scholarly journals A rare case of vaccine-induced immune thrombosis and thrombocytopenia and approach to management

2021 ◽  
Vol 12 ◽  
pp. 408
Author(s):  
Raghavendra Kotal ◽  
Ipe Jacob ◽  
Pradeep Rangappa ◽  
Karthik Rao ◽  
Guruprasad Hosurkar ◽  
...  
Keyword(s):  
Extended Period ◽  
Signs And Symptoms ◽  
Medical Intervention ◽  
Young Female ◽  
Warning Signs ◽  
Neurological Deficits ◽  
Early Presentation ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus

Background: The use of the COVID-19 vaccines Vaxzevria from AstraZeneca and Covishield from Janssen has been associated with sporadic reports of thrombosis with thrombocytopenia, a complication referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT) or vaccine-induced prothrombotic immune thrombocytopenia. It presents commonly as cerebral sinus venous thrombosis (CSVT), within 4–30 days of vaccination. Females under 55 years of age are considered to be especially at high risk. Mortality up to 50% has been reported in some countries. Identification of early warning signs and symptoms with prompt medical intervention is crucial. Case Description: We report here a case of VITT in a young female who presented 11 days after receiving the first dose of the Covishield vaccine, with severe headache and hemiparesis. She was diagnosed with CSVT with a large intraparenchymal bleed, requiring decompressive craniectomy and extended period on mechanical ventilation. Conclusion: The patient was successfully treated with intravenous immunoglobulin and discharged after 19 days in ICU. Although she was left with long-term neurological deficits, an early presentation and a multidisciplinary approach to management contributed toward a relatively short stay in hospital and avoided mortality.

scholarly journals Rare Presentation and Successful Management of Cerebral Sinus Venous Thrombosis in a Patient with Sickle Cell Trait

2020 ◽  
Author(s):  
Khalid Khan ◽  
Anuj Chaturvedi
Keyword(s):  
Venous Thrombosis ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Rare Presentation ◽  
Initial Stage ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Clonic Seizures ◽  
Sinus Venous Thrombosis

Cerebral Venous Thrombosis (CVT) is an uncommon cause of stroke and is generally present with headache. It is very difficult to diagnose it in initial stage due to its widely varying clinical features, risk factors, radiological findings and outcomes. Early diagnosis of CVT and its treatment can reduce the disease progress, its burden and risk of acute and long-term complications including mortality. A 23-year-old male patient was admitted from casualty department with complaints of severe generalised headache and photophobia since one week and four episodes of Generalised Tonic Clonic Seizures (GTCS) with post-ictal confusion and drowsiness since two days. All investigations were insignificant for the cause except that he was a sickle cell trait (AS pattern), that lead to CVT related headache and convulsion. He was treated with hydration in the form of intravenous fluids, warfarin, mannitol and syrup glycerol, Tab. Sodium bicarbonate and Tab. Hydroxyurea.

Endovascular thrombolysis for pediatric cerebral sinus venous thrombosis with tissue plasminogen activator and abciximab

2014 ◽  
Vol 13 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Imad S. Khan ◽  
Travis R. Ladner ◽  
Komal F. Satti ◽  
Moneeb Ehtesham ◽  
Lori C. Jordan ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Treatment Strategy ◽  
Management Strategies ◽  
Tissue Plasminogen ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Sinus Venous Thrombosis

Cerebral sinus venous thrombosis (CSVT) is a relatively rare but potentially devastating disease. Medical management of CSVT with systemic anticoagulation has been the mainstay treatment strategy with these patients. However, some patients may not respond to this treatment or may present with very severe symptoms indicating more aggressive management strategies. The authors present the case of a pediatric patient who presented with severe CSVT, who underwent successful recanalization with endovascular tissue plasminogen activator (tPA) and abciximab. To the authors' knowledge there are no cases of endovascular thrombolysis for CSVT described in the literature in which abciximab has been used in conjunction with tPA. The authors also review the literature regarding the agents used and outcome in pediatric patients with CSVT after endovascular thrombolysis. The use of abciximab in conjunction with tPA may be considered in patients whose blood is hypercoagulable and in whom the treatment strategy is to obtain acute recanalization and long-term venous patency. However, the use of adjunctive agents increases the risk of hemorrhagic complications and must be done judiciously.

