Trombosis venosa cerebral y COVID-19: ¿Asesino silencioso durante la pandemia? / Cerebral venous thrombosis and COVID-19: A silent killer during the pandemic?

RESUMEN Trombosis venosa cerebral (TVC) es una rara condición clínica caracterizada por una obstrucción de los senos venosos durales o de las venas corticales cerebrales que desencadena hipertensión intracraneal y síntomas tales como cefalea, crisis epilépticas y coma, entre otros. Se ha asociado como complicación neurológica del síndrome respiratorio agudo severo (SARS-CoV-2) del Coronavirus 2. Objetivo: Describir los casos reportados de TVC en pacientes con Enfermedad por Coronavirus 2019 (COVID-19). Material y Métodos: Se realizó una búsqueda bibliográfica en PubMed para recabar sólo los reportes de caso en los que los pacientes con COVID-19 desarrollaron TVC. Resultados: Se analizaron reportes de 13 pacientes y se recabó información sobre sexo, edad, comorbilidades, severidad del COVID-19, tipo de TVC, tratamiento recibido, complicaciones y desenlace final. Conclusión: TVC asociada a COVID-19 se puede presentar en pacientes con características variadas, suele tener complicaciones graves y en algunos casos, un desenlace mortal.

SUMMARY Cerebral venous thrombosis (CVT) is a rare clinical condition that consists of an obstruction of the dural venous sinuses or the cerebral cortical veins, triggering intracranial hypertension and symptoms such as headache, seizures and coma among others. CVT has recently been associated as a neurological complication of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Objective: To describe reported cases of CVT in patients with Coronavirus Disease 2019 (COVID - 19). Material and Methods: A literature search was conducted on PubMed to collect only case reports of patients with COVID-19 who developed CVT. Results: Report of 13 patients were analyzed and information was collected about sex, age, comorbidities, severity of COVID-19, type of CVT, treatments received, complications and the final outcome. Conclusion: CVT associated with COVID-19 can occur in patients with varied characteristics, often with serious complications and in some cases, a fatal outcome.

Cerebral venous thrombosis in Argentina: clinical presentation, predisposing factors, outcomes and literature review.

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare medical condition that primarily affects young adults. The clinical spectrum is broad and its recognition remains a challenge for clinicians. Limited information is available on CVT in Argentina. Our goal was to report the results of the first National registry on CVT in Argentina and to compare clinical presentation, predisposing factors and outcomes with other international registries. MATERIAL AND METHOD: The Argentinian National Registry on CVT (ANR-CVT) is a multicenter retrospective cohort study comprising patients aged 18 and older with a diagnosis of CVT from January 2015 to January 2019. We evaluated demographics, predisposing factors, clinical presentation, and radiological characteristics (e.g. number of involved sinuses, venous infarction or hemorrhage on CT and MRI scans at admission), therapeutic interventions and functional outcomes at discharge and at 90 days. Our results were compared to a literature review of CVT registries. RESULTS: Overall, one hundred and sixty-two patients met the inclusion criteria. The mean age was 42 (±17) years; 72% were women. Seventy percent of patients were younger than 50 years. The most common presenting symptom was headache (82%). The transverse sinus was the most common site of thrombosis (70%) followed by the sigmoid sinus (46%). The main predisposing factor in women was contraceptive use (44%), 3% of the events occurred during pregnancy and 9% during the puerperium. Participants 50 years and older had a higher frequency on malignancy related (7.5% vs. 30%, p = 0.0001) and infections (2% vs. 11%, p = 0.001). The modified Rankin Scale (mRS) ≤2 at discharge was 81% and the rate of mortality at discharge was 4%. At 90 days, the mRS≤2 was 93%. When the ANR-CVT was compared with larger registries from Europe and Asia, the prevalence of cancer among patients with CVT was two to five-fold higher (15% vs. 7% and 3%, respectively; p = 0.002 and p < 0.001). Anticoagulation rates at discharge were also higher (94%) compared to registries from Asia (ASCVT - 68%) or Turkey (VENOST - 67%). CONCLUSION: Participants in the first ANR-CVT had a low mortality and disability at 90 days. Clinical and radiological characteristics were similar to CVT from other international registries with a higher prevalence of cancer. There was a high variability in treatment adherence to guidelines as reflected by anticoagulation rates (range 54.5%-100%) at discharge.

