Uncontrolled seizures resulting from cerebral venous sinus thrombosis complicating neurobrucellosis

ABSTRACTCerebral venous sinus thrombosis is a rare form of stroke caused by thrombosis in venous sinuses of the brain. In this study, we reported on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure despite being treated with anti-epileptic drugs at high doses. The case was a 33-year-old woman with a history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month. She was febrile and a brain CT scan indicated hemorrhagic focus in the left posterior parietal and the temporal lobe. Magnetic resonance imaging and magnetic resonance venography also proved venous sinus thrombosis in the left transverse sinus. Besides [In addition], a laboratory assessment confirmed brucellosis. Following the treatment with anti-coagulant, anti-brucellosis, and anti-epileptic agents, the patient was discharged in good condition with medical orders. Clinical suspicion and accurate evaluation of a patient′s history is the most important clue in diagnosis and treatment of brucellosis and cerebral venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control.

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Postpartum Seizures: Cerebral Venous Sinus Thrombosis, Case Report

Austin Journal of Obstetrics and Gynecology ◽

10.26420/austiniobstetgynecol.2021.1167 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Ahmed AAH ◽

Keyword(s):

Magnetic Resonance ◽

Sinus Thrombosis ◽

Past History ◽

Good Condition ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

High Grade Fever ◽

Venous Sinus Thrombosis ◽

Magnetic Resonance Imaging Mri ◽

The Right

Cerebral venous sinus thrombosis is of rarity during pregnancy, and it is included in the differential diagnosis of a woman presenting with seizures during pregnancy and puerperium. Here we report a case of young lady who developed Cerebral Venous Sinus Thrombosis (CVST) 6 days after delivery, presented with a chief complain of loss of consciousness and high grade fever with recent past history of severe occipital headache and generalized convulsions, which progressed into left sided weakness. Magnetic Resonance Imaging (MRI) / Magnetic Resonance Venography (MRV) demonstrated filling defects at the right transverse and sigmoid sinuses. The patient was started on Enoxaparin and warfarin. The patient kept on improving gradually and was discharged after 24 days in a good condition.

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Visual loss after long-haul flight

European Journal of Ophthalmology ◽

10.1177/1120672120965499 ◽

2020 ◽

pp. 112067212096549

Author(s):

Nurliyana Ain Abdul Ghani ◽

Azlindarita Aisyah Binti Mohd Abdullah ◽

Shamsiah Abdul Hamid ◽

Muhamad Yazli Yuhana ◽

Norlina Ramli

Keyword(s):

Magnetic Resonance ◽

Anticoagulant Therapy ◽

Visual Loss ◽

Sinus Thrombosis ◽

Complete Recovery ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Medical Illness ◽

Venous Sinus Thrombosis

Background: Deep cerebral venous sinus thrombosis is a reversible yet potentially serious thromboembolic event. A number of reports suggest a relationship between long-haul flights and thromboembolic events, mainly deep venous thrombosis (DVT) and pulmonary embolism (PE). It is rarely reported to cause deep cerebral venous sinus thrombosis. We report a case of a bilateral papilledema after long-haul flight secondary to deep cerebral venous sinus thrombosis with subsequent complete recovery post corticosteroid and anticoagulant therapy. Case: A case of a 21-year-old woman with no known medical illness who presented with gradual painless bilateral visual loss is described. She had a history of travelling on a long-haul flight 3 weeks prior to presentation. Examination showed presence of bilateral papilloedema, no vitritis, choroiditis and retinitis. Blood investigations showed raised international normalised ratio (INR). Otherwise, workup for infectious causes of optic disc swelling, connective tissue disease screening were normal. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain showed loss of flow signal in the right transverse sinus and the left sigmoid sinus. Blood workup for preexisting hypercoagulable state was normal. She was diagnosed with deep cerebral venous sinus thrombosis and showed complete recovery with oral corticosteroid and anticoagulant therapy. Conclusion: Deep cerebral venous sinus thrombosis is a potentially serious consequence of long-haul flights. A high index of suspicion along with radiological techniques is needed for early detection and initiation of anticoagulation for this reversible condition.

