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1.
Acta Neurol Scand ; 140(6): 435-442, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505028

RESUMO

OBJECTIVES: One of the most important prognostic factors of cerebral venous sinus thrombosis (CVST) is intracranial hemorrhage (ICH). We studied the risk factors, clinical, and radiologic characteristics of early, delayed, and expanded ICH in Iranian patients with CVST. MATERIALS AND METHODS: In a retrospective study, from August 2012 to September 2016, all adult patients with a confirmed diagnosis of CVST were recruited. Demographic, clinical, and radiologic characteristics of the patients were recorded. The predictors of early, delayed, and expanded ICH were assessed through logistic regression analysis. RESULTS: Among 174 eligible patients, 35.1% of the patients had early ICH. Delayed and expanded hemorrhage occurred in 5% and 7.4% of the patients, respectively. Higher age was a risk factor (odds ratio [OR] = 1.038, 95% confidence interval [CI] = 1.008-1.069), and involvement of multiple sinuses/veins was associated with lower risk of early ICH (OR = 0.432, CI = 0.226-0.827). The risk of delayed ICH was higher in the patients with early hemorrhage (OR = 4.44, CI: 0.990-19.94), men (OR = 4.18, CI: 0.919-19.05), and those with a focal neurologic deficit on admission (OR = 16.05, CI: 1.82-141.39). Acute onset was the predictor of the expansion of early ICH (OR = 8.92, CI: 1.81-43.77), whereas female gender-related conditions were associated with a lower risk of hemorrhage expansion (OR = 0.138, CI: 0.025-0.770). Administration of anticoagulants was associated with neither delayed (P value = .140) nor expanded hemorrhage (P-value = .623). CONCLUSIONS: Male gender, early hemorrhages, acute onset, and presence of focal neurologic deficit are the risk factors for delayed and/or expanded hemorrhages in the patients with CVST.


Assuntos
Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/patologia , Trombose dos Seios Intracranianos/complicações , Adulto , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
2.
Int J Mol Med ; 44(3): 813-822, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31257456

RESUMO

The key to successful treatment of cerebral venous­sinus occlusion (CVO) is the rapid recanalization of the sinus following venous­sinus occlusion; however, rapid recanalization of the sinus may also cause secondary cerebral injury. The present study examined mechanical thrombectomy­related brain injury and the possible molecular mechanisms following CVO recanalization, and investigated the protective effect of glycyrrhizin (GL) in CVO recanalization. The cerebral venous sinus thrombosis (CVST) model was induced in rats using 40% FeCl3. Mechanical thrombectomy was performed at 6 h post­thrombosis. GL was administered to rats following thromboembolism. Neurological function and brain water content were measured prior to sacrifice of the rats. Serum malondialdehyde, superoxide dismutase and nitric­oxide synthase concentrations were measured. The expression levels of high­mobility group box 1 (HMGB1) and receptor of advanced glycation end products (RAGE) and its downstream inflammatory mediators were measured in serum and brain tissues. Rapid CVO recanalization caused brain injury, and the brain parenchymal damage and neurological deficits caused by CVO were not completely restored following recanalization. Similarly, following rapid recanalization in the venous sinus, the expression levels of HMGB1 and RAGE were lower than those in the CVST group, but remained significantly higher than those of the sham group. The combination of mechanical thrombectomy and GL improved cerebral infarction and cerebral edema in rats, and inhibited the extracellular transport of HMGB1, and the expression of downstream inflammatory factors and oxidative­stress products. The administration of exogenous recombinant HMGB1 reversed the neural protective effects of GL. In conclusion, mechanical thrombectomy subsequent to CVO in rats can cause brain injury following recanalization. HMGB1 and RAGE promote inflammation in the process of brain injury following recanalization. GL has a relatively reliable neuroprotective effect on brain injury by inhibiting HMGB1 and its downstream inflammatory factors, and decreasing oxidative stress.


