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Karakas C, Herman I, Kralik SF, Webber TA, Takacs DS, Bhar S, Pehlivan D. A Comprehensive Examination of Clinical Characteristics and Determinants of Long-Term Outcomes in Pediatric Cerebral Sinus Venous Thrombosis. Pediatr Neurol 2024; 155:76-83. [PMID: 38608552 DOI: 10.1016/j.pediatrneurol.2024.03.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To analyze the clinical and neuroimaging features, risk factors, treatment choices, and long-term clinical outcomes in children with cerebral sinus venous thrombosis (CSVT). METHODS This is a retrospective cohort study of children diagnosed with CSVT between 2002 and 2018 at Texas Children's Hospital. RESULTS A total of 183 children (male: 62.3%) with CSVT were included. The average presenting age was 7.7 years (S.D.: 5.6). The mean follow-up duration was 33.7 months (S.D.: 38.6). The most common presenting clinical feature was headache (36.6%). Head and neck infections other than meningitis (36.6%) were the most common risk factors. Prevalent neurological examination findings included motor deficit (21.3%) and altered mental status (AMS, 20.2%). Neuroimaging features included hemorrhagic infarction (19.6%), ischemic infarction (8.2%), and intracranial hemorrhage without infarction (5.5%). The most common site of thrombosis was the superior sagittal sinus (37.2%), with 78.2% of patients demonstrating involvement of multiple sinuses. Treatment of choice was low-molecular-weight heparin in 69.4% of patients. Factors associated with worse clinical outcomes included head and neck infections, malignancy (other than hematologic), cardiac disease, and recent surgery; seizure and dehydration on initial presentation; motor abnormalities and AMS on initial examination; ischemic infarct only; and involvement of vein of Trolard on neuroimaging. Thrombus condition on repeat imaging, receiving any anticoagulant/antithrombotic treatment, treatment duration, or follow-up duration was not associated with severity of long-term outcome. CONCLUSIONS CSVT may lead to unfavorable long-term outcomes in a remarkable portion of pediatric patients. Thus, a high index of suspicion and early and appropriate management of pediatric CSVT is imperative.
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Affiliation(s)
- Cemal Karakas
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas; Division of Pediatric Neurology, Department of Neurology, Norton Children's Medical Group, University of Louisville, Louisville, Kentucky
| | - Isabella Herman
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Boys Town National Research Hospital, Boys Town, Nebraska
| | - Stephen F Kralik
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Danielle S Takacs
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas
| | - Saleh Bhar
- Division of Hematology and Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
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Saridas F, Mesut G, Dinc Y, Koc ER, Ozpar R, Hakyemez B, Turan OF. Characteristics of Cerebral Venous Sinus Thrombosis Due to Autoimmune Diseases: A Single-Center Retrospective Observational Study. Neurologist 2024; 29:152-157. [PMID: 38251750 DOI: 10.1097/nrl.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease characterized by thrombosis of the cerebral venous or dural sinuses. Autoimmune diseases (AD) are important causes of CVST. This study aims to reveal the differences between CVST associated with autoimmune diseases compared with other causes (OCs) and Behcet's syndrome (BS) compared with other ADs. METHODS This is a single-center retrospective study in which the medical records of 187 patients we followed with a diagnosis of CVST between 2008 and 2023 were collected retrospectively. Four neurologists collected data on initial symptoms, neurological examinations, and laboratory findings. Findings on magnetic resonance imaging and magnetic resonance venography performed on all patients (thrombosis localizations, hemorrhagic or ischemic complications, and collateralization) were re-evaluated by 2 radiologists. The results were compared with AD, other ADs, and OCs groups. RESULTS There were 28 cases of CVST associated with AD. Of these, 18 were BS, and 10 were other AD. Subacute-chronic onset, headache, and transverse sinus involvement were more common in AD-related patients than in OCs. However, collateralization, venous infarction, hemorrhagic transformation, and bleeding were less common. BS-related patients had earlier age, more frequent transverse sinus, less frequent cortical vein thrombosis, and better collateralization than other ADs. CONCLUSION CVST is one of the rare complications in autoimmune diseases. It has a more subacute-chronic onset. Since headaches are more common, it is essential to make a differential diagnosis of CVST in autoimmune diseases with chronic headaches. Transverse sinus thrombosis is more common. Collateralization, venous infarction, and hemorrhagic transformation are less.
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Affiliation(s)
- Furkan Saridas
- Department of Neurology, Bursa Uludağ University Medicine Faculty
| | - Gizem Mesut
- Department of Neurology, Bursa Uludağ University Medicine Faculty
| | - Yasemin Dinc
- Department of Neurology, Bursa Uludağ University Medicine Faculty
| | - Emine Rabia Koc
- Department of Neurology, Bursa Uludağ University Medicine Faculty
| | - Rifat Ozpar
- Department of Radiology, Bursa Uludağ University Medicine Faculty, Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Bursa Uludağ University Medicine Faculty, Bursa, Turkey
| | - Omer Faruk Turan
- Department of Neurology, Bursa Uludağ University Medicine Faculty
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Kiuchi Z, Tanaka E, Nunokawa S, Yoshida S, Hosaki A, Kogure T, Narita M. Pediatric frequent relapsing nephrotic syndrome with multiple cerebral infarctions accompanied by patent foramen ovale and cerebral venous sinus thrombosis: a case report. BMC Nephrol 2024; 25:146. [PMID: 38658845 PMCID: PMC11040989 DOI: 10.1186/s12882-024-03579-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Idiopathic nephrotic syndrome (NS) presents as a hypercoagulable state, of which thromboembolism (TE) is a well-known life-threatening complication. Although TE is more likely to occur in venous vessels than arterial vessels, arterial TE is important because it may cause after-effects, including tissue necrosis and cerebral infarction (CI); therefore, prompt diagnosis and appropriate treatment are required. We report a pediatric NS case with multiple CIs. CASE PRESENTATION A 14-year-7-month-old Japanese girl was diagnosed with frequent relapsing NS, accompanied by headache and disturbance of consciousness during the second relapse. Brain magnetic resonance imaging (MRI) and four-dimensional computed tomography revealed multiple CIs, vasogenic edema, and cerebral venous sinus thrombosis (CVST). The patient had no underlying thrombophilia other than hypercoagulability due to NS and prednisolone (PSL), and no cardiac arrhythmia; however, a right-to-left shunt through the patent foramen ovale (PFO) was observed with the Valsalva maneuver by echocardiography. Therefore, we assumed that a potential cause of multiple CIs might be an embolic stroke, caused by thrombosis formed from a hypercoagulable state due to NS and PSL treatment and reached through PFO. Antiplatelet and anticoagulant therapies were administered for TE. She was treated with PSL and mycophenolate mofetil (MMF) for NS. Rituximab (RTX) was administered to prevent NS relapse after complete remission (CR). She underwent transcatheter PFO closure at age 14 years and 9 months because we considered that the right-to-left shunt through the PFO would be one of the risks for recurrent cerebral embolism when NS relapses. One year after the onset of CIs, an MRI indicated that the CVST had resolved, leaving no neurological sequelae due to CI; therefore, anticoagulant therapy was discontinued. And then she has been in CR for NS with only MMF therapy. CONCLUSIONS CI is a serious complication in patients with NS. The pathogenesis of multiple CIs is various, including right-to-left shunt through PFO, in addition to the hypercoagulability due to NS. It is important to investigate and manage underlying risks such as PFO, besides preventing the relapses of NS by aggressive treatments using MMF and RTX, in patients with NS.
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Affiliation(s)
- Zentaro Kiuchi
- Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan.
| | - Eriko Tanaka
- Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Saaya Nunokawa
- Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Sawako Yoshida
- Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Akira Hosaki
- Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Tomohito Kogure
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Masami Narita
- Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
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Petchprom P, Sanghan N, Khumthong R, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Factors associated with venous collaterals in patients with cerebral venous thrombosis. PLoS One 2024; 19:e0302162. [PMID: 38626092 PMCID: PMC11020378 DOI: 10.1371/journal.pone.0302162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/27/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVES To identify the factors associated with venous collaterals in Thai patients with cerebral venous thrombosis. MATERIALS AND METHODS This retrospective 20-year cohort study enrolled patients diagnosed with cerebral venous thrombosis between January 2002 and December 2022. Data was collected from the electronic medical record, and venous collaterals were independently reviewed by two neuroradiologists using the Qureshi classification. Patients with and without venous collaterals were compared. Significant factors (P<0.05) in the univariate analysis were recruited into the multivariate logistic regression analysis to determine independently associated factors. RESULTS Among 79 patients with cerebral venous thrombosis, the prevalence of venous collaterals at the initial neuroimaging was 25.3%. In the univariate analysis, patients with cerebral venous thrombosis and venous collaterals were significantly younger (37.0±13.9 years vs. 44.9±17.4 years, P = 0.048), more often had occlusion in the superior sagittal sinus (80.0% vs. 54.2%, P = 0.041), and were associated with hormonal exposure (35.0% vs. 6.8%, P = 0.002). Multivariate logistic regression analysis revealed occlusion in the superior sagittal sinus (adjusted odds ratio [aOR] 3.581; 95% confidence interval [95% CI] 1.941-13.626; P = 0.044) and hormonal exposure (aOR 7.276, 95% CI 1.606-32.966, P = 0.010) as independent factors associated with venous collaterals in cerebral venous thrombosis. CONCLUSIONS In this cohort, the prevalence of venous collaterals was 25.3%. Occlusion in the superior sagittal sinus and hormonal exposure were independently associated with venous collaterals in patients with cerebral venous thrombosis.
