SUPERIOR SAGITTAL SINUS THROMBOSIS PRESENTING AS DETERIORATING RESIDUAL WEAKNESS

To the Editor: Sir, the study by Canhao and colleagues made the important point that the most frequent cause of death in patients with cerebral venous thrombosis (CVT) is transtentorial herniation and that these patients may potentially have benefited from decompressive hemicraniectomy.1 We would like to corroborate this argument by providing evidence for a rise in intracranial pressure (ICP) preceding brain herniation and death in a patient with CVT. A 29-year-old pregnant woman who presented with confusion and vomiting was admitted to a district general hospital. A right-sided weakness developed within 2 days. A CT brain scan showed a left temporal hemorrhage without mass effect. Her Glasgow Coma Scale score dropped to 8/15; she was intubated and transferred to the neurocritical care …

3-T contrast-enhanced MR angiography with parallel imaging in cerebral venous and sinus thrombosis

Intracranial haemorrhage with a twist

Development of a new model of transvenous thrombosis in the pig superior sagittal sinus using thrombin injection and balloon occlusion

A Case of Cerebral Venous Thrombosis in a 77-Year-Old White Man

Cerebral venous thrombosis (CVT) is a rare disease. It has numerous and complex etiologies. Inherited or acquired prothrombotic states play a key role in the development of this disease, such as factor V G1691A mutation (FV Leiden). A 15-year-old girl presented to the Department of Neurology with a complaint of severe headache with visual blurring. The diagnosis of CVT was not initially suspected because of the patient's condition on presentation. An MRI showed thrombosis in the superior sagittal sinus, confirming venous stroke. Anticardiolipin and antiphospholipid antibodies were assessed. In addition, inherited prothrombotic defects, such as protein C, protein S, and antithrombin deficiencies, and genetic mutations for FV Leiden, prothrombin gene G20210A (FII G20210A), and methyltetrahydrofolate reductase C677T (MTHFR C677T) were studied. All results were unremarkable except for the unique homozygous FV Leiden mutation, which likely contributed to this prothrombotic situation. This study highlights the fact that FV Leiden may play a significant role in the onset of CVT in young patients.

Background: Plasma levels of D-dimer shown to be elevated and sensitive for the diagnosis of deep vein thrombosis including cerebral venous thrombosis (CVT). Objective: To assess the usefulness of serum D-dimer level, for the diagnosis of CVT. Subjects and Methods: This retrospective analysis included 65 patients who was diagnosed with cerebral venous thrombosis proved by magnetic resonance venography (MRV) or computed tomographic venography (CTV), from Jan. 2005 up to Dec. 2014. The patient’s files were collected and the data were extracted for the study. Based on these data, the usefulness of serum D-dimer level for the diagnosis of CVT, were analyzed. Results: The records of 23 male and 42 female were taken for this clinical review. The D-dimer level were elevated in 42 patients (64.6%) versus 23 patients (35.4%) with normal level; P <0.018. Eight patients had slight elevation of D-dimer level (200-500 ngm/ml), 18 patients had moderate elevation of D-dimer level (500-1000 ngm/ml) and 16 patients had very high level of D-dimer (1000-2000 ng/ml). The sensitivity and specificity of predicting cerebral venous sinus thrombosis using D-dimer were 64.6% and 71.5%. The pattern of venous sinuses involved, the neurological deficits were different and did not correlate with serum D-dimer levels (r=0.18, P<0.108). Conclusion: Raised D-dimer level are often helpful for early diagnosis of CVT and an important screening tool to determine the early need of neuroimaging in patients who are suspected of CVT.

Cerebral vein and sinus thrombosis and hyperthyrodism: A case report and a systematic review of the literature

Introduction: Muslim women are not allowed to perform religious ceremonies in menstrual period. Some of them use oral contraceptive pills (OCPs) to delay menstruation, which can lead to cerebral venous - sinus thrombosis (CVST). Therefore, the incidence of CVST is significantly higher in Iranian women. Thrombosis incidence is directly related to estrogen level of OCPs. In this study, the estrogen level of OPCs was evaluated in a group of female CVST patients.Methods: This study was conducted from 2010 to 2011, including two consecutive months of Ramadan in Zanjan Province of Iran. The remaining tablets of patients with CVST and OCP consumption history were analyzed by HPLC method.Results: Of 32 female CVST patients, 27 patients had a history of OCPs consumption. 24 cases of them consumed LD. Analysis of LD tablets revealed normal level of estrogen except for one case.Conclusion: Using contraceptive products among Muslim women in incorrect manner to delay menstruation should be considered by healthcare system. It is recommended to decrease amount of estrogen in OCPs till their contraceptive effect is unaffected.