Assuntos
Lesões Encefálicas/etiologia , Ácido Glicirrízico/farmacologia , Proteína HMGB1/genética , Fármacos Neuroprotetores/farmacologia , Receptor para Produtos Finais de Glicação Avançada/genética , Trombectomia , Animais , Biomarcadores , Biópsia , Lesões Encefálicas/metabolismo , Lesões Encefálicas/patologia , Lesões Encefálicas/terapia , Expressão Gênica , Proteína HMGB1/metabolismo , Masculino , Ratos , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/terapia , Trombectomia/métodos
3.
Pediatr Neurosurg ; 54(4): 288-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291634

RESUMO

Cerebral sinovenous thrombosis (CSVT) is a rare but not a negligible complication in pediatric brain tumor. An 11-year-old male with suprasellar germ cell tumor developed treatment-related vascular complications of CSVT and subdural hematoma. The underlying mechanism of CSVT was attributed to multiple risk factors, such as adipsic diabetes insipidus, obesity, central apnea, and chemotherapy-induced endothelial injury. In an attempt to minimize the possible risk of vascular complications, including late effect in pediatric brain tumors, we would like to stress the importance of individualized supportive therapy, i.e., hormone replacement, fluid management, thromboprophylaxis, and bi-level positive airway pressure therapy.


Assuntos
Diabetes Insípido/complicações , Germinoma/complicações , Hematoma Subdural/complicações , Neoplasias Hipofisárias/complicações , Trombose dos Seios Intracranianos/complicações , Anticoagulantes , Criança , Tratamento Farmacológico , Germinoma/diagnóstico , Hematoma Subdural/terapia , Humanos , Masculino , Obesidade/complicações , Trombose dos Seios Intracranianos/terapia
4.
Neurologist ; 24(4): 132-135, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31246722

RESUMO

The occurrence of dural arteriovenous fistula (DAVF) is rare. The clinical manifestation varies and depends on the location and venous drainage pattern. We present a case of a 57-year-old man with a left transverse sinus DAVF along with sigmoid thrombosis, cortical venous reflux, and congestion, that initially presented as parkinsonism. The patient was alert and fully oriented; however, decreased facial expressions were noted. His left forearm showed rigidity and bradykinesia, and it was difficult for the patient to smoothly perform rapid alternating movement testing. His complaints about hearing a rhythmic bruit above the left ear, particularly when lying down, alerted the physician of the presence of vascular lesions. Magnetic resonance imaging and angiography confirmed the diagnosis of DAVF. The patient received a combined surgical and endovascular approach to permanently block the fistula blood flow. The motion and movement of his left upper limb improved after fistula embolization. Images at the 1-month follow-up showed a decrease in the volume of tortuous vessels, and the fistula was completely occluded.


Assuntos
Encéfalo/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Transtornos Parkinsonianos/etiologia , Trombose dos Seios Intracranianos/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/diagnóstico por imagem , Seios Transversos
5.
J Clin Neurosci ; 66: 275-277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101584

RESUMO

We report the case of a 59 year old woman who presented with a six week history of worsening bifrontal headache. On CT brain the only abnormal finding was a partially empty sella potentially indicative of increased intracranial pressure. MRI found a large cerebral venous sinus thrombosis in the superior sagittal sinus. Blood tests and a bone marrow biopsy revealed a diagnosis of JAK2 positive primary polycythaemia rubra vera. The lack of sensitivity and specificity of CT in the diagnosis of CVST should engender a low threshold for MRI in patients with risk factors and/or non-diagnostic abnormalities on initial CT. Management of this dual pathology involves both the immediate treatment of the thrombus with heparin bridging to warfarin and the long treatment for polycythaemia involving repeat venesections and cytoreductive therapy.


Assuntos
Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/diagnóstico por imagem , Policitemia Vera/complicações , Policitemia Vera/diagnóstico por imagem , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Diagnóstico Diferencial , Síndrome da Sela Vazia/terapia , Feminino , Cefaleia/complicações , Cefaleia/diagnóstico por imagem , Cefaleia/terapia , Heparina/administração & dosagem , Humanos , Pessoa de Meia-Idade , Policitemia Vera/terapia , Sela Túrcica/diagnóstico por imagem , Trombose dos Seios Intracranianos/terapia , Varfarina/administração & dosagem
6.
Medicine (Baltimore) ; 98(19): e15134, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083150

