Anesthetic Management of a Child with β-Thalassemia Major and Cortical Venous Thrombosis

Abstractβ-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalassemia major is the severe form of disease, and the patients often display an array of associated organ dysfunction which thus increase the risk associated with surgery and anesthesia. Patients with β-thalassemia major can have multiple pathological defects that may lead to thromboembolic events. Here, we report such a case who was complicated by occurrence of cerebral sinus thrombosis and presented for decompressive hemicraniectomy under general anesthesia. The anesthetic challenges during in such scenario have been discussed.

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Cerebral venous thrombosis as a rare thromboembolic complication of celiac disease: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa200 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-5

Author(s):

Maha Bouziane ◽

Salim Arous ◽

Rachida Habbal

Keyword(s):

Celiac Disease ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Anticoagulation Therapy ◽

Thromboembolic Complication ◽

Favourable Outcome ◽

Complete Regression ◽

Thromboembolic Events ◽

Cerebral Magnetic Resonance Imaging

Abstract Background Celiac disease is a digestive inflammatory syndrome with several complications. It is associated with coagulation and platelets abnormalities leading to thromboembolic events. Cerebral venous thrombosis is an exceptional localization of thrombosis in celiac disease and could be life-threatening. Case summary A 17-year-old female patient with history of celiac disease and not following a gluten-free diet, checked in to the emergency department for a sudden, 2-week-old, and deteriorating, onset of intense headache and muscle weakness. The cerebral computed tomography-scan showed bilateral fronto-parietal hypodensity with micro-bleeds. We investigated using a cerebral magnetic resonance imaging that revealed superior longitudinal sinus thrombosis and right transverse and sigmoid sinuses thrombosis, along with right haematoma and ischaemic areas. The patient was prescribed anticoagulation therapy. Follow-ups over a 2-year period confirmed a favourable outcome and a complete regression of symptoms. Discussion Evolution of celiac disease could be associated with several complications. Eighty-five percent of patients is potentially exposed to thromboembolic events due to the hypercoagulability state of the disease and different coagulation and fibrinolysis abnormalities (e.g. hyperhomocysteinaemia, protein C and S deficiencies, vitamin K and B deficiencies). Cerebral venous thrombosis is a rare thromboembolic localization. Anticoagulation is efficient in most cases though endovascular treatment might be required.

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Decompressive Hemicraniectomy in Cerebral Sinus Thrombosis

Stroke ◽

10.1161/strokeaha.108.543421 ◽

2009 ◽

Vol 40 (6) ◽

pp. 2233-2235 ◽

Cited By ~ 67

Author(s):

Jonathan M. Coutinho ◽

Charles B.L.M. Majoie ◽

Bert A. Coert ◽

Jan Stam

Keyword(s):

Sinus Thrombosis ◽

Decompressive Hemicraniectomy ◽

Cerebral Sinus Thrombosis ◽

Cerebral Sinus

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Mutation in the Prothrombin Gene G20210A as a Cause of Cerebral Venous Thrombosis

Case Reports in Medicine ◽

10.1155/2012/828050 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jorge A. Arroyave ◽

Jairo Quiñones

Keyword(s):

Venous Thrombosis ◽

Sinus Thrombosis ◽

Gene Mutations ◽

Signs And Symptoms ◽

Cerebral Venous Sinus Thrombosis ◽

Prothrombin G20210a ◽

Coding Region ◽

Blood Disorders ◽

Prothrombin Gene ◽

Superior Longitudinal Sinus

Introduction. Cerebral venous sinus thrombosis (CVST) is a rare form of cerebrovascular disease, which may manifest clinically by a wide variety of signs and symptoms. It has been associated with multiple risk factors including genetic or acquired blood disorders, infections, and trauma.Case Report. Man of 17 years who presented with 10 days of intense global headache with nausea and vomiting and subsequent onset of mild hemiparesis and hypoesthesia in right hemibody. Studies show venous thrombosis of the superior longitudinal sinus. It was identified a gene mutation in prothrombin G20210A as a probable cause of the thrombosis.Conclusions. Substitution of guanine for adenine at nucleotide 20210 in the coding region of the prothrombin gene is the second most common primary thrombophilia. Multiple cases of CVST have been associated with this mutation. In the presence of CVST must be considered the primary studies for thrombophilia gene mutations, including prothrombin G20210A.

