Cerebral venous thrombosis with a catch

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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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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Increased Risk of Deep Venous Thrombosis with Endovascular Cooling in Patients with Traumatic Head Injury

The American Surgeon ◽

10.1177/000313480707300508 ◽

2007 ◽

Vol 73 (5) ◽

pp. 461-464 ◽

Cited By ~ 14

Author(s):

Hector F. Simosa ◽

Dustin J. Petersen ◽

Suresh K. Agarwal ◽

Peter A. Burke ◽

Erwin F. Hirsch

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Head Injuries ◽

Vena Cava ◽

Surgical Intensive Care Unit ◽

High Risk Population ◽

Surgical Intensive Care ◽

Increased Risk ◽

Endovascular Cooling ◽

Traumatic Head

Endovascular therapeutic hypothermia has been shown to preserve neurological function and improve outcomes; however, its use and potential complications have not been fully described in patients with traumatic head injuries. We believe that the use of endovascular cooling leads to deep venous thrombosis (DVT) in this high-risk population. We performed a retrospective review of 11 patients with severe head injuries admitted to our Level I trauma center surgical intensive care unit who underwent intravascular cooling. Duplex sonograms were obtained after 4 days at catheter removal or with clinical symptoms that were suspicious for DVT. Patients had a mean age of 23.2 (range, 16–42) years and an Injury Severity Score of 31.9 (range, 25–43). The overall incidence of DVT was 50 per cent. The DVT rate was 33 per cent if catheters were removed in 4 days or less and 75 per cent if removed after 4 days (risk ratio = 2.25; odds ratio = 6; P = ns). An elevated international normalized ratio upon admission was protective against DVT (no DVT = 1.26 vs DVT = 1.09; P = 0.02). Inferior vena cava filters were placed in most patients with DVT. The use of endovascular cooling catheters is associated with increased risk of DVT in patients with traumatic head injuries. Therefore, we discourage the use of endovascular cooling devices in this patient population.

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Elevated Plasma Factor VIII in Non-Pyogenic Cerebral Venous Thrombosis after Head Trauma without Skull Fracture

Austin Journal of Cerebrovascular Disease & Stroke ◽

10.26420/austinjcerebrovascdisstroke.2019.1082 ◽

2019 ◽

Vol 6 (1) ◽

Author(s):

Kipyoung Jeon ◽

◽

Jean Hee Kim ◽

Kijeong Lee ◽

Kyu-Nam Park ◽

...

Keyword(s):

Venous Thrombosis ◽

Factor Viii ◽

Head Trauma ◽

Cerebral Venous Thrombosis ◽

Skull Fracture ◽

Hemorrhagic Transformation ◽

Venous Infarction ◽

Sagittal Sinus ◽

Plasma Factor ◽

Post Traumatic

Cerebral Venous Thrombosis (CVT) is a relatively uncommon but important cause of stroke that tends to affect young adults, especially women. Head trauma with or without skull fracture was reported to be triggering factors for CVT, but the underlying pathophysiology was not well elucidated. Endothelial injury and coexistent hypercoagulability were supposed to contribute to CVT after head trauma without skull fracture. We report a 49-year-old female patient who presented with headache with vomiting after head trauma and was initially diagnosed as post-traumatic Intracerebral Hemorrhage (ICH), but subsequently, progressed to CVT that resulted in cerebral venous infarction with hemorrhagic transformation. Magnetic Resonance brain Venography (MRV) confirmed CVT in superior sagittal sinus as well as right transverse and sigmoid sinuses. She was treated with endovascular mechanical thrombectomy followed by anticoagulation. The coagulopathy panel was checked both in hospital and in outpatient clinic for evaluating the etiology underlying post-traumatic nonpyogenic CVT. Persistently elevated level of plasma Factor VIII was identified. We should consider that patients with recent head trauma history without skull fracture and coexistent hypercoagulability could develop CVT resulting in cerebral venous infarction with hemorrhagic transformation even when the patient showed no definite focal neurologic deficit or the patient’s initial CT scan revealed no intracranial hemorrhage.

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Delayed acute onset post traumatic sigmoid sinus/cerebral venous thrombosis

International Surgery Journal ◽

10.18203/2349-2902.isj20174638 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3765

Author(s):

Bopaiah K. S. ◽

Shreykumar P. Shah

Keyword(s):

Differential Diagnosis ◽

Head Injury ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Acute Onset ◽

Sigmoid Sinus ◽

Rare Entity ◽

Post Traumatic ◽

Initial Recovery ◽

High Index Of Suspicion

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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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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