Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants

2021 ◽  
pp. 197140092110269
Author(s):  
Dale F Vaslow
Keyword(s):  
Sinus Thrombosis ◽  
Retinal Hemorrhage ◽  
Evidence Base ◽  
Venous Sinus ◽  
Subdural Hemorrhage ◽  
Minor Trauma ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis

For infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the “consensus” opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis and cortical vein thrombosis is a false mimic. This article contends that this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury and is the result of a poor radiologic evidence base and misinterpreted data. Underdiagnosis of thrombosis is the result of rapid clot dissolution and radiologic under recognition. A pre-existing/chronic subdural hemorrhage predisposes to development of venous sinus thrombosis/cortical vein thrombosis, triggered by minor trauma or an acute life-threatening event such as dysphagic choking, variably leading to retinal and subdural hemorrhages and neurologic decline. These conclusions are based on analysis of the neuroradiologic imaging findings in 11 infants, all featuring undiagnosed cortical vein or venous sinus thrombosis. Subtle neuroradiologic signs of and the mechanisms of thrombosis are discussed. Subarachnoid hemorrhage from leaking thrombosed cortical veins may be confused with acute subdural hemorrhage and probably contributes to the development of retinal hemorrhage ala Terson’s syndrome. Chronic subdural hemorrhage rebleeding from minor trauma likely occurs more readily than bleeding from traumatic bridging vein rupture. Radiologists must meet the challenge of stringent evaluation of neuro imaging studies; any infant with a pre-existing subdural hemorrhage presenting with neurologic decline must be assumed to have venous sinus or cortical vein thrombosis until proven otherwise.

Headache in cerebral venous sinus thrombosis revisited: Exploring the role of vascular congestion and cortical vein thrombosis

Cephalalgia ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 503-510 ◽  
Author(s):  
Ravinder-Jeet Singh ◽  
Jitender Saini ◽  
Shriram Varadharajan ◽  
Girish Baburao Kulkarni ◽  
Mustare Veerendrakumar
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
Vascular Congestion

Background and purpose Headache constitutes the most common symptom of cerebral venous sinus thrombosis (CVST), but its pathophysiology is unclear. We sought to investigate the potential mechanism for headache genesis in patients with CVST based on its imaging correlates. Methods A subgroup of CVST patients having headache as the predominant symptom without significant parenchymal lesion were retrospectively analysed for imaging features of vascular congestion (VC), in addition to cortical venous (CVT) and dural sinus thrombosis (DST) on magnetic resonance imaging. Headache and imaging patterns were classified into lateralized and nonlateralized phenotypes and their correlation was sought. Results Among 41 patients included, 28 had lateralized headache (LH group; 15 males; mean age 32.25 ± 9.19 years) while 13 had nonlateralized headache (non-LH group; six males; mean age 27.15 ± 8.65 years). Headache characteristics in both the groups were quite similar. Imaging showed VC in 39 of 41 and CVT among 35 of 41 patients, which were lateralized in 23 of 39 and 18 of 35 patients, respectively. Nearly all lateralized imaging patterns (21 of 23 for VC and 17 of 18 for CVT) occurred in the LH group and ipsilateral to (concordant) headache, while the non-LH group showed lateralized VC and CVT in only two and one patient respectively. Sinus thrombosis was lateralized in both groups irrespective of headache laterality. Whole cohort headache-imaging laterality (including patients with nonlateralized headache and nonlateralized imaging) concordance was 31 of 39, 24 of 35 and 18 of 41 for vascular congestion, cortical vein thrombosis and dural sinus thrombosis respectively. Conclusion Co-localization of VC and CVT with overlying headache might provide a possible explanation of headache and its laterality in patients with CVST.

scholarly journals Prophylactic lumboperitoneal shunt in cases of cerebral venous sinus thrombosis with papilledema

2021 ◽  
Vol 8 (7) ◽  
pp. 2104
Author(s):  
Deepak Ranade ◽  
Bhagirath More ◽  
Dushyant Kashyap ◽  
Vybhav Raghu ◽  
Shobhit Chhabra
Keyword(s):  
Complete Resolution ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Shunt Insertion ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Sagittal Sinus ◽  
Cortical Vein Thrombosis