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Recurrent Unprovoked Venous Thrombosis (Cerebral Sinus Thrombosis and Mesenteric Vein Thrombosis) in Young Patient with Crohn’s Disease: A Case Report and Review

Case Reports in Gastrointestinal Medicine ◽

10.1155/2020/8863900 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Abdullah Mohammed Albishi ◽

Rafaat Chakik ◽

Ali Saleh Alshamrani

Keyword(s):

Inflammatory Bowel Disease ◽

Case Report ◽

Venous Thrombosis ◽

Disease Activity ◽

Bowel Disease ◽

Sinus Thrombosis ◽

Outpatient Setting ◽

Vein Thrombosis ◽

Cerebral Sinus ◽

Inflammatory Bowel

Inflammatory bowel disease (IBD) patients have a higher risk of thrombosis. Most data about thrombosis in inflammatory bowel disease are related mainly to inpatients with disease activity, but in this article, we report one case of inflammatory bowel disease with two different sites of venous thrombosis which happened in a patient with nonactive IBD at an outpatient setting.

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High Antibody Levels to Prothrombin Imply a Risk of Deep Venous Thrombosis and Pulmonary Embolism in Middle-aged Men

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657711 ◽

1997 ◽

Vol 78 (04) ◽

pp. 1178-1182 ◽

Cited By ~ 59

Author(s):

Timo Palosuo ◽

Jarmo Virtamo ◽

Jari Haukka ◽

Philip R Taylor ◽

Kimmo Aho ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasma Proteins ◽

Alpha Tocopherol ◽

Index Number ◽

Thromboembolic Events ◽

Middle Aged ◽

Phospholipid Binding ◽

Antiprothrombin Antibodies

SummaryAntibodies against phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2-GPI) and prothrombin, are associated with thromboembolic events in patients with systemic lupus erythematosus and also in subjects with no evident underlying diseases. We wanted to examine whether increased levels of antibodies to negatively-charged phospholipids (cardiolipin), to phospholipid-binding plasma proteins β2-GPI and prothrombin and to oxidised low-density lipoprotein (LDL) were associated with risk of deep venous thrombosis or pulmonary embolism in subjects with no previous thrombosis. The antibodies were measured in stored serum samples from 265 cases of deep venous thrombosis of the lower extremity or pulmonary embolism occurring during a median follow-up of about 7 years and from 265 individually matched controls. The study subjects were middle-aged men participating in a cancer prevention trial of alpha-tocopherol and beta-carotene and the cases of thromboembolic events were identified from nationwide Hospital Discharge Register.The risk for thrombotic events was significantly increased only in relation to antiprothrombin antibodies. As adjusted for body mass index, number of daily cigarettes and history of chronic bronchitis, myocardial infarction and heart failure at baseline, the odds ratio per one unit of antibody was 6.56 (95% confidence interval 1.73-25.0). The seven highest individual optical density-unit values of antiprothrombin antibodies were all confined to subjects with thromboembolic episodes.In conclusion, the present nested case-control study showed that high autoantibody levels against prothrombin implied a risk of deep venous thrombosis and pulmonary embolism and could be involved in the development of the thrombotic processes.

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Bee sting with cortical venous thrombosis

Indian Journal Of Applied Research ◽

10.15373/2249555x/may2014/152 ◽

2011 ◽

Vol 4 (5) ◽

pp. 488-489

Author(s):

Dr. Arun kumar.N Dr. Arun kumar.N ◽

◽

Dr.Ramesh. S.S Dr.Ramesh. S.S ◽

Dr.M.M.Basavaraju Dr.M.M.Basavaraju ◽

Dr.Mohan kumar.V Dr.Mohan kumar.V ◽

...

