scholarly journals Acute subarachnoid hemorrhage as initial presentation of dural sinus thrombosis

2010 ◽  
Vol 01 (01) ◽  
pp. 23-25 ◽  
Author(s):  
Shriram Sharma ◽  
Nalini sharma ◽  
M. E. Yeolekar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Sinus Thrombosis ◽  
Wide Spectrum ◽  
Venous Pressure ◽  
Clinical Manifestations ◽  
Venous Sinus ◽  
Vascular Lesions ◽  
Dural Sinus ◽  
Lateral Sinus

ABSTRACTSubarachnoid hemorrhage (SAH) in the older is most often due to aneurismal rupture. Other vascular lesions are known to rarely cause SAH. Cerebral venous thrombosis (CVT) can be diffi cult to diagnose because of its wide spectrum of clinical manifestations. Its diagnosis can be further complicated when patients initially present with acute SAH. We report a case of dural venous sinus thrombosis with SAH, most probably, due to raised venous pressure draining venous tributaries. A 59-year-old man presented with severe headache. Computerized tomography (CT) scan head was normal. Magnetic resonance imaging (MRI) suggested right parasagittal fronto-parietal hemorrhage. No aneurysm was detected on magnetic resonance angiography (MRA) or digital subtraction angiography (DSA). MRV revealed superior sagittal sinus (SSS) and lateral sinus thrombosis. DSA showed occlusion of intracranial SSS and lateral venous sinus. The patient improved with anticoagulant therapy. This case highlights the fact that SAH may reveal a CVT, and emphasizes on the inclusion of MRV in the diagnostic workup of SAH, particularly in cases in which aneurysm is not detected.

scholarly journals Arteriovenous Fistula After Cerebral Venous Sinus Thrombosis

2019 ◽  
Vol 30 (1) ◽  
pp. 35-37
Author(s):  
Low Qin Jian ◽  
Cheo Seng Wee
Keyword(s):  
Magnetic Resonance ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Venous Infarction ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein Thrombosis

Thrombosis of the deep cerebral vein is a rare entity. Thrombosis of cerebral veins or dural sinus obstructs blood drainage from brain tissue, leading to cerebral parenchymal dysfunction and increased venous and capillary pressure with disruption of the blood-brain barrier. Many conditions are associated with cerebral venous sinus thrombosis. Prothrombotic conditions, malignancy, infection and head injury has been reported as risk factors for cerebral venous sinus thrombosis (CVST). Neuroimaging features of CVST include focal areas of oedema or venous infarction, hemorrhagic venous infarction, diffuse brain edema or rarely subarachnoid haemorrhage. Magnetic resonance imaging of the brain in combination with magnetic resonance venography is the most informative technique in demonstrating the presence of dural thrombus and cortical vein thrombosis. Bangladesh J Medicine Jan 2019; 30(1) : 35-37

scholarly journals Cerebral Venous Sinus Thrombosis: Two Case presentations with different clinical manifestations and multifactorial etiology

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Anusha Skandini Ganeshan ◽  
Angel Alberto Caderon Chango
Keyword(s):  
Young Adults ◽  
Clinical Presentation ◽  
Sinus Thrombosis ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Medical Practitioner ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
First Case

Cerebral Venous Sinus Thrombosis (CVST) is a rare form of venous thrombosis which commonly affects young adults. CVST has variable clinical presentation such as headache, seizure, hemiparesis and even coma, thus mimicking stroke and other neurological disorders. Due to such non-specific wide spectrum of clinical presentations and variable etiology in young adults, CVST can be misdiagnosed easily, especially in initial stages of presentation which consequently affects the outcome and prognosis of the patient. Thus when a previously healthy young adults acutely presented with such variable but primarily neurological clinical presentation, it is vital for medical practitioner to have fine knowledge and skills to suspect CVST as a differential diagnosis. We present two cases: first case is a 21 year old female with puerperal CVST who had caesarean section under spinal anaesthesia three weeks before, who presented with headache and recurrent seizures, followed by hemiparesis; the second case is a 25 year old female with CVST, on oral contraceptives, who presented with right monoparesis, aphasia and facial asymmetry. In both cases though CVST was not the initial diagnosis, it was subsequently diagnosed early and confirmed by MRI brain and MRI angiogram and anticoagulation was commenced effectively, despite associated haemorrhagic infarct in the first case. Both patient made remarkable recovery without any significant residual neurological deficit.

