Thrombophilia - Some Interesting Case Reports of Cerebral Venous Thrombosis

Abstract Background Cerebral venous thrombosis (CVT) is a multifactorial disease with a variety of related conditions and risk factors. Thyroid dysfunction—especially hyperthyroidism—has been linked to CVT, but this is mainly based on case reports ranging back to 1913, while systematic investigations addressing this issue are lacking. Therefore, we investigated the frequency and clinical characteristics of thyroid dysfunction in a large single-center cohort of CVT patients. Methods We retrospectively identified all consecutive patients with aseptic CVT treated at our center between 2006 and 2020. Clinical information was extracted from our electronic medical documentation system. Thyroid-stimulating hormone (TSH) had been routinely measured at admission, free thyroid hormones and thyroid autoantibodies were analyzed whenever available. Results Of 120 patients with imaging-confirmed CVT, our main analysis included 107 patients (mean age 42 ± 16 years, 74% female) in whom TSH measurements were available. Nineteen patients (17.8%, 95% confidence interval 10–25%) had thyroid dysfunction. Two had newly diagnosed hyperthyroidism (1.9%, 95% confidence interval 0–4%) caused by Graves’ disease, but without typical symptoms for this condition. Seventeen patients (15.9%, 95% confidence interval 9–23%) had hypothyroidism (12 previously diagnosed with ongoing thyroid hormone replacement therapy; 5 with newly diagnosed subclinical hypothyroidism). Clinical CVT characteristics were similar comparing patients with versus without thyroid dysfunction. Conclusion We observed a remarkably high prevalence of thyroid dysfunction in CVT patients. Whether this finding reflects a causal relationship warrants further studies. Despite that, the frequent coexistence of both diseases argues for TSH screening in CVT patients.

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Cerebral venous thrombosis secondary to an occult maxillary sinusitis in a young male from sub-Saharan Africa

10.36811/ojor.2019.110002 ◽

2019 ◽

pp. 08-12

Author(s):

Mazou N Temgoua ◽

Mickael Essouma ◽

Larry N Tangie ◽

Cedric Tsinda ◽

Drusille Feze Foko ◽

...

Keyword(s):

Venous Thrombosis ◽

Acute Stroke ◽

Cerebral Venous Thrombosis ◽

Fungal Infections ◽

Sinus Thrombosis ◽

Maxillary Sinusitis ◽

Case Reports ◽

Sub Saharan Africa ◽

First Case ◽

Increased Risk

Cerebral venous thrombosis (CVT) also termed cerebral venous sinus thrombosis (CVST), is a special type of cerebrovascular disease characterized by cerebral venous infarction [1]. As from 1825 when the first case was described by Ribes[2], epidemiological descriptions are still restricted to case reports and small retrospective cross-sectional studies yielding low butincreasing incidence: <10 cases per million per year in 1995 to about 13.2 cases per million per year in 2012.CVT mainly occurs in women of child bearing age, probably owing to the use of oral contraceptive pills, and mostly has an acute or subacute course [1]. It can be categorized as primary/idiopathicand secondary. Secondary CVT can further be classified into infective (mainly due to bacterial or fungal infections) and non-infective CVT; the latterbeing due tocoagulation disorders, neoplasms, procoagulant hemodynamic states, vascularitis,homocystinuria, or head trauma [3].With the advent of antibiotics, the epidemiology of CVT has shifted from predominant infective CVT to predominant non-infective CVT, leading to increased risk of misdiagnosis and delayed treatment [3]. We report occult purulent maxillary sinusitis-related CVT in a male Cameroonian patient who presented with headaches, seizures and acute stroke syndrome. The aim of this paper is to reiterate CVT as the main cause of acute stroke syndrome in young adults irrespective of ethnic origin and sex, and suggest systematic screening of infections in those patients, especially in regions with high rates of infections likesub-Saharan Africa.We describe this case with regard to CARE guidelines.

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Cerebral venous thrombosis in young adults: 2 Case reports

Archives of Physical Medicine and Rehabilitation ◽

10.1053/apmr.2001.19244 ◽

2001 ◽

Vol 82 (5) ◽

pp. 683-688 ◽

Cited By ~ 7

Author(s):

Ann Francine Dzialo ◽

Randie M. Black-Schaffer

Keyword(s):

Young Adults ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Case Reports

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Serial Arterial Spin Labeling May Be Useful in Assessing the Therapeutic Course of Cerebral Venous Thrombosis: Case Reports

Neurologia medico-chirurgica ◽

10.2176/nmc.cr.2017-0033 ◽

2017 ◽

Vol 57 (10) ◽

pp. 557-561 ◽

Cited By ~ 3

Author(s):

Sho FURUYA ◽

Masahito KAWABORI ◽

Noriyuki FUJIMA ◽

Kikutaro TOKAIRIN ◽

Shuho GOTO ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Arterial Spin Labeling ◽

Case Reports ◽

Spin Labeling

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The use of new anticoagulants in cerebral venous thrombosis

10.5327/1516-3180.416 ◽

2021 ◽

Author(s):

Letícia Luísa Mattos ◽

Amanda Mendes Clemente Vilella

Keyword(s):

