scholarly journals DIAGNOSIS OF VENOUS ISCHEMIC STROKE. PART I (CLINICAL POLYMORPHISM). A REVIEW ARTICLE

2019 ◽  
Vol 8 (2) ◽  
pp. 125-134
Author(s):  
S. E. Semenov ◽  
I. V. Moldavskaia ◽  
E. A. Yurkevich ◽  
M. G. Shatokhina ◽  
A. S. Semenov
Keyword(s):  
Ischemic Stroke ◽  
Sinus Thrombosis ◽  
Fold Increase ◽  
Cerebral Venous Sinus Thrombosis ◽  
Pathological Process ◽  
Arterial Ischemic Stroke ◽  
Mild Disability ◽  
Contrast Ct ◽  
Leading Symptom ◽  
Venous Stroke

Venous stroke being “relatively unknown cerebrovascular disease” occurs in 0.55% of all strokes. Specific diagnostic concerns to venous stroke and the expansion of the volume of radiologic examinations from routinely used non-contrast CT to angiographic and perfusion CT- and MRI, diffusion MRI allowed us to increase the number of diagnosed and verified venous ischemic stroke from 0.4% of all strokes treated in our center to 2.4%, resulting in a 6-fold increase within the 5-year period. Symptoms of cerebral venous sinus thrombosis depend on the size and the growth rate of thrombus. In addition, focal neurological symptoms are diverse and largely dependent on thrombus localization and safety of collateral blood flow, as well as patients’ age and severity of cerebral edema. Cerebral symptoms are nonspecific and may occur in varying degrees of severity related to the localization of the pathological process. The routinely used assessment scales such as the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, Rankin Scale do not reliably identify this type of acute ischemic stroke. The leading symptom is headache with the mean visual analogue scale of 7.3±1.6. The tendency towards a less pronounced neurologic deficit at admission and mild disability status at discharge have been found among patients with venous stroke. The clinical course of venous stroke mostly demonstrated a tendency towards rapid regression of focal symptomatology and neurological deficit in comparison with arterial ischemic stroke.

scholarly journals DIAGNOSIS OF VENOUS ISCHEMIC STROKE. PART II (ALGORITHMS AND SEMIOLOGY OF DIAGNOSTIC RADIOLOGY. LIMITATIONS IN CLINICAL PRACTICE). A REVIEW

2019 ◽  
Vol 8 (3) ◽  
pp. 104-115
Author(s):  
S. E. Semenov ◽  
E. A. Yurkevich ◽  
I. V. Moldavskaia ◽  
M. G. Shatokhina ◽  
A. S. Semenov
Keyword(s):  
Ischemic Stroke ◽  
Transcranial Doppler ◽  
Sinus Thrombosis ◽  
Pathological Condition ◽  
Diagnostic Algorithm ◽  
Diagnostic Procedures ◽  
Cerebral Venous Sinus Thrombosis ◽  
Standards Of Care ◽  
Unstable Process ◽  
Venous Stroke

Venous stroke in cerebral venous sinus thrombosis is a rare pathological condition with uncertain diagnostic algorithm to ensure prompt treatment by neurologists and radiologists. All the methods are not obligatory in the workup of acute stroke, except computed tomography (CT) and transcranial Doppler. Researchers and clinicians are commonly guided by their own experiences. Therefore, the diagnosis of venous stroke is an unstable process resulting in its underestimation in the general stroke population. The optimal use of neuroimaging methods within the existing standards of care for patients with stroke, determination of the necessary and sufficient set of diagnostic procedures is an organizational and methodical problem. In addition, there is no complete description of venous ischemic stroke patterns in the medical literature. The article reviews existing evidence-based data on the diagnostic algorithms for venous stroke and discusses the probability of detecting radiologic symptoms based on the diagnostic accuracy and effectiveness of such methods as conventional CT and magnetic resonance imaging (MRI), CT and MR angiography, CT and MR perfusion, transcranial Doppler (TCD) and ultrasound of the brachiocephalic arteries stated in the national and international guidelines, as well as our own experience. Limitations of their use and options to overcome major drawbacks including the introduction of teleradiology are considered.

scholarly journals Parametric Features of Regional Cerebral Blood Flow in Venous Ischemic Stroke

2019 ◽  
Vol 4 (3) ◽  
pp. 138-147
Author(s):  
S. E. Semenov
Keyword(s):  
Ischemic Stroke ◽  
Diffusion Mri ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Reference Points ◽  
Regional Cerebral Blood ◽  
Definition Of ◽  
The Brain ◽  
Venous Ischemia ◽  
Venous Stroke