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Safety and Validity of Mechanical Thrombectomy and Thrombolysis on Severe Cerebral Venous Sinus Thrombosis

Neurosurgery ◽

10.1227/neu.0b013e318285c1d3 ◽

2013 ◽

Vol 72 (5) ◽

pp. 730-738 ◽

Cited By ~ 36

Author(s):

Guangwen Li ◽

Xianwei Zeng ◽

Mohammed Hussain ◽

Ran Meng ◽

Yi Liu ◽

...

Keyword(s):

Magnetic Resonance ◽

Treatment Modality ◽

Mechanical Thrombectomy ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Magnetic Resonance Venography ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Digital Subtract Angiography

Abstract BACKGROUND: Although the majority of patients with cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, there remains a subgroup of patients who do not respond to conventional anticoagulation treatment. These patients, especially younger people, as documented by hospital-based studies, have a high morbidity and mortality rate. OBJECTIVE: To verify the safety and efficacy of a dual mechanical thrombectomy with thrombolysis treatment modality option in patients with severe CVST. METHODS: Fifty-two patients diagnosed with CVST were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 to 1500 × 103 IU intravenous sinus injection via a jugular catheter after confirming diagnoses of CVST by using either magnetic resonance imaging/magnetic resonance venography or digital subtract angiography. Information obtained on the patients included recanalization status of venous sinuses as evaluated by magnetic resonance venography or digital subtract angiography at admission, during operation, and at 3- and 6-month follow-up after treatment. RESULTS: The percentage of patients that showed complete and partial recanalization were 87% and 6%, respectively, after mechanical thrombectomy combined with thrombolysis treatment; 8% of the patients showed no recanalization. The modified Rankin Scale scores were 1.0 ± 0.9, 0.85 ± 0.63, and 0.37 ± 0.53 for discharge, and 3- and 6-month follow-up, respectively. A total of 6 patients died despite receiving aggressive treatment. No cases of relapse occurred after 3 to 6 months of follow-up. CONCLUSION: Thrombectomy combined with thrombolysis is a safe and valid treatment modality to use in severe CVST cases or in intractable patients that have shown no adequate response to antithrombotic drugs.

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Superior Ophthalmic Vein Thrombosis with Cerebral Venous Sinus Thrombosis: A Rare Entity in a Child

Journal of Enam Medical College ◽

10.3329/jemc.v9i2.41415 ◽

2019 ◽

Vol 9 (2) ◽

pp. 127-132

Author(s):

Kanij Fatema ◽

Muhammad Mizanur Rahman ◽

Laila Areju Man Banu

Keyword(s):

Sinus Thrombosis ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

High Dose ◽

Partial Recovery ◽

Superior Ophthalmic Vein ◽

Venous Sinus Thrombosis ◽

Vein Thrombosis ◽

Methyl Prednisolone

Cerebral venous sinus thrombosis (CVST) is a rare stroke-like syndrome. Sometimes it may be rarely associated with ophthalmic vein occlusion. We present a 10-year-old girl who had severe headache, diplopia, severe congestion of eye, proptosis and orbital pain. She had no signs of meninigeal irritation, no focal deficit except left sided lateral rectus palsy and altered visual acuity. Investigations regarding vasculitis and thrombophillia were normal except thrombocytosis. MRI of brain showed ‘dense triangle sign’ and thickened superior ophthalmic vein. Magnetic resonance venography (MRV) showed occlusion of superior sagital sinus and transverse sinus. She was treated with paracetamol, acetazolamide, rivaroxaban and antibiotics followed by high dose pulse methyl prednisolone. She made a partial recovery within one week and at 3 months follow-up she was completely normal. J Enam Med Col 2019; 9(2): 127-132

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Abstract 1122‐000170: Stent Retrievers Utilization in Endovascular Treatment of Cerebral Venous Sinus Thrombosis

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000170 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Abdallah O Amireh ◽

Hassan Ali ◽

Muhammad Nagy ◽

Siddhart Mehta ◽

Haralabos Zacharatos ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Stent Retriever ◽