Background: Although the mainstay of cerebral venous sinus thrombosis treatment is medical, rarely surgical intervention is warranted. We aimed to determine the role of prophylactic lumbo-peritoneal (LP) shunt in cases of CVST with papilledema.Methods: This is a retrospective review of 70 cases of CVST managed between November 2019 to April 2020. Indications for surgical management included poor response to medical management and severe vision impairment.Results: The mean age of the patients included in the study was 39.44±4.76 years. The most common presenting complaint was headache (83%) and nausea/vomiting (69%). On examination, the common findings were papilledema (57%), blurred vision (31%), double vision (21%) and hemiparesis (11%). Two cases had sudden loss of vision, who underwent emergency LP shunt surgery. Of the 40 cases with papilledema, 8 had severe papilledema. Based on MRI venography, transverse sinus was involved in half of all patients, superior sagittal sinus was involved in 29% and 21% had both the sinuses involved, while 7% had cortical vein thrombosis. Anticoagulants was the first line of therapy for the patients. Papilledema was present in 40 cases, of which 10 showed complete resolution of symptoms, 15 cases had reduced severity of symptoms and symptoms persisted in rest of the 15 cases. The 10 cases who had complete resolution of symptoms included two patients who underwent LP shunt. There were no deaths.Conclusions: We recommend that a LP shunt insertion in a patient with severe papilledema with superior sagittal sinus thrombosis can prevent disease progress, preserve vision and facilitate re-canalisation.

Cortical Vein Thrombosis in a Case of Clinically Isolated Syndrome and Psoriasis—A Case Report and Review of Literature

2021 ◽  
pp. 251660852199857
Author(s):  
Jagadish B. Agadi ◽  
Lakshminarayanapuram Gopal Viswanathan ◽  
Sujit Kumar ◽  
Manithody Narayan-Bhat Pramod
Keyword(s):  
Sinus Thrombosis ◽  
Clinically Isolated Syndrome ◽  
Severe Headache ◽  
Review Of Literature ◽  
Rare Finding ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Multiple Factors ◽  
Cortical Vein Thrombosis

Cortical vein/venous sinus thrombosis (CVT) occurring in the context of a clinically isolated syndrome (CIS) is highly unusual. Our patient presented with dorsal cord demyelination and psoriasis. She developed severe headache post-lumbar puncture, which was followed by focal seizures. She had developed CVT with a hemorrhagic infarct in the left parietal region. Multiple factors, both patient related and as a consequence of treatment and management, may have contributed to this outcome. We aim to discuss the relevance of this rare finding with a brief review of literature.

scholarly journals Diagnosis and Management of Lemierre’s Syndrome Presented with Multifocal Pneumonia and Cerebral Venous Sinus Thrombosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yasar Sattar ◽  
Ammu Thampi Susheela ◽  
Bibek Karki ◽  
Adnan Liaqat ◽  
Waqas Ullah ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Fusobacterium Nucleatum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Jugular Vein Thrombosis ◽  
Lemierre Syndrome ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Cerebral Sinus Venous Thrombosis ◽  
Magnetic Resonance Imaging Mri

A 27-year-old female patient initially presented with fever, myalgia, sore throat that progressed to multifocal pneumonia, and cerebral sinus venous thrombosis. A combination of upper respiratory symptoms with tooth infection, positive blood culture for Fusobacterium nucleatum, computed tomography (CT) chest finding of multifocal pneumonia, and magnetic resonance imaging (MRI) finding of internal jugular vein thrombosis (IJVT) and cerebral venous sinus thrombosis (CVST) suggested Lemierre syndrome. The patient was managed with fluids, antibiotics, and anticoagulants. The patient survived and discharged from the hospital. The patient’s symptoms improved at 2 months of follow-up.

Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: computed tomography and magnetic resonance findings

2000 ◽  
Vol 114 (10) ◽  
pp. 798-801 ◽  
Author(s):  
Maria F. López-Peláez ◽  
José M. Millán ◽  
Joaquin de Vergas
Keyword(s):  
Sinus Thrombosis ◽  
Major Complication ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Jugular Vein Thrombosis ◽  
Cervical Mass ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Sagittal Sinus ◽  
Common Causes

Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5–30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.

