Cerebral deep venous thrombosis and COVID-19: case report

Herein, the authors present the case of a 54-year-old male diagnosed with coronavirus disease 2019 (COVID-19) during a screening test. The patient was asked to self-isolate at home and report with any exacerbations of symptoms. He presented later with pneumonia complicated by encephalopathy at days 14 and 15 from initial diagnosis, respectively. MRI of the brain showed bithalamic and gangliocapsular FLAIR signal abnormality with mild right-sided thalamic and periventricular diffusion restriction. A CT venogram was obtained given the distribution of edema and demonstrated deep venous thrombosis involving the bilateral internal cerebral veins and the vein of Galen. CSF workup was negative for encephalitis, as the COVID-19 polymerase chain reaction (PCR) test and bacterial cultures were negative. A complete hypercoagulable workup was negative, and the venous thrombosis was attributed to a hypercoagulable state induced by COVID-19. The mental decline was attributed to bithalamic and gangliocapsular venous infarction secondary to deep venous thrombosis. Unfortunately, the patient’s condition continued to decline, and care was withdrawn.

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Surgical management of pineal region lesions

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0037 ◽

2019 ◽

pp. 439-446

Author(s):

Christoph M. Woernle ◽

René L. Bernays ◽

Nicolas de Tribolet

Keyword(s):

Third Ventricle ◽

Pineal Region ◽

Cerebral Veins ◽

Internal Cerebral Veins ◽

Supracerebellar Infratentorial Approach ◽

Occipital Transtentorial Approach ◽

Basal Vein Of Rosenthal ◽

Third Ventricle Tumours ◽

Quadrigeminal Plate ◽

The Brain

Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.

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Role of MRI in Cerebral Venous Thrombosis

QJM ◽

10.1093/qjmed/hcab106.029 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmad Shawki Geneidi ◽

Nermeen Nasry Keriakos ◽

Khaled Mostafa Mohammad Khaled

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Venous Occlusion ◽

Acute Onset ◽

Radiology Department ◽

Cerebral Veins ◽

Limb Weakness ◽

Inflammatory Conditions ◽

Imaging Department ◽

The Brain

Abstract Background Cerebral venous thrombosis CVT is a type of stroke where the thrombosis occurs in the venous side of the brain circulation, leading to occlusion of one or more cerebral veins and Dural venous sinus. CVT is a potentially life-threatening disease, accounting for approximately 0.5 % of stroke cases. Aim of the Work The aim of this subject is to illustrate the various aspects of CVT on MRI. Patients and Methods This is a retrospective study included 30 patients (19 females &11 males), their ages range from 3 months to 74 years with the median age 22 years. Mean age 22.04 years. The study was performed in radiology department El Demerdash Hospital between March 2018 & September 2019. The study included patients presented to the Medical Imaging Department of Ain Shams university Al-Demerdash hospital with cerebral venous occlusion neurological symptoms or imaging diagnosis. Results In our study,. Most common presenting symptom was headache noted in 22 patients (73.3%) followed by eye manifestations (blurring of vision or clinically having papilledema) was the second most seen in 18 patients (60%). Then comes convulsions in8 patients (26.7 %), Limb weakness in 5 patients (16.7%), finally disturbed consciousness level in 4 patients (13.3%). Most common mode of onset was subacute which was seen in 16 patients (53.3%) acute onset was seen in 6 patients (20%) as predominantly isointense on T1 weighted images and hypo intense on T2 weighted images, chronic onset was seen in 8 patients (26.7%) as hypo intense signal in both T1 and T2 WIs. MRV successfully diagnosed occlusion in most cases by absence of signal intensity with consequent non-visualization of occluded sinuses or veins in almost all patients and except 3 patients; those were having just cortical veins thrombosis detected by T2* sequence electing blooming artifacts with intact sinuses, and dilated distal collaterals seen in 18 patients. Conclusion Dural venous occlusion can occur due to many factors as thrombosis, inflammatory conditions of the brain and tumors. Cerebral venous thrombosis (CVT) has long been a neglected entity because of complexities in diagnosis and non-specific clinical presentation. Conventional MRI and phase contrast MRV in conjugation with recent techniques such SWI & DWI were considered more accurate diagnostic tool, non invasive, non ionizing, with high resolution in evaluating patients with suspected cerebral venous occlusion or thrombosis. It is also considered very useful to demonstrate brain parenchymal affection, the age or stage of the thrombus and its extension

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Cerebral Venous Thrombosis in the Rhesus Monkey

