Brain MRI-findings in Ph - negative myeloproliferative disorders

Myeloproliferative disorders (MPD) are accompanied by a high proportion of thrombotic complications, which may lead to cerebrovascular disease (CVD). Aim. To describe MRI-findings in patients with Ph - negative MPD and evaluate any cerebrovascular disease. Materials and methods. We included 104 patients with Ph - negative MPD (age varied between 20 and 58) with clinical correlates of cerebrovascular pathology. Results. Brain MRI showed post - stroke lesions in 20% of patients (7 hemispheric infarcts due to thrombotic occlusion of one of the large cerebral arteries, 14 - cortical infarcts). 37 patients (36%) had vascular cerebral lesions. Cerebral venous sinus thrombosis occurred in 5 patients - in 7% (n=3) of patients with polycythemia vera and 5% (n=2) - in patients with essential thrombocythemia. The incidence of vascular cerebral lesions was associated with higher levels of the following: erythrocyte, platelet count, fibrinogen, and with the decrease in fibrinolytic activity, as well. Conclusion. The pioneering results of the study include the description and analysis of brain MRI-findings in patients with Ph - negative MPD. The underlying mechanisms of cerebrovascular pathology in these patients are associated with certain blood alterations (particularly, hemorheology) which present a major risk factor.

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COVID-19 and cerebrovascular diseases: a comprehensive overview

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420978004 ◽

2020 ◽

Vol 13 ◽

pp. 175628642097800

Author(s):

Georgios Tsivgoulis ◽

Lina Palaiodimou ◽

Ramin Zand ◽

Vasileios Arsenios Lioutas ◽

Christos Krogias ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Clinical Laboratory ◽

Sinus Thrombosis ◽

Case Reports ◽

Cardiac Injury ◽

Clinical Manifestations ◽

Relevant Information ◽

Cerebral Venous Sinus Thrombosis ◽

Stroke Patients ◽

Comprehensive Overview

Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

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Cerebrovascular disease

10.1093/med/9780199664368.003.0004 ◽

2016 ◽

Author(s):

Sathiji Nageshwaran ◽

Heather C Wilson ◽

Anthony Dickenson ◽

David Ledingham

Keyword(s):

Cerebrovascular Disease ◽

Carotid Artery Disease ◽

Sinus Thrombosis ◽

Vertebral Artery Dissection ◽

Cerebral Venous Sinus Thrombosis ◽

Artery Dissection ◽

Risk Factor Modification ◽

Symptomatic Carotid ◽

Transient Ischaemic Attacks ◽

Artery Disease

This chapter on cerebrovascular disease discusses the evidence-based management of acute stroke, transient ischaemic attacks (TIAs), and secondary stroke prevention (antiplatelet therapy, risk factor modification, atrial fibrillation (AF), carotid and vertebral artery dissection, and symptomatic carotid artery disease). Drug treatment of intracerebral haemorrhage, subarachnoid haemorrhage, and cerebral venous sinus thrombosis are also discussed.

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Prothrombogenic polymorphic variants of hemostatic and folate metabolism genes In patients with aseptic cerebral venous thrombosis

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2019.065 ◽

2019 ◽

pp. 79-86

Author(s):

MYu Maksimova ◽

YuI Dubovitskaya ◽

MV Krotenkova ◽

AA Shabalina

Keyword(s):