Venous Sinus ◽

Heparin Infusion ◽

Venous Sinus Thrombosis ◽

History Of ◽

Stent Retrievers

Introduction : Patients with Cerebral Venous Sinus Thrombosis (CVT) are candidates for Endovascular Mechanical Thrombectomy (EMT) in cases of coma on presentation or clinical deterioration despite anticoagulation. We present two cases of CVT successfully treated with mechanical thrombectomy using Medtronic’s Solitaire Stent retriever. Methods : A retrospective review at a single center university hospital was performed for all cerebral venous sinus thrombosis case log from December 2018 to November 2020. Cases resistant to conventional medical therapy that underwent intrasinus stent retriever endovascular thrombectomy were noted. Results : Case 1: 26 year‐old male with a history of hypertension presented with 2 weeks of headaches, left sided numbness and blurriness of vision. Imaging revealed superior sagittal (SSS) and bilateral transverse sinus thrombosis. Patient was treated with heparin infusion and discharged home on oral apixaban. The following day he presented with new onset expressive aphasia. Imaging was unchanged. Due to worsening symptoms despite anticoagulation, Patient underwent mechanical thrombectomy using a stent retriever. Solitaire 6 × 40 mm stent was advanced and deployed through the microcatheter and retracted in the upper segment of posterior one third of SSS followed by alteplase infusion at 1 mg/hr (25 ml/hr) via Berenstein catheter for the next 36 hours. Intravenous heparin infusion was also started with aPTT goal 60–80. Cerebral angiogram was repeated two days later revealing successful recanalization of previously thrombosed SSS and bilateral transverse sinuses with significantly improved cerebral venous drainage. Patient was transitioned again to oral apixaban. Repeat CTA in 3 months showed significantly improved patency and recanalization. Case 2: A 42 year‐old male with history of ulcerative colitis presented with sudden onset right‐sided hemiparesis and hemisensory loss along with one month of headaches. Presenting NIHSS 14. Imaging revealed SSS thrombosis with thrombosis of the left transverse sinus complicated by left frontal intraparenchymal hemorrhage and subarachnoid hemorrhage. Patient underwent mechanical thrombectomy of SSS using Solitaire 6 × 40mm stent retriever with distal aspiration resulting in improved flow. Clinical course was complicated by seizures and acute respiratory distress syndrome requiring intubation followed by tracheostomy and G‐tube placement which were eventually removed during recovery. Patient was treated with high intensity heparin during his hospitalization and eventually transitioned to apixaban. Work up revealed protein S deficiency. Serial CT angiograms at 6 and 11 months revealed resolution of CVT. NIHSS improved to 1 with mRS of 2. Conclusions : These cases imply that intra‐cerebrovenous sinus mechanical thrombectomy with stent retrievers may be considered in patients with continuing worsening despite optimal medical management.

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Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012237 ◽

2016 ◽

Vol 9 (1) ◽

pp. 34-38 ◽

Cited By ~ 22

Author(s):

Darrin J Lee ◽

Arjang Ahmadpour ◽

Tamar Binyamin ◽

Brian C Dahlin ◽

Kiarash Shahlaie ◽

...

Keyword(s):

Superior Sagittal Sinus ◽

Sinus Thrombosis ◽

Anticoagulation Therapy ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Dural Sinus ◽