Veterinary Pathology ◽

10.1177/030098588101800305 ◽

1981 ◽

Vol 18 (3) ◽

pp. 326-334 ◽

Cited By ~ 12

Author(s):

W. D. Sheffield ◽

R. A. Squire ◽

J. D. Strandberg

Keyword(s):

Ulcerative Colitis ◽

Central Nervous System ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Rhesus Monkeys ◽

Venous Occlusion ◽

Thromboembolic Disease ◽

Cerebral Veins ◽

Centrum Semiovale ◽

Internal Cerebral Veins

Cerebral venous thrombosis was identified in four rhesus monkeys. Two initially showed neurologic signs and three had diarrhea or dysentery. All four had severe intestinal disease, including three cases of ulcerative colitis complicated by extracerebral thromboembolic disease. Central nervous system lesions, confined to the centrum semiovale, were multiple thrombi of internal cerebral veins, perivenular demyelination, and gemistocytic astrocytosis. The lesions resembled those found in people with cerebral venous thrombosis, and support the hypothesis that perivenular demyelination may occur as a sequela to venous occlusion. The lesions were identical to those found in “leukoencephalosis and perivascular myelosis,” an entity of unknown cause previously described in monkeys.

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Proximal deep venous thrombosis following PTA of the superficial femoral artery – an obligation to disclose a complication that is rarely taken into account

VASA ◽

10.1024/0301-1526.35.1.41 ◽

2006 ◽

Vol 35 (1) ◽

pp. 41-44 ◽

Cited By ~ 5

Author(s):

Klein-Weigel ◽

Pillokat ◽

Klemens ◽

Köning ◽

Wolbergs ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Rare Complication ◽

Femoral Vein ◽

Vein Thrombosis ◽

Explicit Information ◽

Life Threatening ◽

Legal Consequences

We report two cases of femoral vein thrombosis after arterial PTA and subsequent pressure stasis. We discuss the legal consequences of these complications for information policies. Because venous thrombembolism following an arterial PTA might cause serious sequel or life threatening complications, there is a clear obligation for explicit information of the patients about this rare complication.

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Perforation of inferior vena cava during filter placement

VASA ◽

10.1024/0301-1526/a000087 ◽

2011 ◽

Vol 40 (2) ◽

pp. 157-162 ◽

Cited By ~ 6

Author(s):

Piecuch ◽

Wiewiora ◽

Nowowiejska-Wiewiora ◽

Szkodzinski ◽

Polonski

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

Retroperitoneal Hematoma ◽

Ivc Filter ◽

Filter Placement ◽

Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

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Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽

10.1024/0301-1526/a000508 ◽

2016 ◽

Vol 45 (2) ◽

pp. 141-147 ◽

Cited By ~ 7

Author(s):

Jakob Martin Burgstaller ◽

Johann Steurer ◽

Ulrike Held ◽

Beatrice Amann-Vesti

Keyword(s):

Systematic Review ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Cochrane Library ◽

Compression Stockings ◽

Post Thrombotic Syndrome ◽

Study Results ◽

Preventive Efficacy ◽

One Year ◽

The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

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Is Quantitative Determination of Fibrin(ogen) Degradation Products and Thrombin-Antithrombin III Complexes Useful to Diagnose Deep Venous Thrombosis in Outpatients?

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647113 ◽

1989 ◽

Vol 62 (04) ◽

pp. 1043-1045 ◽

Cited By ~ 12

Author(s):

Paul F M M van Bergen ◽

Eduard A R Knot ◽

Jan J C Jonker ◽

Auke C de Boer ◽

Moniek P M de Maat

Keyword(s):

Quantitative Determination ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Antithrombin Iii ◽

Degradation Products ◽

Family Doctor ◽

Diagnostic Value ◽

Impedance Plethysmography ◽

Fibrin Degradation Products

SummaryWe studied the diagnostic value of recently introduced ELISA’s for the determination of thrombin-antithrombin III (TAT) complexes, fibrin degradation products (FbDP), fibrinogen degradation products (FgDP) and total degradation products (TDP) for deep venous thrombosis (DVT) in plasma of 239 consecutive outpatients, suspected for DVT by their family doctor. DVT was confirmed by impedance plethysmography in 60 patients. Using the 95th percentile range of 42 healthy volunteers the sensitivity for the detection of DVT was: 37% for TAT, 95% for TDP, 92% for FbDP and 90% for FgDP. Specificity was: 88% for TAT, 16% for TDP, 20% for FbDP and 25% for FgDP.We conclude that these assays are of little value in the diagnosis of DVT in outpatients.

