Chronic headache as a clinical manifestation of cerebral venous sinus thrombosis

Patients with cerebral venous thrombosis (CVT) pre-sent with a range of symptoms, which varies widely from headache to coma. Chronic occlusion of venous dural sinuses leads to the initiation of compensation processes, such as vascular collatera-lization, recanalization of the organized thrombus. Consequently, their efficacy determines disease course and severity. The purpose of our study was to highlight the clinical challenges while managing a patient with subcompensated CVT. Taking into account the fact that mild severity is observed in 20 % of cases, eventually, about a quarter of patients presenting with the headache of unclear etio-logy becomes unnoticed and results in low quality of life. To analyze the disease outcome and prognosis, we accurately studied compensation mechanisms, which occur in a patient due to cerebral venous sinus thrombosis, notably venous collateral circulation and thrombus recanalization. However, the most important “pitfall” of chronic dural sinuses occlusion, when not appropriately treated, is the fact that hemodynamic compensation also leads to a high risk of cerebrovascular events, which may lead to death or disabi-lity. The patient with cerebral venous thrombosis of the transverse and sigmoid sinuses manifested migraine-like headache with a vegetative issue and signs of increased intracranial pressure. Due to the absence of anticoagulant therapy, venous drainage through collateral pathways and recanalization of thrombosed sinuses were insufficient to maintain a cerebral blood supply, resulting in diffuse cerebral edema, secondary brain injury. After an accurate survey, diagnostic procedures, prescribing of individualized treatment, and long-term follow-up with correction of therapy the patient experienced regression of CVT symptoms. Cerebral MRI venography is an important tool for the diagnosis and prediction of the prognosis of this condition. Thus, patients with a long history of untreatable headache and signs of intracranial hypertension should undergo this procedure. To consider intracranial vascular events and outcomes, the venous hemodynamics should be evaluated. Moreover, it is often necessary to examine cerebral veins and sinuses, when hemorrhagic stroke does not correspond to cerebral arterial territories and has unclear etiology.

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Cerebral Venous Sinus Thrombosis (CVST) in a Middle-Aged Female with Clustering of Risk Factors

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/605 ◽

2021 ◽

Vol 10 (34) ◽

pp. 2960-2963

Author(s):

Maria Prothasis ◽

Yash Gupte ◽

Sourya Acharya ◽

Samarth Shukla ◽

Neema Acharya

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Factor V ◽

Venous Sinus Thrombosis

Thrombosis of cerebral venous channel is a known complication of hypercoagulable states. Hyperhomocysteinaemia is a known hypercoagulable state. Obesity is a modern-day global epidemic. Disorders such as myocardial infarction (MI), stroke, and venous thromboembolism are on the rising trend and its increased morbidity and mortality is being associated with obesity. To date, however, the knowledge about the association between obesity and adult cerebral venous thrombosis (CVT) is sparse. We report a 44-year-old young morbidly obese metabolically unhealthy female who presented with headache, nausea, vomiting and giddiness. On evaluation, magnetic resonance venogram showed cerebral venous sinus thrombosis. On investigations, she had concomitant hyperhomocysteinaemia and metabolic syndrome. Cerebral venous sinus thrombosis causing stroke in young adults is uncommon with various conditions precipitating it.1,2,3 Severe headache (70 - 90 %), focal lateralized signs (25 % - 75 %), seizures (30 – 40 %) as well as behavioural symptoms such as delirium, amnesia, and disturbances in consciousness are the various associated clinical symptoms. The known inherited hypercoagulable risk factors that cause CVST are gain of function mutations in the genes encoding factor V (factor V Leiden) and prothrombin, Protein C, S and antithrombin III deficiency. Hyperhomocysteinaemia, is a known risk factor for causing venous thrombosis of the lower limbs. However, till date there is no data available showing its role in causing cerebral venous thrombosis. The interaction between genetic and acquired determinants result in high plasma levels of total homocysteine (tHcy).4,5,6 Vitamins such as folic acid, pyridoxine, and cobalamin are involved in the metabolic pathways of homocysteine and its deficiencies represent the acquired determinants. Venous thromboembolism (VTE) comprises of deep vein thrombosis of the leg and pulmonary embolism and obesity is now being recognised as one of the risk factors causing it. The risk of VTE is approximately increased to 2-fold in an individual with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30 or more compared with a normal BMI (< 25), and higher BMIs increase more risk with approximately 3 times higher risk in individuals with a BMI greater than 40.7, 8,9 Again obesity as a risk factor for CVST is less known.

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Cerebral venous sinus thrombosis after ChAdOx1 nCov-19 vaccination with a misleading first cerebral MRI scan

Stroke and Vascular Neurology ◽

10.1136/svn-2021-001095 ◽

2021 ◽

pp. svn-2021-001095

Author(s):

Benno Ikenberg ◽

Antonia Franziska Demleitner ◽

Thomas Thiele ◽

Benedikt Wiestler ◽

Katharina Götze ◽

...