Keyword(s):

Venous Thrombosis ◽

Bee Sting ◽

Cortical Venous Thrombosis

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Successful treatment of Thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26. COV2 .S vaccination

American Journal of Hematology ◽

10.1002/ajh.26237 ◽

2021 ◽

Author(s):

Gemlyn George ◽

Kenneth D. Friedman ◽

Brian R. Curtis ◽

Stuart E. Lind

Keyword(s):

Venous Thrombosis ◽

Successful Treatment ◽

Cerebral Sinus Venous Thrombosis ◽

Cerebral Sinus ◽

Sinus Venous Thrombosis

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Scrub typhus with cerebral venous sinus thrombosis: a rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-241401 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241401

Author(s):

Sayonee Das ◽

Sidhartha Chattopadhyay ◽

Kausik Munsi ◽

Sagar Basu

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Scrub Typhus ◽

Sinus Thrombosis ◽

Hormonal Contraception ◽

Neurological Involvement ◽

Rare Presentation ◽

Specific Test ◽

Satisfactory Outcome ◽

The Brain

This is a rare presentation of scrub typhus with cerebral venous thrombosis. A 32-year-old woman presented with signs of raised intracranial tension. Examination revealed maculopapular skin rashes and an ‘eschar’ over the right thigh. Nuchal rigidity and bilateral papilloedema were found. Scrub typhus was diagnosed by the presence of IgM antibody in serum. CT scan of the brain showed cerebral oedema. MRI of the brain was normal. Magnetic resonance venography of the brain showed thrombosis of several venous sinuses. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with raised protein level. Other causes of prothrombotic states were ruled out by doing specific test results. There was no history of hormonal contraception and prolonged bed rest. A case of scrub typhus complicated with meningoencephalitis and cerebral venous thrombosis was diagnosed. She responded to treatment with doxycycline, anticoagulants, antipyrectics and intravenous saline. Early identification of such atypical neurological involvement in scrub typhus was helpful in satisfactory outcome.

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Cerebral venous sinuses thrombosis in both transverse sinus and torcula: Multistep endovascular treatment and stenting

Interventional Neuroradiology ◽

10.1177/1591019916674917 ◽

2016 ◽

Vol 23 (1) ◽

pp. 84-89 ◽

Cited By ~ 6

Author(s):

G Cabral de Andrade ◽

A Lesczynsky ◽

VM Clímaco ◽

ER Pereira ◽

PO Marcelino ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Endovascular Treatment ◽

Clinical Symptoms ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Severe Form ◽

Venous Sinus ◽

Lateral Sinus ◽

Mechanical Thrombolysis

Purpose Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy. This case report presents the possibility of endovascular treatment in multiple steps with mechanical thrombolysis with balloon, local pharmacological thrombolysis and stenting, in a patient with a severe form of CVST. Case summary A 67-year-old woman presented severe headache, agitation and confusion with diagnosis of venous sinus dural thrombosis in both lateral sinus and torcula. After 24 h there was neurological worsening evolving with seizures and numbness even after starting heparin, without sinus recanalization; CT scan showed left temporal intracerebral hemorrhage. We decided to take an endovascular approach in multiple steps. The first step was mechanical static thrombolysis with balloon; the second step was dynamic mechanical thrombolysis with a balloon partially deflated and “pulled”; the third step was local thrombolysis with Actilyse™; finally, the fourth step was angioplasty and reconstruction of the sinuses using multiple carotid stents and complete angiographic recanalization of both sinuses and torcula. After 24 h of endovascular treatment there was full clinical recovery and no tomographic complications. Conclusion This result shows that mechanical clot disruption, intrasinus thrombolysis and reconstruction of wall sinuses with stenting can be an endovascular option in the severe form of CVST with intracerebral hemorrhage and rapid worsening of neurological symptoms. Although this type of treatment can re-channel the occluded sinuses, further comparative and randomized studies are needed to clarify its efficacy versus other therapeutic modalities.

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