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Affiliation(s)
- Phirat Petchprom
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Nuttha Sanghan
- Division of Neuroradiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Rujimas Khumthong
- Division of Neuroradiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Balla Y, Hashi AS, Osman AA, Hassan MS, Mutlu E. Cerebral Venous Sinus Thrombosis as an Initial Presentation of Nephrotic Syndrome: A Case Report. Vasc Health Risk Manag 2024; 20:177-181. [PMID: 38623542 PMCID: PMC11018128 DOI: 10.2147/vhrm.s458539] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Cerebral sinovenous thrombosis (CSVT) encompasses a spectrum of disorders involving thrombosis of the cerebral venous system. As shown by previous epidemiological studies, the prevalence of cerebral sinovenous thrombosis is 4-7 cases per million people. Nephrotic syndrome was very rarely associated with thrombosis cerebral veins or sinuses. Hypercoagulability and thrombotic complications in nephrotic syndrome are most commonly seen in deep veins of the lower extremities and renal veins. Our case highlights a unique scenario in which cerebral sinovenous thrombosis was the initial presentation of nephrotic syndrome in a patient that was not an important past medical or surgical problem. The patient was brought to the emergency department with severe headache, vomiting, altered mental status, and generalized body swelling. Laboratory results showed proteinuria, hypoalbuminemia and hyperlipidemia. Non-contrast brain CT demonstrated hemorrhagic venous infarct associated with vasogenic edema. A subsequent brain MR venogram demonstrated occlusion of superior sagittal and right transverse sinuses. She was managed with low molecular weight heparin and intervenous corticosteroids then shifted to rivaroxaban and oral steroids, respectively, which resulted in massive clinical improvement and resolution of thrombus.
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Affiliation(s)
- Yassir Balla
- Department of Internal Medicine, Somali-Sudanese Specialized hospital, Mogadishu, Somalia
| | - Abdullahi Said Hashi
- Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Adam Osman
- Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Faculty of Medicine and Surgery, University of Somalia, Mogadishu, Somalia
| | - Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Eren Mutlu
- Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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McGuckin E, Ho KM, Honeybul S, Stuckey E, Song S. A Prospective Cohort Study Characterizing Incidence of Dural Venous Sinus Thrombosis in Traumatic Brain Injury Patients with Skull Fractures. World Neurosurg 2024; 184:e374-e383. [PMID: 38302002 DOI: 10.1016/j.wneu.2024.01.132] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterizing the incidence of DVST in patients with high-risk TBI are sparse but are needed to develop evidence-based TBI management guidelines. METHODS After obtaining institutional approval, 36 adult patients with TBI with skull fractures admitted to an Australian level III adult intensive care unit between April 2022 and January 2023 were prospectively recruited and underwent computed tomography venography or magnetic resonance venography within 72 hours of injury. When available, daily maximum intracranial pressure was recorded. RESULTS Dural venous sinus abnormality was common (36.1%, 95% confidence interval 22.5%-52.4%) and strongly associated with DVST (P = 0.003). The incidence of DVST was 13.9% (95% confidence interval 6.1%-28.7%), which was lower than incidence reported in previous retrospective studies. Of DVSTs confirmed by computed tomography venography, 80% occurred in patients with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (P = 0.006). However, dural venous sinus abnormality and DVST were not associated with an increase in maximum daily intracranial pressure within the first 7 days after injury. CONCLUSIONS Dural venous sinus abnormality was common in TBI patients with skull fractures requiring intensive care unit admission. DVST was confirmed in more than one third of these patients, especially patients with concomitant temporal or parietal and occipital bone fractures. Computed tomography venography is recommended for this subgroup of TBI patients.
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Affiliation(s)
- Ellen McGuckin
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Kwok M Ho
- Department of Intensive Care Medicine, Fiona Stanley Hospital, University of Western Australia & Murdoch University, Perth, Western Australia, Australia
| | - Stephen Honeybul
- Department of Neurosurgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Emma Stuckey
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Swithin Song
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Liang AS, Bounajem MT, Shoskes A, Grandhi R. Dural arteriovenous fistula in the setting of cerebral venous sinus thrombosis and COVID-19 infection. Neurosurg Focus 2024; 56:E17. [PMID: 38427997 DOI: 10.3171/2023.12.focus23794] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The aim of this study was to examine the presence of concurrent venous thrombosis and COVID-19 infections in patients with dural arteriovenous fistulas (dAVFs). METHODS An analysis of all patients diagnosed with dAVF via cerebral angiography by the senior author was conducted, with special attention given to the presence of cerebral venous sinus thrombosis (CVST) and COVID-19 infection. General demographics, clinical presentation, presence of CVST, and COVID-19 infection status were reported. RESULTS A total of 30 patients with dAVFs were included in this study. Three patients were diagnosed with COVID-19 (10%), with one of these patients developing CVST (33%) at 6 months postinfection. Of the 27 patients not infected with COVID-19, one was diagnosed with a likely chronic CVST at the time of presentation of dAVF (4%). A total of 11 case reports and 3 retrospective studies describing patients diagnosed with CVST at or after diagnosis of dAVFs have been reported in the literature. The incidence of dAVFs in patients with CVST has been reported as 2.4%, and the incidence of dAVF has reportedly increased five- to tenfold since the COVID-19 pandemic. CONCLUSIONS COVID-19 infections may pose as an emerging risk factor for the development of CVST and subsequent dAVF development. To the authors' knowledge, this study presents the first cases in the literature describing a temporal relationship between COVID-19 and development of a dAVF with CVST. The effect of both COVID-19 and associated vaccines should be further assessed in future studies to examine its impact as an effect modifier on the association of dAVF and CVST.
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Affiliation(s)
| | | | - Aaron Shoskes
- 2Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Schwartz DA, Talbott J, Callen A, Laguna B, Narvid J, Ch'ang JH, Singh V. Classification of traumatic injury to the dural venous sinus using CT venography. J Neuroimaging 2024; 34:205-210. [PMID: 38146071 DOI: 10.1111/jon.13182] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis (CVST) is an underrecognized cause of morbidity in acute traumatic brain injury (TBI). Radiologic diagnosis is challenging in the setting of concurrent extra-axial injury and a lack of standardized diagnostic criteria. The prevalence of traumatic thrombosis versus compression is unknown. Treatment with anticoagulation is often determined by the appropriate classification of the type of traumatic venous injury. METHODS We developed a two-part radiologic grading method for standardized assessment of traumatic CVST based on (1) the degree of flow limitation through the affected sinus and (2) the location of venous pathology (ie, external compression vs. intrinsic thrombosis) based on computed tomography venography. We applied this grading method to a retrospective cohort of TBI patients presenting to a Level 1 Trauma center. Chart review was performed to identify potential clinical correlates. A senior neuroradiologist graded the entire cohort and a random subsample was selected for blinded rating by two independent neuroradiologists. RESULTS Seventy-six of 221 patients were identified for inclusion after excluding nontraumatic mechanisms. Seven unique grades were employed to characterize the full extent of venous injuries. The plurality of patients from the cohort (43/76 = 43.4%) suffered compressive injuries. Inter-rater reliability was moderate for the combined grade, kappa = 0.48, p<.05, and substantial for the flow limitation component, kappa = 0.69, p<.05. CONCLUSIONS We introduce a standardized two-part classification system for traumatic venous sinus injury with moderate-substantial inter-rater reliability. Compressive injuries were more common than thrombotic injuries. Further prospective work is needed to validate the clinical significance of this classification system.
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Affiliation(s)
- Daniel A Schwartz
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Neuro-Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jason Talbott
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Andrew Callen
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
- Department of Neuroradiology, University of Colorado, Aurora, Colorado, USA
| | - Benjamin Laguna
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Jared Narvid
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Judy H Ch'ang
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Vineeta Singh
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California, USA
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Batista S, Sanches JPB, Andreão FF, Porto Sousa M, Oliveira LDB, Yuri Ferreira M, Bertani R, Alves Filho CAF, de Oliveira Braga F, Machado EAT, da Mata Pereira PJ, Niemeyer Filho P, Almeida Filho JA. Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis. J Clin Neurosci 2024; 120:154-162. [PMID: 38244530 DOI: 10.1016/j.jocn.2024.01.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. METHODS A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS ≤ 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. RESULTS A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I2 = 19 %). CONCLUSION This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Faculty of Medicine, State University of Ponta Grossa, Ponta Grossa, PR, Brazil; Faculty of Medicine, Ninth July University - São Paulo, SP, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil; Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Paulo Niemeyer Filho
- Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
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Serra SMB, de Oliveira RRB, Galvão IFG, Maia JS. Cerebral sinovenous thrombosis as a cause of subdural hemorrhage in the pediatric population: Is there a correlation? Childs Nerv Syst 2024; 40:603-605. [PMID: 37874377 DOI: 10.1007/s00381-023-06199-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Cerebral sinovenous thrombosis is an increasingly recognized cause of stroke in children and neonates. Its true incidence appears to be underestimated. Despite being a rare event, certain studies have found a correlation between subdural hemorrhage and cerebral sinus thrombosis. The literature suggests that spontaneous cerebral sinovenous thrombosis in the pediatric population may lead to the occurrence of a subdural hemorrhage. In this report, we present a case of cerebral venous thrombosis associated with chronic subdural hematoma and review the literature to highlight the importance of these conditions. CASE REPORT An 11-year-old boy was admitted in the neurosurgery department with headache and a neurological examination without changes. The imaging studies identified a heterogeneous subdural collection in the fronto-temporo-parietal region. The patient underwent surgical drainage of the subdural hematoma, and the procedure was performed without complications. The magnetic resonance and angiography showed an extensive thrombosis of the superior sagittal sinus, extending downward to the occipital sinus and partially to the right transverse sinus. CONCLUSIONS Appropriate management in the diagnosis and an early treatment of dural sinus thrombosis associated with subdural hemorrhage can reduce the risk of recurrence and improve the clinical outcome.