Clinical Profile and Long-term Outcome in Neonatal Cerebral Sinus Venous Thrombosis

2021 ◽  
Author(s):  
Isabella Herman ◽  
Cemal Karakas ◽  
Troy A. Webber ◽  
Stephen F. Kralik ◽  
Danielle S. Takacs ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Clinical Profile ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Sinus Venous Thrombosis

scholarly journals Long-Term Evaluation of the Risk of Recurrence After Cerebral Sinus-Venous Thrombosis

Circulation ◽  
2010 ◽  
Vol 121 (25) ◽  
pp. 2740-2746 ◽  
Author(s):  
Ida Martinelli ◽  
Paolo Bucciarelli ◽  
Serena M. Passamonti ◽  
Tullia Battaglioli ◽  
Emanuele Previtali ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Risk Of Recurrence ◽  
Cerebral Sinus Venous Thrombosis ◽  
Term Evaluation ◽  
Cerebral Sinus ◽  
Sinus Venous Thrombosis

scholarly journals IL-4/STAT6 signaling facilitates innate hematoma resolution and neurological recovery after hemorrhagic stroke in mice

2020 ◽  
Vol 117 (51) ◽  
pp. 32679-32690
Author(s):  
Jing Xu ◽  
Zhouqing Chen ◽  
Fang Yu ◽  
Huan Liu ◽  
Cheng Ma ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Hemorrhagic Stroke ◽  
Brain Injuries ◽  
Primary Cultures ◽  
Young Female ◽  
Neurological Deficits ◽  
Beneficial Effects ◽  
Collagenase Injection ◽  
Enhanced Expression

Intracerebral hemorrhage (ICH) is a devastating form of stroke affecting millions of people worldwide. Parenchymal hematoma triggers a series of reactions leading to primary and secondary brain injuries and permanent neurological deficits. Microglia and macrophages carry out hematoma clearance, thereby facilitating functional recovery after ICH. Here, we elucidate a pivotal role for the interleukin (IL)-4)/signal transducer and activator of transcription 6 (STAT6) axis in promoting long-term recovery in both blood- and collagenase-injection mouse models of ICH, through modulation of microglia/macrophage functions. In both ICH models, STAT6 was activated in microglia/macrophages (i.e., enhanced expression of phospho-STAT6 in Iba1+cells). Intranasal delivery of IL-4 nanoparticles after ICH hastened STAT6 activation and facilitated hematoma resolution. IL-4 treatment improved long-term functional recovery in young and aged male and young female mice. In contrast, STAT6 knockout (KO) mice exhibited worse outcomes than WT mice in both ICH models and were less responsive to IL-4 treatment. The construction of bone marrow chimera mice demonstrated that STAT6 KO in either the CNS or periphery exacerbated ICH outcomes. STAT6 KO impaired the capacity of phagocytes to engulf red blood cells in the ICH brain and in primary cultures. Transcriptional analyses identified lower level of IL-1 receptor-like 1 (ST2) expression in microglia/macrophages of STAT6 KO mice after ICH. ST2 KO diminished the beneficial effects of IL-4 after ICH. Collectively, these data confirm the importance of IL-4/STAT6/ST2 signaling in hematoma resolution and functional recovery after ICH. Intranasal IL-4 treatment warrants further investigation as a clinically feasible therapy for ICH.

scholarly journals Clinical presentation and management of proatlas segmentation defect presenting with palatal myoclonus: case report

2015 ◽  
Vol 16 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Raheel Ahmed ◽  
Arnold H. Menezes
Keyword(s):  
Developmental Disorders ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Neurological Deficits ◽  
Palatal Myoclonus ◽  
Clinical Presentations ◽  
Neurological Morbidity