Venous Thrombosis ◽

Young Women ◽

Cerebral Venous Thrombosis ◽

Lower Risk ◽

Case Reports ◽

High Recovery ◽

Risk Of Bleeding ◽

New Anticoagulants ◽

Hemorrhagic Complications ◽

Primary Focus

Background: Cerebral venous thrombosis (CVT) is still documented as a rare disease that affects less than 1% of the population, mainly young women. Symptoms are nonspecific, easily confused with less severe pathologies, with a primary focus on headache, which requires attention and knowledge from professionals. The diagnosis is made possible by the use of complementary exams, when the diagnosis is made early, it is of high recovery. In case of late diagnosis or incorrect treatment, the sequelae may be irreversible. Objectives and methodology: to analyze the use of new anticoagulants (NOACs) in relation to treatment with warfarin in cases of CVT, through narrative review. Studies from the years 2015-2020 were used in the following databases: Pubmed, Scielo and Medline. Results: Studies from the last 5 years, composed mainly of case reports and multicentric analyzes, report non-inferiority of the outcome when treatments are compared or better outcome with NOACs due to the lower risk of bleeding. However, the European Stroke Organization in its last guideline (2017) does not recommend the use, especially during the acute phase. Conclusions: CVT can affect patients of various ages, so knowledge of the best therapy is essential. Currently, the use of warfarin and heparin is still recommended for acute cases, assessing the risk of complications such as bleeding. In view of the possible safety of new anticoagulants in view of the risk of hemorrhagic complications, further studies of non-inferiority in relation to warfarin are necessary so that the best approach is employed for these patients.

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European stroke organization interim expert opinion on cerebral venous thrombosis occurring after SARS-CoV-2 vaccination

European Stroke Journal ◽

10.1177/23969873211030842 ◽

2021 ◽

pp. 239698732110308

Author(s):

José M Ferro ◽

Diana Aguiar de Sousa ◽

Jonathan M Coutinho ◽

Ida Martinelli

Keyword(s):

Venous Thrombosis ◽

Expert Opinion ◽

Cerebral Venous Thrombosis ◽

Case Reports ◽

Case Series ◽

Guidance Document ◽

Level Of Evidence ◽

Platelet Factor ◽

Quality Evidence ◽

Platelet Transfusions

Severe cases of cerebral venous thrombosis (CVT) with thrombocytopenia and anti-platelet factor 4 (PF4) antibodies occurring after adenoviral vector anti-SARS-CoV-2 vaccines have been recently reported. We aim to present a guidance document on the diagnosis and treatment of patients presenting with CVT after vaccination against SARS-CoV-2 infection. We reviewed the available evidence which consists on case reports, small case series, expert opinion and analogy with heparin-induced thrombocytopenia (HIT) management. Because of the low level of evidence, this is an interim document, based only on expert opinion consensus. In patients presenting with CVT after being vaccinated against SARS-CoV-2 infection, if there is thrombocytopenia a reliable HIT PF4 Antibody ELISA test should be performed, to confirm vaccine-induced immune thrombotic thrombocytopenia (VITT). In patients with CVT and thrombocytopenia, in whom VITT is suspected or confirmed, heparin (unfractionated or low molecular weight) should be avoided and non-heparin anticoagulants are preferred. If possible, platelet transfusions should be avoided. If the diagnosis of VITT is confirmed or suspected, early intravenous immunoglobulins are indicated. This expert opinion is supported by low quality evidence. It should be periodically updated, or changed to a formal guideline, as new and higher quality evidence is eventually produced. Because of their potential unfavourable clinical course, patients developing symptoms and signs suggestive of CVT after being vaccinated against SARS-CoV-2 virus should undergo urgent clinical and neuroimaging evaluation. In cases of suspected or confirmed VITT, non-heparin anticoagulants should be used, platelet transfusions avoided and intravenous immunoglobulin started early.

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Characteristic Cerebral Venous Thrombosis (CVT) in COVID-19: A Systematic Review

Ulum Islamiyyah ◽

10.33102/uij.vol33no1.298 ◽

2021 ◽

pp. 140-148

Author(s):

Sulistyani ◽

Iwan Setiawan ◽

Titian Rakhma ◽

Burhannudin Ichsan

Keyword(s):

Systematic Review ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Virus Disease ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Eligibility Criteria ◽

Online Databases ◽

D Dimer

Cerebral venous thrombosis (CVT) is one of the diagnoses reported in coronavirus disease 2019 (COVID-19 patients). Meanwhile, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has the potential to cause endothelial dysfunction, increase thrombin generation and inhibit fibrinolysis. This causes hyper coagulopathy, with the potential to become CVT. Therefore, this study aims to determine the characteristics of CVT cases in COVID-19 patients. This systematic review refers to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. The articles were obtained systematically from online databases, Pubmed, Science Direct, as well as Google Scholar, using the search keywords ("COVID 19" OR "SARS-CoV-2 infection" OR "COVID-19 virus disease" OR "2019-nCoV infection" OR "coronavirus disease 2019" OR "coronavirus disease-19" OR "2019- nCoV disease "OR" COVID-19 virus infection") AND" cerebral venous thrombosis " as well as " cerebral venous thrombosis ". After deduplication, eligibility criteria selection and critical assessment on journals, the study reviewed eight patients from four case reports and two case series. According to the characterization, CVT patients with COVID-19 had a mean age of 42.4 years, were mostly male, tended to be cryptogenic, as well as varied neurological symptoms, and increased D-Dimer in most cases. All patients showed CVT features on imaging and were treated using mostly anticoagulants. Five out of the eight patients (50%) died.

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