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Affiliation(s)
- S Maria Bezerra Serra
- Department of Neurosurgery, Hospital da Restauração Governador Paulo Guerra, Recife/PE, Brazil
| | | | | | - J Santos Maia
- Faculdade Pernambucana de Saúde (FPS), Recife/PE, Brazil
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11
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Ruiz-Castellano E, Cortés-García JI, Láinez-Ramos Bossini AJ. [Intracranial dural sinus hypodensity as a sign of acute thrombosis: an unusually atypical radiological manifestation]. Rev Neurol 2024; 78:59-60. [PMID: 38223949 DOI: 10.33588/rn.7802.2023301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
| | | | - A J Láinez-Ramos Bossini
- Hospital Universitario Virgen de las Nieves, Granada, España
- Instituto Biosanitario de Granada, Granada, España
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12
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Qi M, Qu X, Wang N, Jiang LD, Cheng WT, Chen WJ, Xu YQ. Role of Decompressive Craniectomy in the Treatment of Malignant Cerebral Venous Sinus Thrombosis: A Single Center Consecutive Case Series Study in China. World Neurosurg 2024; 181:e867-e874. [PMID: 37931876 DOI: 10.1016/j.wneu.2023.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Patients with cerebral venous sinus thrombosis (CVST) may die during the acute phase due to increased intracranial pressure and cerebral herniation. The purpose of this study was to assess the role of decompressive craniectomy in the treatment of patients with malignant CVST. METHODS Patients who underwent decompressive craniectomy and were consequently admitted to the Critical Care Unit, Department of Neurosurgery, at Capital Medical University Xuanwu Hospital from March 2010 to January 2021 were retrospectively examined with follow-up data at 12 months. RESULTS In total, 14 cases were reviewed, including 9 female and 5 male patients, aged 23-63 years (42.7 ± 12.3 years). Prior to surgery, all patients had a GCS score <9. 6 patients had a unilateral dilated pupil, while 4 patients had bilateral dilated pupils. According to the head computed tomography (CT), all patients had hemorrhagic infarction, and the median midline shift was 9.5 mm before surgery. Thirteen patients underwent unilateral decompressive craniectomy, and 1 patient underwent bilateral decompressive craniectomy, among whom, 9 patients underwent hematoma evacuation. Within 3 weeks of surgery, 3 cases (21.43%) resulted in death, with 2 patients dying from progressive intracranial hypertension and 1 from acute respiratory distress syndrome (ARDS). Eleven patients (78.57%) survived after surgery, of whom 4 (28.57%) patients recovered without disability at 12-month follow-up (mRS 0-1), 2 (14.29%) patients had moderate disability (mRS 2-3), and 5 (35.71%) patients had severe disability (mRS 4-5). CONCLUSIONS Emergent decompressive craniectomy may provide a chance for survival and enable patients with malignant CVST to achieve an acceptable quality of life (QOL).
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Affiliation(s)
- Meng Qi
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Xin Qu
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Ning Wang
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Li-Dan Jiang
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Wei-Tao Cheng
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Wen-Jin Chen
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Yue-Qiao Xu
- Department of Neurosurgery, Critical Care Unit, Capital Medical University Xuanwu Hospital, Beijing, China.
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Maher K, Amlie-Lefond C. Cow's Milk Anemia in Childhood Manifesting as Severe Cerebral Venous Sinus Thrombosis. J Child Neurol 2024; 39:61-65. [PMID: 38263607 DOI: 10.1177/08830738241227064] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
We describe a series of 7 toddler-aged children with iron deficiency anemia from excessive cow's milk consumption who presented with cerebral venous sinus thrombosis and no other identifiable risk factors for thrombosis. The deep venous system was involved in 6 patients, 6 had venous infarcts, and 5 have significant neurocognitive sequelae.
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Affiliation(s)
- Kristin Maher
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine Amlie-Lefond
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
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14
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Sharma S, Rizwi MK, Prasad SN, Meena A. Dural Sinus Thrombosis with Vein of Labbe Thrombosis in a Child. Neurol India 2024; 72:230-231. [PMID: 38443056 DOI: 10.4103/neurol-india.neurol-india-d-24-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Srishti Sharma
- Department of Radio Diagnosis, AIIMS, Patna, Bihar, India
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15
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Yamutai S, Sornplaeng P, Sanghan N, Khumtong R, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Factors associated with the initial intracranial hemorrhage occurrence in patients with cerebral venous thrombosis. Clin Neurol Neurosurg 2024; 236:108109. [PMID: 38218059 DOI: 10.1016/j.clineuro.2023.108109] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/20/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Studies focusing on intracranial hemorrhage (ICH) in patients with cerebral venous thrombosis (CVT) are limited; thus, we aimed to identify factors associated with the occurrence of ICH in Thai patients with CVT. METHODS This retrospective cohort study recruited patients with CVT admitted to a tertiary university-based hospital between 2002 and 2022. The baseline characteristics, clinical presentations, radiographic findings, and etiologies were compared between the ICH and non-ICH groups. The factors with p < 0.2 in the univariate analysis were further analyzed using multivariable logistic regression analysis to identify independent factors associated with ICH in patients with CVT. RESULTS Of 228 screenings, 202 patients were eligible. The incidence rate of ICH was 36.63%. The ICH group showed a higher prevalence of focal neurological deficits (63.51% vs. 26.56%, p < 0.001), seizures (68.92% vs. 21.88%, p < 0.001), dependency status at admission (60.81% vs. 39.84%, p = 0.004), superior sagittal sinus thrombosis (71.62% vs. 39.07%, p < 0.001), superficial cortical vein thrombosis (36.49% vs. 10.16%, p < 0.001), and hormonal use (17.57% vs. 7.03%, p = 0.021) than the non-ICH group. In contrast, the ICH group showed a lower prevalence of isolated increased intracranial pressure (10.81% vs. 21.88%, p = 0.048) than the non-ICH group. Seizures (adjusted odds ratio [aOR], 4.537; 95% confidence interval [CI], 2.085-9.874; p < 0.001), focal neurological deficits (aOR, 2.431; 95% CI, 1.057-5.593; p = 0.037), and superior sagittal sinus thrombosis (aOR, 1.922; 95% CI, 1.913-4.045; p = 0.045) were independently associated with ICH in the multivariable logistic regression analysis. CONCLUSIONS Seizures, focal neurological deficits, and superior sagittal sinus thrombosis are associated with ICH in patients with CVT.
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Affiliation(s)
- Suppakorn Yamutai
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Pitchayaporn Sornplaeng
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Nuttha Sanghan
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Rujimas Khumtong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
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Ge S, Wang L, Cui X, Wang XP. Spontaneous intracranial hypotension combined with venous sinus thrombosis: A case series. Asian J Surg 2024; 47:810-812. [PMID: 37891105 DOI: 10.1016/j.asjsur.2023.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Affiliation(s)
- Shihao Ge
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lele Wang
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaocong Cui
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiao-Peng Wang
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Agircan D, Bal M, Demir TG, Ethemoglu O. Multi-inflammatory index as a new predictive and prognostic marker of acute symptomatic seizures in patients with cerebral venous sinus thrombosis. J Stroke Cerebrovasc Dis 2023; 32:107453. [PMID: 37922681 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107453] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The multi-inflammatory index (MII) is a novel marker that indicates the diagnosis, prognosis, and clinical severeness of inflammation-associated diseases. It is indicated that inflammatory biomarkers may help predict the occurrence of acute symptomatic seizures(ASS) after ischemic stroke. OBJECTIVE Our goal was to search the predictive and prognostic capability of the MII-1 and MII-2 for ASS in cerebral venous sinus thrombosis (CVST) patients. METHOD 91 patients with CVST were retrospectively analyzed from the medical records of patients between 2010 and 2023 and divided into the ASS group and non-ASS group. The MII-1 and MII-2 levels on admission, demographic and clinic features, predisposing risk factors, radiological characteristics involving thrombotic cerebral veins, and the type of parenchymal lesions were documented. Modified Rankin Scale (mRS) on admission and at the 3rd month were evaluated to determine the disability. RESULTS MII-1 and MII-2 were statistically significantly higher in the ASS group and predictors for the occurrence of seizures with CVST in multivariate analysis. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve for MII-1 was 0.791 (95 %CI = 0.691-0.891, p < 0.001), and AUC for MII-2 was 0.761 (95%CI = 0.660-0.861, p < 0.001). When the clinical variables that were included in the multivariate analysis and MII-1 and MII-2 were combined, the predictive power was greater with the AUC of 0.959. A significant positive correlation was found between mRS at the 3rd month and MII-1 and MII-2 in the ASS group. CONCLUSION MII-1 and MII-2 can be used as new predictive and prognostic markers of ASS in patients with CVST.
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Affiliation(s)
- Dilek Agircan
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey.
| | - Mehmet Bal
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey
| | - Tulin Gesoglu Demir
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey
| | - Ozlem Ethemoglu
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey
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18
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Oragui C, Gonzalez L, Agha R. Pediatric Cavernous Sinus Thrombosis and COVID-19 Infection: Case Report. Clin Pediatr (Phila) 2023; 62:1461-1464. [PMID: 36919824 PMCID: PMC10018112 DOI: 10.1177/00099228231161024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Chika Oragui
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
| | - Lisandra Gonzalez
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
| | - Rabia Agha
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
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19
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Byer SH, Madarang EJ, Abraham MG. Dual-Stent retriever thrombectomy for extensive dural sinus thrombosis. Int J Neurosci 2023; 133:1374-1379. [PMID: 35593753 PMCID: PMC9744960 DOI: 10.1080/00207454.2022.2080675] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/12/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION First line treatment for cerebral venous thrombosis (CVT) is systemic anticoagulation. In cases with symptoms of elevated ICP, endovascular thrombectomy (EVT) is pursued. We describe two cases in which dual stent-retrievers were used for EVT. OBJECTIVES The use of dual stent-retrievers has been described in arterial stroke when clot is present in the M1 artery and both M2 branches as a rescue therapy after 1 stent-retriever failed to remove the clot. We applied this same thinking to our EVT patients. METHODS A 17-year-old female with imaging demonstrating occlusion of the superior sagittal sinus (SSS), dominant right transverse sinus (TS), right sigmoid sinus (SS), and upper right internal jugular vein (IJV). A 20-year-old female with a magnetic resonance venography (MRV) noting CVT in the dominant lateral left TS, SS, and upper left IJV. RESULTS Both were taken for EVT due to severity of symptoms. Two 6 × 40 mm stent-retrievers were deployed into the CVT and then remove with continuous aspiration with significant recanalization. CONCLUSIONS The average diameter of the dural sinuses is 8 mm compared to the average size of the middle cerebral artery 3-4 mm. The largest available SR in the United States is 6 mm, and the largest outer diameter of available aspiration catheters is 2-3 mm. Due to the larger size of the dural sinuses, using two SRs can result in more efficient recanalization and less radiation.
