Extensive Cerebral Venous Thrombosis Secondary to Recreational Nitrous Oxide Abuse

Nitrous oxide, colloquially known as “whippets,” is a commonly abused inhalant by adolescents and young adults. There are limited data describing the adverse effects of this abuse. We present a 16-year-old girl with no medical history who presented to the emergency department for confusion, hallucinations, weakness, and headaches. Imaging revealed extensive cerebral thrombosis. She had no prior history of venous or arterial thrombosis. Hypercoagulability workup demonstrated an elevated homocysteine level. She was treated with effective anticoagulation and vitamin B12 folate supplementation. To our knowledge, there are a very few cases in the medical literature of cerebral venous thrombosis following the use of nitrous oxide. The pathophysiology of the disorder appears to be linked to the metabolism of vitamin B12 inducing hyperhomocysteinemia and a procoagulant state.

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Assessing diagnostic error in cerebral venous thrombosis via detailed chart review

Diagnosis ◽

10.1515/dx-2019-0003 ◽

2019 ◽

Vol 6 (4) ◽

pp. 361-367

Author(s):

Ava L. Liberman ◽

Ekaterina Bakradze ◽

Daryl C. Mchugh ◽

Charles C. Esenwa ◽

Richard B. Lipton

Keyword(s):

Venous Thrombosis ◽

Medical Records ◽

Cerebral Venous Thrombosis ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Categorical Variables ◽

Prior History ◽

Continuous Variables ◽

Clinical Factor ◽

History Of

Abstract Background Diagnostic error in cerebral venous thrombosis (CVT) has been understudied despite the harm associated with misdiagnosis of other cerebrovascular diseases as well as the known challenges of evaluating non-specific neurological symptoms in clinical practice. Methods We conducted a retrospective cohort study of CVT patients hospitalized at a single center. Two independent reviewers used a medical record review tool, the Safer Dx Instrument, to identify diagnostic errors. Demographic and clinical factors were abstracted. We compared subjects with and without a diagnostic error using the t-test for continuous variables and the chi-square (χ2) test or Fisher’s exact test for categorical variables; an alpha of 0.05 was the cutoff for significance. Results A total of 72 CVT patients initially met study inclusion criteria; 19 were excluded due to incomplete medical records. Of the 53 patients included in the final analysis, the mean age was 48 years and 32 (60.4%) were women. Diagnostic error occurred in 11 cases [20.8%; 95% confidence interval (CI) 11.8–33.6%]. Subjects with diagnostic errors were younger (42 vs. 49 years, p = 0.13), more often women (81.8% vs. 54.8%, p = 0.17), and were significantly more likely to have a past medical history of a headache disorder prior to the index CVT visit (7.1% vs. 36.4%, p = 0.03). Conclusions Nearly one in five patients with complete medical records experienced a diagnostic error. Prior history of headache was the only evaluated clinical factor that was more common among those with an error in diagnosis. Future work on distinguishing primary from secondary headaches to improve diagnostic accuracy in acute neurological disease is warranted.

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Isolated cortical venous thrombosis after fetal demise

BMJ Case Reports ◽

10.1136/bcr-2018-228484 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228484

Author(s):

Mohammad Al-Jundi ◽

Ghassan Al-Shbool ◽

Mohamad Muhailan ◽

Moutasem Aljundi ◽

Christian J Woods

Keyword(s):

Family History ◽

Early Diagnosis ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Presentation ◽

Young Patients ◽

Fetal Demise ◽

History Of ◽

Venous Stroke ◽

Cortical Venous Thrombosis

Isolated cortical venous thrombosis (ICVT) occurring in the absence of dural venous thrombosis, constitutes about 2%–5% of all cerebral venous thrombosis. Its vague, non-specific presentation makes it a difficult and challenging diagnosis that needs an extensive workup especially in young patients. Outcome and prognosis depend mainly on early diagnosis and treatment. Here we discuss the clinical presentation, diagnosis and the treatment of a young woman diagnosed with ICVT with acute ischaemic venous stroke, in the setting of eclampsia and family history of coagulation disease.

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Homocysteine, folate and vitamin B12 in puerperal cerebral venous thrombosis

Journal of the Neurological Sciences ◽

10.1016/j.jns.2008.03.021 ◽

2008 ◽

Vol 272 (1-2) ◽

pp. 43-47 ◽

Cited By ~ 18

Author(s):

Dindagur Nagaraja ◽

Mohan Leslie Noone ◽

Venkata Pinnelli Bharatkumar ◽

Rita Christopher

Keyword(s):

Venous Thrombosis ◽

Vitamin B12 ◽

Cerebral Venous Thrombosis ◽

Folate And Vitamin B12

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SARS-COV-2 infection in a patient with Evans syndrome: A silent enemy or an ally?

