scholarly journals Hyperthyroidism: A Rare Cause of Cerebral Venous Thrombosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A935-A936
Author(s):  
Joseph Arguinchona ◽  
Anusha Pinjala ◽  
Andrea George
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Factor Ix ◽  
Dural Sinus ◽  
Caucasian Woman ◽  
Thyroid Peroxidase ◽  
Graves Disease ◽  
Normal Range ◽  
Increased Risk

Abstract Background: Cerebral venous thrombosis (CVT) accounts for <1% of strokes. In most cases, there is a predisposition to hypercoagulability; however, in about 30% of cases there is no identifiable etiology. Risk factors include pregnancy, puerperium, oral contraceptives, and coagulopathies and rarely hyperthyroidism. To the best of our knowledge there is no reported cases of CVT in uncontrolled hyperthyroidism with no underlying hypercoagulable disorder. We present a case where a woman developed CVT in the setting of uncontrolled hyperthyroidism. Clinical Case: A 24 year-old Caucasian woman was diagnosed with hyperthyroidism during 1st trimester of pregnancy based labs and was treated with propylthiouracil (PTU) 150 mg bid. At 34 weeks of pregnancy her FT4 normalized and PTU was discontinued. Three and half months post-partum she presented with left frontal headache, photophobia, phonophobia and transient visual loss on the right. Physical exam revealed right homonymous hemianopia without meningismus and an enlarged thyroid. Vitals showed BP 108/57 mm of Hg, HR 162 beats/min, RR of 23/min. CT head without contrast showed 8 mm focal hyperdensity along the left tentorium projecting at the left occipital lobe. She developed seizures after admission. MRI brain with and without contrast showed diffusely small left transverse and sigmoid sinus with a focal area of dural sinus thrombosis. MRI venogram of head confirmed CVT. She was started on levetiracetam and low dose heparin drip. Further workup showed: TSH <0.005 UIU/ml with FT4>8 ng/dl, TSH receptor antibodies 11.10 (normal range 0.00 - 1.75 IU/L), thyroid peroxidase antibody >1300 (normal range <=59 u/ml), and thyroid stimulating antibodies 6.85 (0.00 - 0.55 IU/L) suggestive of Graves disease. She was initiated on PTU 200 mg Q8hrs, propranolol 80 mg Q8hrs and lugol’s iodine 5 drops Q8hrs. Hypercoagulable workup except for protein C and S returned unremarkable. Over the next several days, thyroid levels improved significantly. She was discharged home on warfarin and methimazole. Conclusion: The exact pathophysiology of CVT in hyperthyroidism remains unclear. Some proposed mechanisms include increased activity of pro coagulative plasma constituents including Von Willebrands Factor, Factor IX, X, antithrombin, and fibrinogen as well as an increased aPTT and a decrease in thrombolytic factors like t-PA. These changes result in an increased risk of thrombosis. This case demonstrates the potential development of CVT as a result of untreated overt hyperthyroidism. It highlights the importance of treatment and close follow up of Graves’ disease to prevent severe complications. Further studies need to be done to understand the process of coagulation in hyperthyroidism and this could allow clinicians to better identify hyperthyroid patients at risk for clotting.

scholarly journals Cerebral venous thrombosis secondary to an occult maxillary sinusitis in a young male from sub-Saharan Africa

2019 ◽  
pp. 08-12
Author(s):  
Mazou N Temgoua ◽  
Mickael Essouma ◽  
Larry N Tangie ◽  
Cedric Tsinda ◽  
Drusille Feze Foko ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Acute Stroke ◽  
Cerebral Venous Thrombosis ◽  
Fungal Infections ◽  
Sinus Thrombosis ◽  
Maxillary Sinusitis ◽  
Case Reports ◽  
Sub Saharan Africa ◽  
First Case ◽  
Increased Risk

