Delayed acute onset post traumatic sigmoid sinus/cerebral venous thrombosis

Post traumatic Sinus/cerebral venous thrombosis is a rare entity. A high index of suspicion is required as the prognosis is poor in this clinical setting, in view of the effects of the head injury. We report 2 cases of the patient worsening acutely after initial recovery from trauma. The etiology and pathogenesis in such cases are varied and hypothetical with no definite underlying cause identified. Cerebral venous thrombosis (CVT) as an etiology of headache is not always easy to diagnose unless suspected, and in any patient with head injury and delayed deterioration after initial recovery, post traumatic Cerebral venous thrombosis should be kept as a differential diagnosis.

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Pancreatic Panniculitis Associated with Acinar Cell Pancreatic Carcinoma

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2007.00032 ◽

2008 ◽

Vol 12 (1) ◽

pp. 38-42 ◽

Cited By ~ 10

Author(s):

Susan M. Poelman ◽

Khue Nguyen

Keyword(s):

Differential Diagnosis ◽

Pancreatic Disease ◽

Acute Onset ◽

Clinical Approach ◽

Rare Entity ◽

Subcutaneous Nodules ◽

History Of ◽

Practical Tool ◽

Pancreatic Disorders ◽

Pancreatic Panniculitis

Background: Pancreatic panniculitis is a rare entity, occurring in less than 2% of patients with pancreatic disorders. Skin manifestations may precede the diagnosis of a pancreatic disease by many months. When treatable, correction of the underlying pancreatic disorder may lead to prompt resolution of the panniculitis. Objective: We present the case of a 74-year-old-man with a history of chronic pancreatitis who presented with an acute onset of tender, nonulcerating nodules. The clinical and histologic features of pancreatic panniculitis are discussed, with a brief review of the differential diagnosis and clinical approach to panniculitis. Conclusions: Pancreatic panniculitis is a recognizable clinical entity with characteristic histologic features that may resolve with treatment of the underlying pancreatic disorder. The algorithm-based clinical approach to panniculitis presented in this study is a practical tool designed to guide clinicians in ordering investigations and determining the appropriate management for patients presenting with subcutaneous nodules.

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

Thrombosis and Haemostasis ◽

10.1055/s-0038-1642636 ◽

2018 ◽

Vol 118 (06) ◽

pp. 1067-1077 ◽

Cited By ~ 2

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.

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A young woman with headache and seizures

Italian Journal of Medicine ◽

10.4081/itjm.2008.4.25 ◽

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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Clinical profile of cerebral venous thrombosis in pregnancy and puerperium in South India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172946 ◽

2017 ◽

Vol 6 (7) ◽

pp. 3124

Author(s):

Ramasamy Sasikala ◽

Jagan Aishwarya ◽

Syed Dilshath

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

South India ◽

Total Mortality ◽

Acute Onset ◽

Clinical Profile ◽

Focal Neurological Deficit ◽

Presenting Symptoms ◽

Laboratory Investigations ◽

In Pregnancy

Background: Cerebral venous thrombosis (CVT) is any thrombosis occurring in intracranial veins and sinuses, which is a rare disorder affecting 5 persons per million per year with huge regional variation. Pregnancy and puerperium are the most prevalent prothrombotic states leading to cerebral venous thrombosis. The objective of this study was to analysis the clinical profile of CVT in pregnancy and puerperium.Methods: In this prospective study, we analysed 52 consecutive patients admitted with impairment of consciousness, seizures or focal neurological deficit at our hospital. The diagnosis of CVT was confirmed by neuroimaging. Detailed history, clinical examination and laboratory investigations were carried out in all the cases and analysed.Results: The incidence of CVT associated with pregnancy and puerperium at our Hospital was 3.9 per 1000 obstetric admissions. The age of the patients varied from 18-35 years with a maximum age incidence (77%) in the III decade (21-30 years). The maximum incidence was during the first two weeks of puerperium (61.8%). The most common presenting symptoms were focal or generalised seizures (88.4%) followed by headache (65.3%). In spite of the alarming clinical picture, recovery was rapid and remarkable. Total mortality was 15.5% (8 cases).Conclusions: CVT is more common during the puerperium than in the antenatal period. Obstetric CVT has a more acute onset with excellent recovery when promptly diagnosed and treated.

