Cerebral venous thrombosis.

Cerebral venous thrombosis is part of the so-called thrombosis in unusual sites. It is defined as an occlusion in the cerebral venous territory. Its incidence is progressively increasing, especially in developing countries. It is more frequently observed in young women, with hormonal factors such as pregnancy or hormonal contraception being significant risk factors in the development of this condition. The clinical presentation will depend fundamentally on the topography of the thrombosis, with a confirmatory diagnosis based mainly on imaging tests. The treatment generally consists of anticoagulation, and other options may be considered depending on the severity of the case. Overall, the prognosis is better than that of other intracranial vascular disorders. This review describes the current evidence available regarding cerebral venous thrombosis.

Cerebral venous thrombosis presented with symmetrical crescent-shaped intracranial hemorrhage in alcoholic liver disease: Case reports.

RATIONALE: Cerebral venous thrombosis (CVT) is a relatively uncommon but fatal disease. It can be caused by a variety of hereditary or acquired thrombotic diseases. Initial presentation with intracranial hemorrhage (ICH) in CVT is rare but can further complicate the therapeutic measures and prognosis. Cases of CVT presented with ICH in patients with alcoholic liver disease (ALD) have not been described in the literature, and it might be related with hemostatic abnormalities in ALD patients. PATIENT CONCERNS: We report 2 cases of men admitted to our hospital who were diagnosed with CVT but initially presented with symmetrical crescent-shaped ICH; both of them were ALD patients. DIAGNOSES: Cerebral imaging revealed extended CVT in both cases. The first case was a 64-year-old man with ALD deteriorated with unconsciousness and convulsions; computed tomography showed symmetrical crescent-shaped ICH in the right temporal lobe, and magnetic resonance venography revealed CVT. Another 50-year-old man with ALD complained about dizziness and weakness of his right limbs; computed tomography revealed symmetrical crescent-shaped ICH in bilateral parietal and occipital lobes, and magnetic resonance venography revealed CVT. INTERVENTIONS: The first patient was referred to the endovascular thrombectomy. Both of them were treated with anticoagulation treatment. OUTCOMES: Favorable outcomes were observed in both patients. LESSONS: Symmetrical or multiple crescent-shaped ICH requires a high suspicion in the diagnosis of CVT; even with hemorrhage, it is still important to initiate anticoagulation therapy promptly. The crescent-shaped ICH might be a new sign for CVT, and further studies are needed in the underlying mechanisms of ALD and potential thrombophilia.

Hereditary Antithrombin Deficiency Presenting with Cerebral Venous Thrombosis in Three Members of a Family.

Hereditary antithrombin (AT) deficiency is a rare thrombophilia associated with cerebral vein thrombosis (CVT). We report a case study of hereditary AT deficiency causing CVT in three members of a family. A 29-year-old female presented with features of CVT. Her mother and a sister had CVT in the past and investigation for hereditary thrombophilia revealed low blood AT activity in all of them. The index patient (proband) was positive for the SERPINC1 gene mutation confirming the diagnosis of hereditary AT deficiency. She recovered well with anticoagulation and was advised to continue it lifelong. Diagnosing hereditary thrombophilia like AT deficiency is important in planning anticoagulation and proper counseling of asymptomatic family members regarding prophylaxis for venous thromboembolism (VTE) in high-risk situations.

