scholarly journals Decompressive craniectomy in hemorrhagic cerebral venous thrombosis: clinicoradiological features and risk factors

2017 ◽  
Vol 127 (4) ◽  
pp. 709-715 ◽  
Author(s):  
Si Zhang ◽  
Hexiang Zhao ◽  
Hao Li ◽  
Chao You ◽  
Xuhui Hui
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Decompressive Craniectomy ◽  
Surgical Outcomes ◽  
Cerebral Venous Thrombosis ◽  
Lesion Volume ◽  
Venous Involvement ◽  
Life Saving ◽  
Potential Risk Factors ◽  
The Mean

OBJECTIVEDecompressive craniectomy (DC) is a life-saving treatment for severe hemorrhagic cerebral venous thrombosis (CVT). However, the correlations between the clinicoradiological features and surgical outcomes of this disease are not well established. Therefore, the authors endeavored to analyze the potential risk factors for this more severe subtype of CVT and to provide more evidence regarding the benefits of DC in patients with hemorrhagic CVT.METHODSThe clinical features, radiological findings, and surgical outcomes of patients with severe hemorrhagic CVT who had undergone DC treatment in the period from January 2005 to March 2015 were retrospectively analyzed, and the risk factors for this disease were evaluated.RESULTSFifty-eight patients, 39 females (67.2%) and 19 males (32.8%), with a mean age of 39.7 ± 12.5 years, were included in this study. The mean duration from symptom onset to surgery was 3.3 ± 1.9 days, and 21 patients experienced acute courses. On neuroimaging, the mean mass lesion volume was 114.7 ± 17.7 ml. Nine patients had bilateral lesions, and 7 patients had deep CVT. According to their hemorrhagic proportion, cases were divided into hemorrhage-dominated (27 [46.6%]) and edema-dominated (31 [53.4%]) groups. After 6 months of follow-up, 56.9% of patients had achieved a favorable outcome, and 8 patients had died. The hemorrhage-dominated lesions (p = 0.026) and deep cerebral venous involvement (p = 0.026) were significantly associated with a poor outcome.CONCLUSIONSIn patients suffering from severe hemorrhagic CVT, DC is an effective life-saving treatment that is associated with favorable outcomes. Hemorrhage-dominated lesions and deep cerebral venous involvement have a significant impact on the outcome of this disease.

Complications Following Decompressive Craniectomy

2021 ◽  
Author(s):  
Jan Mraček ◽  
Jan Mork ◽  
Jiri Dostal ◽  
Radek Tupy ◽  
Jolana Mrackova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decompressive Craniectomy ◽  
Clinical Status ◽  
Fluid Collection ◽  
Epileptic Seizures ◽  
Middle Cerebral Artery Infarction ◽  
Temporal Muscle ◽  
Life Saving ◽  
Potential Risk Factors ◽  
The Impact

Abstract Background Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications. Methods We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed. Results DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome. Conclusions The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.

scholarly journals Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis

2020 ◽  
Author(s):  
Eduardo Soriano-Navarro ◽  
Vanessa Cano-Nigenda ◽  
Fernanda Menéndez-Manjarrez ◽  
Esmirna Farington-Terrero ◽  
Juan José Méndez-Gallardo ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Decompressive Craniectomy ◽  
Cerebral Venous Thrombosis ◽  
Cerebral Oedema ◽  
Therapeutic Option ◽  
Midline Shift ◽  
Sagittal Sinus ◽  
Life Saving ◽  
Venous Infarcts

Introduction: Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment. Patient and methods: We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed. Results: At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3. Discussion: Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.

scholarly journals Cerebral venous thrombosis in a patient with Down syndrome and coronavirus disease 2019: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Henry Robayo-Amortegui ◽  
Natalia Valenzuela-Faccini ◽  
Cesar Quecano-Rosas ◽  
Darlyng Zabala-Muñoz ◽  
Michel Perez-Garzon
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Case Report ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Epidemiological Data ◽  
Thromboembolic Disease ◽  
Hispanic Woman ◽  
Case Presentation ◽  
The World

Abstract Background The new coronavirus disease 2019 pandemic has spread throughout most of the world. Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. Case presentation We report the case of a Hispanic woman with Down syndrome who has coronavirus disease 2019 and presents as a complication extensive cerebral venous thrombosis. Conclusions Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. In the absence of clinical and epidemiological data, it is important to carry out further investigation of the risk factors and pathophysiological causes related to the development of cerebrovascular thrombotic events in patients with Down syndrome with coronavirus disease 2019 infection.

scholarly journals Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Filippo Migliorini ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
The Mean ◽  
Tegner Score