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Affiliation(s)
- Stefano H. Byer
- Department of Neurology, University of Kansas Medical Center
| | | | - Michael G. Abraham
- Department of Neurology, University of Kansas Medical Center
- Department of Radiology, University of Kansas Medical Center
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20
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Can FY, Ateş MP, Turan A. Can the sigmoid notch sign be used on cranial computed tomography to differentiate between thrombosis and hypoplasia of the cerebral transverse venous sinus? Neurol Sci 2023; 44:4379-4383. [PMID: 37428276 DOI: 10.1007/s10072-023-06943-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
OBJECT In patients with headache, the distinction between transverse sinus (TS) atresia/hypoplasia and TS thrombosis in cranial magnetic resonance venography (MRV) may be misleading. In this study, we aimed to distinguish TS thrombosis from atretic or severely hypoplastic TS, with the help of cranial computed tomography (CT). METHOD Non-contrast cranial CT scans of 51 patients with no or severely thin signal on MRV were analyzed retrospectively using the bone window. Absence or asymmetry of the sigmoid notches on the CT predicted atretic or severe hypoplastic TS, and symmetry predicted thrombotic TS. Afterwards, it was investigated whether the patient's other imaging findings and confirmed diagnoses matched with the predictions. FINDINGS Of the 51 patients included in the study, 15 were diagnosed with TS thrombosis, and 36 were diagnosed with atretic/hypoplastic TS. All 36 of the congenital atresia/hypoplasia diagnoses were correctly predicted. Thrombosis was predicted correctly in 14 of 15 patients with TS thrombosis. In cranial CT, the symmetry or asymmetry of the sigmoid notch sign was examined, and it was found that the evaluation predicted with 93.3% sensitivity (95% confidence interval (CI): 68.05-99.83) and 100% specificity (95% CI: 90.26-100.00) the distinction between TS thrombosis and atretic/hypoplastic sinus. CONCLUSION Symmetry or asymmetry of the sigmoid notch on CT is a reliable method that can be used to differentiate congenital atresia/hypoplasia from the TS thrombosis in patients with very thin or absent TS signal on the cranial MRV.
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Affiliation(s)
- Fatma Yılmaz Can
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Health Science University, Ankara, Turkey.
| | - Mehlika Panpallı Ateş
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Aynur Turan
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Health Science University, Ankara, Turkey
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Li QH, Xu LQ, Dong Q, Chu HL, Tang YP. Identification of LDLR mutation in cerebral venous sinus thrombosis co-existing with dural arteriovenous fistulas: a case report. BMC Neurol 2023; 23:423. [PMID: 38017368 PMCID: PMC10683079 DOI: 10.1186/s12883-023-03455-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is typically associated with a prothrombotic state of the blood, with its causative factors varying widely. Prior research has not reported the simultaneous occurrence of CVST and dural arteriovenous fistulas (DAVFs) as potentially resulting from genetic mutations. In this case report, we introduce a unique occurrence wherein a patient with a heterozygous mutation of the low-density lipoprotein receptor (LDLR) gene presented with CVST in conjunction with DAVFs. CASE Presentation: A male patient, aged 51, sought treatment at our facility due to a consistent decline in cognitive functions accompanied by recurrent headaches. Comprehensive evaluations were administered, including neurological examinations, laboratory tests, magnetic resonance imaging, digital subtraction angiography, and whole exome sequencing. Digital subtraction angiography identified DAVFs in the patient's right sigmoid sinus and an occlusion within the left transverse sinus. The whole exome sequencing of blood samples pinpointed a heterozygous mutation in the LDLR gene (NM_000527:exon12:c.C1747T:p.H583Y). Following the confirmed diagnosis of CVST and DAVFs, the patient underwent anticoagulant therapy combined with endovascular procedures - these comprised embolization of the arteriovenous fistula in the right sigmoid sinus and balloon dilation with stent implantation in the left transverse sinus. A six-month follow-up indicated a significant abatement in the patient's symptoms. CONCLUSIONS This report marks the first documented case of an LDLR gene mutation that could be associated with the onset of CVST and DAVFs. The mutation in the LDLR gene might foster a prothrombotic environment, facilitating the gradual emergence of CVST and the subsequent genesis of DAVFs.
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Affiliation(s)
- Qing-Hua Li
- Department of Neurology, Hunan Provincial People's Hospital, No. 61 Jiefang West Road, Furong District, Changsha, Hunan Province, 410005, China
| | - Li-Quan Xu
- Department of Neurosurgery, Fudan University Affiliated Huashan Hospital, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Qiang Dong
- Department of Neurology, Fudan University Affiliated Huashan Hospital, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - He-Ling Chu
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Shanghai, 200233, China.
| | - Yu-Ping Tang
- Department of Neurology, Fudan University Affiliated Huashan Hospital, No. 12 Wulumuqi Road, Shanghai, 200040, China.
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22
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Wang J, Zhou Q, Zhang H. Cerebral Venous Sinus Thrombosis with Ipsilateral Sinus and Jugular Venous Hypoplasia in Pregnancy. Neurol India 2023; 71:1298-1299. [PMID: 38174490 DOI: 10.4103/0028-3886.391349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Jue Wang
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, China
| | - Qing Zhou
- Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, China
| | - He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, China
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23
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Sarıtaş AŞ, Batum M, Ataç C, Öztürk Ü, Yılmaz H, Mavioğlu H, Selçuki D, Ak AK. Prognostic factors in patients with cerebral sinus venous thrombosis presenting with hemorrhage and papilledema. Clin Neurol Neurosurg 2023; 234:108013. [PMID: 37844432 DOI: 10.1016/j.clineuro.2023.108013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The thromboinflammatory process is considered to play a role in the pathogenesis and prognosis of cerebral sinus vein thrombosis (CSVT). The purpose of the study was to compare the thromboinflammatory parameters between individuals with CSVT and healty controls. Additionally, the study sought to compare these parameters among CSVT subgroups with and without haemorrhage, as well as with and without papilledema. Furthermore, the investigation also aimed to identify which parameters had a more significant impact on the risk of hemorrhage and the development of papilledema in CSVT. METHODS Thromboinflammatory parameters were compared retrospectively between the CSVT group of 88 patients and 80 age- and sex-matched healthy controls, and in the CSVT subgroups with (n = 35) /without hemorrhage (n = 53) and with (n = 52) /without papilledema (n = 36) after ethics committee approval. In both groups, parameters contributing to the risk of hemorrhage and papilledema development were determined by univariate and multivariate analyses. RESULTS Regarding the risk of hemorrhage in CSVT patients, the most significant factors included hematocrit of <30.2 (%), mean platelet volume of ≤8.9 fL, neutrophil count of >5600, and hsCRP of >9 mg/L. Regarding the risk of papilledema development, the most important risk factors were age of ≤49, presence of vomiting, presence of blurred vision, HDL of >47 mg/dL, and D-dimer of >178 ng/mL. CONCLUSION It was suggested that evaluating serum thromboinflammatory parameters, as well as demographic characteristics and neurological examination findings, had a critical role regarding prognosis and predictive factors in CSVT.
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Affiliation(s)
| | - Melike Batum
- Celal Bayar University Neurology Department Manisa, Turkey
| | - Ceyla Ataç
- Izmir Bozyaka Training and Research Hospital Neurology Department, Turkey
| | - Üzeyir Öztürk
- Celal Bayar University Neurology Department Manisa, Turkey
| | - Hikmet Yılmaz
- Celal Bayar University Neurology Department Manisa, Turkey
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Torkzad MR, Bjørkelund OA, Labruto F. Cerebral venous sinus thrombosis cases detected in on-call CT venographies in Sweden, 2019-2022. J Thromb Thrombolysis 2023; 56:548-554. [PMID: 37598388 DOI: 10.1007/s11239-023-02883-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
No well-established criteria exist for assessing the risk of cerebral venous sinus thrombosis (CVST). Here, we sought to gain an understanding of CVST cases and associated risk factors, based on the rates of emergency CT venographies (CTVs) performed after hours. Furthermore, we aimed to assess possible correlations between CVST rates and COVID-19, including at the start of the COVID-19 vaccination campaign. We collected reports of emergency CTVs performed after hours at 56 Swedish hospitals between 1/1/2019 and 12/31/2022, and divided them into five groups: (I) from 1/1/2019 to 1/31/2020, before the emergence of COVID-19 cases in Sweden; (II) from 2/1/2020 to 12/26/2020, after the emergence of COVID-19 but before vaccination rollout; (III) from 12/27/2020 to 7/28/2021, from the start of the COVID-19 vaccination campaign until 50% of the adult population in Sweden had been vaccinated; (IV) from 7/29/2021 to 2/1/2022, from when 50% of the adult population was vaccinated until restrictions were lifted; and (V) from 2/2/2022 to 12/31/2022, after restriction measures were suspended. For all included patients, we collected information on demographics and clinical history, including pregnancy, recent partum, and use of oral contraceptives or post-menopausal hormone replacement therapy. In total, we collected 430 reports (92% female, 8% male). The CVST positivity rate was 22.2% in men vs. 2.3% in women. None of the pregnant (n = 49) or postpartum (n = 12) women had CVST positivity. The frequency of CTV examinations was lowest in group 2; during this period, the average time between patients being imaged was 7 days. The frequency of CTV examinations was highest in group IV; during this period, a patient underwent this type of scan every 1.5 days, on average. The frequency of CVST-positive scans was lowest in group II; during this period, a positive case was found every 66 days, on average. The frequency of CVST-positive scans was highest in group IV; during this period, a positive case was found every 62 days, on average, and no statistical difference with respect to group II was observed. Pregnancy and recent partum were not significant risk factors for CVST. The elevated CVST positivity rate observed during the height of the COVID-19 pandemic suggested that patients with less likelihood for positive CVST had fewer emergency visits. The positivity rate did not increase with the start of the COVID-19 pandemic or the rollout of COVID-19 vaccination.
