cerebral veins
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2022 ◽  
Vol 8 ◽  
Author(s):  
Martin Ihnatko ◽  
Ivana Truchla ◽  
L'udmila Ihnatková ◽  
Zoltán Prohászka ◽  
Ivica Lazúrová

COVID-19 vaccine-induced thrombotic thrombocytopenia (VITT) is a rare complication of adenoviral vector (ChAdOx1 nCoV-19) vaccine administration. It is presented as thrombocytopenia and thrombotic manifestations in various sites, especially in cerebral veins. Pulmonary emboli have been reported rarely. We present a case of a young male patient who developed severe thrombocytopenia and pulmonary embolism 12 days after the first dose of the vaccine. Severe thrombocytopenia, skin hematomas, and segmental pulmonary emboli were detected. Anti-platelet factor 4 (aPF-4) antibody was highly positive supporting the diagnosis of VITT. Prompt treatment with fondaparinux, intravenous immunoglobulin, and prednisone led to a marked improvement of clinical condition and thrombocytes count. We report the first known case of VITT in Slovakia.


2022 ◽  
Author(s):  
yue sun ◽  
Zilan Wang ◽  
Fan Jiang ◽  
Xingyu Yang ◽  
Xin Tan ◽  
...  

Abstract Background: When it comes to central nervous system tumor resection, preserving vital venous structures to avoid devastating consequences such as brain edema and hemorrhage is important. Wheras, in clinical practice, it is difficult to obtain clear and vivid intraoperative venous visualization and blood flow analysis.Methods: We retrospectively reviewed patients underwent brain tumor resection through the application of indocyanine green videoangiography (ICG-VA) integrated with FLOW 800 from February 2019 to December 2020 and presented our clinical cases to demonstrate the process of venous preservation. Galen vein, sylvian vein and superior cerebral veins were included in our cases.Results: Clear documentations of the veins from different venous groups were obtained via ICG-VA integrated with FLOW 800, which semiquantitatively analyzed the flow dynamics. ICG-VA integrated with FLOW 800 enabled us to achieve brain tumor resection without venous injury and obstructing the venous flux.Conclusions: ICG-VA integrated with FLOW 800 is an available method for venous preservation, though further comparison between ICG-VA integrated with FLOW 800 and other techniques of intraoperative blood flow monitoring is needed.


Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 100-105
Author(s):  
Carol Mathew ◽  
Marc Zumberg

Abstract Case 1: A 23-year-old female third-year medical student who has no medical history seeks treatment for abdominal distention. She takes an estrogen-containing birth control pill and does not smoke or consume alcohol. Family history is unremarkable. Physical examination is significant for abdominal distention, and an abdominal fluid wave is detected. Complete blood count is normal. Imaging confirms occlusive thrombosis of the main portal vein. On endoscopy, grade 1 to 2 esophageal varices are noted and banded. Unfractionated heparin is begun. Subsequent workup reveals a homozygous factor V Leiden mutation. Long-term anticoagulation is planned, and she asks if warfarin can be avoided given her hectic ward rotations, erratic diet, and need for monitoring. Case 2: A 35-year-old woman who has no medical history seeks treatment for progressively worsening posterior headaches for 1 week. Magnetic resonance imaging of the brain shows dural sinus thrombosis with associated small areas of petechial cerebral hemorrhage. She is started on a continuous unfractionated heparin infusion and admitted to the hospital for further observation. Her grandmother is on warfarin for atrial fibrillation, and the patient would prefer to avoid warfarin because she does not think she can comply with the frequent monitoring that will be required. She inquires about other oral anticoagulant options for her condition.


2021 ◽  
pp. 0271678X2110651
Author(s):  
Brenda L Bartnik-Olson ◽  
Arlin B Blood ◽  
Michael H Terry ◽  
Shawn FL Hanson ◽  
Christopher Day ◽  
...  

