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Objective:To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods:Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center, 988 th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study; primary diseases included meningioma in 7 patients, contusion and laceration of frontal lobe in 2, hypertensive cerebral hemorrhage in 1, and obsessive-compulsive disorder in 1 patient. Epilepsy was the first symptom after craniotomy. Clinical characteristics and efficacy of these patients were analyzed retrospectively; seizure control efficacy was evaluated by Engel grading. Results:First seizure occurred 4 h-7 d after craniotomy in these 11 patients, including 2 with focal sensory retention seizure, 3 with focal bilateral tonic-clonic seizure, and 6 with general tonic-clonic seizure. Follow-up cranial CT revealed hematoma in surgical region, adjacent cortex or subcortex in 9 patients (hematoma volume: 15-50 mL); emergency craniotomy (hematoma clearance) and decompressive craniectomy was performed in 5 patients; only emergency craniotomy (hematoma clearance) was performed in 3 patients; conservative treatment was performed in 1 patient. A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients, and the transient limb paralysis gradually recovered after 2 months of conservative treatment. Follow-up was performed for (4.5±1.7) years ([2.3-7.0] years). During the last follow-up, 4 patients were normal, 5 patients had mild to moderate hemiplegia, 1 had mild decreased vision in the right eye, and 1 had long-term coma. Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion:Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from cortical venous infarction.
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Traumatic acute subdural hematoma (ASDH) is often severe,and bridging vein rupture is one of the case mechanisms of ASDH.After traumatic ASDH,venous reflux disorder,cerebral ischemia,delayed bleeding in other parts of the brain,and intraoperative encephalocele are prone to occur.This article reviews the occurrence and development of ASDH and its relation with intracranial venous circulation.
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Background: According to the WHO, stroke is the second most important cause of death in elderly people with age >60 years and fifth leading cause in the age group of 15 to 59 years. Hyperhomocysteinemia has been linked to increased incidence of ischemic strokes. Thus, the aim of the present study was to assess serum homocysteine levels as an individual risk factor of stroke in young patients.Methods: This was a prospective, cross-sectional, single center study performed in 50 patients admitted in the Department of Medicine, Thanjavur Medical College and Hospital, Thanjavur, over a period of 7 months (i.e., from December 2013 to June 2014). Young patients, aged 1545 years, and diagnosed with stroke were included in the study. Serum homocysteine was measured by fluorescein polarization immunoassay (FPIA). Significant difference between the patients with normal and elevated mean serum homocysteine levels was identified by using unpaired t-test. P value ?0.05 was considered as statistically significant.Results: Majority of the stroke patients were male (78%). Similarly, male patients dominated the total number of patients with elevated serum homocysteine levels (75%). Thirty-two (64%) patients had an elevated serum homocysteine level. There was a significant difference between the patients with increased homocysteine levels as compared to patients with normal homocysteine levels (p value <0.05). Out of 32 patients with hyperhomocysteinemia, 27 (84.38%) patients had ischemic stroke, 4 (12.50%) had cortical vein thrombosis and 1 (3.12%) had hemorrhagic stroke.Conclusions: Findings of the present study confirm that hyperhomocysteinemia is associated with an increased incidence of stroke in young patients. As healthcare providers, we must stress on prevention of stroke, especially by identifying treatable risk factors.
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Postpartum headache is the complaint of head, neck, or shoulder pain occurring during the first 6 weeks following delivery. Among the women who underwent neuraxial aneasthesia Post Dural puncture headache is one of the most common presentations. However, physicians should be aware that post Dural puncture headache is not the only cause of postpartum headache. Authors present a series of four cases that had varied presentation of post partum headache with varied diagnosis, the first case was of subdural haematoma where CT scan revealed an acute on chronic SDH. The second case was diagnosed as meningitis and the CSF for culture sensitivity grew Streptococcus Pneumoniae .In our third case of cortical vein thrombosis , NCCT followed by MR venogram revealed left transverse venous sinus thrombosis and our last case in the series was of posterior reversible encephalopathy syndrome where MRI confirmed the findings of typical findings are symmetric edema involving the white matter of the posterior regions of the cerebral hemispheres. The diagnostic dilemma was resolved by neuroimaging because the clinical presentation was not making us reach a satisfactory diagnosis of the cause of headache. Early resort to neuroimaging and multidisciplinary team effort paved way to early diagnosis and appropriate recovery of the patients.