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Affiliation(s)
| | | | - Fausto Labruto
- Australian Telemedicine Clinic Pty Ltd, Sydney, Australia
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Benedetti GM, Wainwright MS. Commentary: Characteristics and Outcomes of Children with Cerebral Sinus Venous Thrombosis. Neurocrit Care 2023; 39:306-308. [PMID: 37438551 DOI: 10.1007/s12028-023-01787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Giulia M Benedetti
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan and C.S. Mott Children's Hospital, 1540 E Hospital Drive, Ann Arbor, MI, 48105, USA.
| | - Mark S Wainwright
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA, USA
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Rillon P, Zdanowicz N, Jacques D, Dubois T. A Case of Central Venous Sinus Thrombosis after Injection of Zuclopenthixol. Psychiatr Danub 2023; 35:417-418. [PMID: 37800268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Perle Rillon
- Hopital psychiatrique Saint Bernard, Rue Jules Empain 43, 7170 Manage, Belgium,
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Chen S, Chen H, Duan J, Cui L, Liu R, Xing Y. Impaired Dynamic Cerebral Autoregulation in Patients With Cerebral Venous Sinus Thrombosis: Evaluation Using Transcranial Doppler and Silent Reading Stimulation. Ultrasound Med Biol 2023; 49:2221-2226. [PMID: 37532632 DOI: 10.1016/j.ultrasmedbio.2023.07.009] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Cerebral venous sinus thrombosis (CVST) may impair dynamic cerebral autoregulation (dCA) of the middle cerebral artery (MCA). However, most studies have focused on dCA of the MCA; a few studies are based on the posterior cerebral artery (PCA) during silent reading and neurovascular coupling (NVC). This study explored the effects of CVST on dCA of the MCA and PCA during silent reading and NVC. METHODS From January 2021 to August 2022, 60 CVST patients and 30 controls were enrolled in this study. Non-invasive continuous beat-to-beat blood pressure, cerebral blood flow velocity and other associated information on the MCA and PCA during silent reading were collected using a transcranial Doppler. NVC assessment was performed by opening and closing the eyes periodically based on voice prompts, and eye-opening visual stimulation was achieved by silently reading Chinese tourism materials. Visual stimulation signals can selectively activate Brodmann's areas 17, 18, and 19 of the occipital when reading silently with open eyes, prompting them to release neurotransmitters and dilate PCA. dCA was determined by transfer function analysis. RESULTS In dCA of the PCA during silent reading, the CVST group's very low frequency phase was lower than that of the control group (p = 0.047). In NVC, the difference in the indexes of the cerebrovascular conductance and visually evoked flow response of the CVST group were lower than those of the control group (p = 0.017 and p = 0.019, respectively). CONCLUSION Compared with the control group, dCA and NVC of the PCA during silent reading were impaired in CVST patients.
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Affiliation(s)
- Songwei Chen
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Hongxiu Chen
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liuping Cui
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Ran Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Yingqi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
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Sutter PA, Anderson MG, Sahyouni R, Plonsker J, Ravindra VM, Gonda DD, Levy ML, Dziugan K, Votoupal M, DeCuypere M, Leclair NK, Angelo SJ, Halloran PJ, Martin JE, Bookland MJ, Michelow IC, McKay L, Hersh DS. Anticoagulation for the treatment of septic cerebral venous sinus thrombosis in the setting of pediatric sinogenic and otogenic intracranial infections. Neurosurg Focus 2023; 55:E8. [PMID: 37778041 DOI: 10.3171/2023.7.focus23374] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Septic cerebral venous sinus thrombosis (CVST) is a recognized complication of pediatric sinogenic and otogenic intracranial infections. The optimal treatment paradigm remains controversial. Proponents of anticoagulation highlight its role in preventing thrombus propagation and promoting recanalization, while others cite the risk of hemorrhagic complications, especially after a neurosurgical procedure for an epidural abscess or subdural empyema. Here, the authors investigated the diagnosis, management, and outcomes of pediatric patients with sinogenic or otogenic intracranial infections and a septic CVST. METHODS All patients 21 years of age or younger, who presented with an intracranial infection in the setting of sinusitis or otitis media and who underwent neurosurgical treatment at Connecticut Children's, Rady Children's Hospital-San Diego, or Ann and Robert H. Lurie Children's Hospital of Chicago from March 2015 to March 2023, were retrospectively reviewed. Demographic, clinical, and radiological data were systematically collated. RESULTS Ninety-six patients were treated for sinusitis-related and/or otitis media-related intracranial infections during the study period, 15 (15.6%) of whom were diagnosed with a CVST. Of the 60 patients who presented prior to the COVID-19 pandemic, 6 (10.0%) were diagnosed with a septic CVST, whereas of the 36 who presented during the COVID-19 pandemic, 9 (25.0%) had a septic CVST (p = 0.050). The superior sagittal sinus was involved in 12 (80.0%) patients and the transverse and/or sigmoid sinuses in 4 (26.7%). Only 1 (6.7%) patient had a fully occlusive thrombus. Of the 15 patients with a septic CVST, 11 (73.3%) were initiated on anticoagulation at a median interval of 4 (IQR 3-5) days from the most recent neurosurgical procedure. Five (45.5%) patients who underwent anticoagulation demonstrated complete recanalization on follow-up imaging, and 4 (36.4%) had partial recanalization. Three (75.0%) patients who did not undergo anticoagulation demonstrated complete recanalization, and 1 (25.0%) had partial recanalization. None of the patients treated with anticoagulation experienced hemorrhagic complications. CONCLUSIONS Septic CVST is frequently identified among pediatric patients undergoing neurosurgical intervention for sinogenic and/or otogenic intracranial infections and may have become more prevalent during the COVID-19 pandemic. Anticoagulation can be used safely in the acute postoperative period if administered cautiously, in a monitored setting, and with interval cross-sectional imaging. However, some patients exhibit excellent outcomes without anticoagulation, and further studies are needed to identify those who may benefit the most from anticoagulation.
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Affiliation(s)
| | | | - Ronald Sahyouni
- 3Department of Neurosurgery, University of California, San Diego, California
| | - Jillian Plonsker
- 3Department of Neurosurgery, University of California, San Diego, California
| | - Vijay M Ravindra
- 3Department of Neurosurgery, University of California, San Diego, California
- 4Division of Pediatric Neurosurgery, Rady Children's Hospital-San Diego, California
| | - David D Gonda
- 3Department of Neurosurgery, University of California, San Diego, California
- 4Division of Pediatric Neurosurgery, Rady Children's Hospital-San Diego, California
| | - Michael L Levy
- 3Department of Neurosurgery, University of California, San Diego, California
- 4Division of Pediatric Neurosurgery, Rady Children's Hospital-San Diego, California
| | - Klaudia Dziugan
- 5Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Megan Votoupal
- 5Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Michael DeCuypere
- 5Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 6Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | | | | | | | | | | | - Ian C Michelow
- 9Infectious Diseases and Immunology, and
- 10Pediatrics, UConn School of Medicine, Farmington, Connecticut
| | - Laura McKay
- 11Center for Cancer and Blood Disorders, Connecticut Children's, Hartford, Connecticut
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Zhuang Z, Chen S, Chen Z, Lin H, Liu C. A novel SERPINC1 mutation in a young man with cerebral venous sinus thrombosis: a case report. Acta Neurol Belg 2023; 123:2043-2045. [PMID: 36355310 DOI: 10.1007/s13760-022-02132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/23/2022] [Indexed: 11/12/2022]
Affiliation(s)
| | - Sheng Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhiting Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Hanbin Lin
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Changyun Liu
- Fujian Medical University Union Hospital, Fuzhou, China.
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Mora R, Ibarra L, Olivera V, Rosas M, Cibils L, Baltar F, Ruiz V, Turcatti E, Costa G, Mansilla S, Cerisola A, González G. [Venous and cerebral sinus thrombosis in newborns and children]. Medicina (B Aires) 2023; 83 Suppl 4:95-101. [PMID: 37714130] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) is a well-known, although underestimated, cause of stroke in childhood. Its diagnosis requires a high index of suspicion, a correct interpretation of neuroimaging studies and an interrelation between clinicians and radiologists. The clinical features, risk factors and neuroimaging of children under 15 years of age with CVST were analyzed. METHODS multicenter, retrospective, descriptive, study of a consecutive series of cases of children under 15 years of age, who were admitted due to CVST between January 1st, 2010, and March 1st, 2022. RESULTS The study included 51 patients: 39% with acute symptoms and 59% with subacute symptoms. Newborns predominantly presented encephalopathic symptoms and seizures, while children exhibited signs of intracranial hypertension (ICH). Risk factors were identified in 90% of the cases. Magnetic resonance with angiography in venous time confirmed the diagnosis in 80% of the patients, with the straight sinus being the most affected in newborns and the lateral sinus in children. Hemorrhagic complications were found in 30.5%, being more frequent in newborns. Anticoagulation was initiated in 82% without complications. Sequelae were present in 44.4% of newborns and 37.9% of children, being more frequent and severe in newborns. CONCLUSIONS To make an early diagnosis, it is essential to consider CVST in newborns with encephalopathic symptoms and/or seizures, and in children with signs of ICH in the presence of predisposing or triggering conditions.