Prominence of cerebral veins using susceptibility weighted magnetic resonance imaging (SWI) has been used as a qualitative indicator of cerebral venous oxygenation (CvO2). Quantitative susceptibility mapping (QSM) adds more precision to the assessment of CvO2, but has not been applied to neonatal hypoxic ischemic injury (HII). We proposed to study QSM measures of venous susceptibility and their correlation with direct measures of brain oxygenation and cerebral blood flow (CBF) in the neonatal piglet. The association of QSM intravascular cerebral venous susceptibility, with brain tissue O2 tension, CBF, cortical tissue oxyhemoglobin saturation, and the partial pressure of oxygen in arterial blood measurement during various oxygenation states was determined by linear regression. Compared to normoxia, venous susceptibility in the straight sinus increased 56.8 ± 25.4% during hypoxia, while decreasing during hyperoxia (23.5 ± 32.9%) and hypercapnia (23.3 ± 73.1%), which was highly correlated to all other measures of oxygenation (p < 0.0001) but did not correlate to CBF (p = 0.82). These findings demonstrate a strong relationship between venous susceptibility and brain tissue O2 tension. Our results suggest that QSM-derived venous susceptibility is sensitive to cerebral oxygenation status across various oxygenation states.


2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi13-vi14
Author(s):  
Yoshihiro Tsukamoto ◽  
Manabu Natsumeda ◽  
Makoto Oishi ◽  
Yukihiko Fujii

Abstract Introduction Understanding micro structures is important for the safety and reliable tumor resection for high grade glioma(HGG). The high-resolution 3-demension pre-operative simulation image (3D simulation imege) provides the useful information to the operators. We will report the outcome and the device of 3D simulation image at our single institute. Material and Method From April 2019 to July 2021, 56 cases of HGG (grade III: 18 cases, grade IV: 38 cases, initial cases: 49 cases, recurrent cases: 7) were included retrospectively. Zedview, Horos, and Freeform were used to create 3D simulation image from conventional clinical images as CT, MRI, and angiography. The evaluations of anatomical structures were 9 items: cerebral arteries (A), cerebral veins (V), perforators (Per), passing arteries (Pass), feeders (F), drainers (D), sylvian fissure vessels (SV), brain structures (B), and ventricles (Vent). After determining the necessity of 3D visualization for operative planning and evaluating whether it was possible to create the 3D image, the consistency with the anatomical structure and the usefulness for surgery were scored (Excellent 3 points / Good 2 points / Poor 1 point) respectively. Result A: 56 out of 56 cases (100%) was judged as necessary, and the average score was 2.73 points. V: 56/56 cases (100%), 2.70 points. Per: 7/7 cases (100%), 1.80 points. Pass: 7/7 cases (100%), 2.86 points. F: 34/36 cases (94.5%), 2.56 points. D: 22/22 cases (100%), 2.36 points. SA: 7/7 cases (100%), 2.43 points. B: 53/54 (98.1%), 2.70 points. Vent: 27/28 cases (96.5%), 2.50 points. The average score of all structures was 2.59 points. Discussion and Conclusion 3D imaging of the required anatomical structures was possible in almost all cases, and consistency and usefulness in most items were highly scored. Although the evaluation of the perforators was low, the 3D simulation image seemed to be useful for surgical planning.


