scholarly journals Diagnosis and Management of Mixed Transcortical Aphasia Due to Multiple Predisposing Factors, including Postpartum and Severe Inherited Thrombophilia, Affecting Multiple Cerebral Venous and Dural Sinus Thrombosis: Case Report and Literature Review

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1425
Author(s):  
Dragoș Cătălin Jianu ◽  
Silviana Nina Jianu ◽  
Traian Flavius Dan ◽  
Nicoleta Iacob ◽  
Georgiana Munteanu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Sinus Thrombosis ◽  
Laboratory Data ◽  
Internal Capsule ◽  
Late Pregnancy ◽  
Dural Sinus ◽  
Partial Recovery ◽  
Dural Sinus Thrombosis ◽  
Rare Type ◽  
Inherited Thrombophilia

Cerebral venous and dural sinus thrombosis (CVT) is an uncommon disease in the general population, although it is a significant stroke type throughout pregnancy and the puerperium. Studies describing this subtype of CVT are limited. Most pregnancy-associated CVT happen in late pregnancy, or more commonly in the first postpartum weeks, being associated with venous thrombosis outside the nervous system. Case presentation: The current study describes a case of multiple CVT in a 38-year-old woman with multiple risk factors (including severe inherited thrombophilia and being in the puerperium period), presenting mixed transcortical aphasia (a rare type of aphasia) associated with right moderate hemiparesis and intracranial hypertension. The clinical diagnosis of CVT was confirmed by laboratory data and neuroimaging data from head computed tomography, magnetic resonance imaging, and magnetic resonance venography. She was successfully treated with low-molecular-weight heparin (anticoagulation) and osmotic diuretics (mannitol) for increased intracranial pressure and cerebral edema. At discharge, after 15 days of evolution, she presented a partial recovery, with anomic plus aphasia and mild right hemiparesis. Clinical and imaging follow-up was performed at 6 months after discharge; our patient presented normal language and mild right central facial paresis, with chronic left thalamic, caudate nucleus, and internal capsule infarcts and a partial recanalization of the dural sinuses.

Non-Neoplastic Dural Sinus Thrombosis

2005 ◽  
Vol 18 (5-6) ◽  
pp. 581-588
Author(s):  
I. Tsitouridis ◽  
P. Papapostolou ◽  
J. Rudolf ◽  
K. Natsis ◽  
L. Tarazi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sinus Thrombosis ◽  
Magnetic Resonance Venography ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study ◽  
The Brain

Magnetic Resonance Imaging (MRI) study of the brain and Magnetic Resonance Venography (MRV) offer major advantages in evaluating patients suspected of having dural sinus thrombosis. Since 2002, we have examined 49 patients in our department with definite dural sinus thrombosis. MRI and MRV revealed the thrombosis of the dural sinus, and the underlying cause in most patients. There is consensus in the literature that MRI scanning in combination with MRV is the method of choice for evaluating dural sinus thrombosis, and this is also the end result of our study. We also compared the 3D-TOF technique and 2D-PC technique for MRV examination and found that the 3D-TOF technique is clearly the method of choice.

scholarly journals Pearls and Pitfalls in the Magnetic Resonance Diagnosis of Dural Sinus Thrombosis: A Comprehensive Guide for the Trainee Radiologist

2020 ◽  
Vol 10 ◽  
pp. 77
Author(s):  
Vivek Pai ◽  
Iram Khan ◽  
Yih Yian Sitoh ◽  
Bela Purohit
Keyword(s):  
Magnetic Resonance ◽  
Sinus Thrombosis ◽  
False Negative ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Mr Images ◽  
Major Drawback ◽  
Non Invasive ◽  
Enhanced Ct ◽  
Physiological Variations

Dural sinus thrombosis (DST) is a potentially fatal neurological condition that can be reversed with early diagnosis and prompt treatment. Non-enhanced CT scan is often the first imaging investigation in patients presenting with acute neurological symptoms; however, its poor sensitivity in detecting DST is a major drawback. Magnetic resonance (MR) imaging offers multiple advantages such as excellent contrast resolution and unenhanced venography possibilities, making it the mainstay in the non-invasive diagnosis of DST. However, physiological variations, evolution of thrombi, and incorrect selection/application of MR techniques can lead to false positive and false negative interpretations impacting patient management and outcome. This article discusses the MR techniques useful to diagnose DST and describes pitfalls, with troubleshooting methods, to ensure an accurate diagnosis. We have used multiple diagrammatic illustrations and MR images to highlight pertinent take-home points and to serve as an easy guide for day-to-day clinical practice.

Diffusion-weighted magnetic resonance imaging of dural sinus thrombosis

2002 ◽  
Vol 44 (6) ◽  
pp. 481-488 ◽  
Author(s):  
T. Yoshikawa ◽  
O. Abe ◽  
K. Tsuchiya ◽  
T. Okubo ◽  
K. Tobe ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sinus Thrombosis ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Weighted Magnetic Resonance Imaging

Extensive Experience with Dural Sinus Thrombosis

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 534-544 ◽  
Author(s):  
Scott W. Soleau ◽  
Richard Schmidt ◽  
Steve Stevens ◽  
Anne Osborn ◽  
Joel D. MacDonald
Keyword(s):  
Clinical Improvement ◽  
Sinus Thrombosis ◽  
Treatment Strategies ◽  
Retrospective Chart Review ◽  
Dural Sinus ◽  
Hemorrhagic Complication ◽  
Dural Sinus Thrombosis ◽  
Extensive Experience ◽  
Medical Observation ◽  
Hemorrhagic Complications

Abstract OBJECTIVE Dural sinus thrombosis (DST) is an uncommon cause of stroke. The safest and most effective therapy for DST has not been conclusively identified. METHODS A retrospective chart review of data for 31 patients who were treated for DST at our institution between 1992 and 2001 was performed. Four treatment strategies were identified, i.e., 1) medical observation only, 2) systemic anticoagulation (AC) therapy with heparin, 3) endovascular chemical thrombolysis with urokinase or tissue plasminogen activator and concurrent systemic AC therapy, and 4) mechanical endovascular clot thrombolysis with concurrent systemic AC therapy. Complications and clinical outcomes were assessed for each group. RESULTS Patients treated solely with medical observation fared the worst; four of five patients experienced intracranial hemorrhagic complications, and only two of five exhibited clinical improvement. Patients who received systemic AC therapy experienced no hemorrhagic complications, even when pretreatment hemorrhage was present; 75% (six of eight patients) exhibited improvement with AC therapy alone. Chemical thrombolysis was very effective in restoring sinus patency (90% of patients); however, 30% of patients (3 of 10 patients) experienced hemorrhagic complications. Sixty percent of patients (6 of 10 patients) who underwent chemical thrombolysis exhibited clinical improvement. Patients who underwent mechanical thrombectomies demonstrated a low hemorrhagic complication rate, and most (88%) made good recoveries. CONCLUSION Therapy directed at the underlying clot in DST must begin without delay. Our results suggest that supportive medical management of DST, without therapy directed at the clot or clotting process, is not effective. Systemic AC therapy, even in the presence of intracerebral hemorrhage, seems to be safe. Heparin can be safely titrated to yield partial thromboplastin times of 60 to 70 seconds. Chemical clot thrombolysis is efficacious in opening occluded sinuses but may cause intracranial hemorrhage. We currently recommend either systemic AC therapy or systemic AC therapy in conjunction with mechanical clot thrombectomy as a safe effective treatment for DST.

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