Cerebral venous thrombosis (CVT) also termed cerebral venous sinus thrombosis (CVST), is a special type of cerebrovascular disease characterized by cerebral venous infarction [1]. As from 1825 when the first case was described by Ribes[2], epidemiological descriptions are still restricted to case reports and small retrospective cross-sectional studies yielding low butincreasing incidence: <10 cases per million per year in 1995 to about 13.2 cases per million per year in 2012.CVT mainly occurs in women of child bearing age, probably owing to the use of oral contraceptive pills, and mostly has an acute or subacute course [1]. It can be categorized as primary/idiopathicand secondary. Secondary CVT can further be classified into infective (mainly due to bacterial or fungal infections) and non-infective CVT; the latterbeing due tocoagulation disorders, neoplasms, procoagulant hemodynamic states, vascularitis,homocystinuria, or head trauma [3].With the advent of antibiotics, the epidemiology of CVT has shifted from predominant infective CVT to predominant non-infective CVT, leading to increased risk of misdiagnosis and delayed treatment [3]. We report occult purulent maxillary sinusitis-related CVT in a male Cameroonian patient who presented with headaches, seizures and acute stroke syndrome. The aim of this paper is to reiterate CVT as the main cause of acute stroke syndrome in young adults irrespective of ethnic origin and sex, and suggest systematic screening of infections in those patients, especially in regions with high rates of infections likesub-Saharan Africa.We describe this case with regard to CARE guidelines.

scholarly journals Dural Arteriovenous Fistulae After Cerebral Venous Thrombosis

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3344-3347
Author(s):  
José M. Ferro ◽  
Jonathan M. Coutinho ◽  
Olav Jansen ◽  
Martin Bendszus ◽  
Francesco Dentali ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Mr Angiography ◽  
Sinus Thrombosis ◽  
Controlled Trial ◽  
Dabigatran Etexilate ◽  
Dural Sinus ◽  
Arteriovenous Fistulae ◽  
3 Dimensional

Background and Purpose: This analysis examined the frequency of dural arteriovenous fistulae (dAVF) after cerebral venous thrombosis (CVT) in patients included in a randomized controlled trial comparing dabigatran etexilate with dose-adjusted warfarin (RE-SPECT CVT [A Clinical Trial Comparing Efficacy and Safety of Dabigatran Etexilate With Warfarin in Patients With Cerebral Venous and Dural Sinus Thrombosis]), who had systematic follow-up magnetic resonance (MR) imaging. Methods: RE-SPECT CVT was a Phase 3, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded end point adjudication. We allocated patients with acute CVT to dabigatran 150 mg twice daily or dose-adjusted warfarin, for 24 weeks and obtained a standardized MR protocol including time-of-flight MR angiography, 3-dimensional phase-contrast venography, and 3-dimensional contrast-enhanced MR venography at the end of the treatment period. A blinded adjudication committee assessed the presence of dAVF in a predefined substudy of the trial. Results: We analyzed development of dAVF in 112 of 120 randomized patients; 57 allocated to dabigatran and 55 to warfarin. For 3 (2.7%) of these 112 patients, quality of follow-up imaging was insufficient to evaluate dAVF. A dAVF (Borden I) was found in 1 patient (0.9%) allocated to warfarin; however, this dAVF was already present at baseline. The patient did not present with hemorrhage at baseline or during the trial and was asymptomatic at follow-up. Conclusions: Despite systematic imaging, we found no new dAVF 6 months after CVT. Routine follow-up cerebral MR angiography aiming to detect new dAVF 6 months after CVT has a very low yield. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02913326.

scholarly journals Successful Intravascular Ultrasound Thrombolysis of Dural Sinus Thrombosis with Pre-Existing Subarachnoid and Intraparenchymal Hemorrhages

2010 ◽  
Vol 16 (4) ◽  
pp. 455-458 ◽  
Author(s):  
M.E. Atherton ◽  
W.C. Culp ◽  
A.T. Brown ◽  
E. Erdem
Keyword(s):  
Venous Thrombosis ◽  
Intravascular Ultrasound ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Direct Infusion ◽  
Tissue Plasminogen ◽  
Thrombolytic Effect ◽  
Subarachnoid Hemorrhages

A case of cerebral venous thrombosis with intraparenchymal and subarachnoid hemorrhages was initially treated unsuccessfully with mechanical and pharmacologic thrombolysis using intrathrombus tissue plasminogen activator (tPA) and angioplasty, and later successfully treated with an intravascular ultrasound tPA infusion catheter. This new microcatheter allowed direct infusion of tPA while using local therapeutic intravascular ultrasound to increase the thrombolytic effect. Flow was quickly restored. Our patient recovered from coma to discharge home without worsening of existing hemorrhages.