Clinical presentation of craniovertebral junction disorders may range from acute catastrophic neurological deficits to insidious signs and symptoms that may mask the underlying etiology. Prompt recognition and treatment is essential to avert long-term neurological morbidity. Proatlas segmentation disorders are a rare group of developmental disorders involving the craniocervical junction. Abnormal bony segmentation leads to malformed bony structures that can in turn lead to neurological deficits through bony compression of the cervicomedullary junction. This report details a proatlas segmentation defect presenting as palatal myoclonus, a rare movement disorder. The clinical presentation, surgical management, and neuroanatomical basis for the disorder is presented. This report highlights the myriad clinical presentations of craniovertebral disorders and emphasizes a rare but treatable etiology for palatal myoclonus.

scholarly journals Cerebral Venous Thrombosis: A Comprehensive Review

2020 ◽  
Vol 83 (4) ◽  
pp. 369-379 ◽  
Author(s):  
Pretty Sara Idiculla ◽  
Dhineshreddy Gurala ◽  
Manikandan Palanisamy ◽  
Rajendran Vijayakumar ◽  
Sindhu Dhandapani ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Literature Search ◽  
Anticoagulation Therapy ◽  
Diagnosis And Treatment ◽  
Neurological Deficits ◽  
Comprehensive Review ◽  
Neurological Condition ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Sinus Venous Thrombosis

Background: Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword “Cerebral sinus venous thrombosis” was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease. Summary: The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment. Conclusion: CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.

scholarly journals Long-Term Cryopreservation Does Not Affect Quality of Peripheral Blood Stem Cell Grafts: A Comparative Study of Native, Short-Term and Long-Term Cryopreserved Haematopoietic Stem Cells

2021 ◽  
Vol 30 ◽  
pp. 096368972110360
Author(s):  
Daniel Lysak ◽  
Michaela Brychtová ◽  
Martin Leba ◽  
Miroslava Čedíková ◽  
Daniel Georgiev ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Statistical Significance ◽  
Extended Period ◽  
High Dose ◽  
Atp Production ◽  
Cd34 Cells ◽  
Negative Effect

Cryopreserved haematopoietic progenitor cells are used to restore autologous haematopoiesis after high dose chemotherapy. Although the cells are routinely stored for a long period, concerns remain about the maximum storage time and the possible negative effect of storage on their potency. We evaluated the effect of cryopreservation on the quality of peripheral stem cell grafts stored for a short (3 months) and a long (10 years) period and we compared it to native products.The viability of CD34+ cells remained unaffected during storage, the apoptotic cells were represented up to 10% and did not differ between groups. The clonogenic activity measured by ATP production has decreased with the length of storage (ATP/cell 1.28 nM in native vs. 0.63 in long term stored products, P < 0.05). Only borderline changes without statistical significance were detected when examining mitochondrial and aldehyde dehydrogenase metabolic activity and intracellular pH, showing their good preservation during cell storage. Our experience demonstrates that cryostorage has no major negative effect on stem cell quality and potency, and therefore autologous stem cells can be stored safely for an extended period of at least 10 years. On the other hand, long term storage for 10 years and longer may lead to mild reduction of clonogenic capacity. When a sufficient dose of stem cells is infused, these changes will not have a clinical impact. However, in products stored beyond 10 years, especially when a low number of CD34+ cells is available, the quality of stem cell graft should be verified before infusion using the appropriate potency assays.

scholarly journals Management of a Mycotic Aneurysm in a Patient with COVID-19: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 620
Author(s):  
Muzammil H. Syed ◽  
Mark Wheatcroft ◽  
Danny Marcuzzi ◽  
Hooman Hennessey ◽  
Mohammad Qadura
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Mycotic Aneurysm ◽  
Neurological Deficits ◽  
Endovascular Stent ◽  
Endovascular Stents ◽  
Abdominal Aortic ◽  
Short Period

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.

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