Isolated headache and its association with characteristics and outcome of cerebral venous sinus thrombosis

We aimed to evaluate the clinical characteristics and outcome, hospital stay, and intracranial hemorrhage (ICH) development of patients with cerebral venous sinus thrombosis (CVST) who presented with isolated headache. In a retrospective study, consecutive patients with a definite diagnosis of CVST referred to Namazi hospital (Shiraz University of Medical Sciences) from 2012 to 2016 were included. Clinical, radiological, and prognostic characteristics and outcome on discharge (using modified Rankin Scale (mRS)) were compared between the CVST patients who presented with isolated headache and other CVST patients through univariate analyses. The associations of isolated headache with poor outcome (mRS > 2), presence or development of ICH, and duration of hospital stay were assessed through multivariable analyses. Of the 174 patients, 45 (26.0%) presented with isolated headache. Presence of isolated headache was more frequent in men ( p value = 0.048) and patients with thrombophilia ( p value = 0.040). Lateral sinus involvement was more common in patients with isolated headache ( p value = 0.005). After adjustment for other variables, the isolated headache was significantly associated with shorter hospital stay (odds ratio (OR): 0.85, confidence interval (CI): 0.73–0.99) and lower risk of early ICH (OR: 0.314, CI: 0.132–0.749). Although poor outcome was significantly less frequent in patients with isolated headache on univariate analysis ( p value < 0.001), this association was not significant in multivariable analysis (OR: 0.324, CI: 0.035–2.985). CVST patients with isolated headache had lower ICH events and shorter hospital stay. CVST should be considered as a possible differential diagnosis in certain patients who present only with headache, particularly those with diffuse progressive headache, or underlying provocative conditions.

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The role of decompressive craniectomy in cerebral venous sinus thrombosis

Journal of Neurosurgery ◽

10.3171/2012.6.jns11102 ◽

2012 ◽

Vol 117 (4) ◽

pp. 738-744 ◽

Cited By ~ 28

Author(s):

Thanga Thirupathi Rajan Vivakaran ◽

Dwarakanath Srinivas ◽

Girish Baburao Kulkarni ◽

Sampath Somanna

Keyword(s):

Decompressive Craniectomy ◽

Sinus Thrombosis ◽

Univariate Analysis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Self Report ◽

Venous Sinus Thrombosis ◽

Poor Outcome ◽

Gcs Score

Object Studies on the role of decompressive craniectomy for cerebral venous sinus thrombosis (CVST) in the literature are scanty. Randomized trials face a lot of drawbacks, including ethical issues. In this article the authors discuss their experience with this procedure for CVST and review the available literature. Methods This study was a retrospective analysis of all patients who underwent decompressive craniectomy for CVST between August 2006 and June 2008 at the National Institute of Mental Health and Neurosciences. The cases were evaluated for demographic and clinicoradiological features, operative findings, and outcome of surgery. Ethical clearance was obtained from the institutional ethics committee. The data for each patient were obtained from the database of the department. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire. The Glasgow Outcome Scale (GOS) and the Rankin Disability Scale were used to assess the outcome. Results A total of 34 patients (13 men and 21 women) were included; their mean age was 31.6 years, with a range from 18 to 65 years. In univariate analysis, the Glasgow Coma Scale (GCS) score prior to surgery and that in the immediate postoperative period had a statistically significant correlation with poor outcome. The GCS score immediately postoperatively was the only independent, significant predictor of poor outcome on multivariate analysis. Conclusions Decompressive craniectomy in a selected cohort of patients had a good outcome in a majority of the patients: 26 of 34 in this study had a GOS score of 4 or 5. In this series, which is the largest in the available literature, the authors review their experience and recommend usage of this procedure in selected patients.

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Abstract TMP18: Heparin Resistance is an Independent Predictor of Poor outcome in Cerebral Venous Sinus Thrombosis

Stroke ◽

10.1161/str.49.suppl_1.tmp18 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Nazan Aksan ◽

Edgar Samaniego ◽

Amir Shaban ◽

Fazeel Siddiqui ◽

Biyue Dai ◽

...

Keyword(s):

Independent Predictor ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Poor Outcome ◽

Heparin Resistance

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Stenting of symptomatic lateral sinus thrombosis refractory to mechanical thrombectomy

Interventional Neuroradiology ◽

10.1177/1591019919852168 ◽

2019 ◽

Vol 25 (6) ◽

pp. 714-720

Author(s):

Guangdong Lu ◽

Jae Ho Shin ◽

Yunsun Song ◽

Deok Hee Lee

Keyword(s):

Mechanical Thrombectomy ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Lateral Sinus ◽

Variable Degree ◽

Venous Sinus Thrombosis ◽

Lateral Sinus Thrombosis ◽

Antiplatelet Medication ◽

Endovascular Mechanical Thrombectomy

Objective Endovascular mechanical thrombectomy for the treatment of cerebral venous sinus thrombosis is not always successful. We present our experience of using self-expanding stents to facilitate effective recanalization of persistent lateral sinus thrombosis refractory to endovascular mechanical thrombectomy. Methods Data from patients who underwent endovascular mechanical thrombectomy for the treatment of acute symptomatic cerebral venous sinus thrombosis between August 2015 and July 2018 were evaluated. Patient demographics, procedural techniques, devices used and follow-up outcomes were assessed. Results A total of 14 patients underwent endovascular mechanical thrombectomy during the study period. Of these, stenting of the occluded sinus was performed in five patients with extensive sinus thrombosis after conventional endovascular mechanical thrombectomy. Three of the five patients had a variable degree of venous infarction and/or hemorrhage before treatment. The target lesion was located in the right lateral sinus in all five patients. Due to the length of the involved sinus, two stents were required in one patient and three stents in two patients. The only procedure-related complication was an asymptomatic tearing of the sinus wall in one patient. Stent patency could not be maintained in two patients due to stent buckling within the jugular foramen segment and an inability to maintain antiplatelet medication. Modified Rankin Scale scores at 2–16 months were zero in two patients, one in two patients, and five in one patient. Conclusions Stenting for the thrombotic occlusion of the lateral sinus is a feasible rescue method to overcome unsuccessful endovascular mechanical thrombectomy. However, currently available stenting systems may be unsuitable for use in the intracranial dural sinus system.

