A clinical study of cerebral venous thrombosis

Background: Cerebral venous thrombosis (CVT) is an uncommon form of stroke, usually affecting young population. Clinical features of CVT are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions. The objectives of the study were to analyse the commonest clinical modes of presentation, possible etiologies, and to evaluate clinical outcome.Methods: This study was prospective, clinical study was conducted on 40 patients during the period of September 2010 to September 2011 in the Department of Emergency, Institute of Internal medicine at Government General Hospital (GGH), Chennai. All the patients included in the study were subjected to neuroimaging techniques like Computed tomography (CT), magnetic resonance imaging (MRI) along with magnetic resonance venography (MRV) according to guidelines and standard protocol.Results: Majority of the patients involved in the study were in the age group of 15-35 years contributing to 75%. Male: female ratio was 1.5: 1. Headache was the most common presenting symptom seen in 36 (87.5%) cases followed by convulsions in 32 (80%) patients. Altered sensorium was observed in 26 (65%), focal deficits in 22 (55%), and 18 (45%) had fever. Two of them had ear discharge and another with diarrhea. Cranial nerve involvement in 35% and pappiledema was noted in 20% of patients. Out of 40, 17 (42.5%) patients were anemic. Eighteen (18) patients who were suspected of meningitis underwent CSF analysis. Abnormality was seen in 10 patients with pleocytosis being the maximum. On CT scan, haemorrhagic infarct was seen in 22 (55%) cases followed by edema in 8 (20%) and 10% showed normal CT picture. On MRI scan, superior sagittal sinus thrombosis was observed in 24 (60%) patients followed by transverse sinus in 20 (50%) patients. Etiology factor were identified in 25 (62.5%) of patients and in 15 (37.5%) cases risk factors could not be identified. The mortality rate in the study was 20%.Conclusions: The clinical symptoms of CVT are not specific, as a result of chances of misdiagnosis tends to be more. CT scan and MRI along with MRV can improve the precision of CVT diagnosis.

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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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Dulaglutide-induced cerebral venous thrombosis in a patient with type 2 diabetes mellitus

BMJ Case Reports ◽

10.1136/bcr-2018-226346 ◽

2018 ◽

pp. bcr-2018-226346 ◽

Cited By ~ 1

Author(s):

Rajesh Rajput ◽

Vaibhav Pathak ◽

Pawan Kumar Yadav ◽

Sanat Mishra

Keyword(s):

Diabetes Mellitus ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Nausea And Vomiting ◽

Acute Infarct ◽

Patients With Diabetes ◽

The Right

Though patients with diabetes mellitus are at a high risk of atherothrombotic events, every such event should not be attributed to the disease itself. We present a case of a patient with diabetes with headache and blurring of vision for 3 days. Brain imaging revealed right transverse sinus thrombosis and acute infarct of the right posterior parieto-occipital region, predominantly in the posterior cortical watershed zone. The patient was on subcutaneous dulaglutide for 3 weeks and was having nausea and vomiting. Various causes of cerebral venous thrombosis were ruled out with appropriate laboratory investigations. Finally, cerebral venous thrombosis was attributed to dulaglutide-induced nausea and vomiting which led to severe dehydration.

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Abstract WP224: Transverse Sinus Hypoplasia as a Predisposing Factor for Cerebral Venous Thrombosis

Stroke ◽

10.1161/str.47.suppl_1.wp224 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Monica Chavarria-Medina ◽

Miguel Barboza ◽

Elizabeth Varela ◽

Hernán M Patriño-Rdoriguez ◽

Mayra Becerril ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Anatomical Variation ◽

Univariate Analysis ◽

Transverse Sinus ◽

Predisposing Factor ◽

Cross Sectional ◽

Tertiary Center ◽

Transverse Sinuses

Background: Transverse sinuses (TS) are frequently asymmetric. Hypoplasia or aplasia of TS is a common anatomical variation, right TS is dominant in 61% of cases. The relationship between hypoplastic TS and cerebral venous thrombosis is not well established. Hypothesis: Transverse sinus hypoplasia is a predisposing factor for ipsilateral transverse sinus thrombosis Methods: We retrospectively evaluated 27 confirmed cases with isolated transverse sinus thrombosis and 54 age-and-sex matched controls, treated in a Neurological tertiary center from 2010 to 2015. A stroke neurologist and a neuroradiologist measured TS using an MRI sequence (Inhance 3D Inflow IR); interrater reliability was calculated using Bland-Altman plots. Hypoplasia was defined as a transverse sinus diameter less than 50% of the cross-sectional diameter of the lumen of the distal superior sagittal sinus. Univariate analysis was performed to evaluate the association between transverse sinus hypoplasia (TSh) and thrombosis. Results: There was a good inter-rater reliability (p=0.55 on the Bland-Altman plot by ANOVA test). There were a total of 45 left hypoplastic transverse sinuses (TS) (19 [70.4%] cases vs. 26 [48.1%] controls), and 16 right hypoplastic TS (11 [40.7%] cases vs. 5 [9.3%] controls). Ipsilateral thrombosis was present in 9 (33.3%) right and 15 (55.5%) left hypoplastic transverse sinuses. Transverse sinus thrombosis was more likely to be present when associated with left TSh (RR 2.57, 95% CI 1.17-5.69; p=0.001), than right TSh and ipsilateral thrombosis (RR 0.15, 95% CI 0.04-0.57; p<0.001). Conclusion: Isolated transverse sinus hypoplasia might be a predisposing factor for ipsilateral transverse sinus thrombosis.