Keyword(s):

Sinus Thrombosis ◽

Intravenous Immunoglobulins ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Pathological Findings ◽

Mri Scan ◽

Platelet Factor ◽

Venous Sinus Thrombosis ◽

Activation Assay ◽

Cerebral Mri

Vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST) have been recently described as rare complications following vaccination against SARS-CoV-2 with vector vaccines. We report a case of a young woman who presented with VITT and cerebral CVST 7 days following vaccination with ChAdOx1 nCov-19 (AstraZeneca). While the initial MRI was considered void of pathological findings, MRI 3 days later revealed extensive CVST of the transversal and sigmoidal sinus with intracerebral haemorrhage. Diagnostic tests including a platelet-factor-4-induced platelet activation assay confirmed the diagnosis of VITT. Treatment with intravenous immunoglobulins and argatroban resulted in a normalisation of platelet counts and remission of CVST.

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Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study

Stroke Research and Treatment ◽

10.1155/2020/8610903 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Derya Uluduz ◽

Sevki Sahin ◽

Taskin Duman ◽

Serefnur Ozturk ◽

Vildan Yayla ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Sinus Thrombosis ◽

Previous History ◽

Epileptic Seizures ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

History Of ◽

The Mean

Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38±9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). Conclusion. The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.

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Case Report: Cerebral Venous Sinus Thrombosis and COVID-19 Infection

Frontiers in Medicine ◽

10.3389/fmed.2021.741594 ◽

2021 ◽

Vol 8 ◽

Author(s):

Manasa Anipindi ◽

Amanda Scott ◽

Li Joyce ◽

Salman Wali ◽

Mark Morginstin

Keyword(s):

Venous Thrombosis ◽

Sinus Thrombosis ◽

Oral Anticoagulants ◽

Endothelial Activation ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Initial Symptom ◽

Venous Sinus Thrombosis ◽

High Index Of Suspicion ◽

The Brain

Coronavirus disease-2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). Coronavirus disease-2019 (COVID-19) was declared a pandemic in March 2020 and has changed our lives in many ways. This infection induces a hypercoagulable state leading to arterial and venous thrombosis, but the exact pathophysiology of thrombosis is unknown. However, various theories have been postulated including excessive cytokine release, endothelial activation, and disseminated intravascular coagulation (DIC). We present a patient diagnosed with cerebral venous sinus thrombosis (CVST) with COVID-19 infection. A 66-year-old man presented to a hospital for evaluation of persistent headaches. He tested positive for COVID-19, and MRI of the brain and CT venogram revealed CVST. He was started on heparin drip in the hospital and transitioned to oral anticoagulants at the time of discharge. His headaches improved with treatment. Even though headache is the most frequent and initial symptom of cerebral venous thrombosis, it is rarely the only symptom. A high index of suspicion is therefore required to diagnose CVST especially if the patient presents with a simple complaint like a headache. Common complaints can delay the diagnosis leading to disease progression. Considering the high mortality rates in patients diagnosed with CVST, we suggest the importance of knowing the association between COVID-19 infection and CVST, especially in susceptible patients.

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Cerebral venous sinus thrombosis with internal jugular venous thrombosis in a male patient with nephrotic syndrome

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.11355-14.1 ◽

2014 ◽

Author(s):

Cigdem Hacifazlioglu ◽

Erhan Arslan ◽

Elif Acar Arslan ◽

Gulseren Buyukserbetci

Keyword(s):

Nephrotic Syndrome ◽

Venous Thrombosis ◽

Male Patient ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis

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Cerebral venous sinus thrombosis: Incidence of venous thrombosis recurrence and survival

Neurology ◽

10.1212/01.wnl.0000233887.17638.d0 ◽

2006 ◽

Vol 67 (5) ◽

pp. 814-819 ◽

Cited By ~ 80

Author(s):

I. Gosk-Bierska ◽

W. Wysokinski ◽

R. D. Brown ◽

K. Karnicki ◽

D. Grill ◽

...

Keyword(s):

Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis

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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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Successful endovascular recanalization of massive cerebral venous sinus thrombosis in a patient with tuberous sclerosis and protein S deficiency: a case report

Oxford Medical Case Reports ◽

10.1093/omcr/omz060 ◽

2019 ◽

Vol 2019 (7) ◽

Author(s):

Yasuhiro Nishiyama ◽

Masayuki Ueda ◽

Kanako Muraga ◽

Takahiro Ota ◽

Hiroshi Horikawa ◽

...

Keyword(s):

Venous Thrombosis ◽

Tuberous Sclerosis ◽

Tuberous Sclerosis Complex ◽

Sinus Thrombosis ◽

Protein S ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Protein S Deficiency ◽

Venous Sinus Thrombosis ◽

S Deficiency

Abstract Here, we report the case of a 27-year-old woman with tuberous sclerosis complex who underwent successful endovascular intervention for cerebral venous thrombosis at the superior sagittal sinus. She had protein S deficiency and a long-term history of anemia caused by menorrhagia from uterine fibroids, possibly leading to a hypercoagulable state. Cerebral venous sinus thrombosis accounts for ~0.5–1% of all strokes. Several cases of venous thrombosis in patients with tuberous sclerosis complex and protein S or protein C deficiency have been reported, but further studies are needed to identify whether an association of this rare combination may be explained.

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