Vojnosanitetski pregled ◽

10.2298/vsp200811115p ◽

2020 ◽

pp. 115-115

Author(s):

Nikola Pantic ◽

Mirjana Mitrovic ◽

Marijana Virijevic ◽

Nikica Sabljic ◽

Zlatko Pravdic ◽

...

Keyword(s):

Platelet Count ◽

Case Report ◽

Autoimmune Diseases ◽

Reference Range ◽

Prior History ◽

Limited Data ◽

Evans Syndrome ◽

History Of ◽

Current Outbreak ◽

Platelet Count Monitoring

During the current outbreak of Coronavirus disease 2019 (COVID-19), the way to manage patients with autoimmune diseases remains elusive due to limited data available. Case report: Addressing this issue we report a case of a COVID-19 positive 20-year-old female with prior history of Evans syndrome. She remained asymptomatic even though she had been treated with immunosuppressants (prednisolone and azathioprine) together with romiplostim. Moreover, her course of infection was accompanied by thrombocytosis, although her platelet count was mostly below the reference range before the infection. The patient was monitored vigilantly, with special regard to platelet count and signs of thrombotic events. Conclusion: Platelet count monitoring and romiplostim administration should be performed more cautiously in ITP patients infected by SARS-CoV-2.

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The risk and prevention of venous thromboembolism in the pregnant traveller

Journal of Travel Medicine ◽

10.1093/jtm/taz091 ◽

2019 ◽

Vol 27 (2) ◽

Cited By ~ 2

Author(s):

Divya J Karsanji ◽

Shannon M Bates ◽

Leslie Skeith

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Absolute Risk ◽

Careful Consideration ◽

Prior History ◽

Average Risk ◽

Limited Data ◽

Compression Stockings ◽

History Of ◽

The Absolute

Abstract Background The average risk of venous thromboembolism (VTE) in long haul travellers is approximately 2.8 per 1000 travellers, which is increased in the presence of other VTE risk factors. In pregnant long-haul travellers, little is known in terms of the absolute risk of VTE in these women and, therefore, there is limited consensus on appropriate thromboprophylaxis in this setting. Objective This review will provide guidance to allow practitioners to safely minimize the risk of travel-related VTE in pregnant women. The suggestions provided are based on limited data, extrapolated risk estimates of VTE in pregnant travellers and recommendations from published guidelines. Results We found that the absolute VTE risk per flight appears to be <1% for the average pregnant or postpartum traveller. In pregnant travellers with a prior history of VTE, a potent thrombophilia or strong antepartum risk factors (e.g. combination of obesity and immobility), the risk of VTE with travel appears to be >1%. Postpartum, the risk of VTE with travel may be >1% for women with thrombophilias (particularly in those with a family history) and other transient risk factors and in women with a prior VTE. Conclusions Based on our findings, we recommend simple measures be taken by all pregnant travellers, such as frequent ambulation, hydration and calf exercises. In those at an intermediate risk, we suggest a consideration of 20–30 mmHg compression stockings. In the highest risk group, we suggest careful consideration for low-molecular-weight heparin thromboprophylaxis. If there are specific concerns, we advise consultation with a thrombosis expert at the nearest local centre.

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Patients with Coronary Artery Disease Have an Increased Incidence of Aspirin Resistance: Association of PFA-100 Closure Time with Clinical Findings.

Blood ◽

10.1182/blood.v104.11.1859.1859 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1859-1859 ◽

Cited By ~ 2

Author(s):

Andrew L. Frelinger ◽

Matthew D. Linden ◽

Mark I. Furman ◽

Marsha L. Fox ◽

Marc R. Barnard ◽

...

Keyword(s):