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Platelet Adhesiveness and Fibrinolysis after Recent Cerebro-Vascular Accidents and their Relationship with Subsequent Deep Venous Thrombosis of the Legs

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648016 ◽

1976 ◽

Vol 36 (01) ◽

pp. 127-132 ◽

Cited By ~ 11

Author(s):

C. P Warlow ◽

J. A. N Rennie ◽

D Ogston ◽

A. S Douglas

Keyword(s):

Platelet Count ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasminogen Activator ◽

Fibrinogen Level ◽

Plasma Fibrinogen ◽

Platelet Adhesiveness ◽

Plasma Fibrinogen Level ◽

Vascular Accidents ◽

Subsequent Rise

SummaryIn fifteen patients with a cerebro-vascular accident resulting in an acute hemiplegia there was a subsequent rise in the platelet count and plasma fibrinogen level. There were no significant alterations in platelet adhesiveness, plasminogen activator, plasminogen, FR-antigen and haematocrit. Patients diagnosed as developing deep venous thrombosis with the 125I-fibrinogen technique had a significantly lower platelet adhesiveness and plasminogen level than those who were not.

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Markers of Hemostatic System Activation in Acute Deep Venous Thrombosis-Evolution during the First Days of Heparin Treatment

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649698 ◽

1993 ◽

Vol 70 (06) ◽

pp. 0909-0914 ◽

Cited By ~ 45

Author(s):

Keyword(s):

Molecular Weight ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Low Molecular Weight Heparin ◽

Factor Xa ◽

Low Molecular Weight ◽

Dose Adaptation ◽

Heparin Treatment ◽

Lung Scan

SummaryFibrin D-Dimer (D-Di), prothrombin activation fragment (F 1+2) and thrombin-antithrombin III complexes (TAT) were measured using ELISA procedures in the plasma of patients with an acute deep venous thrombosis (DVT), at presentation and on days 2, 6 and 10 after initiation of heparin treatment. Patients were randomly allocated into two treatment groups: 44 patients received adapted doses of continuous intravenous unfractionated heparin (UH) whereas 47 received 1 mg/kg every twelve hours of a low molecular weight heparin (enoxaparin) subcutaneously. A phlebography and a perfusion lung scan were performed before inclusion and on day 10. Failure of therapy (n = 9) was defined by venogram worsening or confirmed pulmonary embolism. Improvement (n = 44) or stationary state (n = 38) were defined by venogram evolution in the absence of new leg scan defects.At presentation, D-Di, F 1 + 2 and TAT were above cut-off values in 97, 66 and 89% of patients respectively. D-Di levels correlated with the extent of venous thrombosis whereas TAT and F 1 + 2 did not. Mean levels of D-Di decreased sharply during the first days of treatment but were still abnormal on day 10. A secondary increase of D-Di on days 6 or 10 by more than 3 μg/ml occurred in 4 of the 9 patients who developed a thromboembolic recurrence but in none of the 72 patients who had a more favorable outcome. F 1 + 2 and TAT time-courses were not related to clinical evolution. In the Enoxaparin group, there was no relationship between antifactor Xa activities and any biological markers. TAT and F 1 + 2 levels fell on day 2 and remained stable until day 10. In contrast, in the UH group, TAT and F 1 + 2 did not significantly decrease on day 2, probably due to a delay in dose adaptation, but they declined slowly until day 10.In conclusion, D-Di displays a higher sensitivity than F 1 + 2 or TAT for the diagnosis of D\T. D-Di, but not TAT or F 1 + 2, follow-up seems to be of potential value for early detection of recurrency. Hemostatic activation is controlled earlier by fixed doses of a low molecular weight heparin, irrespective of the plasma anti-factor Xa activities, than by unfractionated heparin at adapted doses.

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Investigations into the Clinical Utility of Latex D-Dimer in the Diagnosis of Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651178 ◽

1993 ◽

Vol 69 (01) ◽

pp. 008-011 ◽

Cited By ~ 22

Author(s):

Cedric J Carter ◽

D Lynn Doyle ◽

Nigel Dawson ◽

Shauna Fowler ◽

Dana V Devine

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Clinical Utility ◽

Rapid Test ◽

Fibrin Degradation Product ◽

Current Form ◽

Non Invasive ◽

Clinically Significant ◽

D Dimer

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

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