The lecture is devoted to the peculiarities of changes in tissue and cell perfusion of the brain with a rare pathology – venous ischemic stroke. Venous stroke, being a “relatively unknown cerebrovascular disease”, occurs up to 5 % of all cases of stroke. The terms “venous ischemia” and “venous stroke” have long been used in the literature and the definition of the venous nature of stroke should lead to a change in therapeutic tactics. Neuroimaging should ensure the verification of stroke and cerebral venous sinus thrombosis, which are the main cause of such a stroke. A certain “alertness” to the venous nature of the stroke with the expansion of the volume of radiologic methods of investigation and the performance of angiographic and perfusion CT and MR techniques, diffusion MRI allowed to increase the number of diagnosed and verified venous strokes from 0.4 % of the total number of stroke patients to 2.4 %. A distinctive feature of venous ischemic stroke from the arterial is moderate hyperemia in the central part in cases where necrosis does not develop and perifocal hyperperfusion in the development of necrosis. Moderate plethora, defined by perfusion parameters (up to 30 % CBF, CBV, MTT) of CT, MRI and SPECT techniques, and not oligemia is the primary damaging factor of the pathogenesis of venous stroke in contrast to the arterial and hyperemia patterns should be the reference points in emergency diagnosis venous stroke along with tomoangiographic symptoms of cerebral venous sinustrombosis.

scholarly journals A comparative study of seizures in arterial and venous stroke

2017 ◽  
Vol 04 (01) ◽  
pp. 006-011
Author(s):  
R. Singh ◽  
S. Bhoi ◽  
Jayantee Kalita ◽  
Usha Misra ◽  
D. Gupta
Keyword(s):  
Ischemic Stroke ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Modified Rankin Scale ◽  
Mr Venography ◽  
Resonance Imaging ◽  
Venous Sinus Thrombosis ◽  
Magnetic Resonance Imaging Mri ◽  
Venous Stroke ◽  
Early Seizures

Abstract Objective This study was undertaken to compare the frequency, spectrum and predictors of seizures in arterial stroke and cerebral venous sinus thrombosis (CVST). Methods The patients having seizures following arterial stroke or CVST during 2010–2015 were included. Stroke was confirmed by computerized tomography (CT) scan, magnetic resonance imaging (MRI) and or MR Venography (MRV). The seizures were categorized into early seizures (<14 days) and late seizures (≥14 days) of arterial stroke or CVST. Neurological findings, risk factors for stroke and CVST were noted. The severity of stroke was defined by National Institute of Health Stroke Scale (NIHSS). The outcome on discharge was assessed by modified Rankin Scale (mRS) as good (0–2) or poor (>2). Results There were 870 patients with arterial stroke and 128 with CVST. Seizures occurred in 74 (57.8%) of CVST and 119 (13.7%) of arterial stroke. Early seizures were more common in CVST than arterial stroke (98.6% vs. 47.9%, p = 0.001) whereas late seizures were more common after arterial stroke than CVST (52.1% vs. 1.4%, p = 0.001). In the arterial stroke, seizures were predicted by carotid territory ischemic stroke (OR 3.95, 95% CI 1.51–10.32, p = 0.005) and CVST by parenchymal involvement (OR 2.61, 95% CI 1.04–6.55, p = 0.04) Conclusion CVST results in more frequent and early seizures whereas in arterial stroke late seizures are common. Post stroke seizures in ischemic stroke were predicted by carotid territory infarction and venous stroke by parenchymal involvement.

scholarly journals Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity

2015 ◽  
Vol 13 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Virgínia Machado ◽  
Sónia Pimentel ◽  
Filomena Pinto ◽  
José Nona
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Cerebral Stroke ◽  
Left Middle Cerebral Artery ◽  
Arterial Ischemic Stroke ◽  
Venous Sinus Thrombosis ◽  
Neonatal Stroke

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.

scholarly journals Cerebral Venous Thrombosis: A Challenging Diagnosis. A New Nonenhanced Computed Tomography Standardized Semi-Quantitative Method

Tomography ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 1-9
Author(s):  
Andrea Romano ◽  
Maria Camilla Rossi-Espagnet ◽  
Luca Pasquini ◽  
Alberto Di Napoli ◽  
Francesco Dellepiane ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Ad Hoc ◽  
Sinus Thrombosis ◽  
High Sensitivity ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous System ◽  
Maximum Variation ◽  
Initial Symptoms ◽  
The Mean ◽  
Contrast Ct

