Cerebral Venous Thrombosis in a Patient with Clinically Isolated Spinal Cord Syndrome

Background. The association between cerebral venous thrombosis (CVT) and multiple sclerosis (MS) has already been reported in patients with clinically definite MS in relation to intravenous methylprednisolone (IVMP) or previously performed lumbar puncture (LP).Case Summery. We report a 29-year-old Indian female who presented with a clinically isolated spinal cord syndrome according to the revised 2010 McDonald Criteria. She developed CVT after a lumbar puncture and two days of finishing the course of IVMP.Conclusion. We conclude that the sequence of doing lumbar puncture followed by high-dose IVMP may increase the risk of CVT. A prophylactic anticoagulation may be indicated in this setting.

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A Case of Multiple Sclerosis with Cerebral Venous Thrombosis: The Role of Lumbar Puncture and High-Dose Steroids

European Neurology ◽

10.1159/000047949 ◽

2002 ◽

Vol 47 (1) ◽

pp. 57-58 ◽

Cited By ~ 14

Author(s):

Dilek Ince Gunal ◽

Nazire Afsar ◽

Nese Tuncer ◽

Sevinc Aktan

Keyword(s):

Multiple Sclerosis ◽

Venous Thrombosis ◽

Lumbar Puncture ◽

Cerebral Venous Thrombosis ◽

High Dose

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Cerebral venous thrombosis and demyelinating diseases: report of a case in a clinically isolated syndrome suggestive of multiple sclerosis onset and review of the literature

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1125cr ◽

2005 ◽

Vol 11 (2) ◽

pp. 242-244 ◽

Cited By ~ 14

Author(s):

Maurizia Maurelli ◽

Roberto Bergamaschi ◽

Elisa Candeloro ◽

Alessandra Todeschini ◽

Giuseppe Micieli

Keyword(s):

Multiple Sclerosis ◽

Venous Thrombosis ◽

Lumbar Puncture ◽

Cerebral Venous Thrombosis ◽

Corticosteroid Treatment ◽

Clinically Isolated Syndrome ◽

Demyelinating Diseases ◽

High Dose ◽

First Case ◽

Definite Multiple Sclerosis

Cerebral venous thrombosis (CVT) has been described in several cases of clinically definite multiple sclerosis (MS). In the majority of these, lumbar puncture followed by intravenous corticosteroid treatment was suspected as the cause. We report what is, to our knowledge, the first case of a patient with a multifocal clinically isolated syndrome suggestive of MS onset, who developed multiple CVT after lumbar puncture and during high-dose i.v. corticosteroid treatment. We conclude that the sequence ‘lumbar puncture followed by corticosteroid treatment’ may be a contributory risk factor for the development of CVT when associated with other risk factors.

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Cerebral venous thrombosis after lumbar puncture and intravenous high dose corticosteroids: A case report of a childhood multiple sclerosis

Brain and Development ◽

10.1016/j.braindev.2012.09.001 ◽

2013 ◽

Vol 35 (6) ◽

pp. 602-605 ◽

Cited By ~ 7

Author(s):

Anna Presicci ◽

Vincenza Garofoli ◽

Marta Simone ◽

Maria Gloria Campa ◽

Anna Linda Lamanna ◽

...

Keyword(s):

Multiple Sclerosis ◽

Case Report ◽

Venous Thrombosis ◽

Lumbar Puncture ◽

Cerebral Venous Thrombosis ◽

High Dose

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Venous Thrombosis in Multiple Sclerosis Patients after High-Dose Intravenous Methylprednisolone: The Preventive Effect of Enoxaparin

Thrombosis ◽

10.1155/2011/785459 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Hossein Kalanie ◽

Ali Amini Harandi ◽

Shapoor Alidaei ◽

Daryoosh Heidari ◽

Saeed Shahbeigi ◽

...