Scrub typhus with cerebral venous sinus thrombosis: a rare presentation

2021 ◽  
Vol 14 (4) ◽  
pp. e241401
Author(s):  
Sayonee Das ◽  
Sidhartha Chattopadhyay ◽  
Kausik Munsi ◽  
Sagar Basu
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Scrub Typhus ◽  
Sinus Thrombosis ◽  
Hormonal Contraception ◽  
Neurological Involvement ◽  
Rare Presentation ◽  
Specific Test ◽  
Satisfactory Outcome ◽  
The Brain

This is a rare presentation of scrub typhus with cerebral venous thrombosis. A 32-year-old woman presented with signs of raised intracranial tension. Examination revealed maculopapular skin rashes and an ‘eschar’ over the right thigh. Nuchal rigidity and bilateral papilloedema were found. Scrub typhus was diagnosed by the presence of IgM antibody in serum. CT scan of the brain showed cerebral oedema. MRI of the brain was normal. Magnetic resonance venography of the brain showed thrombosis of several venous sinuses. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with raised protein level. Other causes of prothrombotic states were ruled out by doing specific test results. There was no history of hormonal contraception and prolonged bed rest. A case of scrub typhus complicated with meningoencephalitis and cerebral venous thrombosis was diagnosed. She responded to treatment with doxycycline, anticoagulants, antipyrectics and intravenous saline. Early identification of such atypical neurological involvement in scrub typhus was helpful in satisfactory outcome.

scholarly journals Cerebral venous thrombosis and Covid 19: Literature review

2021 ◽  
Vol 11 (2) ◽  
pp. 57-68
Author(s):  
Carlos Alexandre Martins Zicarelli ◽  
Jonathan Vinicius Martins ◽  
Wesley Vieira Doni ◽  
Rafael Rodrigues Pinheiro dos Santos ◽  
Ana Carla Mondek Rampazzo ◽  
...  
Keyword(s):  
Literature Review ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Risk Of Death ◽  
Cranial Sinus Thrombosis ◽  
Stent Retrievers ◽  
Low Incidence

Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

Bilateral Blood Reflux Into Schlemm Canals Caused by a Unilateral Dural Sinus Arteriovenous Fistula in a Patient With Cerebral Venous Thrombosis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tung Thanh Hoang ◽  
Hoa Dung Do ◽  
Ha Thai Do ◽  
Cuong Ngoc Nguyen ◽  
Wallace L.M. Alward
Keyword(s):  
Venous Thrombosis ◽  
Arteriovenous Fistula ◽  
Cerebral Venous Thrombosis ◽  
Dural Sinus

scholarly journals Risk factors and diagnosis of cerebral venous thrombosis: Data from a cohort of 45 Romanian patients

2014 ◽  
Vol 60 (5) ◽  
pp. 207-214
Author(s):  
Rodica Bălaşa ◽  
M Daboczi ◽  
Oana Costache ◽  
Smaranda Maier ◽  
Z Bajko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Brain Imaging ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Demographic Data ◽  
Brain Mri ◽  
Clinical Aspects ◽  
Initial Symptom ◽  
Clinical Criteria

Abstract Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment. Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT. Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied. Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment. Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

The Performance of CT versus MRI in the Differential Diagnosis of Cerebral Venous Thrombosis

2018 ◽  
Vol 118 (06) ◽  
pp. 1067-1077 ◽  
Author(s):  
Weilin Xu ◽  
Liansheng Gao ◽  
Tao Li ◽  
Neha Ramdoyal ◽  
Jianmin Zhang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Significant Heterogeneity ◽  
Summary Receiver Operating Characteristic ◽  
Ct And Mri