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Cerebral venous thrombosis with a catch

Surgical Neurology International ◽

10.25259/sni_1021_2021 ◽

2021 ◽

Vol 12 ◽

pp. 590

Author(s):

Raj Swaroop Lavadi ◽

B. V. Sandeep ◽

Manpreet Singh Banga ◽

Sangamesh Halhalli ◽

Anantha Kishan

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Head Injuries ◽

Skull Fracture ◽

Wound Debridement ◽

Postoperative Mri ◽

Depressed Fracture ◽

Traumatic Head ◽

High Index Of Suspicion ◽

Plan Management

Background: Cerebral venous thrombosis (CVT) is a rare entity typically occurring in patients in hypercoagulable states. They can also occur in cases of trauma. The symptoms are nonspecific. Case Description: A 28-year-old male presented to the emergency department with a head injury. During the necessary imaging, it was found that he had a depressed skull fracture and other signs of traumatic brain injury. Unbeknownst to the patient and the patient party, it was also revealed that the patient only had one kidney. Wound debridement and excision of the depressed fracture were performed. A postoperative MRI revealed that the patient had CVT. Conclusion: There should be a high index of suspicion for CVT in case of traumatic head injuries. The surgeon should plan management according to the patient’s comorbidities.

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Case 5

10.1093/med/9780190603434.003.0009 ◽

2018 ◽

Author(s):

Bashar Katirji

Keyword(s):

Differential Diagnosis ◽

Young Woman ◽

Mechanism Of Action ◽

Rare Entity ◽

Lumbosacral Plexus ◽

Retroperitoneal Hemorrhage ◽

Lumbosacral Plexopathy ◽

Common Causes ◽

Main Component ◽

High Index Of Suspicion

Lumbosacral plexopathy is a relatively rare entity with a variety of etiology and pathophysiology. The diagnosis of lumbosacral plexopathy requires high index of suspicion and knowledge of the detailed anatomy of the lumbosacral plexus is a prerequisite to the accurate conclusion. This case describes a young woman with injury to the lumbosacral trunk (cord), a main component of the lumbosacral plexus, occurring during the delivery of her newborn and outlines its mechanism of action, pathophysiology and risks. The case highlights also the differential diagnosis of lumbosacral plexopathy and discusses the most common causes including retroperitoneal hemorrhage, lumbosacral plexitis, and intrapartum maternal lumbosacral plexopathy.

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Role of MRI in Cerebral Venous Thrombosis

QJM ◽

10.1093/qjmed/hcab106.029 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmad Shawki Geneidi ◽

Nermeen Nasry Keriakos ◽

Khaled Mostafa Mohammad Khaled

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Venous Occlusion ◽

Acute Onset ◽

Radiology Department ◽

Cerebral Veins ◽

Limb Weakness ◽

Inflammatory Conditions ◽

Imaging Department ◽

The Brain

Abstract Background Cerebral venous thrombosis CVT is a type of stroke where the thrombosis occurs in the venous side of the brain circulation, leading to occlusion of one or more cerebral veins and Dural venous sinus. CVT is a potentially life-threatening disease, accounting for approximately 0.5 % of stroke cases. Aim of the Work The aim of this subject is to illustrate the various aspects of CVT on MRI. Patients and Methods This is a retrospective study included 30 patients (19 females &11 males), their ages range from 3 months to 74 years with the median age 22 years. Mean age 22.04 years. The study was performed in radiology department El Demerdash Hospital between March 2018 & September 2019. The study included patients presented to the Medical Imaging Department of Ain Shams university Al-Demerdash hospital with cerebral venous occlusion neurological symptoms or imaging diagnosis. Results In our study,. Most common presenting symptom was headache noted in 22 patients (73.3%) followed by eye manifestations (blurring of vision or clinically having papilledema) was the second most seen in 18 patients (60%). Then comes convulsions in8 patients (26.7 %), Limb weakness in 5 patients (16.7%), finally disturbed consciousness level in 4 patients (13.3%). Most common mode of onset was subacute which was seen in 16 patients (53.3%) acute onset was seen in 6 patients (20%) as predominantly isointense on T1 weighted images and hypo intense on T2 weighted images, chronic onset was seen in 8 patients (26.7%) as hypo intense signal in both T1 and T2 WIs. MRV successfully diagnosed occlusion in most cases by absence of signal intensity with consequent non-visualization of occluded sinuses or veins in almost all patients and except 3 patients; those were having just cortical veins thrombosis detected by T2* sequence electing blooming artifacts with intact sinuses, and dilated distal collaterals seen in 18 patients. Conclusion Dural venous occlusion can occur due to many factors as thrombosis, inflammatory conditions of the brain and tumors. Cerebral venous thrombosis (CVT) has long been a neglected entity because of complexities in diagnosis and non-specific clinical presentation. Conventional MRI and phase contrast MRV in conjugation with recent techniques such SWI & DWI were considered more accurate diagnostic tool, non invasive, non ionizing, with high resolution in evaluating patients with suspected cerebral venous occlusion or thrombosis. It is also considered very useful to demonstrate brain parenchymal affection, the age or stage of the thrombus and its extension