Keyword(s):

Multiple Sclerosis ◽

Venous Thrombosis ◽

High Dose ◽

Intravenous Methylprednisolone ◽

Relapsing Remitting ◽

Acute Attacks ◽

Multiple Sclerosis Patients ◽

Relapsing Remitting Multiple Sclerosis ◽

Preventive Role

Aim. This study was designed to examine the possible role of high-dose intravenous methylprednisolone (IVMP) in the development of venous thrombosis (VT). The cerebral one anecdotally had been reported in patients with relapsing remitting multiple sclerosis (RRMS) in acute attacks and the possible preventive role of enoxaparin. Material and Methods. From a pool of 520 patients, 388 patients with definite RRMS who fulfilled entry characteristics were selected and randomly received either a 5-day course of daily 1 gr IVMP or the aforementioned plus 5 days of daily subcutaneous 40 units of enoxaparin according to a predefined protocol. Results. Mean age, gender ratio, mean relapse rate, and EDSS were similar in both groups of patients (P > 0.05). Finally, 366 patients remained in the study. Of 188 patients treated with IVMP with 855 relapses, 5 developed VT (0.37% per patient per year and 0.58% per each course of IVMP) within 3 to 15 days of starting therapy. None of the 178 patients who experienced 809 relapses who received IVMP plus enoxaparin developed such complications. Conclusion. The study implies that high-dose IVMP in MS exacerbation may increase the risk of VT and prophylactic anticoagulant treatment in this setting is warranted.

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Cerebral venous thrombosis after lumbar puncture and treatment with high-dose corticosteroids

Neurología (English Edition) ◽

10.1016/j.nrleng.2012.11.002 ◽

2014 ◽

Vol 29 (5) ◽

pp. 315-316

Author(s):

M. Sillero Sánchez ◽

N. Rodriguez Fernandez ◽

L. Sánchez Vera ◽

B. Gómez González ◽

J.J. Asencio Marchante

Keyword(s):

Venous Thrombosis ◽

Lumbar Puncture ◽

Cerebral Venous Thrombosis ◽

High Dose

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Brief Course of Ultra-High Dose IV Methylprednisolone in the Treatment of Multiple Sclerosis Exacerbations

10.47363/jnrrr/2020(2)114 ◽

2020 ◽

pp. 1-4

Author(s):

Robert Knobler ◽

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Spinal Cord Injury ◽

High Dose ◽

Side Effect Profile ◽

Intravenous Methylprednisolone ◽

The Past ◽

Disease Modifying Therapies ◽

Cord Injury ◽

Disease Modifying

Despite the introduction of a number of effective disease modifying therapies (DMT) for multiple sclerosis (MS) over the past 25 years, a need remains for an effective method of treating breakthrough relapses, which impact disease progression. ACTH and corticosteroids have fulfilled this role for the past 50 years. However, based upon our current understanding of the cadence of an exacerbation, and its importance in the progression of MS, an alternative is proposed. This utilizes a very brief course of an ultra-high dose of intravenous methylprednisolone, adapted from the megadose protocol of methylprednisolone in acute spinal cord injury. Despite the known side effect profile of corticosteroids, and the ultra-high dose employed, the brevity in administration yields a well-tolerated, rapid resolution of the relapse

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Cerebral venous thrombosis after lumbar puncture and high steroid cycle in a patient with multiple sclerosis

The Journal of Headache and Pain ◽

10.1007/pl00012186 ◽

2001 ◽

Vol 2 (1) ◽

pp. 45-48 ◽

Cited By ~ 2

Author(s):

Andrea Giorgetti ◽

Maria Vittoria Calloni ◽

Roberto Freschi ◽

Giuseppe Mariani ◽

Patrizia Perrone ◽

...

Keyword(s):

Multiple Sclerosis ◽

Venous Thrombosis ◽

Lumbar Puncture ◽

Cerebral Venous Thrombosis

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Changing Pattern of Headache Pointing to Cerebral Venous Thrombosis After Lumbar Puncture and Intravenous High-Dose Corticosteroids

Headache The Journal of Head and Face Pain ◽

10.1046/j.1526-4610.1999.3908559.x ◽

1999 ◽

Vol 39 (8) ◽

pp. 559-564 ◽

Cited By ~ 50

Author(s):

Saadia Aidi ◽

Marie-Pierre Chaunu ◽

Valerie Biousse ◽

Marie-Germaine Bousser

Keyword(s):

Venous Thrombosis ◽

Lumbar Puncture ◽

Cerebral Venous Thrombosis ◽

High Dose

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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