2021 ◽  
pp. 1-13

OBJECTIVE The authors investigated the microvascular anatomy of the hippocampus and its implications for medial temporal tumor surgery. They aimed to reveal the anatomical variability of the arterial supply and venous drainage of the hippocampus, emphasizing its clinical implications for the removal of associated tumors. METHODS Forty-seven silicon-injected cerebral hemispheres were examined using microscopy. The origin, course, irrigation territory, spatial relationships, and anastomosis of the hippocampal arteries and veins were investigated. Illustrative cases of hippocampectomy for medial temporal tumor surgery are also provided. RESULTS The hippocampal arteries can be divided into 3 segments, the anterior (AHA), middle (MHA), and posterior (PHA) hippocampal artery complexes, which correspond to irrigation of the hippocampal head, body, and tail, respectively. The uncal hippocampal and anterior hippocampal-parahippocampal arteries contribute to the AHA complex, the posterior hippocampal-parahippocampal arteries serve as the MHA complex, and the PHA and splenial artery compose the PHA complex. Rich anastomoses between hippocampal arteries were observed, and in 11 (23%) hemispheres, anastomoses between each segment formed a complete vascular arcade at the hippocampal sulcus. Three veins were involved in hippocampal drainage—the anterior hippocampal, anterior longitudinal hippocampal, and posterior longitudinal hippocampal veins—which drain the hippocampal head, body, and tail, respectively, into the basal and internal cerebral veins. CONCLUSIONS An understanding of the vascular variability and network of the hippocampus is essential for medial temporal tumor surgery via anterior temporal lobectomy with amygdalohippocampectomy and transsylvian selective amygdalohippocampectomy. Stereotactic procedures in this region should also consider the anatomy of the vascular arcade at the hippocampal sulcus.


2021 ◽  
Vol 14 (12) ◽  
pp. e246200
Author(s):  
Syed Noman Atta ◽  
Nariman Othman ◽  
Munir Babar

Thrombosis and thrombocytopaenia secondary to ChAdOx-1 nCov-19 vaccine is a new phenomenon that usually occurs after the first dose of vaccine. Most of these patients are healthy without any prior history of thromboembolic events or heparin use. Hall marks of this condition include detectable antibodies to platelet factor 4 and thrombosis at atypical sites particularly cerebral veins and sinuses mimicking atypical heparin induced thrombocytopaenia. We describe a case of a patient who was diagnosed with this rare condition and treated successfully.


Author(s):  
Dhananjay Radhakrishnan Subramaniam ◽  
Ginu Unnikrishnan ◽  
Aravind Sundaramurthy ◽  
Jose E. Rubio ◽  
Vivek Bhaskar Kote ◽  
...  

Multiple finite-element (FE) models to predict the biomechanical responses in the human brain resulting from the interaction with blast waves have established the importance of including the brain-surface convolutions, the major cerebral veins, and using non-linear brain-tissue properties to improve model accuracy. We hypothesize that inclusion of a more detailed network of cerebral veins and arteries can further enhance the model-predicted biomechanical responses and help identify correlates of blast-induced brain injury. To more comprehensively capture the biomechanical responses of human brain tissues to blast-wave exposure, we coupled a three-dimensional (3-D) detailed-vasculature human-head FE model, previously validated for blunt impact, with a 3-D shock-tube FE model. Using the coupled model, we computed the biomechanical responses of a human head facing an incoming blast wave for blast overpressures (BOPs) equivalent to 68, 83, and 104 kPa. We validated our FE model, which includes the detailed network of cerebral veins and arteries, the gyri and the sulci, and hyper-viscoelastic brain-tissue properties, by comparing the model-predicted intracranial pressure (ICP) values with previously collected data from shock-tube experiments performed on cadaver heads. In addition, to quantify the influence of including a more comprehensive network of brain vessels, we compared the biomechanical responses of our detailed-vasculature model with those of a reduced-vasculature model and a no-vasculature model for the same blast-loading conditions. For the three BOPs, the predicted ICP values matched well with the experimental results in the frontal lobe, with peak-pressure differences of 4–11% and phase-shift differences of 9–13%. As expected, incorporating the detailed cerebral vasculature did not influence the ICP, however, it redistributed the peak brain-tissue strains by as much as 30% and yielded peak strain differences of up to 7%. When compared to existing reduced-vasculature FE models that only include the major cerebral veins, our high-fidelity model redistributed the brain-tissue strains in most of the brain, highlighting the importance of including a detailed cerebral vessel network in human-head FE models to more comprehensively account for the biomechanical responses induced by blast exposure.


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