Platelet Function ◽

Aspirin Resistance ◽

Clinical Findings ◽

Prior History ◽

Limited Data ◽

Closure Time ◽

Cyclooxygenase 1 ◽

History Of ◽

Artery Disease

Abstract Background: The occurrence of thrombotic events despite aspirin (ASA) therapy in patients with vascular disease has been termed ASA resistance. However, limited data are available correlating laboratory evidence of platelet function with clinical ASA resistance. The PFA-100 collagen/epinephrine (COL/EPI) cartridge can detect the ASA-induced inhibition of platelet cyclooxygenase 1 in a high shear flow environment that mimics in vivo arterial conditions. Aim: To investigate whether there is an association of PFA-100 test results with clinical ASA resistance. Methods: Peripheral blood was collected prior to angiography from 560 sequential ASA-treated patients (81 or 325 mg > 3 d). Patients receiving thienopyridines were not excluded but those receiving GPIIb-IIIa antagonists were. Patients with normal angiographic arteries ("No CAD", low probability of ASA resistance) were compared to those with angiographic CAD or a single prior CAD event and to those with multiple CAD events ("CAD" and "Repeat CAD" respectively, higher probability of ASA resistance). Citrate 3.8% anticoagulated blood was tested in the PFA-100 in duplicate using the COL/EPI test cartridge. Patients in the No CAD group were younger, more often female, and less often diabetic, hypertensive, and lipidemic than CAD or Repeat CAD patients. Results: A short (< 142 s) closure time (CT) in at least one of the duplicate PFA-100 COL/EPI cartridges occurred more frequently in CAD and Repeat CAD patients compared to No CAD patients (p < 0.05, Table). Conclusions: Failure of ASA to inhibit platelet function, as measured by the PFA-100, is associated with CAD, even in patients without prior history of CAD. The PFA-100, a shear-dependent system, may therefore be a useful test to assess the presence of ASA resistance. This test, unlike some tests for aspirin resistance, does not include ADP and therefore can be used in patients receiving thienopyridines (a frequent co-medication with aspirin). No CAD CAD Repeat CAD *p<0.05 vs. No CAD PFA-100 CT < 142 s (no. of patients) 4 45 26 PFA-100 CD ≥ 142 s (no. of patients) 79 251 155 Total (no. of patients) 83 296 181 % PFA-100 CT < 142 s 5% 15%* 14%*

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Obstetrical Outcome of Young Women with a Past History of Cerebral Venous Thrombosis

Cerebrovascular Diseases ◽

10.1159/000351507 ◽

2013 ◽

Vol 36 (1) ◽

pp. 55-61 ◽

Cited By ~ 13

Author(s):

Jonathan Ciron ◽

Gaëlle Godenèche ◽

Xavier Vandamme ◽

Marie-Pierre Rosier ◽

Igor Sharov ◽

...

Keyword(s):

Venous Thrombosis ◽

Young Women ◽

Cerebral Venous Thrombosis ◽

Past History ◽

History Of ◽

Obstetrical Outcome

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Comparing the performance of QuantiFERON-TB Gold Plus with QuantiFERON-TB Gold in-tube among highly TB exposed gold miners in South Africa

Gates Open Research ◽

10.12688/gatesopenres.13191.1 ◽

2021 ◽

Vol 5 ◽

pp. 66

Author(s):

Thobani Ntshiqa ◽

Violet Chihota ◽

Raoul Mansukhani ◽

Lindiwe Nhlangulela ◽

Kavindhran Velen ◽

...

Keyword(s):

South Africa ◽

Latent Tuberculosis ◽

Prior History ◽

Interferon Gamma Release Assay ◽

Limited Data ◽

History Of ◽

Gold Miners ◽

Release Assay ◽

Additional Antigen ◽

Hiv Negative

Background: QuantiFERON-TB Gold in-tube (QFT-GIT) is an interferon-gamma release assay (IGRA) used to diagnose latent tuberculosis infection. Limited data exists on performance of QuantiFERON-TB Gold-Plus (QFT-Plus), a next generation of IGRA that includes an additional antigen tube 2 (TB2) while excluding TB7.7 from antigen tube 1 (TB1), to measure TB specific CD4+ and CD8+ T lymphocytes responses. We compared the performance of QFT-Plus with QFT-GIT among highly TB exposed goldminers in South Africa. Methods: We enrolled HIV-negative goldminers in South Africa, ≥33 years with no prior history of TB disease or evidence of silicosis. Blood samples were collected for QFT-GIT and QFT-Plus. QFT-GIT was considered positive if TB1 tested positive; while QFT-Plus was positive if both or either TB1 or TB2 tested positive, as per manufacturer's recommendations. We compared the performance of QFT-Plus with QFT-GIT using Cohen’s Kappa. To assess the specific contribution of CD8+ T-cells, we used TB2−TB1 differential values as an indirect estimate. A cut-off value was set at 0.6. Logistic regression was used to identify factors associated with having TB2-TB1>0.6 difference on QFT-Plus. Results: Of 349 enrolled participants, 304 had QFT-Plus and QFT-GIT results: 205 (68%) were positive on both assays; 83 (27%) were negative on both assays while 16 (5%) had discordant results. Overall, there was 94.7% (288/304) agreement between QFT-Plus and QFT-GIT (Kappa = 0.87). 214 had positive QFT-Plus result, of whom 202 [94.4%, median interquartile range (IQR): 3.06 (1.31, 7.00)] were positive on TB1 and 205 [95.8%, median (IQR): 3.25 (1.53, 8.02)] were positive on TB2. A TB2-TB1>0.6 difference was observed in 16.4% (35/214), with some evidence of a difference by BMI; 14.9% (7/47), 9.8% (9/92) and 25.3% (19/75) for BMI of 18.5-24.9, 18.5-25 and >30 kg/m2, respectively (P=0.03). Conclusion: In a population of HIV-negative goldminers, QFT-Plus showed a similar performance to QFT-GIT.