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Abstract TP222: Characteristic Phenotype and Prognostic Factors in Magnetic Resonance Perfusion Weighted Image of Cerebral Venous Thrombosis

Stroke ◽

10.1161/str.48.suppl_1.tp222 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Moo-seok Park ◽

Woo-Keun Seo ◽

Oh Young Bang ◽

Chin-Sang Chung ◽

Kwang Ho Lee ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Magnetic Resonance ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sigmoid Sinus ◽

Weighted Image ◽

Magnetic Resonance Perfusion ◽

Good Outcome ◽

Univariate Analyses

Introduction: Cerebral venous thrombosis is a rare form disease. It can be difficult to diagnose and predict patient’s outcome. There are a few reports suggesting characteristic image phenotype and hypothesis of prognosis prediction but those are very rare and still controversial. We sought to identify image phenotype and prognostic factors associated with cerebral venous thrombosis using magnetic resonance perfusion weighted image. Methods: We retrospectively collected patients who had cerebral venous thrombosis from January 2000 to December 2015. Patients who had underwent magnetic resonance image with perfusion weighted image, non-contrast computerized tomography and magnetic resonance venography were enrolled. Perfusion weighted image was analyzed by visual assessment. We evaluated patient outcome by checking presence of recanalization and disappearance of symptom. Results: We collected 35 patients who had cerebral venous thrombosis. The mean age of these patients was 42.91 ± 15.47, and 57% were women. Perfusion abnormalities were observed in 25 cases. Cerebral blood volume abnormality was observed in 31 cases, cerebral blood flow abnormality in 31 cases, mean transit time abnormality in 18 cases, and time to peak abnormality in 22 cases. All perfusion abnormalities were localized in the areas adjacent to the occluded sinuses. In the univariate analyses, our study showed location of cerebral venous thrombosis was correlated with good outcome (transverse sinus: p = 0.042, sigmoid sinus: p = 0.026). Gradient echo sequences’ vessel sign ( p = 0.094) and cerebral blood flow on perfusion weighted image ( p = 0.055) was also related with good outcome. In the multivariate model with adjustment for variables with p<0.10 in the univariate analyses, sigmoid sinus thrombosis (Odd ratio 0.125, 95% confidence interval 0.014-0.756, p = 0.034) and increased cerebral blood flow on perfusion weighted image (Odd ratio 17.749, 95% confidence interval 1.427-544.176, p = 0.044) remained an independent predictor for good outcome. Conclusions: Our study suggest that cerebral blood flow is able to predict good outcome in cerebral venous thrombosis. It is similar to penumbra phenomenon in ischemic stroke.

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Cerebral venous thrombosis

10.1093/med/9780198737889.003.0012 ◽

2017 ◽

Author(s):

Hugh Markus ◽

Anthony Pereira ◽

Geoffrey Cloud

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Arterial Disease ◽

Venous Occlusion ◽

Neurological Complications ◽

Appropriate Treatment ◽

Clinical Presentations ◽

Neurological Conditions ◽

High Index Of Suspicion ◽

Better Than

Most stroke results from arterial disease but venous occlusion can also cause stroke, and other neurological complications. This condition is uncommon and needs a high index of suspicion if it is not to be missed. The clinical presentations are varied and can mimic other neurological conditions. The diagnosis is important because with appropriate treatment the prognosis can be much better than for arterial infarction.

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Acute subdural haemorrhage complicating cerebral venous thrombosis in a patient with protein C deficiency

BMJ Case Reports ◽

10.1136/bcr-2020-236745 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236745

Author(s):

Elvin Yuan Ting Lim ◽

Vivek Pai ◽

Yih Yian Sitoh ◽

Bela Purohit

Keyword(s):

Risk Factors ◽

Literature Review ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Protein C ◽

Uneventful Recovery ◽

Rare Entity ◽

Subdural Haemorrhage ◽

Protein C Deficiency ◽

Occipital Headache

Cerebral venous thrombosis (CVT) directly causing subdural haemorrhage (SDH) is a rare entity. We present a case of an 18-year-old female patient who presented with severe occipital headache. Neuroimaging showed acute SDH and CVT. She was eventually discovered to have underlying protein C deficiency. She was treated with anticoagulation and made an uneventful recovery. We aim to highlight the epidemiology, risk factors and aetiopathogenesis of CVT. We have included a literature review of previously described 13 case studies/reports describing SDH associated with CVT and a brief discussion of the dilemmas associated with management.

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