Trombosis venosa cerebral en adultos: cohorte de 35 casos de un hospital terciario / Cerebral venous thrombosis in adults: A case series of 35 patients from a tertiary hospital

Objetivos Describir las características basales, de presentación clínica, de imagen y evolución e identificar potenciales factores pronósticos en una cohorte de pacientes con trombosis venosa cerebral (TVC). Pacientes y métodos Estudio observacional retrospectivo, unicéntrico, que incluye a pacientes adultos con diagnóstico de TVC desde enero 2016 hasta diciembre 2020. Las variables fueron recogidas a través de la historia clínica electrónica. Resultados Se incluyeron 35 pacientes con una edad media al diagnóstico de 50,3 (±17,8) años, siendo la mayoría mujeres (74,4%). El 95% de los pacientes presentaba al menos un factor de riesgo para el desarrollo de TVC. El 97,1% recibió tratamiento anticoagulante con heparinas en la fase aguda, en su mayoría heparina de bajo peso molecular (75%). El evento compuesto (muerte, ingreso en unidad de cuidados intensivos, National institute of Health Stroke Scale al alta >3, recurrencia de TVC, hemorragia mayor, o la presencia de complicaciones) en las primeras dos semanas ocurrió en el 28,6%. El seguimiento medio fue de 3,3 años, durante el cual el 14,3% falleció (solo un paciente en relación con la TVC), un paciente presentó hemorragia mayor y ningún paciente presentó recurrencia de TVC. Conclusiones En nuestra cohorte, la TVC afectó con mayor frecuencia a mujeres jóvenes, y ocurrió en pacientes con al menos un factor de riesgo para TVC. La presencia de edema en la tomografía computarizada y el tratamiento con corticosteroides asociaron un peor pronóstico a corto plazo. Se observó un buen pronóstico a largo plazo en términos de mortalidad, recurrencia y sangrado (AU)

Objective To describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). Patients and methods This retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. Results A total of 35 patients were included, with a median age at diagnosis of 50.3 (± 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins. During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients). Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. Conclusions In our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding (AU)

Cerebral venous thrombosis in adults: a case series of 35 patients from a tertiary hospital.

OBJECTIVE: To describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). PATIENTS AND METHODS: This retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. RESULTS: A total of 35 patients were included, with a median age at diagnosis of 50.3 (+/- 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins.During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients).Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. CONCLUSIONS: In our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding.

Fulminant Extra- And Intracranial Arteriovenous Thrombosis And Non-aneurysmal Subarachnoid Hemorrhage Following COVID-19 Infection.

PURPOSE: Coronavirus disease of 2019 (COVID-19) is associated with increased risk of stroke and intracranial hemorrhage. This first report of fulminant panvascular arteriovenous thrombosis with subarachnoid hemorrhage (SAH) in a post-COVID-19 infection is attributed to extensive arteriovenous inflammation leading to arterial rupture following vasculitis. CASE REPORT: We report a rare case of extensive extra- and intra-cranial cerebral arteriovenous thrombosis following COVID-19 infection, presenting as fatal non-aneurysmal subarachnoid hemorrhage. The clinical course, biochemical and radiological evaluation is discussed. The other possible etiological differentials which were analysed and ruled out during case management are also detailed. CONCLUSION: A high degree of suspicion for COVID-19 induced coagulopathy leading to extensive non- aneurysmal, non-hemispheric SAH and malignant intracranial hypertension should be entertained. Our experience and previous reports on non-aneurysmal SAH in such patients show a poor prognosis.

Cerebral venous thrombosis in an adult with relapsing minimal change disease.

Minimal change disease (MCD) is a well-known cause of fulminant acute nephrotic syndrome (NS) and has been associated with thrombotic complications. We report the case of a 51-year-old woman with previous biopsy-proven MCD in remission who presented with worsening headache and acute confusion shortly after a relapse of the NS and was diagnosed with cerebral venous thrombosis (CVT) complicated by intracranial hemorrhage and midline shift. One month prior, she had been initiated on an oral contraceptive agent during remission of the NS. After initiation of systemic anticoagulation, her condition rapidly deteriorated, and she passed away before being able to undergo catheter-based venous thrombectomy. We conducted a systematic literature review and identified 33 case reports of adults with NS-associated CVT. The most common symptoms were headache (83%), nausea or vomiting (47%), and altered mental status (30%). 64% of patients presented at time of initial diagnosis of the NS and 32% during a relapse. Mean urinary protein excretion was 9.32 g/day and mean serum albumin was 1.8 g/dL. 91% of patients received systemic anticoagulation, and 19% died. The outcome in the remaining cases was favorable with only one report (5%) of residual neurological deficit. Of the available kidney biopsy results, MCD was the most common diagnosis (70%), raising the hypothesis that the fulminant acute onset of the NS might be a predisposing factor for this serious thrombotic complication. Clinicians should have a high index of suspicion for CVT in patients with the NS who present with new-onset neurological symptoms, including headache and nausea.

Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension.

A 38-year-old woman with untreated Graves' disease was admitted to our hospital because of headache and diplopia for 3 months. A neuro-ophthalmic examination showed bilateral papilledema and abducens nerve paralysis. The cerebrospinal fluid pressure was extremely high. Brain magnetic resonance imaging showed cerebral venous thrombosis in the superior sagittal and right transverse and sigmoid sinuses. Laboratory investigations revealed elevated factor VIII and von Willebrand factor levels. The patient recovered after propylthiouracil and anticoagulation therapy. We herein report a rare case of cerebral venous thrombosis with hyperthyroidism presenting as chronic isolated intracranial hypertension. Hyperthyroidism can induce a hypercoagulable state and lead to venous thromboembolism.

Clinical and prognostic characteristics of cerebral venous thrombosis at high altitude: a single-center retrospective study of Tibet.

OBJECTIVE: Data regarding diagnosis, management, and prognosis of patients with cerebral venous thrombosis (CVT) from high altitude are limited. The aim of the present study is to identify the clinical features, risk factors, and outcomes of cerebral venous thrombosis (CVT) in Tibet. METHODS: We retrospectively included patients with a diagnosis of CVT consecutively admitted to Tibet Autonomous Region People's Hospital between July 2015, and September 2022. The risk factors, clinical and radiological presentations, treatment and outcomes were analyzed. RESULTS: A total of 38 patients with CVT were included in this study. The median age was 31 years, and females accounted for 63.2%. Patients of Tibetan nationality accounted for 71.1% (n = 27) and the median altitude of residence in Tibet was 3800 m (3657, 4054). Headache was the most common symptom (92.1%). The most common risk factors of CVT were infection in the past 4 weeks (34.2%) and pregnancy or puerperium (23.7%). Lateral sinus (transverse and/or sigmoid sinus) (68.4%) and superior sagittal sinus (55.3%) were the most commonly involved. The D-dimer increased in 31 patients (81.6%). All three patients who died in hospital and during follow-up had risk factor of recent infection. Favorable outcome at follow-up with a median length of 454 days (189, 1059) was observed in 85.3% of patients. CONCLUSIONS: CVT at high altitude is more common in young patients and women, with various clinical manifestations and risk factors. Recent infection is the most common risk factor and may increase the mortality of CVT at high altitude. The long-term prognosis of CVT at high altitude is favorable.

SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature.

Cerebral venous thrombosis in pediatric patient has a varied etiology. The authors present the case of a teenager who, since the debut of SARS-CoV-2 infection, has accused intermittent right side hemicrania, which has become persistent in association with nausea and vomiting since the 5th day of quarantine. She was hospitalized in the 9th day since the debut. Neuroimaging revealed extended venous cerebral thrombosis affecting the right sigmoid sinus, the transverse sinus bilaterally, the confluence of the transverse sinuses and the right internal jugular vein. The evolution was favorable under anticoagulant and symptomatic treatment. Laboratory tests excluded other etiological causes for the cerebral venous thrombosis, thus the authors consider that cerebral thrombosis is a possible complication of SARS-CoV-2 infection in teenagers.

Cerebral venous thrombosis following an immunoglobulin-E mediated anaphylactic reaction.