Bilateral renal vein thrombosis and venous sinus thrombosis in a neonate with factor V mutation (FV Leiden)

1998 ◽  
Vol 132 (1) ◽  
pp. 159-161 ◽  
Author(s):  
Martin Pohl ◽  
Lothar B. Zimmerhackl ◽  
Florian Heinen ◽  
Anton H. Sutor ◽  
Reinhard Schneppenheim ◽  
...  
Keyword(s):  
Renal Vein ◽  
Sinus Thrombosis ◽  
Renal Vein Thrombosis ◽  
Venous Sinus ◽  
Factor V ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Fv Leiden

scholarly journals Superior Ophthalmic Vein Thrombosis with Cerebral Venous Sinus Thrombosis: A Rare Entity in a Child

2019 ◽  
Vol 9 (2) ◽  
pp. 127-132
Author(s):  
Kanij Fatema ◽  
Muhammad Mizanur Rahman ◽  
Laila Areju Man Banu
Keyword(s):  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
High Dose ◽  
Partial Recovery ◽  
Superior Ophthalmic Vein ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Methyl Prednisolone

Cerebral venous sinus thrombosis (CVST) is a rare stroke-like syndrome. Sometimes it may be rarely associated with ophthalmic vein occlusion. We present a 10-year-old girl who had severe headache, diplopia, severe congestion of eye, proptosis and orbital pain. She had no signs of meninigeal irritation, no focal deficit except left sided lateral rectus palsy and altered visual acuity. Investigations regarding vasculitis and thrombophillia were normal except thrombocytosis. MRI of brain showed ‘dense triangle sign’ and thickened superior ophthalmic vein. Magnetic resonance venography (MRV) showed occlusion of superior sagital sinus and transverse sinus. She was treated with paracetamol, acetazolamide, rivaroxaban and antibiotics followed by high dose pulse methyl prednisolone. She made a partial recovery within one week and at 3 months follow-up she was completely normal. J Enam Med Col 2019; 9(2): 127-132

Cerebral Venous Sinus Thrombosis due to Thrombosis with Thrombocytopenia Syndrome Following Ad26.COV2.S: A First Real-World Case Report of a Male Subject

2021 ◽  
pp. 194187442110550
Author(s):  
Samia Asif ◽  
Meghana Kesireddy ◽  
Scott A. Koepsell ◽  
Marco A. Gonzalez-Castellon ◽  
Krishna Gundabolu ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Young Male ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
First Case ◽  
Control And Prevention ◽  
Underlying Pathophysiology

Thrombosis with Thrombocytopenia Syndrome (TTS) or Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) had been reported in patients receiving the Ad26.COV2.S vaccination (Johnson & Johnson [J&J]/Janssen) vaccine. They frequently presented with cerebral venous sinus thrombosis (CVST), but venous or arterial thrombosis at other locations can be present. The majority of those affected are younger adult females. Therefore, after a brief pause from April 13–23, 2021, the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) recommended caution in using this vaccine in females under 50 years. Based on the reported 28 cases of TTS after this vaccination (data till April 21, 2021) by CDC, 22 were females (78%), and 6 were male. None of those males had CVST but had thrombosis at other locations. We report the first case of a young male with TTS and CVST following Ad26.COV2.S vaccine presented with severe headache and diagnosed with acute right transverse and sigmoid cerebral venous sinus thrombosis, multiple right-sided pulmonary emboli, and right hepatic vein thrombosis. He was treated with parenteral anticoagulation with argatroban and intravenous immune globulin with the improvement of his symptoms. A heparin-induced thrombocytopenia with thrombosis (HITT) like syndrome caused by the genesis of a platelet-activating autoantibody against platelet factor 4 (PF4) triggered by adenoviral vector-based COVID-19 vaccinations is understood to be the underlying pathophysiology. TTS with CVST should be considered when patients present with headaches, stroke-like neurological symptoms, thrombocytopenia, and symptom onset 6–15 days after Ad26.COV2.S vaccination.

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