Venous Sinus Thrombosis ◽

Sagittal Sinus ◽

The Impact

BackgroundCerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with a variable presentation, ranging from headaches, to coma and death. Although the American Stroke Association has developed guidelines for the treatment of CVST, data are sparse on the outcome after treatment with anticoagulation, thrombolysis, and thrombectomy.MethodsIn this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST.ResultsForty-one patients (mean age 37.5±23.1, range 0–96 years; 29 female) were identified with CVST. The majority of cases involved the transverse sinus (75.6%), sigmoid sinus (58.5%), and superior sagittal sinus (29.3%). The most common form of treatment was anticoagulation or antiplatelet therapy (n=35), while six patients were managed by observation alone. The overall 1-year modified Rankin score (mRS) was 1.4±1.5. Male patients and patients with a poor admission mRS had a worse outcome. Outcome was unaffected by hypercoagulable state, number of dural sinuses involved, the presence of intracranial hemorrhage, or seizures. Two patients who underwent anticoagulation therapy also required endovascular thrombectomy; both patients had a 1-year mRS of ≤2. Two patients underwent direct open surgical canalization of the superior sagittal sinus with varying outcomes (mRS 2 vs mRS 6).ConclusionsIn our series, the majority (92.9%) of patients with spontaneous dural sinus thrombosis had a favorable clinical outcome as defined by a mRS ≤2. Further prospective studies are needed to study the impact of anticoagulation on the clinical course of the disease.

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Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029621999104 ◽

2021 ◽

Vol 27 ◽

pp. 107602962199910

Author(s):

Huixin Shen ◽

Xiaoqin Huang ◽

Chunqiu Fan

Keyword(s):

Antiphospholipid Syndrome ◽

Endovascular Therapy ◽

Clinical Characteristics ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Good Prognosis ◽

Venous Sinus ◽

Initial Manifestation ◽

Venous Sinus Thrombosis

Antiphospholipid syndrome (APS) with cerebral venous sinus thrombosis (CVST) is a relatively rare phenomenon, and this observational study aimed to investigate the clinical characteristics of APS patients complicated with CVST. We retrospectively investigated the clinical characteristics of CVST events in APS and compared differential characteristics and associated factors between APS patients with and without CVST. Twenty-one CVST patients with APS were enrolled including 14 females (9.4%) and 7 males (5.8%). The median age and disease duration at onset of CVST was 33 years (IQR 28-48) old and 1.3 months (IQR 0.7-4), respectively. Among APS patients with CVST, 12 (57.1%) cases presented with neurologic symptoms of CVST as the initial manifestation. Onset of CVST was mainly chronic (52.4%). Headache (90.5%) was the most common neurological symptom. The common locations of CVST were transverse sinus (76.2%) and superior sagittal sinus (57.1%), with more frequently (76.2%) dual or multiple sinuses involved. All patients with CVST were treated with anticoagulant, and 5 (23.8%) patients received endovascular therapy. Sixteen (84.2%) patients had good outcomes and 3 (15.8%) patients died at last follow-up. There were no significant differences ( P > 0.05) between two groups in the analysis of related APS indicators. There were no significant differences ( P > 0.05) between two groups in the analysis of related APS indicators. Although APS complicated with CVST is rare and predominately chronic developed. The evaluation of CVST should be performed for APS patients with intracranial hypertension syndrome. The routine screening of antiphospholipid antibodies (aPLs) is highly recommended in unexplained CVST patients. Most CVST patients with APS will have a good prognosis after treatment, and endovascular therapy is an alternative treatment.

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Diagnosis and treatment of headache probably attributed to cerebral venous sinus thrombosis

Clinical Management Issues ◽

10.7175/cmi.v8i4.966 ◽

2014 ◽

Vol 8 (4) ◽

pp. 97-101

Author(s):

Rosario Iannacchero ◽

Amerigo Costa ◽

Antonio Sergi ◽

Aida Squillace ◽

Giuseppe Vescio ◽

...

Keyword(s):

Chronic Migraine ◽

Sinus Thrombosis ◽

Rare Condition ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Warning Signs ◽

Venous Sinus ◽

Diagnosis And Treatment ◽

Secondary Headache ◽

Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is a rare condition whose most common and sometimes only symptom is headache. Alas, diagnosis and treatment of CVST is often delayed or overlooked because of its high clinical variability. Using guidelines advices in detecting warning signs or symptoms of secondary headaches might ease the diagnosis of CVST.The article presents the case of a woman who is in treatment for chronic migraine and assessed for secondary headache in a multidisciplinary outpatient headache program. Alert symptoms like sudden worsening headache presentation, along with anamnestic cues, prompted neuroimaging that detected left transverse sinus thrombosis whose onset was difficult to date.

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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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