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Affiliation(s)
- Ricardo Mora
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. E-mail:
| | - Luis Ibarra
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Valentina Olivera
- Cátedra de Pediatría, Facultad de Medicina de la Universidad de la República, Sanatorio Americano, Montevideo, Uruguay
| | - Melania Rosas
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Lucía Cibils
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Federico Baltar
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Victoria Ruiz
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Emilio Turcatti
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Gonzalo Costa
- Cátedra de Neurocirugía, Facultad de Medicina de la Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Santiago Mansilla
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Alfredo Cerisola
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Gabriel González
- Cátedra de Neuropediatría, Facultad de Medicina, Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
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Yao S, Liu Y, Sun Q, Qi L, Liu X. A Case of MPO-ANCA-Positive Hypertrophic Cranial Pachymeningitis with Spinal Dura Mater Involvement and Cranial Venous Sinus Thrombosis. Neurol India 2023; 71:807-809. [PMID: 37635533 DOI: 10.4103/0028-3886.383833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Shengjun Yao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Yingchao Liu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lianping Qi
- Department of Neurology, The People Hospital of Huaiyin Jinan, Jinan, China
| | - Xiaohui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
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Lu VM, Abou-Al-Shaar H, Rangwala SD, Kappel AD, Lehman LL, Orbach DB, See AP. Neurosurgical outcomes of pediatric cerebral venous sinus thrombosis following acute mastoiditis: a systematic review and meta-analysis. J Neurosurg Pediatr 2023; 32:60-68. [PMID: 37060317 DOI: 10.3171/2023.2.peds2319] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/27/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific notable sequelae are otogenic (otitic) hydrocephalus and CVST management. Correspondingly, the aim of this study was to integrate the currently published metadata to summarize these outcomes. METHODS Electronic searches were performed using the Ovid Embase, PubMed, Scopus, and Cochrane databases from inception to November 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort-level data were then abstracted for analysis for appropriate pediatric patients. Outcomes were pooled by random-effects meta-analyses of proportions where possible. RESULTS Twenty-three study cohorts describing 312 pediatric patients with otogenic CVST were included. At a cohort level, the median patient age was 6 years among 181 boys (58%) and 131 girls (42%). Modeling indicated papilledema at presentation in 46% of cases (95% CI 30%-62%). Regarding management, antibiotics were applied universally in all cases, mastoidectomy or other otologic surgery was performed in 91% (95% CI 82%-98%), and prophylactic anticoagulation was administered in 86% (95% CI 75%-95%). There was only 1 case (0.3%) of postprocedural intracranial hemorrhage, and there were no deaths reported among all studies. Although diagnostic lumbar puncture was performed in 14% (95% CI 3%-28%) at presentation, clinical otogenic hydrocephalus was ultimately suspected in 31% (95% CI 14%-49%), and acetazolamide was given in 65% (95% CI 35%-91%) overall. There were 10 cases (3%) that proceeded to permanent CSF diversion in the form of ventricular shunting. At a median follow-up of 8 months among all studies, the venous sinus was completely recanalized in 67% (95% CI 53%-79%). CONCLUSIONS Most CVSTs following acute mastoiditis will recanalize with the standard use of antibiotics, otologic surgery, and anticoagulation, with minimal symptomatic hemorrhage risk. However, an appreciable proportion of these patients will develop symptomatic otogenic hydrocephalus, and it is imperative that the appropriate surveillance and workup is performed to fully optimize patient outcomes long-term. The possible need for permanent CSF diversion should be recognized.
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Affiliation(s)
- Victor M Lu
- Departments of1Neurosurgery and
- 2Department of Neurological Surgery, University of Miami, Florida
| | - Hussam Abou-Al-Shaar
- 3Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | | | | | - Laura L Lehman
- 4Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Darren B Orbach
- Departments of1Neurosurgery and
- 5Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Alfred P See
- Departments of1Neurosurgery and
- 5Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
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Parija S, Dash N, Jeyaraj G. Sixth cranial nerve palsy and dense cerebral venous sinus thrombosis in a child with nephrotic syndrome. BMJ Case Rep 2023; 16:e254044. [PMID: 37270177 PMCID: PMC10255118 DOI: 10.1136/bcr-2022-254044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Nephrotic syndrome (NS) is a common glomerular disease characterised by massive proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia. Cerebral venous sinus thrombosis (CVST) is a rare complication in children with NS. Here, we report a case of relapsing NS on steroid therapy, in a male in early childhood who presented with symptoms of headache, vomiting and double vision. On prism cover test there was 25 PD esotropia with abduction restriction in the left eye. Fundus examination showed bilateral papilloedema. He was diagnosed as sixth cranial nerve palsy of left eye. Neuroimaging reported dense CVST. He was managed with subcutaneous low molecular weight heparin and steroids. After 2 months of treatment, there was a complete resolution of esotropia and optic disc oedema. This case highlights the importance of early diagnosis of acute onset esotropia and sagittal sinus thrombosis in a case of NS.
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Affiliation(s)
- Sucheta Parija
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Nikita Dash
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Genickson Jeyaraj
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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Bussieres MP, Jull P. A case of suspected canine multifocal cervical venous sinus thrombosis causing cervical myelopathy. Can Vet J 2023; 64:534-540. [PMID: 37265814 PMCID: PMC10204878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 10-year-old spayed female standard poodle was admitted for marked cervical pain. Magnetic resonance imaging (MRI) suggested cervical venous sinus thrombi. An excellent clinical response to clopidogrel and warfarin combination was achieved. Repeat MRI showed partial resolution of the thrombosis. The etiology of the thrombosis is suspected to be due to the previous long-term, chronic use of corticosteroids. To the authors' knowledge, this is the first case report with follow-up imaging of canine venous sinus thrombosis. This clinical case report may help practitioners recognize this condition as a possible differential diagnosis for cervical pain, and it provides important guidelines in the prognosis. This case report highlights the use of anticoagulant therapy for 14 wk leading to complete resolution of clinical signs and to partial resolution of the thrombus 5 wk into the treatment, based on comparative MRI. Key clinical message: To the authors' knowledge, this is the first report of suspected multiple cervical venous sinus thrombi that includes comparative imaging into the course of therapy. The aim of this report is to provide additional information for future guidance on the duration of venous sinus thrombosis therapy.
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Affiliation(s)
- Marie-Philippe Bussieres
- Veterinary Specialty Clinic for Anesthesia and Neurology, 1155 Lola Street, #203, Ottawa, Ontario K1K 4C1
| | - Philip Jull
- Veterinary Specialty Clinic for Anesthesia and Neurology, 1155 Lola Street, #203, Ottawa, Ontario K1K 4C1
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Yang Y, Cheng J, Peng Y, Luo Y, Zou D, Yang Y, Ma Y. Clinical features of patients with cerebral venous sinus thrombosis at plateau areas. Brain Behav 2023; 13:e2998. [PMID: 37095720 PMCID: PMC10275515 DOI: 10.1002/brb3.2998] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Cerebral venous sinus thrombosis (CVST) is believed to be associated with high-altitude exposure and has worse clinical prognosis in plateau areas than in plain areas, although this needs to be further verified. This retrospective study aims to compare the clinical differences of patients with CVST in plateau and plain areas and further ascertain the role of high-altitude exposure in the etiology of aggravating predisposition toward CVST. METHODS Twenty-four symptomatic CVST patients occurring at plateau areas (altitude ≥ 4000 m), in corresponding with 24 CVST patients occurring at plain areas (altitude ≤ 1000 m), were recruited according to the inclusion and exclusion criteria from June 2020 to December 2021. The collected data and compared parameters include clinical features, neuroimaging findings, hematology profile, lipid profile, and coagulation profile within 24 h of hospital admission, as well as the treatment method and final outcome. RESULTS There were no obvious differences of demographic characteristics, including gender, age, height, and weight between patients with CVST in plateau and plain areas, as well as medical history, neuroimaging findings, treatment protocols, and clinical outcome (all p > .05). Compared to patients with CVST at plain areas, time before hospital admission was longer and heartbeat was slower in patients with CVST at plateau areas (all p < .05). More importantly, elevated red blood cells counts, hemoglobin level, and altered coagulation function were found in patients with CVST at plateau areas (all p < .05). CONCLUSION CVST patients in plateau areas presented with altered clinical characteristics, altered coagulation function, and aggravated predisposition toward venous thromboembolism compared with CVST patients in plain areas. Future prospective studies will be needed to further elucidate the influences of a high altitude on the pathogenesis of CVST.
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Affiliation(s)
- Yongxiang Yang
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Jingmin Cheng
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yuping Peng
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yan Luo
- Department of OncologyThe General Hospital of Western Theater CommandChengduChina
| | - Dongbo Zou
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yongjian Yang
- Department of CardiologyThe General Hospital of Western Theater CommandChengduChina
| | - Yuan Ma
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
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Stetter I, Werner JM, Schroeter M, Baumann C, Neuneier J, Schlamann M, Schmidt M, Drzezga A, Fink GR, Galldiks N. Differentiation of a Falcine Meningioma From Cerebral Venous Sinus Thrombosis Using DOTATATE PET. Clin Nucl Med 2023; 48:e235-e236. [PMID: 36758554 DOI: 10.1097/rlu.0000000000004594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
ABSTRACT Differentiating brain tumors from nonneoplastic lesions using conventional MRI may be challenging. Clinical symptoms often remain unspecific, and imaging findings from MRI may be inconclusive. We present the case of a 23-year-old woman in whom an MRI suggested a cerebral venous sinus thrombosis. On the other hand, additional atypical MRI findings raised doubts regarding the initial diagnosis. Given the need for a diagnostic procedure with higher sensitivity and specificity for neoplastic tissue, PET with the radiolabeled somatostatin receptor ligand DOTATATE ( 68 Ga-DOTA- d -Phe1-Tyr3-octreotate) was performed. DOTATATE PET facilitated the diagnosis of a falcine meningioma consistent with its value for the differential diagnosis of meningioma.