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Isolated cortical vein thrombosis is rare. It is easy to be missed or misdiagnosed due to variations of cortical vein anatomy, nonspecific clinical presentation, and lack of any imaging gold-standard of diagnosis. Cerebral venous sinus thrombosis with subdural hematoma is rarer. Because of the side effects of anticoagulation, the optimal therapy for such patients is hard to decide. A 34-year-old puerperal woman who suffered from isolated cerebral cortical venous thrombosis with subdural hematoma was reported and relevant literatures were review, aiming to provide some references for the treatment of this disease.
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La hemorragia subaracnoidea (HSA) no traumática es un subtipo de ictus hemorrágico que representa aproximadamente el 5% de todos los accidentes vasculares encefálicos (AVE). El 85% de los casos de HSA espontánea (no traumática) son secundarios a un aneurisma intracraneano roto, el 10% a hemorragia perimesencefálica no aneurismática y el otro 5% a otras causas. Entre estas se incluyen malformaciones arterio-venosas, fístulas durales, vasculits, trombosis de vena cortical, síndrome de vasoconstricción reversible, angiopatía amiloidea y síndrome de encefalopatía posterior reversible. La aproximación inicial a una HSA no traumática requiere un estudio angiográfico no invasivo con tomografía computada para la toma de decisiones terapéuticas. Si no se detecta un aneurisma sacular intradural que explique el sangrado, las conductas a seguir dependerán del patrón de distribución de la sangre. En esta revisión sugerimos una aproximación basada en 1) revisar el estudio inicial tomando en cuenta los puntos ciegos para la detección de aneurismas, 2) analizar el patrón de distribución de la sangre y 3) analizar los hallazgos en imágenes de acuerdo a las posibles causas según patrón.
Non-traumatic subarachnoid hemorrhage represents approximately 5% of strokes. From these, 85% of nontraumatic subarachnoid hemorrhage are secondary to a ruptured aneurysm, 10% to nonaneurysmal perimesencephalic hemorrhage and the other 5% to other causes. These include but are not limited to arteriovenous malformations, dural fistulae, vasculitis, cortical vein thrombosis, reversible cerebral vasoconstriction syndrome, amyloid angiopathy and posterior reversible encephalopathy syndrome. Initial workup of nontraumatic subarachnoid hemorrhage requires a non-enhanced CT and CT angiography for decision making and management. If there is no aneurysm as a source of hemorrhage, subsequent imaging studies will depend on blood distribution pattern. In this review we suggest an approach: 1) review blind spots for aneurysm detection in the initial CT angiography, 2) analyze blood distribution pattern and 3) evaluate imaging findings and possible causes according to each pattern.
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Humanos , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Vasculite/complicações , Aneurisma Intracraniano/complicações , Angiopatia Amiloide Cerebral/complicações , Trombose Venosa/complicações , Angiografia por Tomografia ComputadorizadaRESUMO
As an essential component of intracranial venous circulation,cortical veins are prone to be injured or compressed,and cortical venous thrombosis was formed after traumatic brain injury (TBI) because of their special anatomical position,which could result in intracranial venous retum disorders,intracranial hypertension,and brain parenchymal damage in drainage areas.The cortical venous related circulation disorders after TBI are summed up in this review.
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Isolated cortical vein thrombosis (ICVT) is a rare disease, accounting for less than 1% of strokes. A 46-year-old woman presented with progressive left side weakness. Magnetic resonance (MR) imaging with T2*-gradient echo (T2*-GE) sequence showed long cord sign at the right frontal cortex. The patient was treated with low molecular weight heparin, followed by oral warfarin for 6 months. The 3-month follow-up MR imaging showed recanalization of the previously thrombosed cortical vein. She was completely recovered without neurological deficits after 6 months. This provides that MR imaging with T2*-GE sequence can help to diagnosis the ICVT and outcomes of the ICVT are generally favorable.