BACKGROUND: Prothrombotic and pro-inflammatory states are known cerebral venous thrombosis risk factors. To date, two cases of venous thrombotic events after immunoglobulin-E mediated anaphylaxis have been reported. Herein, we describe the first case of cerebral venous thrombosis in close temporal relation with an immunoglobulin-E mediated anaphylactic event. CASE DESCRIPTION: A 51-year-old female presented with headache, language, and mental disturbance lasting for two days. Two days before the onset, she had undergone a provocative test with deflazacort to study an allergy history; after the test she developed a severe anaphylactic reaction. There were no other comorbidities, and in addition to contraceptive pill, she did not take other medications. On admission the patient was drowsy, with anomic aphasia, inattention and memory impairment. Magnetic Resonance Imaging depicted a left caudate and lenticulo-capsulo-thalamic venous infarct and thrombosis in the deep venous system. The patient was treated with anticoagulation and showed progressive improvement. Neoplastic and pro-thrombotic diseases were excluded. CONCLUSION: The close temporal association between the anaphylactic reaction and cerebral venous thrombosis suggests that anaphylactic reaction could have been a cerebral venous thrombosis precipitating factor. Immunoglobulin-E have been suggested to have prothrombotic activity by stimulating the release of platelet activation factor, thromboxane A2 and serotonin. This case adds on to the available information on possible cerebral venous thrombosis associated conditions.

Cerebral venous thrombosis associated with infective endocarditis in a young patient.

Cerebral venous thrombosis (CVT) is a rare complication of infective endocarditis. It constitutes a diagnostic and therapeutic emergency. We report a case of cerebral thrombophlebitis due to infective endocarditis in order to discuss the diagnosis and management of this situation. The patient was a 19-year-old man presenting with sudden explosive headaches with meningeal syndrome, right hemiparesis and right hypoesthesia. The cerebral CT angiography showed a left parieto-occipital and intraventricular hematoma without classic aneurysm or mycotic aneurysm or arteriovenous malformation. The injected brain magnetic resonance imaging found a CVT in front of a stopped opacification of the left lateral branch of the superior sagittal sinus. The presence of fever, poor oral status and a heart murmur justified the prescription of transthoracic echodoppler. It showed vegetations on healthy aortic valves. The patient was put on antibiotics and anticoagulants with favorable evolution. The absence of usual risk factors for CVT, the negativity of thrombophilia tests, the inflammatory and prothrombotic state associated with the infection reinforce the causal link of infective endocarditis to CVT formation. The etiology of CVT is variable, can be multiple and requires a comprehensive assessment. Infective endocarditis is one of the rare etiologies of CVT. In this case, anticoagulation and antibiotic drugs are indicated, taking into account the risk of intracerebral bleeding.

MRI-negative myelitis associated with cerebral venous thrombosis after COVID-19 infection.

Transverse myelitis and cerebral venous thrombosis represent some of the described neurological complications of coronavirus disease. A woman in her early 30s presented with headache, left-sided sensory symptoms and voiding difficulty. The patient also reported dry cough, fever, nasal congestion, anosmia and ageusia 2 weeks before presentation. The clinical examination showed sensory disturbances on the left side of the body, starting from the lower abdomen and extending to the left leg, which was consistent with transverse myelitis. The laboratory assessment confirmed a previous infection with coronavirus disease and excluded autoimmune entities. Radiological investigations revealed left transverse sinus thrombosis with no spinal cord abnormalities. The treatment was started with therapeutic anticoagulation and intravenous high-dose steroids. The patient showed significant improvement, and the neurological deficits resolved after 3 months. This is the first documented case of imaging-negative myelitis associated with cerebral venous thrombosis after coronavirus disease.

[Cerebral venous thrombosis associated with COVID-19]. / Tserebral'nye venoznye trombozy, assotsiirovannye s COVID-19.