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Transverse sinus thrombosis - a case report

Morecambe Bay Medical Journal ◽

10.48037/mbmj.v5i1.349 ◽

2006 ◽

Vol 5 (1) ◽

pp. 23-24

Author(s):

M Veerasamy ◽

G Cook

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

University Hospitals ◽

Cranial Nerve Involvement ◽

Medical Problems ◽

Focal Neurological Deficit ◽

Uncommon Presentation ◽

Consultant Physician

Cerebral venous thrombosis is an uncommon presentation of stroke and subarachnoid haemorrhage. Cerebral venous thrombosis may present with headache, seizures, cranial nerve involvement or focal neurological deficit. Venous thrombosis may also be associated with pre-existing medical problems, which need to be diagnosed and treated. Gill Cook is a consultant physician with University Hospitals of Morecambe Bay NHS Trust.

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Spectrum of Cerebral Venous Thrombosis in Oman

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.03.011 ◽

2018 ◽

Vol 18 (3) ◽

pp. 329

Author(s):

Darshan Lal ◽

Arunodaya R. Gujjar ◽

Nandagopal Ramachandiran ◽

Ammar Obaidi ◽

Sunil Kumar ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Patient Outcome Assessment ◽

Tertiary Hospital ◽

University Hospital ◽

Neurological Deficits ◽

Female Ratio ◽

Sultan Qaboos University ◽

High Index Of Suspicion

Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results: A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.Keywords: Venous Thrombosis; Cerebral Thrombosis; Cranial Venous Sinuses; Neurological Manifestations; Patient Outcome Assessment; Oman.

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Scrub typhus with cerebral venous sinus thrombosis: a rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-241401 ◽

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.

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Cerebral venous sinuses thrombosis in both transverse sinus and torcula: Multistep endovascular treatment and stenting

Interventional Neuroradiology ◽

10.1177/1591019916674917 ◽

2016 ◽

Vol 23 (1) ◽

pp. 84-89 ◽

Cited By ~ 6

Author(s):

G Cabral de Andrade ◽

A Lesczynsky ◽

VM Clímaco ◽

ER Pereira ◽

PO Marcelino ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Endovascular Treatment ◽

Clinical Symptoms ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Severe Form ◽

Venous Sinus ◽

Lateral Sinus ◽

Mechanical Thrombolysis

Purpose Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy. This case report presents the possibility of endovascular treatment in multiple steps with mechanical thrombolysis with balloon, local pharmacological thrombolysis and stenting, in a patient with a severe form of CVST. Case summary A 67-year-old woman presented severe headache, agitation and confusion with diagnosis of venous sinus dural thrombosis in both lateral sinus and torcula. After 24 h there was neurological worsening evolving with seizures and numbness even after starting heparin, without sinus recanalization; CT scan showed left temporal intracerebral hemorrhage. We decided to take an endovascular approach in multiple steps. The first step was mechanical static thrombolysis with balloon; the second step was dynamic mechanical thrombolysis with a balloon partially deflated and “pulled”; the third step was local thrombolysis with Actilyse™; finally, the fourth step was angioplasty and reconstruction of the sinuses using multiple carotid stents and complete angiographic recanalization of both sinuses and torcula. After 24 h of endovascular treatment there was full clinical recovery and no tomographic complications. Conclusion This result shows that mechanical clot disruption, intrasinus thrombolysis and reconstruction of wall sinuses with stenting can be an endovascular option in the severe form of CVST with intracerebral hemorrhage and rapid worsening of neurological symptoms. Although this type of treatment can re-channel the occluded sinuses, further comparative and randomized studies are needed to clarify its efficacy versus other therapeutic modalities.

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Cerebral venous thrombosis and Covid 19: Literature review

Journal of Neurology & Stroke ◽

10.15406/jnsk.2021.11.00457 ◽

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.

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

Acta Medica Marisiensis ◽

10.2478/amma-2014-0044 ◽

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.

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Cerebral venous thrombosis demonstration with magnetic resonance angiography

Clinical Imaging ◽

10.1016/0899-7071(94)00052-e ◽

1995 ◽

Vol 19 (3) ◽

pp. 153-161 ◽

Cited By ~ 7

Author(s):

John J. Wasenko ◽

James W. Holsapple ◽

Jeffrey A. Winfield

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis

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