Cerebral venous sinus thrombosis (CVST) on non-contrast CT (NCCT) is often challenging to detect. We retrospectively selected 41 children and 36 adults with confirmed CVST and two age-matched control groups with comparable initial symptoms. We evaluated NCCT placing four small circular ROIs in standardized regions of the cerebral dural venous system. The mean and maximum HU values were considered from each ROI, and the relative percentage variations were calculated (mean % variation and maximum % variation). We compared the highest measured value to the remaining three HU values through an ad-hoc formula based on the assumption that the thrombosed sinus has higher attenuation compared with the healthy sinuses. Percentage variations were employed to reflect how the attenuation of the thrombosed sinus deviates from the unaffected counterparts. The attenuation of the affected sinus was increased in patients with CVST, and consequently both the mean % and maximum % variations were increased. A mean % variation value of 12.97 and a maximum % variation value of 10.14 were found to be useful to distinguish patients with CVST from healthy subjects, with high sensitivity and specificity. Increased densitometric values were present in the site of venous thrombosis. A systematic, blind evaluation of the brain venous system can assist radiologists in identifying patients who need or do not need further imaging.

scholarly journals Acute cerebral circulatory disorders and coronavirus disease

2020 ◽  
pp. 18-25
Author(s):  
N. V. Pizova ◽  
N. A. Pizov ◽  
O. A. Skachkova ◽  
M. A. Sokolov ◽  
I. A. Izmaylov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Sinus Thrombosis ◽  
Clinical Signs ◽  
Cerebral Venous Sinus Thrombosis ◽  
Altered Level ◽  
Wide Range ◽  
Inflammatory State ◽  
Coronavirus Infection ◽  
Systemic Symptoms

The new COVID-19 coronavirus infection caused by SARS-CoV-2 is a global health threat. Neurological disorders detected in patients with coronavirus infection have a wide range of clinical signs: headache, dizziness, altered level of consciousness, acute ischemic stroke, intracerebral hemorrhage, cerebral venous sinus thrombosis. Evidence suggests that patients with more severe systemic symptoms were more likely to experience neurological symptoms. The main risk factors for the development of ischemic stroke in patients with coronavirus infection are considered. It was shown that COVID-19 more often occurred in people with vascular risk factors, among which the mortality rate was higher. Various possible and not mutually exclusive mechanisms which may play a role in the development of ischemic stroke in patients with COVID-19 are described in detail, including hyper-inflammatory state («cytokine storm»), «COVID-19-associated coagulopathy», and disseminated intravascular coagulation syndrome. Stroke risk factors associated with the critical condition in these patients are presented. Stroke, the leading cause of death and disability worldwide, requires immediate treatment and decision-making as well as 24/7 availability for specialized vascular centers. The results of observation of patients with acute cerebral circulation disorder in specialized vascular centers 2 months before and 15 days after quarantine due to COVID-19 are presented. The tactics of managing patients with ischemic stroke under conditions of coronavirus infection is considered.

Baseline Characteristics and Readmissions after Cerebral Venous Sinus Thrombosis in a Nationally Representative Database

2018 ◽  
Vol 46 (5-6) ◽  
pp. 249-256 ◽  
Author(s):  
Yaowaree Leavell ◽  
Mian Khalid ◽  
Stanley Tuhrim ◽  
Mandip S. Dhamoon
Keyword(s):  
Ischemic Stroke ◽  
Readmission Rate ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Index Admission ◽  
Readmission Rates ◽  
Venous Sinus Thrombosis ◽  
Baseline Characteristics ◽  
Nationally Representative

Background: There are limited epidemiologic data on cerebral venous sinus thrombosis (CVST). We aim to summarize baseline characteristics and outcomes using a large nationally representative administrative database. Methods: Using the 2013 Nationwide Readmissions Database, we used validated International Classification of Disease, Ninth Revision codes to identify baseline characteristics of patients admitted with CVST. We calculated readmission rates (per 100,000 index hospitalizations) for neurological complications. Multivariable Poisson regression yielded rate ratios (RR) of associations between index admission variables and all-cause readmission up to 1 year. Results: Among 2,105 patients with index admission for CVST, mean age was 46.8 (SD 18.4); 65.2% were female, and 6.1% were pregnant. Hemorrhagic stroke (15.6%) was more common than ischemic stroke (10.7%), seizure occurred in 16.3, and 3.7% of patients died during index hospitalization. The 90-day readmission rate (per 100,000 index CVST hospitalizations) was the highest for CVST (1,447) and ischemic stroke (755). Diabetes (RR 1.10, 95% CI 1.002–1.22), cancer (1.23, 1.09–1.39), insurance status (0.92, 0.83–0.97 for Medicare/private insurance vs. others), and discharge home (RR 0.89, 95% CI 0.85–0.99) were associated with increased readmission rate. Conclusions: We provide baseline characteristics and readmission rates after CVST over a 1-year period. In-hospital mortality rate and association with pregnancy were lower than previously observed.

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