Vein of Galen Aneurysmal Malformation with Transvenous Endovascular Treatment in an Adult: Case Report

Vein of Galen aneurysmal malformation (VGAM) is the result of the direct communication between the arterial network and the median prosencephalic vein. It is a rare vascular congenital malformation representing less than 1% of intracranial abnormalities. This finding is very rare in adults, and it may or may not present symptoms during childhood. Most cases of VGAM can be detected in the fetus by ultrasonography. The referral of pregnant women with fetuses with this condition to centers where better facilities and resources for childbirth and immediate postpartum care are available has resulted in considerable improvement in the prognosis of newborns. Regarding treatment, the endovascular approach to VGAM includes arterial embolization and percutaneous transvenous techniques. The transvenous endovascular treatment was chosen in the case presented in this article.

A malformação aneurismática da veia de Galeno (MAVG) é resultado da comunicação direta entre a rede arterial e a veia prosencefálica mediana. Trata-se de uma malformação vascular congênita rara, que representa menos de 1% das anormalidades intracranianas. Sua ocorrência é muito rara em adultos, e a malformação pode ou não apresentar sintomas durante a infância. A maioria dos casos pode ser detectada em fetos por ultrassonografia. O encaminhamento de grávidas com fetos com esta malformação para centros mais bem estruturados, com recursos para cuidados no parto e pós-parto, tem resultado em considerável melhora do prognóstico de recémnascidos. Quanto ao tratamento, o acesso endovascular à MAVG inclui a técnica de embolização arterial e o tratamento transvenoso percutâneo. O tratamento transvenoso endovascular foi escolhido no caso apresentado neste artigo.

Severe Edema and Venous Congestion Following Sphenoorbital Meningioma Resection in a Meningiomatosis Case: Importance of Predicting Venous Disturbances.

To achieve local disease control, radical removal is the best option for sphenoorbital meningiomas. Preservation of the venous system is crucial during the resection of skull base meningiomas. This vascular injury represents a major risk both for life and neurologic function. We present a case of a severe postoperative frontotemporal venous disturbance and cerebral edema following the radical removal of a giant sphenoorbital meningioma in a patient with meningiomatosis and occlusion of the superior sagittal sinus. The anatomical, radiologic, and surgical aspects are reviewed and discussed, with the aim of preventing such a serious complication.

Embolismo aéreo venoso en neurocirugía / Venous air embolism in neurosurgery

Venous air embolism is a potentially serious neurosurgical complication. Every neurosurgical procedure is at risk of developing the condition but the sitting and semi-sitting position represent a higher risk. The neuroanesthesiologist plays a key role in the management of the venous air embolism, from diagnosis to treatment. This article reviews the literature on air embolism in terms of its incidence, etiology, diagnosis and therapy.

El embolismo aéreo venoso es una complicacion de neurocirugia que puede llegar a ser potencialmente seria. Todos los procedimientos neuroquirurgicos tienen riesgo de presentarlo, siendo las posiciones sentada y semisentada las que mayor riesgo conllevan. El neuroanestesiologo forma parte primordial en el manejo del embolismo aéreo venoso, desde su diagnostico hasta el tratamiento. Este articulo revisa la literatura relacionada conel embolismo aéreo en cuanto a incidencia, etiologia, diagnostico y terapéutica.

Diagnóstico diferencial de malformação vascular encefálica em umacriança: relato de caso / Differential diagnosis in encephalic vascular malformation in a child: case report

Aims: To report a case of encephalic venous malformation, which is not commonly described in the literature, despite its importance as one of the main differential diagnosis in intracranial hemorrhage in children.Case Description: A five-year old girl presented chronic headache and had the first episode of seizure. Possible intracranial alterations were investigated as etiological factors, and an alteration in the Labbé vein was identified, possibly associated to a cavernoma in the left temporal region, which caused the hemorrhage.Conclusions: Primary seizures and headaches are relatively common in children. However, secondary seizures such as those caused by hemorrhage, despite being less common, must be suspected and investigated, as they may lead to severe complications.

Objetivos: relatar um caso de malformação venosa encefálica, não comumente descrito na literatura, apesar de sua importância como um dos principais diagnósticos diferenciais em hemorragia intracraniana em crianças.Descrição do Caso: uma menina de cinco anos de idade apresentava cefaleia crônica e teve o primeiro episódio de convulsão. Possíveis alterações intracranianas foram investigadas como fatores etiológicos, e foi identificada uma alteração na veia de Labbé, possivelmente associada a um cavernoma na região temporal esquerda, o que provocou a hemorragia.Conclusões: convulsões primárias e cefaleia são relativamente comuns em crianças. No entanto, convulsões secundárias, tais como aquelas causadas por hemorragia, apesar de serem menos comuns, devem ser suspeitadas e investigadas, pois podem levar a complicações graves.