Patient: Female, 50Final Diagnosis: Transverse cerebral venous sinus thrombosisSymptoms: Headache, diplopia, nausea, vomitingMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Rare diseaseBackground:Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke. CVST can be caused by systemic conditions as well as mechanical factors that reduce blood flow to promote thrombosis. These can include hormonal therapies, pregnancy, malignancy, genetic conditions. trauma, neurosurgical procedures, and adjacent infections (mostly mastoiditis). This case report describes a patient with right transverse sinus thrombosis with no prior risk factors.Case Report:A 50-year-old female with no risk factors presented with complaints of headache associated with diplopia for 2 weeks. She did not have any other neurologic signs or symptoms. The patient initially underwent a cerebral magnetic resonance imaging that revealed right transverse sinus thrombosis. She underwent an extensive procoagulant workup and was found to have an increased factor VIII level. All other workups were negative. The patient was started on heparin infusion and bridged to coumadin to achieve a therapeutic international normalized ratio. The patient had improvement in her headache symptoms and was discharged to be followed as an outpatient.Conclusions:We report a case of right transverse sinus thrombosis in a patient with increased factor VIII levels. It is prudent to promptly diagnose cerebral sinus venous thrombosis and start antithrombotic treatment for complete resolution of symptoms.

Profile of Patients with Cerebral Venous Sinus Thrombosis with Cerebellar Involvement

Treatment of cerebral sinus thrombosis with thrombolytics has been reported in cases with a deteriorating clinical course despite anticoagulant therapy. The rationale of this treatment is to promote rapid recanalisation of the occluded sinus. To review the available evidence on the efficacy and safety of thrombolysis in confirmed cerebral sinus thrombosis. We searched the Cochrane Stroke Group trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), and reference lists of all relevant publications. We aimed to analyse separately unconfounded randomised controlled trials comparing thrombolytic agent with placebo, or thrombolytic agent with antithrombotic therapy, or thrombolytic agent and antithrombotic with antithrombotic alone, in patients with dural sinus thrombosis (confirmed by MR venography, intra-arterial venography or CT venography). Two groups of reviewers independently applied the inclusion criteria. No randomised controlled trials were found. There is currently no available evidence from randomised controlled trials regarding the efficacy or safety of thrombolytic therapy in dural sinus thrombosis. A randomised controlled trial is justified to test this therapy especially in patients predicted to have a poor prognosis.

BackgroundHeat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain.Case presentationWe encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid–base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient’s level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved.ConclusionsThis case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.

This study presents a large multicenter cohort of children with cerebral venous thrombosis from 5 centers in the United States and analyzes their clinical findings and risk factors. Seventy patients were included in the study (25 neonates, 35%). The age ranged from 6 days to 12 years. Thirty-eight (55%) were younger than 6 months of age, and 28 (40%) were male. Presenting features included seizures (59%), coma (30%), headache (18%), and motor weakness (21%). Common neurological findings included decreased level of consciousness (50%), papilledema (18%), cranial nerve palsy (33%), hemiparesis (29%), and hypotonia (22%). Predisposing factors were identified in 63 (90%) patients. These included infection (40%), perinatal complications (25%), hypercoagulable/hematological diseases (13%), and various other conditions (10%). Hemorrhagic infarcts occurred in 40% of the patients and hydrocephalus in 10%. Transverse sinus thrombosis was more common (73%) than sagittal sinus thrombosis (35%). Three children underwent thrombolysis, 15 patients received anticoagulation, and 49 (70%) were treated with antibiotics and hydration. Nine (13%) patients (6 of them neonates) died. Twenty-nine patients (41%) were normal, whereas 32 patients (46%) had a neurological deficit at discharge. Seizures and coma at presentation were poor prognostic indicators. In conclusion, cerebral venous thrombosis predominantly affects children younger than age 6 months. Mortality is high (25%) in neonatal cerebral venous thrombosis. Only 18 (25%) patients were treated with anticoagulation or thrombolysis.

The standard evaluation of patients with intracranial hypertension frequently does not reveal a discrete pathophysiologic process, leading in these cases to classification of the syndrome as "benign." We present a 35-year-old woman with a recent diagnosis of pseudotumor cerebri who presented with headache, emesis, and blurring of vision. Her symptoms were progressive despite two lumbar punctures that revealed normal cerebrospinal fluid under high pressure. Contrast and noncontrast CT scans were normal; both the cerebrospinal fluid and CT neuroimaging were thus consistent with benign intracranial hypertension. An MRI, however, supported the presence of sagittal sinus thrombosis, a finding which was confirmed by MR venography. Further workup for an underlying cause of sinus thrombosis disclosed symptoms and signs fulfilling the diagnostic criteria for Behcet's disease. Cerebral venous (or sinus) thrombosis should be considered in the differential diagnosis of intracranial hypertension. Behcet's disease, while extremely rare, should be considered as a potential cause of cerebral venous thrombosis. Magnetic resonance venography can serve as a useful diagnostic study in situations where confirmation or exclusion of sinus thrombosis is required.