scholarly journals Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

2021 ◽  
Vol 10 (8) ◽  
pp. 1599
Author(s):  
Marc E. Wolf ◽  
Beate Luz ◽  
Ludwig Niehaus ◽  
Pervinder Bhogal ◽  
Hansjörg Bäzner ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Venous Sinus ◽  
European Medicines Agency ◽  
Coagulation Disorder ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Antiplatelet Antibodies ◽  
Imaging Results ◽  
Venous Thromboembolic Events

Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena.

scholarly journals Cerebral venous sinuses thrombosis in both transverse sinus and torcula: Multistep endovascular treatment and stenting

2016 ◽  
Vol 23 (1) ◽  
pp. 84-89 ◽  
Author(s):  
G Cabral de Andrade ◽  
A Lesczynsky ◽  
VM Clímaco ◽  
ER Pereira ◽  
PO Marcelino ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Endovascular Treatment ◽  
Clinical Symptoms ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Severe Form ◽  
Venous Sinus ◽  
Lateral Sinus ◽  
Mechanical Thrombolysis

Purpose Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy. This case report presents the possibility of endovascular treatment in multiple steps with mechanical thrombolysis with balloon, local pharmacological thrombolysis and stenting, in a patient with a severe form of CVST. Case summary A 67-year-old woman presented severe headache, agitation and confusion with diagnosis of venous sinus dural thrombosis in both lateral sinus and torcula. After 24 h there was neurological worsening evolving with seizures and numbness even after starting heparin, without sinus recanalization; CT scan showed left temporal intracerebral hemorrhage. We decided to take an endovascular approach in multiple steps. The first step was mechanical static thrombolysis with balloon; the second step was dynamic mechanical thrombolysis with a balloon partially deflated and “pulled”; the third step was local thrombolysis with Actilyse™; finally, the fourth step was angioplasty and reconstruction of the sinuses using multiple carotid stents and complete angiographic recanalization of both sinuses and torcula. After 24 h of endovascular treatment there was full clinical recovery and no tomographic complications. Conclusion This result shows that mechanical clot disruption, intrasinus thrombolysis and reconstruction of wall sinuses with stenting can be an endovascular option in the severe form of CVST with intracerebral hemorrhage and rapid worsening of neurological symptoms. Although this type of treatment can re-channel the occluded sinuses, further comparative and randomized studies are needed to clarify its efficacy versus other therapeutic modalities.

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

Neurosurgery ◽  
2013 ◽  
Vol 72 (5) ◽  
pp. 730-738 ◽  
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.

Subarachnoid Hemorrhage Following Chronic Dural Venous Sinus Thrombosis

Angiology ◽  
2007 ◽  
Vol 58 (4) ◽  
pp. 498-501 ◽  
Author(s):  
Sunil Pradhan ◽  
Ramakant Yadav ◽  
Himanshu Diwakar ◽  
Rajendra V. Phadke
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Dural Venous Sinus ◽  
Dural Venous Sinus Thrombosis

scholarly journals Cerebral Venous Sinus Thrombosis: An Uncommon Presentation of Headache Mimicking Subarachnoid Hemorrhage

1970 ◽  
Vol 10 (2) ◽  
pp. 115-118
Author(s):  
Naima Sultana ◽  
Monzurul H Chowdhury ◽  
Md Shahriar Mahbub ◽  
Md Billal Alam
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Oral Contraceptives ◽  
Sinus Thrombosis ◽  
Serum Levels ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sudden Onset ◽  
Interesting Case ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Uncommon Presentation