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Lateral venous sinus thrombosis associated with MRI abnormalities in the mastoid air sinus.

Stroke ◽

10.1161/str.32.suppl_1.347-a ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 347-347

Author(s):

John N Fink ◽

David L McAuley

Keyword(s):

Venous Thrombosis ◽

Clinical Evidence ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Additional Treatment ◽

Venous Sinus ◽

Lateral Sinus ◽

Venous Sinus Thrombosis ◽

Lateral Sinus Thrombosis ◽

Clinical Records

P45 Background: Lateral venous sinus thrombosis can be associated with mastoiditis. We encountered several cases of lateral sinus thrombosis associated with MRI abnormalities in the ipsilateral mastoid air sinus that had no clinical evidence of mastoiditis. The relationship between lateral sinus thrombosis and mastoid abnormalities was evaluated systematically. Method: The clinical records and radiology of all adult cases of cerebral venous sinus thrombosis (CVT) diagnosed or treated at Auckland Hospital 1990–1999 were reviewed retrospectively. Results: Twenty-six cases of CVT were identified. Thrombosis was present in 23 lateral sinuses in 20 cases. Mastoid abnormalities were detected ipsilateral to nine of 23 thrombosed lateral sinuses (39%) and were associated with none of 29 unaffected lateral sinuses (p<0.001). Clinical evidence of mastoiditis was not present in any case. One case with mastoid abnormality and lateral sinus thrombosis received antibiotics; eight did not. All made uneventful recoveries. Reversal of the MRI abnormality after anticoagulation but without antibiotic treatment was demonstrated. Conclusion: Lateral venous sinus thrombosis is commonly associated with ipsilateral MRI abnormalities in the mastoid air sinus. These abnormalities are most likely to be due to venous congestion as a consequence of venous thrombosis and do not inevitably represent infective mastoiditis. Patients presenting with lateral sinus thrombosis and mastoid congestion should have a thorough clinical assessment for the presence of mastoiditis. When there is no clinical evidence of infection, treatment should be directed at the underlying cerebral venous thrombosis; additional treatment with antibiotics is not required.

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Lower lymphocyte to monocyte ratio is a potential predictor of poor outcome in patients with cerebral venous sinus thrombosis

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000180 ◽

2018 ◽

Vol 4 (3) ◽

pp. 148-153 ◽

Cited By ~ 1

Author(s):

Shen Li ◽

Kai Liu ◽

Rui Zhang ◽

Yuan Gao ◽

Hui Fang ◽

...

Keyword(s):

Poor Prognosis ◽

Cox Regression ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Poor Outcome ◽

Lymphocyte To Monocyte Ratio ◽

The Poor ◽

The Relationship

BackgroundLymphocyte to monocyte ratio (LMR) is associated with functional outcome in patients with stroke. But the relationship between the LMR value and the prognosis of cerebral venous sinus thrombosis (CVST) has not been investigated.MethodsCVST patients, admitted to the First Affiliated Hospital of Zhengzhou University, were retrospectively identified from November 2010 to January 2017. Functional outcomes of patients were evaluated with the modified Rankin Scale (mRS). Patients were divided into good (mRS 0–2) and poor (mRS 3–6) outcomes groups. Univariate and multivariate Cox regression analyses were used to assess the relationship between LMR and the poor survival outcome.ResultsA total of 228 patients were included of which 41 had poor outcomes (18.0%). The duration of follow-up was 22 months (6–66 months). LMR (2.3±1.2 vs 3.2±1.8, p<0.01) was significantly lower in the poor outcome group. Multivariate Cox regression analysis showed that LMR (HR 0.726, 95% CI 0.546 to 0.964, p=0.027) was a independent predictor of poor prognosis.ConclusionsLMR may be a predictor of poor prognosis in CVST patients.

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Cerebral venous sinus thrombosis due to external compression of internal jugular vein

Journal of International Medical Research ◽

10.1177/03000605211006609 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110066

Author(s):

Jingwei Guan ◽

Siying Song ◽

Wei Wang ◽

Xunming Ji ◽

Ran Meng

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Coagulation System ◽

Lateral Sinus ◽

External Compression ◽

Jugular Veins ◽

Venous Sinus Thrombosis ◽

Internal Jugular Veins

Cerebral venous sinus thrombosis (CVST) is a special subtype of stroke that may be life-threatening in severe cases. CVST has distinct risk factors and is frequently overlooked because of its initially nonspecific clinical presentation. We herein describe a 72-year-old man who developed CVST in the right lateral sinus. Despite the absence of common risk factors in this patient, he developed external compression of the bilateral internal jugular veins by a lateral mass of the C1 vertebra and expansion of the carotid artery. Because of his elevated D-dimer and fibrinogen concentrations, which are associated with ongoing activation of the coagulation system, the patient underwent treatment with batroxobin combined with anticoagulation. Recanalization of the sinus was achieved, and his high intracranial pressure and papilledema remarkably decreased. We conclude that external compression of the internal jugular veins, which can be identified with three-dimensional computed tomography venography, may be an important risk factor for CVST.

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