RESUMO

To investigate the pathogenesis of somatic solid cancer-related cerebral venous sinus thrombosis (CVST).A total of 174 patients with CVST were recruited from the hospital between January 2006 and December 2017 and divided into two groups: (1) somatic cancer-related CVST group, defined as active somatic solid cancer patients with acute CVST; (2) cancer group (CG), defined as active somatic solid cancer patients without CVST. The cancer group patients were age and gender-matched somatic cancer-related CVST group patients. In addition, the types and amount distribution of cancer in cancer group were also matched with somatic cancer-related CVST group patients.Compared to cancer group patients, somatic cancer-related CVST group patients had more intracranial metastasis, a higher platelet count, higher plasma D-dimer, carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels, a greater platelet to lymphocyte ratio (PLR), and a greater platelet to neutrophil ratio (PNR). The risk for CVST in somatic cancer-related CVST group patients increased independently by 0.7% (odds ratio [OR] 1.007; 95% confidence interval [CI] 1.000, 1.015; P = .047) with a 1 ng/ml increase in D-dimer levels, by 4.6% (OR 1.046; 95% CI 1.011, 1.083; P = .010) with a 1 U/ml increase in CEA, by 2.7% (OR 1.027; 95% CI 1.003, 1.051; P = .025) with a 1 U/ml increase in CA125, and by 10.6% (OR 1.106; 95% CI 1.002, 1.220; P = .045) with a 1 unit increase in PNR.It was suggested that together impacts of elevated plasma D-dimer, CA125, CEA levels, and a greater PNR may lead to hypercoagulability and to trigger the development of cancer-related CVST.


Assuntos
Neoplasias/complicações , Neoplasias/fisiopatologia , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/fisiopatologia , Cérebro/irrigação sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/terapia , Estudos Retrospectivos , Fatores de Risco , Trombose dos Seios Intracranianos/epidemiologia , Veias
7.
Am J Case Rep ; 20: 419-422, 2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30928992

RESUMO

BACKGROUND Extra-intestinal manifestations of inflammatory bowel disease (IBD) include thromboembolic events that can present as deep vein thrombosis, pulmonary embolism, and cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare complication of IBD that can be associated with high morbidity and mortality. This report is of a case of cerebral venous sinus thrombosis presenting in a young man during a relapse of ulcerative colitis (UC). CASE REPORT A 27-year-old man presented with seizures and focal neurological deficit during a relapse of chronic UC. He was found to have left cerebral venous sinus thrombosis complicated by left frontotemporal infarction that was treated with anticoagulation therapy. CONCLUSIONS Thromboembolic events are well documented extra-intestinal manifestation of IBD. Cerebral venous sinus thrombosis is a rare but serious complication that can be fatal. The correct diagnosis and timely management require a high degree of suspicion in patients with IBD who present with a new-onset headache, focal neurological symptoms, seizure, or altered mental status.


Assuntos
Colite Ulcerativa/complicações , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Adulto , Infarto Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Lobo Parietal/irrigação sanguínea , Lobo Parietal/diagnóstico por imagem , Recidiva , Convulsões/etiologia
8.
J Stroke Cerebrovasc Dis ; 28(6): e60-e63, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30962082

RESUMO

For malignant cerebral venous sinus thrombosis (CVST) complicated with cerebral hernia, decompressive craniectomy may be life-saving, and thrombectomy combined with thrombolysis may obtain better outcomes. This report describes an approach performed on 2 patients diagnosed with CVST combined both thrombectomy and thrombolysis with decompressive craniectomy through incising the superior sagittal sinus. The general procedure of the operation is as follows. The anterior part of the superior sagittal sinus was exposed firstly. After cutting the dura matter for decompression, a superior sagittal sinus incision was taken to detect sinus thrombus. In order to facilitate hemostasis during detecting the sagittal sinus, 2 silk sutures were sutured along the incision. The incision was 5 millimeters long approximately along the middle line of the front third of the superior sagittal sinus. A silicone intubation was inserted in the sinus through the incision. Thrombus was seen in the suction tube. At a depth of about 10 cm, while it is difficult to penetrate the tube, we used the gelatin sponge to cover the sinus incision and fixed the suture lines after cross-knotting. The silicone intubation was drawn out through the forehead and connected to external micro pump for injecting anticoagulant drugs, then cut the dura mater into star-shaped and discard bone flap for decompression. Absorbable artificial dura mater was used to repair bilateral dura mater, respectively. At last, connect the catheter to the micro pump for pumping anticoagulant. After operation, the 2 patients received thrombolysis through the catheter placed in the sinus. Both of them recovered well. There was no incision-related bleeding occurred after surgery. Both the patients achieved incredibly good outcomes. For patients with malignant cerebral venous sinus thrombosis, acute cerebral hernia or cerebral hernia tendency, it may be an effective approach combined both thrombectomy and thrombolysis with decompressive craniectomy through incising the superior sagittal sinus.