Background Cerebral venous thrombosis (CVT) is a rare disease, and with poor prognosis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used image modalities for patients with non-specific neurologic symptoms. We present here a meta-analysis to assess the accuracy of CT and MRI in the differential diagnosis of CVT and cerebral venous sinus thrombosis (CVST). Materials and Methods A comprehensive search of the PubMed, EMBASE, Web of Science, Cochrane Database and Chinese Biomedical (CBM) databases was conducted prior to March 20, 2017. In this report, we assess the methodological quality of each article individually and perform a meta-analysis to obtain the summary of the diagnostic accuracy of CT and MRI in correctly identifying CVT and CVST. Results Twenty-four eligible articles comprising 48 studies (4,595 cases) were included. The pooled sensitivity for CT–CVT/CT–CVST groups is 0.79 (95% confidence interval [CI]: 0.76, 0.82)/0.81(95% CI: 0.78, 0.84), and pooled specificity is 0.90 (95% CI: 0.89, 0.91)/0.89 (0.88, 0.91), with an area under the curve (AUC) for the summary receiver operating characteristic (SROC) of 0.9314/0.9161, respectively. No significant heterogeneity and publication bias was observed across each study. For MRI–CVT/MRI–CVST, the pooled sensitivity is 0.82 (95% CI: 0.78, 0.85)/0.80 (95% CI: 0.76, 0.83), and pooled specificity is 0.92 (95% CI: 0.91, 0.94)/0.91(0.89, 0.92), with an AUC for the SROC of 0.9221/0.9273, respectively. Conclusion This meta-analysis indicates that both CT and MRI have a high level of diagnostic accuracy in the differential diagnosis of CVT and CVST, independent of stage, target for analysis or analysis methods. They could be chosen as alternative sub-optimal gold standards for diagnosing CVT and CVST, especially in emergency.

scholarly journals Cerebral venous thrombosis as a rare thromboembolic complication of celiac disease: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Maha Bouziane ◽  
Salim Arous ◽  
Rachida Habbal
Keyword(s):  
Celiac Disease ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Thromboembolic Complication ◽  
Favourable Outcome ◽  
Complete Regression ◽  
Thromboembolic Events ◽  
Cerebral Magnetic Resonance Imaging

Abstract Background  Celiac disease is a digestive inflammatory syndrome with several complications. It is associated with coagulation and platelets abnormalities leading to thromboembolic events. Cerebral venous thrombosis is an exceptional localization of thrombosis in celiac disease and could be life-threatening. Case summary  A 17-year-old female patient with history of celiac disease and not following a gluten-free diet, checked in to the emergency department for a sudden, 2-week-old, and deteriorating, onset of intense headache and muscle weakness. The cerebral computed tomography-scan showed bilateral fronto-parietal hypodensity with micro-bleeds. We investigated using a cerebral magnetic resonance imaging that revealed superior longitudinal sinus thrombosis and right transverse and sigmoid sinuses thrombosis, along with right haematoma and ischaemic areas. The patient was prescribed anticoagulation therapy. Follow-ups over a 2-year period confirmed a favourable outcome and a complete regression of symptoms. Discussion  Evolution of celiac disease could be associated with several complications. Eighty-five percent of patients is potentially exposed to thromboembolic events due to the hypercoagulability state of the disease and different coagulation and fibrinolysis abnormalities (e.g. hyperhomocysteinaemia, protein C and S deficiencies, vitamin K and B deficiencies). Cerebral venous thrombosis is a rare thromboembolic localization. Anticoagulation is efficient in most cases though endovascular treatment might be required.

scholarly journals A young woman with headache and seizures

2013 ◽  
pp. 25-29
Author(s):  
A.M. Pizzini ◽  
M. Silingardi ◽  
I. Iori
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Mr Angiography ◽  
Sinus Thrombosis ◽  
Factor V Leiden ◽  
Transverse Sinus ◽  
Acute Onset ◽  
Factor V ◽  
Neuroimaging Techniques

CASE REPORT We describe a 31 year-old woman with headache and acute onset of seizures. Medical history and physical examination were unremarkable. She has been on therapy with oral contraceptives for many years for dysmenorrhea. A CT scan was negative, but MRI and MR-angiography showed left transverse sinus thrombosis. Screening for thrombophilia revealed hyperhomocysteinemia and Factor V Leiden heterozigousity. The patient received unfractionated heparin, followed by long-term anticoagulation with warfarin (INR 2-3). CONCLUSIONS Cerebral venous thrombosis is a rare cerebrovascular disorder, frequently in young adult (about 75% are women). The diagnosis might be difficult with consequent high long-term morbidity and mortality rate. New neuroimaging techniques (MRI and MR-angiography) and more effective treatment (anticoagulation and endovascular thrombolysis) have improved the prognosis and the natural history. The risk factors, the clinical presentation, the diagnostic evaluation and the management of cerebral venous thrombosis are reviewed.

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