Scrub typhus with cerebral venous sinus thrombosis: a rare presentation

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.

scholarly journals Improvement in the Prognosis of Cerebral Venous Sinus Thrombosis over a 22-Year Period

2017 ◽  
Vol 45 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Dustin Anderson ◽  
Julie Kromm ◽  
Thomas Jeerakathil
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Hormonal Contraception ◽  
Signs And Symptoms ◽  
Cerebral Venous Sinus Thrombosis ◽  
Treatment Modalities ◽  
Motor Deficit ◽  
Residual Symptoms

AbstractBackground: Cerebral venous thrombosis is a rare cause of stroke, with a number of well-defined risk factors. However, there exist few studies that describe trends in the prognosis of this disease over time. Methods: A retrospective study was performed on patients diagnosed with cerebral venous thrombosis at the University of Alberta Hospital during two time periods: 1988-1998 (21 patients) and 1999-2009 (40 patients). Signs and symptoms, risk factors, imaging findings, etiologies, treatment modalities, and status at discharge were examined. Results: Headache, nausea and vomiting, focal motor deficit, and seizure were the most common signs and symptoms, and active hormonal contraception was the most commonly identified risk factor between the two cohorts. Hematoma and hyperdense sinuses were the most commonly identified CT findings between groups. Thrombophilia and the use of hormonal contraception were the most frequently identified etiologies between the two cohorts. Treatment was similar, with the majority of patients in both cohorts receiving unfractionated heparin as first-line therapy. Patients in the 1999-2009 cohort were significantly less likely to have a severe deficit or be dead at discharge (odds ratio [OR]=0.178; 95% confidence interval [CI95%]=0.051, 0.625) and were more likely to have a favorable modified Rankin Scale score of 0 or 1 at discharge (OR=7.98; CI95%=1.79, 35.71). Conclusions: Our data indicate a reduction in severe residual symptoms at discharge and improved functional status at discharge for patients presenting with cerebral venous thrombosis from 1999 to 2009, as compared with 1988-1998.

scholarly journals Cerebral venous thrombosis: a rare presentation of paroxysmal nocturnal hemoglobinuria

2015 ◽  
Vol 02 (04) ◽  
pp. 198-201
Author(s):  
H. K. Aggarwal ◽  
Deepak Jain ◽  
Geeta Dabas ◽  
R. K. Yadav ◽  
Promil Jain
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Rare Presentation

scholarly journals Cerebral venous thrombosis and Covid 19: Literature review

2021 ◽  
Vol 11 (2) ◽  
pp. 57-68
Author(s):  
Carlos Alexandre Martins Zicarelli ◽  
Jonathan Vinicius Martins ◽  
Wesley Vieira Doni ◽  
Rafael Rodrigues Pinheiro dos Santos ◽  
Ana Carla Mondek Rampazzo ◽  
...  
Keyword(s):  
Literature Review ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Risk Of Death ◽  
Cranial Sinus Thrombosis ◽  
Stent Retrievers ◽  
Low Incidence

Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

scholarly journals Risk factors and diagnosis of cerebral venous thrombosis: Data from a cohort of 45 Romanian patients

2014 ◽  
Vol 60 (5) ◽  
pp. 207-214
Author(s):  
Rodica Bălaşa ◽  
M Daboczi ◽  
Oana Costache ◽  
Smaranda Maier ◽  
Z Bajko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Brain Imaging ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Demographic Data ◽  
Brain Mri ◽  
Clinical Aspects ◽  
Initial Symptom ◽  
Clinical Criteria

Abstract Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment. Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT. Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied. Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment. Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

The Performance of CT versus MRI in the Differential Diagnosis of Cerebral Venous Thrombosis

2018 ◽  
Vol 118 (06) ◽  
pp. 1067-1077 ◽  
Author(s):  
Weilin Xu ◽  
Liansheng Gao ◽  
Tao Li ◽  
Neha Ramdoyal ◽  
Jianmin Zhang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Significant Heterogeneity ◽  
Summary Receiver Operating Characteristic ◽  
Ct And Mri