Assuntos
Craniectomia Descompressiva , Encefalocele/terapia , Trombose dos Seios Intracranianos/terapia , Trombectomia/métodos , Terapia Trombolítica , Adulto , Angiografia Cerebral/métodos , Terapia Combinada , Encefalocele/diagnóstico por imagem , Encefalocele/etiologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Flebografia/métodos , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Acta Neurol Scand ; 139(2): 166-171, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30251405

RESUMO

OBJECTIVES: To examine the clinical characteristics and prognosis of cerebral venous sinus thrombosis (CVST) that presented as pseudotumor cerebri (PTC) patients with JAK2V617F mutation. METHODS: Medical records of all consecutive patients that presented with PTC and a JAK2V617F mutation who were treated were retrospectively reviewed. Data regarding demographics and ocular presenting symptoms and signs, neurological signs, hematological factors treatment, and prognosis were collected. RESULTS: The most common presenting symptoms were headache (5 patients, 83.3%) and visual obscurations (5 patients, 83.3%). CVST of the sagittal sinus and sigmoid sinus were the most common site of thrombus. Platelet count and hemoglobin count were higher than normal during follow-up. There was significant change in the disk edema degree as well as decline in retinal nerve fiber layer (RNFL) thickness (P < 0.001, P < 0.001, Matched pairs). There was no significant change in visual acuity (VA) or mean deviation (MD) during follow-up (P = 0.95, 0.64, respectively, Matched pairs). CONCLUSIONS: Pseudotumor cerebri resulting from CSVT in our patients with JAK2V617F mutation was frequent in young patients and needed medical and surgical treatment, without improvement in visual functions and in third caused poor visual outcome. Therefore, we believe that a screening test for JAK2V617F mutation should be considered for patients with CVST without known risk factor presenting with PTC, especially when sagittal sinus or sigmoid sinus involvement or thrombocytosis or high hemoglobin are found upon presentation. This might lead to more aggressive management which may improve the visual prognosis of those young patients.


Assuntos
Janus Quinase 2/genética , Pseudotumor Cerebral/genética , Trombose dos Seios Intracranianos/complicações , Adulto , Criança , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Mutação , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/etiologia , Trombose dos Seios Intracranianos/diagnóstico
12.
World Neurosurg ; 122: 203-208, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30404063

RESUMO

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke in pediatric patients and young adults. The clinical course of CVST is also highly variable. In particular, coma has been noted as a predictor of poor outcome. The standard treatment for CVST in adults is systemic anticoagulation, which can lead to recanalization. Endovascular mechanical thrombectomy (EMT) is considered as possibly indicated in the event of failure to respond to anticoagulation or a comatose state. However, the role of endovascular therapy in the management of pediatric and young adult CVST is unclear. Here, we describe 3 cases of successful emergent EMT for pediatric and young adult CVST presenting in a comatose state. CASE DESCRIPTION: A 17-year-old boy presented with rapid deterioration and a comatose state despite anticoagulation using heparin. Emergent EMT was performed for CVST. Balloon percutaneous transmural angioplasty and catheter aspiration were repeatedly performed, and partial recanalization of the superior sagittal sinus was achieved by the end of the procedure. The child was discharged without neurologic deficits. Another 2 comatose cases with CVST underwent emergent EMT with balloon percutaneous transmural angioplasty and catheter aspiration, and partial recanalization was again achieved. These patients finally showed complete superior sagittal sinus recanalization and were discharged without neurologic deficits. CONCLUSION: Pediatric and young comatose CVST warrants endovascular mechanical thrombectomy as soon as possible.


