Cerebral venous sinus thrombosis in Saudi Arabia.

OBJECTIVE: To analyze the clinical patterns, etiologies, treatment, and outcome of cerebral venous sinus thrombosis (CVST) in 2 major cities of Saudi Arabia, Jeddah and Al-Baha. METHODS: One hundred and eleven patients diagnosed as CVST were identified from the medical records at King Abdulaziz Medical City, Jeddah, and King Fahad Hospital, Al-Baha, Saudi Arabia, from January 1990 through November 2010. We retrospectively analyzed the data, compared it with local and international studies, and reviewed the literature. RESULTS: There were 92 adults and 19 children. Among adults, females predominated, while more boys were affected than girls. The mean age of onset was 29.5 years. The most common clinical presentations were headache, focal neurologic deficits, seizures, papilledema, and decreased level of consciousness. The main risk factors identified were pregnancy/ puerperium, antiphospholipid antibody syndrome, oral contraceptive pills, malignancy, and infections. Multiple sinuses were affected in 51 patients (45.9%). When a single sinus was involved, the superior sagittal sinus (24.3%) was the most common. Seventy-four patients recovered completely, 23 patients recovered partially, and 10 patients died. Bad prognostic factors included incurable co-morbid conditions, late presentation, and status epilepticus. CONCLUSION: Pregnancy/puerperium was the most common etiological factor in our series. Clinical features were similar to international series. Behcet`s disease was not a major etiological factor in our series. Most patients had involvement of multiple sinuses. Prompt treatment with anticoagulation resulted in complete or partial recovery in 87.4% of patients.

Central pontine myelinolysis due to rapid correction of hyponatremia induced by excessive water intake.

We report a 25-year-old female with a recent diagnosis of gastric B-cell lymphoma based on imaging and pathological findings. She was discharged against medical advice after it was recommended to her, by an "alternative medicine practitioner," to restrict her diet to excessive ingestion of the "Holy water Zamzam" (natural well water in Makkah). She presented back with altered level of awareness and severe, new-onset hyponatremia. The hyponatremia was corrected rapidly and her condition improved. Six days later, she developed the classical pyramidal and extrapyramidal features of central pontine myelinolysis, documented by MRI. The patient succumbed to her original disease 3 months later.

Sporadic creutzfeldt jacob disease.

We report a 65-year-old lady who presented with rapidly progressive dementia and was found to have Creutzfeldt-Jacob disease (CJD). On reviewing the literature, there have been only 3 case reports of CJD from Saudi Arabia. Our aim is to report this rare disease and to include it in the differential diagnosis of rapidly progressive dementia in our practice.