Relationship between cerebral venous sinus thrombosis and intracranial arteritis during pregnancy and post partum

2021 ◽  
pp. jim-2020-001757
Author(s):  
Xiurong Li ◽  
Jianan Dong ◽  
Yaping Sun ◽  
Qing Li ◽  
Li Shi
Keyword(s):  
Sinus Thrombosis ◽  
Post Partum ◽  
White Cell Count ◽  
Fluid Pressure ◽  
Clinical Manifestations ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Disturbance Of Consciousness ◽  
Imaging Results

Our study was conducted to explore the relationship between cerebral venous sinus thrombosis (CVST) and intracranial arteritis during the time of pregnancy as well as puerperium. The current retrospective case study involved a total of 153 patients with pregnancy-related CVST. CVST was diagnosed mainly based on clinical manifestations and imaging results. Detailed information on demographics, risk factors (excluding intracranial arteritis), and pregnancy outcomes was systematically recorded. The average age of patients diagnosed with CVST was 28.67±3.54 years old. Among these patients, there were 62 cases of puerperal CVST and 91 cases of pregnancy-related CVST. The clinical manifestations of patients with CVST included headache in 55 cases (35.95%), symptomatic seizures in 26 cases (16.99%), symptomatic limb weakness in 22 cases (14.38%), symptomatic nausea/vomiting in 18 cases (11.76%), symptomatic disturbance of consciousness in 15 cases (9.80%), symptomatic blurred vision in 10 cases (6.54%), and symptomatic fever in 7 cases (4.58%). A proportion of patients reported higher abnormal cerebrospinal fluid pressure (98.28%), white cell count (79.31%), total cholesterol (71.55%) and low-density lipoprotein (62.93%) (p<0.01). The proportion of intracranial arteritis lesions and CVST lesions was high, including 51 cases (43.97%) on the left side and 31 cases (26.72%) on the right side. Bilateral CVST lesions occurred in 13 cases (11.20%) of unilateral intracranial arteritis lesions, and bilateral intracranial arteritis lesions occurred in 16 cases (13.79%) of unilateral CVST lesions. In summary, CVST indicates a potential positive link to intracranial arteritis at the time of pregnancy and puerperium.

scholarly journals Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

2021 ◽  
Vol 10 (8) ◽  
pp. 1599
Author(s):  
Marc E. Wolf ◽  
Beate Luz ◽  
Ludwig Niehaus ◽  
Pervinder Bhogal ◽  
Hansjörg Bäzner ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Venous Sinus ◽  
European Medicines Agency ◽  
Coagulation Disorder ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Antiplatelet Antibodies ◽  
Imaging Results ◽  
Venous Thromboembolic Events

Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena.

scholarly journals Etiological associations of Cerebral Venous Sinus Thrombosis (CVT) among Sudanese patients in Khartoum state Neurological Centers, Sudan, 2020

2021 ◽  
Author(s):  
Mohamed Malekaldar ◽  
Abbasher Hussien ◽  
Khabab Abbasher Hussien Mohamed Ahmed ◽  
Yassin Abdalla
Keyword(s):  
Oral Contraceptive ◽  
Sinus Thrombosis ◽  
Post Partum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Oral Contraceptive Pills ◽  
Venous Sinus Thrombosis ◽  
Contraceptive Pills ◽  
Work Up ◽  
Treatable Condition

Abstract Background As cerebral venous sinus thrombosis is common in our country and it carries a high risk of morbidity and mortality if it is not detected and treated early. The common aetiological associations of CVST are post-partum, pregnancy and oral contraceptive pills. Objectives To study the etiological association of CVST among Sudanese patients in Khartoum state in neurological centers. Methodology This is a descriptive prospective hospital based study was conducted on CVST patients in four neurological centers in Khartoum state in the period from March to October 2020. Results Sixty patients were studied for etiological association of CVST using standardized questionnaire including medical history, clinical examination, investigation and treatment. The most common etiological association were pregnancy in 15(25%) OCP in 11(18.3) and being in the post-partum period in 23(38.3%). Recommendation Cerebral venous sinus thrombosis is a treatable condition and has good outcome. Early detection of patients and performing suitable work up including thrombophilia and connective tissue disease screening is essential. Conclusion Post-partum, pregnancy and oral contraceptive pills were the most common etiological associations of cerebral venous sinus thrombosis compared with other populations.

scholarly journals Cerebral Venous Sinus Thrombosis Associated with COVID-19: A Case Series and Literature Review