Assuntos
Coma/terapia , Procedimentos Endovasculares , Trombólise Mecânica , Trombose dos Seios Intracranianos/terapia , Trombose Venosa/terapia , Adolescente , Adulto , Coma/complicações , Coma/diagnóstico por imagem , Feminino , Humanos , Masculino , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Adulto Jovem
13.
Medicine (Baltimore) ; 97(50): e13476, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558002

RESUMO

RATIONALE: Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) as the first presentation is extremely rare. PATIENT CONCERNS: A 57-year-old woman presented with dizziness, nausea, and vomiting. DIAGNOSIS: Neuroimaging confirmed a diagnosis of CVST. INTERVENTIONS: The patient was treated with dehydration, scavenging free radicals, and nerve protection therapy. OUTCOMES: After 4 weeks of systematic treatment, the patient resumed independent daily activities and was discharged with only slight non-fluent aphasia. She did not exhibit recurrent thrombosis at an 18-month follow-up point. MAIN LESSONS: The usual treatment for sinus thrombosis is anticoagulation or local thrombolysis. Systemic anticoagulation is the first-line treatment for CVST, even in patients with cerebral hemorrhage or SAH. The present patient's hemorrhage clearly contraindicated heparin; therefore, no anticoagulants or thrombolytic agents were administered during the 4-week hospitalization. We discuss issues for consideration in similar cases and provide an example of determining an individualized approach to treatment.


Assuntos
Hemorragia Cerebral/etiologia , Trombose dos Seios Intracranianos/complicações , Hemorragia Subaracnóidea/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
14.
Med. infant ; 25(4): 303-310, diciembre 2018. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-970470

RESUMO

Introducción: La trombosis de senos venosos cerebrales (TSVC) es infrecuente en pediatría. Está asociada a condiciones como infecciones, deshidratación, fallo renal, traumatismo de cráneo, neoplasias, trastornos hematológicos, etc. Cefalea, vómitos, alteración del sensorio y hemiparesia son los síntomas más frecuentes. El diagnóstico es confirmado por TC con angio y/o RM con angio. La anticoagulación es el tratamiento de elección. Los pacientes suelen evolucionar favorablemente. Materiales y Métodos: Estudio descriptivo observacional de pacientes con TSVC atendidos en el Hospital Garrahan desde 2010 a 2017. Las variables registradas fueron: edad, sexo; manifestaciones clínicas, factores de riesgo; estudios diagnósticos, tratamiento y evolución. Resultados: Se describen 34 pacientes con TSVC. Los adolescentes fueron el grupo mayor. La cefalea fue el síntoma más frecuente. Angio TC, RM y/o angio RM confirmaron el diagnóstico; los senos transverso, sagital superior y sigmoideo fueron los más comprometidos. 21 pacientes tenían patología oncológica y 14 procesos infecciosos. El tratamiento de elección fue la anticoagulación. Tuvieron buena evolución el 82%. Conclusiones: Debemos sospechar esta entidad en dos grupos: el primero formado por lactantes y pre-escolares con patología infecciosa; y un segundo integrado por escolares y adolescentes con patología oncológica, especialmente aquellos que reciben L-ASA.Es importante resaltar el valor de la TC y angio TC para hacer diagnóstico oportuno, resultando accesible las 24 horas en el hospital


Introduction: Cerebral venous sinus thrombosis (CVST) is uncommon in children. CVST is associated with conditions, such as infections, dehydration, renal failure, head trauma, cancer, and hematological disorders. Headache, vomiting, sensory alterations, and hemiparesis are the most common symptoms. Diagnosis is confirmed by angio CT and/or MRA. Anticoagulation is the treatment of choice. Outcome is generally good. Material and Methods: An observational, descriptive study of patients with CVST seen at Garrahan Hospital between 2010 and 2017. The following variables were recorded: age, sex; clinical manifestations, risk factors; diagnostic studies, treatment, and outcome. Results: 34 patients with CVST were studied. Most patients were adolescents. Headache was the most common symptom. Angio CT, MRI, and/or MRA confirmed the diagnosis; the transverse, superior sagittal, and sigmoid sinuses were most frequently affected. Of the patients, 21 had oncological disease and 14 infections. Anticoagulation was the treatment of choice. Outcome was good in 82%. Conclusions: CVST should be suspected in the following two groups: A first group consisting of infants and preschool children with infections and a second group of school-age children and adolescents with cancer, especially those receiving L-ASA. It is important to highlight the role of CT and angio CT for early diagnosis as the study is available day and night at the hospital.