Abstract Background The medial patellofemoral ligament (MPFL) is always damaged after patellar dislocation. In selected patients, MPFL reconstruction is necessary to restore a correct patellar tracking. Despite the large number of different techniques reported to reconstruct the MPFL, there is no consensus concerning the optimal procedure, and debates is still ongoing. The present study analysed the results after isolated MPFL reconstruction in patients with patellofemoral instability. Furthermore, a subgroup analysis of patients presenting pathoanatomical risk factors was made. Methods In November 2020, the main electronic databases were accessed. All articles reporting the results of primary isolated MPFL reconstruction for recurrent patellofemoral instability were considered for inclusion. Only articles reporting a minimum 12-month follow-up were eligible. Results Data from a total of 1777 knees were collected. The mean age of the patients involved was 22.8 ± 3.4 years. The mean follow-up was 40.7 ± 25.8 months. Overall, the range of motion (+ 27.74; P < 0.0001) and all the other scores of interests improved at last follow-up: Kujala (+ 12.76; P = 0.0003), Lysholm (+ 15.69; P < 0.0001), Tegner score (+ 2.86; P = 0.006). Seventy-three of 1780 patients (4.1%) showed a positive apprehension test. Thirty of 1765 patients (1.7%) experienced re-dislocations, while 56 of 1778 patients (3.2%) showed persisting joint instability. Twenty-five of 1786 patients (1.4%) underwent revision surgeries. Conclusion Isolated MPFL reconstruction for recurrent patellofemoral instability provides reliable surgical outcomes. Patients with pathoanatomical predisposing factors reported worse surgical outcomes.

scholarly journals Evaluation of risk factors for thrombophilia in patients with cerebral venous thrombosis

2010 ◽  
Vol 27 (3) ◽  
pp. 162-167 ◽  
Author(s):  
Osman Yokus ◽  
Ozlem Sahin Balcik ◽  
Murat Albayrak ◽  
Funda Ceran ◽  
Simten Dagdas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis

A case series of cerebral venous thrombosis as the first manifestation of homocystinuria

2021 ◽  
pp. 239698732110594
Author(s):  
Antonio Ochoa-Ferraro ◽  
Subadra Wanninayake ◽  
Charlotte Dawson ◽  
Adam Gerrard ◽  
Mary Anne Preece ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Effective Treatment ◽  
Cerebral Venous Thrombosis ◽  
Thrombotic Event ◽  
Case Series ◽  
Autosomal Recessive Disorder ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Physician Awareness ◽  
The Mean

Background Cerebral venous thrombosis (CVT) is an important cause of stroke particularly in younger patients and potentially fatal if diagnosis is delayed. The presentation of symptoms is highly variable and consequently the diagnosis and underlying cause is often delayed or overlooked. Homocystinuria, a rare autosomal recessive disorder is an identified risk factor for CVT. Purpose A timely diagnosis and treatment of the underlying cause of CVT could result in improved outcome and prevent further events. This case series describes the clinical course of six adults presented with unprovoked CVT, in whom the diagnosis of underlying homocystinuria was delayed with adverse consequences. We aim to highlight the importance of recognising homocystinuria as an underlying cause of CVT and offer a practical approach to the diagnosis and management. Methods This is a retrospective case series of a cohort of 30 consecutive patients seen in a UK tertiary referral centre. Result Six out of 30 patients presented with CVT prior to homocystinuria diagnosis. The mean and range of age at the time of the first CVT episode was 22.6 (range 11–31) years. The mean ±SD age at diagnosis of homocystinuria as the underlying cause was 26 ± 4.2 years. The time between first CVT and diagnosis of homocystinuria ranged from 1.6 to 11 years resulting in a delay to introduction of effective treatment and, in some cases, a further large vessels thrombotic event. Conclusion Physician awareness of homocystinuria as an underlying cause for an unprovoked CVT will facilitate timely introduction of effective treatment to prevent a further event.

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

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.

Risk factors for cerebral venous thrombosis and deep venous thrombosis in patients aged between 15 and 50 years

2009 ◽  
Vol 102 (10) ◽  
pp. 620-622 ◽  
Author(s):  
Maarten Uyttenboogaart ◽  
Patrick C. A. J. Vroomen ◽  
Jacques De Keyser ◽  
Gert-Jan Luijckx ◽  
Karen Koopman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Contraceptive Use ◽  
Multivariable Logistic Regression Analysis ◽  
Age Group ◽  
Vein Thrombosis ◽  
Oral Contraceptive Use ◽  
Age Dependent ◽  
Deep Vein

SummaryCerebral venous thrombosis (CVT) and deep vein thrombosis or pulmonary embolism (DVT/PE) are associated with many risk factors. It is unclear why CVT occurs less often than DVT/PE. Age dependent risk factors may play a role. The aim of our study was to compare risk factors in a uniform age group of CVT and DVT/PE patients aged between 15 and 50 years. Thrombophilic markers and clinical risk factors of 79 CVT patients and 173 DVT/PE patients aged 15–50 years were compared. Multivariable logistic regression analysis was performed to investigate if risk factors were independently associated with CVT or DVT/ PE. Cerebral venous thrombosis patients were younger (median age 30 years vs. 42 years; p<0.001) and more often female (82% vs. 52%; p<0.001). There were no differences in thrombophilic markers. Cerebral venous thrombosis was less often associated with trauma, immobilisation or surgery than DVT/PE (6% vs. 21%; adjusted OR 0.29; 95%CI 0.10–0.82). In women, CVT was more frequently associated with oral contraceptive use, pregnancy or puerperium (82% vs. 53%; adjusted OR 2.34; 95%CI 1.03–5.32).This study demonstrated no differences in thrombophilic markers between CVT patients and DVT/PE patients aged between 15 and 50 years, while the frequency of some transient risk factors was different. Cerebral venous thrombosis was relatively more common in women and hormonal factors may predispose to CVT compared to DVT/PE, while trauma, immobilisation and surgery may be less important in the pathophysiology of CVT.

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