of Neurology, MS Ramaiah Medical College & Hospital, MSRIT Post, New BEL Road, Bangalore 560054, Karnataka, India.
| |
Collapse
|