The literature reports that cerebral venous thrombosis (CVT) develops in 1-1.5% of patients with COVID-19. Recently, a new syndrome named vaccine-induced immune thrombotic thrombocytopenia (VITT) has been described. VITT is a rare side-effect of COVID-19 vaccination that also causes CVT. The article presents an overview of the above problem and a clinical case of a patient with CVT that developed within a month after the first component of the Sputnik V vaccination and COVID-19.

[Thrombectomy without temporary clipping for giant partially thrombosed saccular aneurysms]. / Trombektomiya bez vremennogo klipirovaniya pri gigantskikh chastichno trombirovannykh meshotchatykh anevrizmakh.

Cerebral aneurysm thrombosis is one of the factors increasing the risk of microsurgical treatment. Thrombi and calcifications within the aneurysm neck prevent adequate clipping and should be removed before the procedure. At the same time, the process of thrombectomy is difficult and time consuming that increases duration of temporary arterial clipping and risk of cerebral ischemia. OBJECTIVE: To evaluate the results of thrombectomy without temporary arterial clipping for giant aneurysms of anterior brain circulation. MATERIAL AND METHODS: Four patients with giant partially thrombosed saccular aneurysms underwent thrombectomy without temporary clipping followed by neck clipping. In all cases, the aneurysm was thrombosed by more than 80-90% of its baseline volume, and aneurysm neck contained parietal thrombi from all sides. Mean duration of thrombectomy from aneurysm opening to bleeding and temporary clipping of the parent artery was 82 minutes, time of temporary clipping was about 12 minutes. RESULTS: Favorable clinical and radiological postoperative results were obtained in all patients. The authors present a scheme of surgical stages and video presentation involving the main surgical aspects of this procedure. CONCLUSION: Thrombectomy without temporary clipping of the parent artery is an effective technique for microsurgical treatment of giant partially thrombosed saccular intracranial aneurysms. Since most thrombi are removed without bleeding, duration of temporary blood flow discontinuation in the parent artery is significantly reduced. Therefore, we decrease the risk of cerebral ischemia. This technique can be useful in microsurgical treatment of complex aneurysms of the middle cerebral and internal carotid arteries, as well as other aneurysms.

Cerebral venous thrombosis during the COVID-19 Pandemic: A multi-center experience.

OBJECTIVE: To describe the clinical characteristics and outcomes of CVT in patients with history of recent COVID-19 infection or vaccination. METHODS: We reviewed demographic, clinical, and radiographic characteristics of non-pyrogenic, non-traumatic CVT cases at our multi-center institution between March 2020 and December 2021. Patients were grouped according to their history of recent COVID-19 infection or vaccination into group-I (+COVID-19 association) and group-II (-COVID-19 association). RESULTS: Fifty-one patients with CVT were included, of which 14 (27.4%) had a positive COVID-19 association: 10 with infection and 4 with mRNA-COVID-vaccine. Nine patients in group-I had COVID-19 infection or vaccine within 30 days of CVT diagnosis, including 3 patients with active infection at the time of CVT diagnosis. Half of the patients in group-I (n = 7,50.0%) and 32.4% (n = 12) of group-II were male, and mean age was 52.6 years in group-I and 51.4 years in group-II. Fever at presentation was noted in one patient who had active COVID infection (I=1 (7.1%), II= 0 (0%)). Higher rates of comorbidities were observed in group-II: hypertension (I= 2 (14.3%), II= 13 (35.1%)), deep venous thrombosis(I=1(7.1%), II= 10 (27.0%)), pulmonary emboli (I=1(7.1%), II= 8(21.6%)), or stroke(I=0(0%), II= 6(16.4%)). Three patients had thrombocytopenia at the time of CVT diagnosis (5.4%) and most patients (n = 37, 72.5%) were treated medically with anticoagulation. Complication rate during hospitalization was 17.6% (n = 6), and no mortality was noted. CONCLUSION: Twenty-seven percent of CVT patients were associated with COVID-19 infection or vaccination, and the majority presented within 30 days of infection/vaccination.