2020 ◽  
Author(s):  
Vahid Reza Ostovan ◽  
Razieh Foroughi ◽  
Mahtab Rostami ◽  
Mostafa Almasi-Dooghaee ◽  
Manouchehr Esmaili ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Hemorrhagic Transformation ◽  
Venous Sinus ◽  
Teaching Hospitals ◽  
Venous Sinus Thrombosis ◽  
North West ◽  
Confirmatory Tests

Abstract Background: Since the COVID-19 pandemic, several cases of cerebral venous sinus thrombosis (CVST) have been reported in SARS-CoV-2 infected individuals. This study provides a series of patients with CVST and SARS-CoV-2 infection.Methods: Consecutive patients with documented SARS-CoV-2 infection, as well as clinical and radiological characteristics of CVST, were reported from three teaching hospitals in the South West, North West, and the center of Iran from June to July 2020. We also searched the abstract archives until the end of August 2020 and gathered 28 reported cases. The diagnostic criteria for SARS-CoV-2 infection were determined according to SARS-CoV-2 detection in oropharyngeal or nasopharyngeal samples in clinically suspected patients. Demographics, main COVID-19 symptoms, confirmatory tests for SARS-CoV-2 infection diagnosis, the interval between the diagnosis of SARS-CoV-2 infection and CVST, clinical and radiological features of CVST, therapeutic strategies, CVST outcomes, rate of hemorrhagic transformation, and mortality rate were investigated.Results: Six patients (aged 31 to 62 years old) with confirmed CVST and SARS-CoV-2 infection were admitted to our centers. Four patients had no respiratory symptoms of SARS-CoV-2 infection. Five out of six patients developed the clinical manifestations of CVST and SARS-CoV-2 infection simultaneously. Three patients had known predisposing factors for CVST. Despite receiving CVST and SARS-CoV-2 infection treatments, four out of six patients passed away.Conclusions: The role of SARS-CoV-2 as a “cause” versus an “additive contributor” remains to be elucidated. Practitioners should be aware of the possibility of CVST in SARS-CoV-2 infection.

To Predict Visual Deterioration According to the Degree of Intracranial Hypertension in Patients with Cerebral Venous Sinus Thrombosis

2018 ◽  
Vol 80 (1-2) ◽  
pp. 28-33 ◽  
Author(s):  
Jiayue Ding ◽  
Da Zhou ◽  
Tingting Geng ◽  
Liqun Pan ◽  
Jingyuan Ya ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Fluid Pressure ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Conditional Inference ◽  
Venous Sinus Thrombosis ◽  
Visual Deterioration ◽  
Visual Damage ◽  
Severe Group

Background: Visual damage is one of the most common complications of cerebral venous sinus thrombosis (CVST)-associated intracranial hypertension (IH). This study is aimed at stratifying the risk of IH-induced visual damage in an attempt to predict its deterioration and prevent high-risk patients from irreversible eyesight impairment promptly. Methods: A total of 94 patients with confirmed diagnosis of CVST were eligible for enrollment in this study. According to cerebrospinal fluid pressure at admission, the involved patients were classified into mild IH (< 250 mmH2O), moderate IH (250–330 mmH2O), and severe IH (≥330 mmH2O) groups. Results: The ratio of visual deterioration in the severe IH group was 75%, which was significantly higher than in either the moderate (44.4%) or the mild groups (14.3%). As regards subjects without visual symptoms at admission, visual deterioration occurred in 9.4 ± 4.5 days after admission in the severe group while it occurred in 30.5 ± 16.8 days in the moderate group (p = 0.024). The conditional inference tree and random forest revealed that severe IH might be considered as an index of visual deterioration. Visual field defect, fading eyesight, and papilledema were significantly worse in patients with severe IH as compared to patients with mild or moderate IH, all p < 0.01. Conclusions: IH ≥330 mmH2O may be a cut-off value to predict the deterioration of visual damage in CVST, revealing that ophthalmologic interventions should be considered in a timely manner in this condition, particularly when recanalization of cerebral venous sinus cannot be achieved within a short time.

scholarly journals Successful endovascular therapy for cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia

2020 ◽  
Vol 26 (3) ◽  
pp. 341-345
Author(s):  
Yoshihisa Fukushima ◽  
Kenji Takahashi ◽  
Ichiro Nakahara
Keyword(s):  
Medical Treatment ◽  
Endovascular Therapy ◽  
Sinus Thrombosis ◽  
Venous Drainage ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Excellent Outcome ◽  
Disturbance Of Consciousness