Cerebral venous sinus thrombosis is a rare disorder accounting for less than 1% of all strokes. It is more common in children and young adults. Here we report a rare and interesting case of cerebral venous l sinus thrombosis mimicking subarachnoid hemorrhage. A 40 years old women, presented with sudden onset of headache, vomiting and unconsciousness associated with convulsions. She had a history of taking oral contraceptives for the last 12 years. Clinical examinations showed ill-looking women with Glasgow Coma Scale of 12 along with neck rigidity and bilateral papilloedema. Although initially we suspected her as a case of subarachnoid hemorrhage, subsequent investigations with MRI and MRV showed to be a case of superior sagittal and transverse sinus thrombosis. Treatment with anticoagulation recovered her from headache and papilloedema. Serum levels of thrombophilic factors were within the normal physiological limits. Thus we concluded that although cerebral venous thrombosis is 100 times less than the cerebral arterial disease, a women presented with sudden onset of headache and vomiting with long term use of oral contraceptives, cerebral thrombosis should be considered as a differential.  Key words: Cerebral venous sinus thrombosis , Sagittal sinus thrombosis, Subarachnoid hemorrhage , Magnetic resonance venography. doi: 10.3329/jom.v10i2.2826   J MEDICINE 2009; 10 : 115-118

scholarly journals Eosinophilic Granuloma of the Occipital Bone Presenting as Intracranial Venous Hypertension

1991 ◽  
Vol 18 (4) ◽  
pp. 512-514 ◽  
Author(s):  
H. Wightman ◽  
B. Wheelock
Keyword(s):  
Sinus Thrombosis ◽  
Eosinophilic Granuloma ◽  
Pseudotumor Cerebri ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Occipital Bone ◽  
Lytic Lesion ◽  
Dural Sinus ◽  
X Rays ◽  
Venous Sinus Thrombosis

ABSTRACT:Intracranial venous sinus thrombosis is an uncommon cause of pseudotumor cerebri. The diagnosis is often not confirmed on the rationale that treatment will not be altered. We report a case presenting a pseudotumor cerebri where the underlying pathology disclosed dural sinus thrombosis resulting from compression by an eosionophilic granuloma of the occipital bone. Routine CT of the head and Technetium-99m brain scan initially demonstrated neither tumor nor thrombosis. Plain skull x-rays subsequently revealed a lytic lesion of the occiput. When reinvestigated with CT using bone density windows the tumor was revealed. Excision of the tumor and a short course of cobalt therapy was curative. Special techniques in nuclear scanning, CT and MRI designed to improve the sensitivity for diagnosing venous sinus thrombosis are described. This case illustrates the importance of establishing a definitive diagnosis and shows the importance of pre-test consultation between clinicians and radiologists to ensure that specific investigative techniques are properly utilized.

ADJUNCTIVE RHEOLYTIC THROMBECTOMY FOR CENTRAL VENOUS SINUS THROMBOSIS

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. E577-E578 ◽  
Author(s):  
Jacobo Kirsch ◽  
Peter A. Rasmussen ◽  
Thomas J. Masaryk ◽  
John Perl ◽  
David Fiorella
Keyword(s):  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Fibrinolytic Therapy ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Imaging Features ◽  
Venous Sinus Thrombosis ◽  
Current Series ◽  
Systemic Heparinization ◽  
Rheolytic Thrombectomy

Abstract OBJECTIVE Patients with dural sinus thrombosis occasionally present with a malignant clinical course marked by parenchymal hemorrhage accompanied by either a severe neurological deficit or a persistent deterioration on therapeutic levels of antithrombotic medications. This scenario precludes traditional revascularization strategies with direct fibrinolytic infusion because of the risk of exacerbating the preexisting cerebral hemorrhage. In the current series, we describe our experience using the AngioJet (Possis Medical, Minneapolis, MN), a rheolytic mechanical thrombectomy device, in conjunction with systemic heparinization to achieve rapid sinus revascularization without fibrinolytic therapy. METHODS A retrospective review of a prospectively maintained database identified four patients ranging in age from 28 to 67 years (three women, one man) with cerebral venous thrombosis and rapidly deteriorating levels of consciousness who underwent transfemoral intravenous rheolytic thrombectomy using the AngioJet XMI and/or Xpeedior catheters (Possis Medical). The imaging features, treatment specifications, and disease outcome were reviewed. RESULTS All four patients underwent successful mechanical thrombectomy as indicated by restoration of blood flow through the affected sinuses. Three of the four patients demonstrated normalization of angiographic transit time after thrombectomy. In these three patients, rapid neurological improvement ensued. The fourth patient died during the periprocedural period. No procedural complications were encountered. CONCLUSION Systemic heparinization with adjunctive rheolytic thrombectomy (without fibrinolytic therapy) is a safe and effective treatment strategy for selected patients with dural venous sinus thrombosis.

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