Sinus Thrombosis ◽

Brain Mri ◽

Clinical Manifestations ◽

Cerebral Venous Sinus Thrombosis ◽

Folate Metabolism ◽

Control Group ◽

Polymorphic Variants ◽

Pai 1 ◽

Genotype A ◽

Hemostatic Genes

Cerebral venous sinus thrombosis (CVT) becomes the cause of stroke in less than 1% of patients. In 20-30% of patients, the cause of thrombosis remains unclear, and thrombosis is considered idiopathic. Inherited hypercoagulable conditions significantly increase the risk of CVT. The aim of the study was to evaluate the frequency of prothrombogenic polymorphic variants of hemostatic and methionine-homocysteine metabolism genes alleles and genotypes in patients with aseptic CVT. Fifty one patients aged 18–75 with aseptic CVT were examined. The control group included 36 healthy volunteers. Neuroimaging methods included brain MRI in standard modes (T1, T2, T2 d-f (FLAIR), DWI) and MR venosinusography. All patients were surveyed to identify carriers of prothrombogenic polymorphic variants of hemostatic and folate metabolism genes alleles and genotypes. Prothrombogenic polymorphic variants of hemostatic genes were detected in 94% of patients, and the variants of the methionine-homocysteine metabolism genes were observed in 86% of patients. The differences between distributions of alleles and genotypes 5G6754G of the PAI-1 gene, G103T of the FXIIIA1 gene, A66G of the MTRR gene, A2756G of the MTR gene in the group of patients with CVT and in the control group were significant. Allele 4G, genotypes 4G/4G and 5G/4G of 5G6754G polymorphism of the PAI-1 gene; allele T of G103Т polymorphism of the FXIIIA1 gene; allele G and genotype A/G of A66G polymorphism of the MTRR gene; allele G and genotype A/G of A2756G polymorphism of the MTR gene correlated with aseptic CVT. It was concluded that the gene polymorphisms 5G6754G (PAI-1), G103T (FXIIIA1), A66G (MTRR) and A2756G (MTR) carriage increased the risk of aseptic CVT and did not affect the thrombosis clinical manifestations.

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A Case Report of Cerebral Venous Sinus Thrombosis in Palestine: The Importance of Rapid Diagnosis and Treatment of CVST

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.04.06.06 ◽

2019 ◽

Vol 4 (6) ◽

Keyword(s):

Case Report ◽

Sinus Thrombosis ◽

Brain Mri ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Successful Outcome ◽

Venous Sinus Thrombosis ◽

Brain Ct ◽

First Case

Cerebral venous sinus thrombosis (CVST) is an often under-diagnosed, life-threatening condition. We report the first case of CVST in Palestine of a 39-year-old female who presented with a history of loss of consciousness preceded by severe vertigo and headache. Brain CT scan without contrast was done, in which no abnormality was detected. Further Brain MRI and MRV studies with contrast showed thrombosis of left transverse sinus with extension to left sigmoid sinus and left jugular vein. The patient was anticoagulated and admitted to the ICU for regular monitoring and frequent brain CT scans to rule out hemorrhagic transformation. The patient made a full recovery. Lab and molecular studies were carried out as an outpatient to investigate the etiology of this presentation. The aim of this case report is to demonstrate the importance of early detection and treatment of CVST for a successful outcome.

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CEREBROVASCULAR COMPLICATIONS OF COVID-19

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2021;9(3):219-227 ◽

2021 ◽

Vol 9 (3) ◽

Author(s):

Volodymyr Lychko ◽

Mykola Burtyka

Keyword(s):

Cerebrovascular Disease ◽

Clinical Laboratory ◽

Sinus Thrombosis ◽

Case Reports ◽

Clinical Manifestations ◽

Relevant Information ◽

Neurological Complications ◽

Cerebral Venous Sinus Thrombosis ◽

Systemic Review ◽

Stroke Patients

The systematic online search of articles utilizing the search terms ”Coronavirus, SARS-COV-2 and Neurological complications”, published between January 2019 and September 2021, was performed. Neurological manifestations are prevalent during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a clear association between cerebrovascular disease and coronavirus disease 2019 (COVID-19). But today, whether this association is causal or incidental is still unknown. This systemic review presents the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describes the most often neurological complications and their prognosis, discusses several clinical and laboratory characteristics. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune storm with inflammation, coagulopathy, complications due to critical illness and prolonged hospitalization can all contribute as potential etiological and pathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral haemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients, with a prevalence ranging between 0.5 % and 5.0 %. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients. Understanding of the specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ in recognizing COVID-19-related acute neurological complications.