Background Cerebral venous thrombosis (CVT) is a rare disease, and with poor prognosis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used image modalities for patients with non-specific neurologic symptoms. We present here a meta-analysis to assess the accuracy of CT and MRI in the differential diagnosis of CVT and cerebral venous sinus thrombosis (CVST). Materials and Methods A comprehensive search of the PubMed, EMBASE, Web of Science, Cochrane Database and Chinese Biomedical (CBM) databases was conducted prior to March 20, 2017. In this report, we assess the methodological quality of each article individually and perform a meta-analysis to obtain the summary of the diagnostic accuracy of CT and MRI in correctly identifying CVT and CVST. Results Twenty-four eligible articles comprising 48 studies (4,595 cases) were included. The pooled sensitivity for CT–CVT/CT–CVST groups is 0.79 (95% confidence interval [CI]: 0.76, 0.82)/0.81(95% CI: 0.78, 0.84), and pooled specificity is 0.90 (95% CI: 0.89, 0.91)/0.89 (0.88, 0.91), with an area under the curve (AUC) for the summary receiver operating characteristic (SROC) of 0.9314/0.9161, respectively. No significant heterogeneity and publication bias was observed across each study. For MRI–CVT/MRI–CVST, the pooled sensitivity is 0.82 (95% CI: 0.78, 0.85)/0.80 (95% CI: 0.76, 0.83), and pooled specificity is 0.92 (95% CI: 0.91, 0.94)/0.91(0.89, 0.92), with an AUC for the SROC of 0.9221/0.9273, respectively. Conclusion This meta-analysis indicates that both CT and MRI have a high level of diagnostic accuracy in the differential diagnosis of CVT and CVST, independent of stage, target for analysis or analysis methods. They could be chosen as alternative sub-optimal gold standards for diagnosing CVT and CVST, especially in emergency.

Vascular anatomy and stroke syndromes

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Venous Thrombosis ◽  
Carotid Stenosis ◽  
Cerebral Venous Thrombosis ◽  
Vascular Anatomy ◽  
Posterior Circulation ◽  
Arterial Supply ◽  
Symptomatic Carotid ◽  
Posterior Circulation Stroke ◽  
Symptomatic Carotid Stenosis ◽  
The Brain

Determining the arterial territory in which a stroke occurs is important in diagnosis. It also has major implications for management; for example, treatment of a symptomatic carotid stenosis differs greatly to that of an incidental stenosis in a patient with posterior circulation stroke. This chapter describes the arterial supply of the brain and links it to stroke syndromes that present acutely to the stroke clinician. It also covers the venous supply which is important in understanding cerebral venous thrombosis.

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

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.

scholarly journals A young woman with headache and seizures

2013 ◽  
pp. 25-29
Author(s):  
A.M. Pizzini ◽  
M. Silingardi ◽  
I. Iori
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Mr Angiography ◽  
Sinus Thrombosis ◽  
Factor V Leiden ◽  
Transverse Sinus ◽  
Acute Onset ◽  
Factor V ◽  
Neuroimaging Techniques

CASE REPORT We describe a 31 year-old woman with headache and acute onset of seizures. Medical history and physical examination were unremarkable. She has been on therapy with oral contraceptives for many years for dysmenorrhea. A CT scan was negative, but MRI and MR-angiography showed left transverse sinus thrombosis. Screening for thrombophilia revealed hyperhomocysteinemia and Factor V Leiden heterozigousity. The patient received unfractionated heparin, followed by long-term anticoagulation with warfarin (INR 2-3). CONCLUSIONS Cerebral venous thrombosis is a rare cerebrovascular disorder, frequently in young adult (about 75% are women). The diagnosis might be difficult with consequent high long-term morbidity and mortality rate. New neuroimaging techniques (MRI and MR-angiography) and more effective treatment (anticoagulation and endovascular thrombolysis) have improved the prognosis and the natural history. The risk factors, the clinical presentation, the diagnostic evaluation and the management of cerebral venous thrombosis are reviewed.

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