Introduction Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure. A limited number of studies have reported cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia. Here, we present a case of successful endovascular therapy (EVT) without periprocedural heparinization in this situation. Case presentation A 47-year-old woman taking an oral contraceptive was admitted to our hospital with severe headache to be diagnosed as cerebral venous sinus thrombosis. Initially, she got improved by medical treatment with intravenous unfractionated heparin. However, she rapidly developed disturbance of consciousness and right hemiplegia due to cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia on the 14th hospital day. She underwent emergent EVT by immediate conversion of anticoagulation from heparin to argatroban. Despite a large clot burden, sufficient recanalization and anterograde venous drainage were re-established by combined EVT including aspiration, balloon sinoplasty, and local thrombolysis with urokinase infusion. She got improved immediately after the intervention and discharged home without any neurological sequelae after two months. Conclusion This unique case of cerebral venous sinus thrombosis worsened by occurrence of heparin-induced thrombocytopenia during the treatment finally resulted in excellent outcome highlights effectiveness of emergent endovascular intervention for critical cerebral venous sinus thrombosis resistant to initial medical treatment and of immediate establishment of effective anticoagulant strategy for both of heparin-induced thrombocytopenia and cerebral venous sinus thrombosis. Neuroendovascular therapy for cerebral venous sinus thrombosis using alternative argatroban to heparin for periprocedural anticoagulation might be safe and feasible.

scholarly journals Successful treatment of cerebral venous sinus thrombosis by balloon venoplasty: a case report

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110632
Author(s):  
Wei Chen ◽  
Wen-Jing Gu ◽  
Ming-Chao Shi ◽  
De-Rui Kong ◽  
Ke-Xin Zhao ◽  
...  
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Aged People ◽  
The Right

Cerebral venous sinus thrombosis is a special cerebrovascular disease affecting young adult and middle-aged people. The clinical manifestations of cerebral venous sinus thrombosis are diverse and nonspecific; thus, imaging plays an important role in early diagnosis. Anticoagulation with heparin is the preferred treatment for cerebral venous sinus thrombosis. Endovascular treatment is also being increasingly used to achieve recanalization of the cerebral venous sinus. We herein describe a woman in her early 50s who was diagnosed with cerebral venous sinus thrombosis for which anticoagulation with heparin was ineffective. To improve her symptoms and prognosis, we selected balloon venoplasty to treat the right sigmoid sinus thrombosis. Her condition subsequently improved, and no recurrence was observed after several follow-ups.

scholarly journals Cerebral Venous Sinus Thrombosis in Early Pregnancy : A Case Report

2019 ◽  
Vol 18 (1) ◽  
pp. 54-56
Author(s):  
Salma Akhter
Keyword(s):  
Sinus Thrombosis ◽  
Post Partum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Low Molecular Weight ◽  
Contributing Factors ◽  
Venous Sinus Thrombosis ◽  
Mother And Child ◽  
Uncommon Condition ◽  
Neuro Imaging

Cerebral Venous Sinus Thrombosis (CVST) in pregnancy is an uncommon condition and affects about 5 women per million. Actual etiology is difficult to confirm, a hypercoagulable state along with protein Sand C deficiency, hyperhomocystinaemia are the contributing factors. MRV like neuro imaging is the main stay of diagnosis. Treatment with Low molecular weight heparin throughout the pregnancy and post partum period can save the life of both mother and child. Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 54-56

scholarly journals A rare case of post-partum cerebral venous sinus thrombosis

2018 ◽  
Vol 7 (2) ◽  
pp. 762
Author(s):  
Akhileshwar Singh ◽  
Sanjay Singh ◽  
Shakti Vardhan
Keyword(s):  
Sinus Thrombosis ◽  
Post Partum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sudden Onset ◽  
Venous Sinus ◽  
Definitive Treatment ◽  
Motor Deficit ◽  
Timely Initiation ◽  
Venous Sinus Thrombosis ◽  
Warfarin Sodium