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/diagnóstico por imagem , Vômito/etiologia , Veias Cerebrais/diagnóstico por imagem , Cefaleia/etiologia , Trombose dos Seios Intracranianos/tratamento farmacológico , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Estudos Prospectivos , Anticoagulantes/uso terapêutico
15.
J Med Case Rep ; 12(1): 323, 2018 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-30343667

RESUMO

BACKGROUND: Cerebral venous thrombosis refers to acute thrombosis or blood clots that can lead to strokes. This illness can be misdiagnosed as a migraine, resulting in a delay in management and catastrophic outcomes. We present a pitfall case that highlights the importance of careful history taking and physician awareness in diagnosing cerebral venous thrombosis. CASE PRESENTATION: A recently married, previously healthy, young Arabic female presented to the emergency department three times with a complaint of throbbing frontal headache for the past 2 days with no neurological deficit. During her first two visits, she was seen by a junior general practitioner and was prescribed analgesics only as her migraine was precipitated by oral contraceptives and low hemoglobin. No imaging was requested during that visit. At the third visit, she underwent plain computed tomography of the head that was interpreted by an emergency consultant, who revealed the diagnosis despite limited resources. Unfortunately, the patient developed complications of the hydrocephalus, transtentorial brain herniation, and intraventricular hemorrhage that required multiple neurosurgical interventions and resulted in a permanent vegetative state. CONCLUSIONS: Cerebral venous sinus thrombosis is an uncommon and tricky condition with unpredictable presentation and prognosis. A physician needs to have a high index of suspicion to diagnose it, especially when the patient presents with uncomplicated complaints. These simple complaints, such as headaches, usually lead to misdiagnosis and delay the appropriate diagnosis and management.


Assuntos
Estado Vegetativo Persistente/etiologia , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico , Anticoncepcionais Orais/efeitos adversos , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/diagnóstico , Trombose dos Seios Intracranianos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
J Clin Neurosci ; 58: 83-88, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30340972

RESUMO

The aim was to review the neurointensive care (NIC) of cerebral venous sinus thrombosis patients with haemorrhage during a 15-year period. This is a severe condition with substantial mortality caused by increased intracranial pressure (ICP) and studies are lacking describing the complex picture of the NIC, which offers a large treatment arsenal for intracranial hypertension. Patients treated 2000-2015 were investigated. Data regarding patient characteristics, symptoms, imaging, ICP-treatment, NIC-treatment intensity, and outcome were collected and analysed. Twenty-four patients (13 women) were studied, mean age 46 (range 16-75). Twenty patients were in Glasgow coma scale motor score 6 (obeys), 2 in score 5 (localizes) and 2 in score 2 (extension) on admission. Mean haemorrhage volume was 17 ml (range 1-70). Twenty patients (83%) received unfractionated heparin and 3 (13%) low molecular weight heparin. Haemorrhagic progression occurred in 10 patients (42%). In 9 patients (38%), 4-6 of the treatment options mechanical ventilation, hyperventilation, ICP-monitoring, cerebrospinal fluid-drainage, osmotherapy, barbiturates or surgery were used. In 3 patients mechanical ventilation only was used (hyperventilation in 1). Twelve patients were not managed with any of those treatment options. At follow up, 15/24 patients (62%) had favourable outcome (4 missing). The study shows that many patients needed multiple actions to treat intracranial preassure but more than 60% achieved favourable clinical outcome. Preferably, patients with cerebral venous sinus thrombosis and haemorrhage who are awake should have fast access to NIC because it appears difficult to predict who will deteriorate and promptly need NIC treatment.