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Covert Brain Infarcts in Patients with Philadelphia Chromosome-Negative Myeloproliferative Disorders

Journal of Clinical Medicine ◽

10.3390/jcm11010013 ◽

2021 ◽

Vol 11 (1) ◽

pp. 13

Author(s):

Polina I. Kuznetsova ◽

Anton A. Raskurazhev ◽

Rodion N. Konovalov ◽

Marina V. Krotenkova ◽

Andrey O. Chechetkin ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Arterial Hypertension ◽

Carotid Atherosclerosis ◽

Complete Blood Count ◽

Brain Mri ◽

Philadelphia Chromosome ◽

Clinical History ◽

Myeloproliferative Disorders ◽

Cerebral Lesions ◽

Brain Infarcts

Backgrounds and Purpose. Philadelphia chromosome-negative myeloproliferative disorders (Ph-negative MPD) are a rare group of hematological diseases, including three distinct pathologies: essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). They most often manifest with thrombotic complications, including cerebrovascular events. Covert brain infarcts (CBIs) are defin ed as predominantly small ischemic cerebral lesions that are detected using magnetic resonance imaging (MRI) in the absence of clinical stroke events. The relationship between MPD and CBIs remains unclear. Methods. Included in the study were 103 patients with the diagnosis of Ph-MPD (according to WHO 2016 criteria) (median age—47 (35; 54) years; 67% female). In total, 38 patients had ET, 42 had PV, and 23 had PMF. They underwent clinical examination, routine laboratory analyses (complete blood count), brain MRI, ultrasound carotid artery, flow-mediated dilatation (as a measure of endothelial dysfunction—FMD). Results. Overall, 23 patients experienced an ischemic stroke (as per MRI and/or clinical history), of which 16 (15.5%) could be classified as CBIs. The rate of CBIs per MPD subtype was statistically non-significant between groups (p = 0.35): ET–13.2%, PV–21.4%, and PMF–8.7%. The major vascular risk factors, including arterial hypertension, carotid atherosclerosis, and prior venous thrombosis, were not associated with CBIs (p > 0.05). Age was significantly higher in patients with CBIs compared to patients without MRI ischemic lesions: 50 (43; 57) years vs. 36 (29; 48) (p = 0.002). The frequency of headaches was comparable between the two groups. CBIs were associated with endothelial dysfunction (OR - 0.71 (95% CI: 0.49–0.90; p = 0.02)) and higher hemoglobin levels (OR—1.21 (95% CI: 1.06–1.55); p =0.03). Conclusions. CBIs are common in patients with Ph-negative MPD. Arterial hypertension and carotid atherosclerosis were not associated with CBIs in this group of patients. The most significant factors in the development of CBIs were endothelial dysfunction (as measured by FMD) and high hemoglobin levels. Patients with Ph-negative MPD and CBIs were older and had more prevalent endothelial dysfunction.

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Cerebral Venous Sinus Thrombosis Score and its Correlation with Clinical and MRI Findings

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2019.104324 ◽

2019 ◽

Vol 28 (11) ◽

pp. 104324

Author(s):

Jayantee Kalita ◽

Varun K. Singh ◽

Neeraj Jain ◽

Usha K. Misra ◽

Sunil Kumar

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Mri Findings ◽

Venous Sinus Thrombosis

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A Case of Turner Syndrome with Multiple Embolic Infarcts

Case Reports in Neurology ◽

10.1159/000449282 ◽

2016 ◽

Vol 8 (3) ◽

pp. 199-203 ◽

Cited By ~ 2

Author(s):

Cindy W. Yoon ◽

Eungseok Lee ◽

Byung-Nam Yoon ◽

Hee-Kwon Park ◽

Joung-Ho Rha

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Turner Syndrome ◽

Cerebral Arteries ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Holter Monitoring ◽

Sudden Onset ◽

Embolic Stroke ◽

Mri Findings

Only a few cases of Turner syndrome (TS) with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI) findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

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