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Headache in Cerebral Venous Thrombosis

Stroke ◽

10.1161/str.32.suppl_1.345-d ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 345-346

Author(s):

Erica C S de Camargo ◽

Ayrton R Massaro ◽

Luiz A Bacheschi ◽

Marcelo Calderaro ◽

Luis O S P Caboclo ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Head Movements ◽

Striking Feature ◽

Thunderclap Headache ◽

Visual Field Defects ◽

Prior History ◽

Initial Symptom ◽

Headache Onset

P37 Objectives: Although headache is the most frequent and often the earliest symptom of cerebral venous thrombosis (CVT), few studies have attempted to define its clinical features. Our aim is to describe the main characteristics of headache in CVT patients. Methods: From March 1996 to June 2000 we prospectively evaluated 39 patients. After clinical examination, diagnostic confirmation was obtained by magnetic resonance imaging and/or angiography. Information about headache was recorded on a standardized form, including location, severity, duration, quality, worsening and associated features. Results: The group included 69% females (mean age 35 years; range 8–81). Headache occurred in 35 patients (89.7%), and was the initial symptom in 84.6%. In 28.6% an isolated intracranial hypertension syndrome occurred. Among 66 % with severe headaches, 70% had multiple sinus thrombosis and 43.4% had intraparenchymal lesions. Four patients (11.4%) had a thunderclap-like headache. Headache onset was acute (< 48 hours) in 9 patients (26%), subacute (48 hours to 30 days) in 7 (20%) and chronic (> 30 days) in the remaining 54%. Headache was mostly focal (63%) and pulsatile in 48.6% patients. Pain worsened with head movements in 31.4% of patients, physical activity in 23% and coughing or sneezing in 20%. The most striking feature was the presence of focal signs (aphasia, motor and sensory deficits and visual field defects) in 74% of patients. In 11 of the 23 patients with severe headache, mean initial CSF pressure was 37.6 cmH2O and in those with thunderclap headache it was 51.7 cmH2O. Prior history of headache was present in 17 of CVT patients (48.6%). Conclusions: Headache was a frequent symptom, usually severe and focal at onset in our CVT patients. The severity of headache seems to be associated with initial CSF pressures, however, a clear relationship with intraparenchymal lesions was not observed. A striking feature was the association of headache and other neurological abnormalities. Thunderclap headache is seldom considered in patients with CVT. Prior headache was frequent and may contribute to diagnostic delays. The recognition of headache characteristics may help earlier identification of CVT patients in the emergency room.

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Clinical features, predisposing factors and radiological study of cerebral venous sinus thrombosis: experience from a tertiary care center in Southern India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172981 ◽

2017 ◽

Vol 5 (7) ◽

pp. 3023 ◽

Cited By ~ 1

Author(s):

Aneesh T. ◽

Hemamalini Gururaj ◽

Arpitha J. S. ◽

Anusha Rao ◽

Vaishnavi Chakravarthy ◽

...

Keyword(s):

Venous Thrombosis ◽

Clinical Features ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Tertiary Care ◽

Disease Process ◽

Predisposing Factors ◽

Wide Range ◽

History Of ◽

Study Population

Background: Cerebral venous thrombosis (CVT) is a less common cause of stroke with a wide range of clinical presentations, predisposing factors, radiological features and outcomes. A high index of suspicion is absolutely essential to diagnose cerebral venous thrombosis. In this article, we have reviewed the clinical spectrum and radiological profile of patients with cerebral venous thrombosis and attempted to identify the specific predisposing factors for developing cerebral venous thrombosis particularly in this region of India.Methods: 116 patients hospitalized from January 2015 to March 2017 with a final diagnosis of Cerebral Venous Thrombosis which was confirmed by imaging (MRI/MRV or CT angiography) were included. Patients who were initially diagnosed as CVT but imaging were not suggestive of the same were excluded.Results: The mean age of the study population was 35.21 years, with most patients aged between 21-30 years. 18.1% of the study population were puerperal women, much lower than earlier series. 54.54% of the men had a significant history of alcohol consumption and 10.34% of the non-puerperal women revealed a history of consuming oral contraceptive pills. Among men, seizures were the most common presenting symptom followed by headache. Women presented with headache followed by vomiting. Superior sagittal sinus, transverse sinus, cortical veins and sigmoid sinus involvement were quite common in comparison to the other sinuses.Conclusions: Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term sequelae. In this article, we have reviewed the epidemiology, causative factors, clinical features and as well as radiological pattern of CVT from an Indian perspective. Over the last decade, a relatively high incidence of CVT in fairly young individuals warrants further evaluation towards genetic predisposition for pro-thrombotic states particularly in this region of India.

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