Cerebral venous sinus thrombosis is a rare neurologic emergency during pregnancy. Life threatening complications can be prevented if it is detected and treated well in time. A 24 years P2L3A2 lady, who had undergone elective caesarean delivery developed sudden onset severe episodic parieto-occipital headache and bilateral diminution of vision on 4th post-partum day. She had no known risk factors for thrombosis. There was no history suggestive of sepsis or pre-eclampsia. On clinical examination her blood pressure was found to be very high (164-180/104-110 mm Hg). There was no sensory or motor deficit. Relevant haematological and biochemical investigations were within normal limits. Urinary protein was negative. With a provisional diagnosis of imminent eclampsia, she was put on antihypertensive and Magnesium Sulphate. However, in view of persistence of the symptoms even after 24 hours, contrast-enhanced computed tomography (CECT) was done, which revealed venous infarction in occipital cortex and subcortical white matter. Magnetic resonance (MR) venography confirmed thrombus in left transverse and sigmoid sinuses. Thus, definitive treatment in the form of heparin in therapeutic doses was started. Antihypertensive was continued and prophylactic anticonvulsant was added in view of presence of the infarction. Patient responded well. Vision improved, and headache resolved completely. The patient was discharged on antihypertensive, anticonvulsant and vitamin K antagonist (Warfarin sodium) with an advice of regular follow-up. Cerebral venous thrombosis (CVT) is an uncommon entity and a high index of suspicion is needed to diagnose it at an earlier stage for timely initiation of treatment and prevention of complications. Prognosis in pregnant cases is better than that during a non-pregnant state.

scholarly journals Surgical management of cerebral venous sinus thrombosis: Case series and literature review

2021 ◽  
Vol 12 ◽  
pp. 133
Author(s):  
Ahmed Mohamed Alselisly ◽  
Hieder Al-Shami ◽  
Ahmed Mohamed Salah
Keyword(s):  
Standard Deviation ◽  
Sinus Thrombosis ◽  
Previous History ◽  
Clinical Manifestations ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
University Hospital ◽  
Venous Sinus Thrombosis ◽  
The Mean

Background: Cerebral venous sinus thrombosis (CVST) is not a common type of stroke (5%) but still hazardous to be misdiagnosed or mistreated. Aggressive medical treatment is usually failed to hinder increase intracranial tension. Therefore, decompressive craniectomy (DC) is the final measure to mitigate the deleterious effect of supratentorial herniation. The purpose of the study is to illustrate our experience with the surgical treatment of CVST and reviewing the previous works of literature. Methods: Forty-two patients were admitted to Kasr Al-Ainy University Hospital from June 2019 to March 2020. The admission was either to the neurology department or intensive care unit or neurosurgery department. Every patient who was diagnosed with CVST received an emergency neurosurgery consultation. Seven patients were operated on with DC according to the criteria mentioned above. Therapeutic heparin was given in addition to intracranial pressure lowering measures. Results: The mean and standard deviation of the age was (25.14 ± 10.1) years. There were five females (71.45%) in our series. The mean and standard deviation of clinical manifestations are (8.5 ± 7.77) weeks with range (3– 14 weeks). Most of the cases were presented by a decreased level of consciousness (6/7) and anisocoria (6/7), followed by fits (3/7). Four cases out of seven had the previous history of oral contraceptive administration. Conclusion: DC provides an urgent last arm for intractable increased intracranial tension. Patients with CVST need urgent consultation for neurosurgical intervention.

scholarly journals Cerebral Venous Sinus Thrombosis: Two Case presentations with different clinical manifestations and multifactorial etiology

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Anusha Skandini Ganeshan ◽  
Angel Alberto Caderon Chango
Keyword(s):  
Young Adults ◽  
Clinical Presentation ◽  
Sinus Thrombosis ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Medical Practitioner ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
First Case

Cerebral Venous Sinus Thrombosis (CVST) is a rare form of venous thrombosis which commonly affects young adults. CVST has variable clinical presentation such as headache, seizure, hemiparesis and even coma, thus mimicking stroke and other neurological disorders. Due to such non-specific wide spectrum of clinical presentations and variable etiology in young adults, CVST can be misdiagnosed easily, especially in initial stages of presentation which consequently affects the outcome and prognosis of the patient. Thus when a previously healthy young adults acutely presented with such variable but primarily neurological clinical presentation, it is vital for medical practitioner to have fine knowledge and skills to suspect CVST as a differential diagnosis. We present two cases: first case is a 21 year old female with puerperal CVST who had caesarean section under spinal anaesthesia three weeks before, who presented with headache and recurrent seizures, followed by hemiparesis; the second case is a 25 year old female with CVST, on oral contraceptives, who presented with right monoparesis, aphasia and facial asymmetry. In both cases though CVST was not the initial diagnosis, it was subsequently diagnosed early and confirmed by MRI brain and MRI angiogram and anticoagulation was commenced effectively, despite associated haemorrhagic infarct in the first case. Both patient made remarkable recovery without any significant residual neurological deficit.

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