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Feminino , Humanos , Pessoa de Meia-Idade , Diagnóstico , Seguimentos , Heparina de Baixo Peso Molecular , Imageamento por Ressonância Magnética , Doenças Raras , Acidente Vascular Cerebral , Trombose , Veias , VarfarinaRESUMO
Objective To investigate the morphological characteristics of superior sagittal sinus (SSS) and bridging vein (BrV) with virtual reality (VR) technology and their clinical significances.Methods Forty-three patients with parasagittal meningioma (PSM group) and 21 patients with trigeminal neuralgia or hemifacial spasm who had no intracranial venous system diseases (normal group),admitted to our hospital from October 2011 to March 2013,were chosen.The morphological characteristics of SSS and parasagittal BrV of patients from the 2 groups were observed,which was finished in the VR workstation.The number and diameter differences of cortical veins between the 2 groups,and bilatelal side and the first,middle and third 1/3 of SSS of normal group were analyzed.Results Among the patients from the 2 groups,4 having SSS extremity with morphological variation were observed firstly.The direction of BrV entering the SSS mainly was retrograde,which concentrated in the middle and third 1/3 of SSS.There were many directions of BrV entering the SSS in the first 1/3 of SSS,and the direction mostly was perpendicular.In normal group,there were no statistical differences of number and diameter in the bilatelal cortical veins (P＞0.05); in the first,middle and third 1/3 of SSS,there was statistical difference of cortical veins number (P＜0.05),but no difference of diameter (P＞0.05).The number and diameter of cortical veins of PSM group were under the normal group,with statistically significant difference (P＜0.05).With the growth of PSM,violations of SSS and cortical venous gradually aggravated,affecting venous return,which resulted in increase number and complication of collateral veins.Conclusions There is certain variability of SSS and related BrV.The direction of BrV entering the SSS may be associated with intracranial venous system hemodynamic.It is clear and three-dimensional to observe SSS and cortical veins in the help of VR,and to analyze the venous circulation changes caused by PSM.
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Wegener's granulomatosis is an uncommon disease characterized by variable degrees of disseminated vasculitits involving both small arteries and veins. This disease is rarely associated with thrombosis. Isolated reports of intracranial thromboses of large and small vessels have been described in both adults and children. This report describes the first case of cortical vein thrombosis which was central nervous system manifestation in Wegener's granulomatosis.
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Adulto , Criança , Humanos , Artérias , Sistema Nervoso Central , Trombose Intracraniana , Trombose , Veias , Granulomatose com PoliangiiteRESUMO
Wegener's granulomatosis is an uncommon disease characterized by variable degrees of disseminated vasculitits involving both small arteries and veins. This disease is rarely associated with thrombosis. Isolated reports of intracranial thromboses of large and small vessels have been described in both adults and children. This report describes the first case of cortical vein thrombosis which was central nervous system manifestation in Wegener's granulomatosis.
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Adulto , Criança , Humanos , Artérias , Sistema Nervoso Central , Trombose Intracraniana , Trombose , Veias , Granulomatose com PoliangiiteRESUMO
Cortical vein thrombosis (CVT) is rare and is most common in the third decade of life. Cerebral venous thrombosis may be due to a variety of pathologic conditions like deficiencies of protein S (PS), antithrombin III, protein C, factor V Leiden, prothrombin gene mutations and hyperhomocysteinemia. Protein S is a vitamin K-dependent anticoagulant present in plasma and prevent thrombosis in association with protein C. Lack of it results in venous thromboembolism (VTE) rarely causing thrombosis of cerebral venous sinuses. Our patient is a 35-year-old male who presented with focal seizures. MRI brain showed venous infarcts, and MR venogram showed extensive thrombosis of superior sagittal sinus. Later work up for hypercoagulable state showed significant Protein S deficiency.
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Adulto , Humanos , Masculino , Deficiência de Proteína S/complicações , Convulsões/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/etiologiaRESUMO
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, diffuse dural thickening, and enhancement in MRI associated with low cerebrospinal fluid pressure. While SIH causes several complications such as subdural hematoma, cranial nerve palsies, and altered consciousness, cerebral venous thrombosis caused by SIH has been rarely described. We report a patient presenting with generalized tonic-clonic seizure that was probably caused by cortical vein thrombosis that had developed after SIH.