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Affiliation(s)
| | | | | | | | | | | | - Matthias Schmidt
- Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, Cologne
| | - Alexander Drzezga
- Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, Cologne
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Xu C, Chen J, Li J. Recurrence of Cranial Venous Sinus Thrombosis Associated with Trousseau's Syndrome. Neurol India 2023; 71:628-629. [PMID: 37322795 DOI: 10.4103/0028-3886.378685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Chang Xu
- Department of Radiology, Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Jinbo Chen
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People's Republic of China
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Abstract
INTRODUCTION Our report sheds light on the risk of topical hormonal use in relation to cerebral venous sinus thrombosis. We diagnosed our patient with cerebral venous thrombosis (CVT) using computed tomography venogram, then detailed history and examination were obtained, and thorough blood tests and imaging were done to exclude other causes of CVT like thrombophilias, infections, and malignancies. CASE REPORT Our patient is a 37-year-old heterosexual male, presented with headache only. The computed tomography venogram showed extensive CVT in the right internal jugular vein, sigmoid, transverse, and straight cerebral venous; detailed history and investigations suggest that his use of crushed oral contraceptive pills mixed with water topically on the scalp is the most important predisposing factor. This patient was managed with anticoagulants and is being followed in the clinic. CONCLUSION Oral hormonal use in contraceptives is a known risk factor for CVT. This case sheds light on the importance of topical hormonal use concerning CVT in females and males; it stresses the need for more studies in that area, as it is poorly studied.
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Affiliation(s)
- Moneera O Aldraihem
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Saudi Arabia
| | - Fahmi Al-Senani
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Saudi Arabia
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Carletti F, Vilela P, Jäger HR. Imaging Approach to Venous Sinus Thrombosis. Radiol Clin North Am 2023; 61:501-519. [PMID: 36931766 DOI: 10.1016/j.rcl.2023.01.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease caused by an occlusion of the cerebral venous sinuses or cortical veins. It has a favorable prognosis if diagnosed and treated early. CVT can be difficult to diagnose on clinical grounds, and imaging plays a key role. We discuss clinical features and provide an overview of current neuroimaging methods and findings in CTV.
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Affiliation(s)
- Francesco Carletti
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Pedro Vilela
- Neuroradiology Department. Lisbon Western University Center (Centro Hospitalar Lisboa Ocidental -CHLO), Lisbon Portugal; Imaging Department, Hospital da Luz Lisbon, Portugal
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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Boukobza M, Guinebert S, Laissy JP. Comparison of susceptibility-weighted angiography (SWAN) and T2 gradient-echo sequences for the detection of acute cerebral venous thrombosis. Neuroradiol J 2023; 36:148-157. [PMID: 35722681 PMCID: PMC10034706 DOI: 10.1177/19714009221109885] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy and lesion conspicuity of susceptibility-weighted angiography (SWAN) and T2* for the clot detection in acute cerebral venous thrombosis (CVT) by comparison with contrast-enhanced MR venography. METHODS Venous thrombi detection and conspicuity were assessed by two readers for 18 venous segments on both T2*, SWAN source images, 2D SWAN reformats matching with T2*, and 3D SWAN images (SWAN-MinIP). Images obtained with the three reading techniques were systematically scored and compared to CE MRV findings, in a blinded fashion, per patient and per segment, and compared to each other. RESULTS In 30 patients, 137 thrombosed venous segments were evaluated. The sensitivity of T2*, SWAN source images, 2D SWAN, and SWAN MinIP were, respectively, of 89.3%/82.1%, 82.1%, and 82.1% for dural sinus thrombosis and of 100%/100%/100%/96.6% for cortical venous thrombosis. There were significant differences in thrombus detection between T2* and SWAN: T2* versus SWAN source images and 2D SWAN (p = 0.04) and versus SWAN MinIP (p = 0.03). There were no significant differences between the three modalities of SWAN images. T2* was more sensitive than all SWAN images for both sigmoid sinus thrombosis and intracranial internal jugular vein thrombosis (p = 0.04). Inter-observer agreement was slightly superior with T2* (p < 0.05). CONCLUSION In this small cohort, SWAN sequence at 3T did not yield additional value for thrombus detection in acute CVT compared to T2*. This study highlights SWAN's greatest weakness both for diagnostic accuracy and lesion conspicuity compared to T2* for acute venous clot detection near the skull base.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat
Hospital, Assistance Publique-Hôpitaux de
Paris, Paris, France
| | | | - Jean-Pierre Laissy
- Department of Radiology, Bichat
Hospital, Assistance Publique-Hôpitaux de
Paris, Paris, France
- INSERM U1148, Paris, France
- Paris University, Paris, France
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Wang Z, Dandu C, Guo Y, Gao M, Lan D, Pan L, Zhou D, Ding Y, Ji X, Meng R. A novel score to estimate thrombus burden and predict intracranial hypertension in cerebral venous sinus thrombosis. J Headache Pain 2023; 24:29. [PMID: 36932331 PMCID: PMC10022088 DOI: 10.1186/s10194-023-01562-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Current methods to evaluate the severity of cerebral venous sinus thrombosis (CVST) lack patient-specific indexes. Herein, a novel scoring method was investigated to estimate the thrombus burden and the intracranial pressure (ICP) of CVST. METHODS In this retrospective study from January 2019 through December 2021, we consecutively enrolled patients with a first-time confirmed diagnosis of CVST by contrast-enhanced magnetic resonance venography (CE-MRV) or computed tomography venography (CTV). In these patients, a comprehensive CVST-Score was established using magnetic resonance black-blood thrombus imaging (MRBTI) to estimate the thrombus burden semi-quantitatively. The relationship between CVST-Score and ICP was explored to assess the potential of using the CVST-score to evaluate ICP noninvasively and dynamically. RESULTS A total of 87 patients were included in the final analysis. The CVST-Scores in different ICP subgroups were as follows: 4.29±2.87 in ICP<250mmH2O subgroup, 11.36±3.86 in ICP =250-330mmH2O subgroup and 14.99±3.15 in ICP>330mmH2O subgroup, respectively (p<0.001). For patients with ICP ≤330mmH2O, the CVST-Score was linearly and positively correlated with ICP (R2=0.53). The receiver operating characteristic (ROC) curves showed the optimal CVST-Score cut-off values to predict ICP ≥250mmH2O and >330mmH2O were 7.15 and 11.62, respectively (P<0.001). Multivariate analysis indicated CVST-Score as an independent predictor of ICP ≥250mmH2O (odds ratio, 2.15; 95% confidence interval, 1.49-3.10; p<0.001). CONCLUSIONS A simple and noninvasive CVST-Score can rapidly estimate the thrombus burden and predict the severity of intracranial hypertension in patients with CVST. The CVST-Score can aid in evaluating therapeutic responses and avoiding unnecessary invasive procedures at long-term follow-up.
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Affiliation(s)
- Zhongao Wang
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Chaitu Dandu
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Yibing Guo
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Meini Gao
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Duo Lan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Liqun Pan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Da Zhou
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yuchuan Ding
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Xunming Ji
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Ran Meng
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
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Olivas-Mazón R, Almécija Muñoz A, León JL, Nova Lozano C. Venous sinus thrombosis in a patient with immune thrombocytopenia. An Pediatr (Barc) 2023; 98:241-243. [PMID: 36841675 DOI: 10.1016/j.anpede.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/13/2022] [Indexed: 02/27/2023] Open
Affiliation(s)
- Raquel Olivas-Mazón
- Unidad de Oncohematología Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Ara Almécija Muñoz
- Unidad de Oncohematología Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - José L León
- Departamento de Neurorradiología, Grupo Biomédico Ascires-Universitats, Valencia, Spain
| | - Cristina Nova Lozano
- Unidad de Oncohematología Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Abstract
The range of intracranial venous anomalies in children differs from that in adults. As a commonly encountered highly morbid disease, sinovenous thrombosis has been discussed extensively in the literature, and the associated imaging considerations are similar in pediatric and adult patients. The authors shift the focus to less frequently discussed cerebral venous diseases in pediatric patients. First, the practical embryology pertinent to malformations, syndromes, and variants such as vein of Galen aneurysmal malformation, Sturge-Weber syndrome, and developmental venous anomalies are discussed. Second, anatomic considerations that are applicable to neuroimaging in pediatric patients with cerebral venous anomalies are reviewed. In the discussion of anatomy, special attention is given to the medullary venous system that serves the cerebral white matter, superficial cortical veins (tributaries of the dural venous sinuses), and bridging veins, which carry blood from the superficial cortical veins through the potential subdural space into the dural venous sinuses. Third, the selection of imaging modalities (US, CT and CT venography, and MRI) is addressed, and various MR venographic pulse sequences (time-of-flight, phase-contrast, and contrast-enhanced sequences) are compared. Finally, a broad variety of congenital and acquired superficial and deep venous diseases in children are reviewed, with emphasis on less frequently discussed entities involving the medullary (eg, deep medullary venous engorgement and thrombosis, periventricular hemorrhagic venous infarction due to germinal matrix hemorrhage), cortical (eg, cortical venous thrombosis), and bridging (eg, acute and chronic manifestations of injury in abusive head trauma) veins, as well as the deep veins and dural venous sinuses (eg, varix). © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Asha Sarma
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Dann Martin
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Sumit Pruthi
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Richard Jones
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Stephen B Little
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
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Cmor N, Dora E, Rajtman D, Tibaut M, Horvat S, Zver J, Lainscak M. Late-post-COVID-19 cerebral venous sinus thrombosis and stroke: a case report. J Cardiovasc Med (Hagerstown) 2023; 24:72-74. [PMID: 36574302 PMCID: PMC9793994 DOI: 10.2459/jcm.0000000000001400] [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: 07/16/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) disease increases risk of venous thromboembolisms (VTE), primarily deep vein thrombosis and pulmonary embolism. Only a few cases of cerebral venous sinus thrombosis (CVST) in association with a COVID-19 infection have been reported and are limited to acute COVID-19 disease. Hypercoagulable conditions persist in postacute COVID-19 disease, which carries an increased risk of VTE. CASE PRESENTATION We report a case of CVST and stroke 56 days post-COVID-19 infection presenting with an atypical clinical picture. DISCUSSION To the best of our knowledge, this is one of the first observations of CVST in the postacute phase of COVID-19 disease. Clinicians should be aware of this potential late complication and should consider appropriate diagnostic imaging techniques in patients with COVID-19-infection history.
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Affiliation(s)
| | | | | | | | - Sabina Horvat
- Division of Neurology, General Hospital Murska Sobota, Murska Sobota
| | - Janja Zver
- Department of Radiology, Institute of Oncology, Ljubljana, Slovenia
- Department of Radiology, General Hospital Murska Sobota, Murska Sobota
| | - Mitja Lainscak
- Division of Cardiology
- Faculty of Medicine, University of Ljubljana, Ljubljana
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
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M O, JK CG, I G, NR K, CM C, W B. Prevalence of cerebral vein thrombosis among patients with spontaneous intracranial hypotension. Interv Neuroradiol 2022; 28:719-725. [PMID: 34904470 PMCID: PMC9706257 DOI: 10.1177/15910199211065912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis (CVST) is a rare condition but an important complication of spontaneous intracranial hypotension (SIH). We reviewed our experience of patients with SIH and assessed for the presence of CVST. METHODS We reviewed the medical records and imaging studies from our tertiary referral institution, assessing patients with clinically suspected SIH as well as imaging findings of intracranial hypotension. All relevant brain MRIs were reviewed for the presence of brain sag, pachymeningeal enhancement, and CVST. RESULTS Among 563 patients with a clinical diagnosis of SIH, 431 (76%) demonstrated brain sag. In the overall patient cohort, a total of 5 patients had CVST (0.9%) and all 5 of these patients demonstrated findings of brain sag. Of the patients with CVST, 3 had significant complications, including dural arteriovenous fistulas (2 patients) and lobar hemorrhage with seizure (1 patient). CONCLUSION SIH is a risk factor for the development of CVST. In our review of 563 patients with clinical and/or imaging findings of SIH, 0.9% of patients were diagnosed with CVST and 3 of these patients (60%) had additional severe complications.
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Affiliation(s)
- Oien M
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Garza I
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kissoon NR
- Neurology, Mayo Clinic, Rochester, MN, USA
| | - Carr CM
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Brinjikji W
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
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Guinness F, Rodriguez-Herrera A. Central venous sinus thrombosis in a young girl with ulcerative colitis. BMJ Case Rep 2022; 15:e249904. [PMID: 36351672 PMCID: PMC9644294 DOI: 10.1136/bcr-2022-249904] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Paediatric central venous sinus thrombosis (CVST) is an uncommon but important life-threatening complication of inflammatory bowel disease (IBD). As the incidence of IBD has increased in the last four decades, paediatricians need to be aware of this complication. There is currently no consensus on when children with IBD should receive prophylactic anticoagulation. We present the case of a young girl with ulcerative colitis who suffered an acute ischaemic event secondary to a CVST during an acute flare of her disease. We aim to bring awareness to CVST in IBD due to its high risk of morbidity and mortality.
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Affiliation(s)
- Freya Guinness
- Paediatrics, Saint Luke's General Hospital, Kilkenny, Ireland
| | - Alfonso Rodriguez-Herrera
- Paediatrics, Saint Luke's General Hospital, Kilkenny, Ireland
- UCD School of Medicine, University College Dublin, Dublin, Ireland
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Zheng SF, Zhang YB, Xie BS, Wang HJ, Fan WJ, Chen GR, Dai LS, Yu LH, Yao PS, Kang DZ. Mechanical Thrombectomy with Tandem Double Stent Retriever in Combination with Intermediate Catheter Aspiration for Refractory Severe Hemorrhagic Cerebral Venous Sinus Thrombosis. World Neurosurg 2022; 167:e990-e997. [PMID: 36058490 DOI: 10.1016/j.wneu.2022.08.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to describe the initial experience of mechanical thrombectomy using tandem double stent retrievers combined with intermediate catheter aspiration to treat refractory severe hemorrhagic (SH)-cerebral venous sinus thrombosis (CVST). METHODS All refractory SH-CVST patients treated with mechanical thrombectomy using tandem double stent retriever (SR) combined with intermediate catheter aspiration (MT-TDSA) in our institution were retrospectively reviewed. MT-TDSA is a technique that fully engages the clot with double SRs and retrieves the clot using a double SR in combination with aspiration from an intermediate catheter. Demographics, clinical manifestation, medical history, the location of the occluded venous sinus, intraoperative details, procedure-related complications, and modified Rankin Scale (1, 6, 12 months postoperatively) were collected and analyzed. RESULTS Fourteen patients (median age, 43 years) with refractory SH-CVST were treated with MT-TDSA between January 2016 and January 2020. Ten of 14 (71.4%) had a successful intraoperative recanalization rate (>90%) using MT-TDSA. No procedure-related complications occurred. Eleven patients had good clinical outcomes (modified Rankin Scale score 0-2 at 12 months postoperatively). CONCLUSIONS MT-TDSA for refractory SH-CVST might improve clot-capturing ability and remove blood clots from cerebral venous sinuses effectively and safely, achieving good clinical outcomes.
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Affiliation(s)
- Shu-Fa Zheng
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yi-Bin Zhang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Bin-Sen Xie
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hao-Jie Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wen-Jian Fan
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guo-Rong Chen
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Lin-Sun Dai
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Hong Yu
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Pei-Sen Yao
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - De-Zhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Provincial Clinical Research Center for Neurological Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Clinical research and translation center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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48
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Linley-Adams S, Halpin S, Hughes T. Unilateral thalamic oedema secondary to venous sinus thrombosis. BMJ Case Rep 2022; 15:e250711. [PMID: 36123005 PMCID: PMC9486235 DOI: 10.1136/bcr-2022-250711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Serena Linley-Adams
- Department of Neurology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Shawn Halpin
- Department of Radiology, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Tom Hughes
- Department of Neurology, Cardiff and Vale University Health Board, Cardiff, UK
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Zhang K, Li TX, Gao BL, Zhu LF, Wang ZL. Endovascular recanalization of extensively-thrombosed cerebral venous sinuses in early pregnancy: A case report. Medicine (Baltimore) 2022; 101:e30266. [PMID: 36086789 PMCID: PMC10980448 DOI: 10.1097/md.0000000000030266] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The incidence of pregnancy-related cerebral venous sinus thrombosis (CVST) is rare, and cerebral hemorrhage caused by CVST in the early pregnancy period is even rarer. Only 3 cases of cerebral hemorrhage caused by CVST had been reported in the early pregnancy period in the literature. In this study, we reported successful endovascular treatment of such a case. PATIENT CONCERNS A 27-year-old woman presented with rapidly progressive neurologic decline in her second pregnancy for 8 weeks. She was afebrile and completely conscious, without neurological deficits. She did not have any previous history of venous thrombosis, hematologic, or autoimmune diseases. DIAGNOSIS Urgent brain computed tomography demonstrated parietal-occipital hemorrhage surrounded by a large hypodense area and full brain swelling. Magnetic resonance venography showed complete occlusion of the right sigmoid sinus, transverse sinus, and two-thirds of the superior sagittal sinus. Transvaginal sonography demonstrated early intrauterine pregnancy, with the size of gestation sac being 6 × 7 × 6 mm and the fetal heart not being detected. CVST-related cerebral hemorrhage was confirmed based on the clinical and imaging data. INTERVENTIONS The CVST in this pregnant woman was treated endovascularly with a 6 Fr Navien catheter for aspiration, thrombolysis, and anticoagulation. OUTCOMES Ten days after treatment, the cerebral hemorrhage had gradually been absorbed. Follow-up angiography performed 2 weeks later demonstrated complete recanalization of her cortical veins and sinuses. Two months later, the patient was completely recovered without cognitive or neurological dysfunction. LESSONS Pregnancy-related CVST can be successfully treated with a combined endovascular approach of aspiration, thrombolysis, and anticoagulation to complete recovery.
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Affiliation(s)
- Kun Zhang
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Tian-Xiao Li
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bu-Lang Gao
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liang-Fu Zhu
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zi-Liang Wang
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
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Cleaver J, Ibitoye R, Morrison H, Flood R, Crewdson K, Marsh A, Abhinav K, Bosnell R, Crossley R, Mortimer A. Endovascular treatment for vaccine-induced cerebral venous sinus thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccination: a report of three cases. J Neurointerv Surg 2022; 14:853-857. [PMID: 34782400 DOI: 10.1136/neurintsurg-2021-018238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaccine-induced thrombosis and thrombocytopenia (VITT) is a rare complication following ChAdOx1 nCoV-19 vaccination. Cerebral venous sinus thrombosis (CVST) is overrepresented in VITT and is often associated with multifocal venous thromboses, concomitant hemorrhage and poor outcomes. Hitherto, endovascular treatments have not been reviewed in VITT-related CVST. METHODS Patient records from a tertiary neurosciences center were reviewed to identify patients who had endovascular treatment for CVST in VITT. RESULTS Patient records from 1 January 2021 to 20 July 2021 identified three patients who underwent endovascular treatment for CVST in the context of VITT. All were female and the median age was 52 years. The location of the CVST was highly variable. Two-thirds of the patients had multifocal dural sinus thromboses (sigmoid, transverse, straight and superior sagittal) as well as internal jugular vein thromboses. Intracerebral hemorrhage occurred in all patients; subarachnoid blood was noted in two of them, and intraparenchymal hemorrhage occurred in all. There was one periprocedural parenchymal extravasation which abated on temporary cessation of anticoagulation. Outcome data revealed a 90-day modified Rankin Scale (mRS) score of 2 in all cases. CONCLUSIONS We demonstrate that endovascular treatment for VITT-associated CVST is feasible and can be safe in cases that deteriorate despite medical therapy. Extensive clot burden, concomitant hemorrhage, rapid clinical progression and persistent rises in intracranial pressure should initiate multidisciplinary team discussion for endovascular treatment in appropriate cases.
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Affiliation(s)
- Jonathan Cleaver
- Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Richard Ibitoye
- Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Hamish Morrison
- Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Richard Flood
- Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Kate Crewdson
- Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Aidan Marsh
- Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Kumar Abhinav
- Neurosurgery, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Rose Bosnell
- Stroke, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Robert Crossley
- Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Alex Mortimer
- Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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