Assuntos
Hemorragia Cerebral/etiologia , Hemorragia Cerebral/terapia , Cuidados Críticos/métodos , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
17.
BMC Neurol ; 18(1): 159, 2018 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-30268100

RESUMO

BACKGROUND: Cerebral venous sinus thrombosis or stenosis (here collectively referred to as cerebral venous sinus occlusion, CVSO) can cause chronically-elevated intracranial pressure (ICP). Patients may have no neurological symptoms other than visual impairment, secondary to bilateral papilledema. Correctly recognizing these conditions, through proper ophthalmological examination and brain imaging, is very important to avoid delayed diagnosis and treatment. CASE PRESENTATION: We report a case series of 3 patients with chronic CVSO, who were admitted to an ophthalmological department in Chongqing, China, from 2015 March to 2017 February. All patients presented with decreased vision and bilateral papilledema, but had no headache or other neurological symptoms. The visual fields of all patients were impaired. Flash visual evoked potentials (VEPs) in two patients showed essentially normal peak time of P2 wave, and pattern VEPs in one patient displayed decreased P100 amplitude in one eye, while a normal P100 wave in the other eye. In all patients, lumbar puncture (LP) revealed significantly elevated ICP. And magnetic resonance venography (MRV) demonstrated cerebral venous sinus abnormalities in every patient: one right sigmoid sinus thrombosis, one superior sagittal sinus thrombosis, and one right transverse sinus stenosis. CONCLUSIONS: CVSO can cause chronically-elevated ICP, leading to bilateral papilledema and visual impairment. A considerable amount of patients have no apparent neurological symptoms other than visual loss. Unlike other optic nerve lesions, such as neuritis or ischemic optic neuropathy, the optic disc edema in CVSO is usually bilateral, the flash or pattern VEP is often normal or only mildly affected, and patients are often not sensitive to steroid therapy. CVSO should be suspected in such patients when unenhanced brain imaging is normal. Further investigations, such as LP and contrast-enhanced imaging (MRV and digital subtraction angiography), should be performed to diagnose or exclude CVSO.


Assuntos
Cavidades Cranianas/patologia , Hipertensão Intracraniana/etiologia , Papiledema/etiologia , Trombose dos Seios Intracranianos/complicações , Transtornos da Visão/etiologia , Adulto , Idoso , China , Constrição Patológica/patologia , Feminino , Humanos , Masculino , Adulto Jovem
18.
World Neurosurg ; 120: 485-489, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30253994

RESUMO

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke. Medical and neurointerventional strategies, such as in situ thrombolysis, are standard therapies. These techniques are insufficient when clinical deterioration arises from mass-associated effects and transtentorial herniation; in such cases, decompressive hemicraniectomy may be indicated. To the best of our knowledge, the association of open surgical thrombectomy with bilateral decompressive craniectomy has not been reported to date. CASE DESCRIPTION: A 45-year-old woman presented with extensive cerebral venous sinus thrombosis that was resistant to anticoagulation and endovascular therapies. Her clinical condition deteriorated until she became comatose, and bilateral hemicraniectomy combined with open surgical thrombectomy through the superior sagittal sinus was indicated. Computed tomography angiography confirmed postoperative maintenance of sinus permeability. The patient's clinical status improved dramatically, and she had a favorable outcome, including recovery of her functional independence to perform all activities of daily living (modified Rankin Scale score = 0). The follow-up period was 5 years. CONCLUSIONS: Open surgical thrombectomy combined with decompressive craniectomy is a lifesaving procedure that can lead to favorable outcome and should be considered for treatment of refractory malignant cerebral venous sinus thrombosis.


Assuntos
Craniotomia/métodos , Descompressão Cirúrgica/métodos , Trombose do Seio Lateral/cirurgia , Trombose do Seio Sagital/cirurgia , Trombectomia/métodos , Angiografia Digital , Angiografia Cerebral , Coma/etiologia , Angiografia por Tomografia Computadorizada , Estado Terminal , Procedimentos Endovasculares , Feminino , Humanos , Trombose do Seio Lateral/complicações , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Trombose do Seio Sagital/complicações , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/cirurgia , Seio Sagital Superior
19.
J Clin Ethics ; 29(3): 185-190, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30226818

RESUMO

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology.


Assuntos
Simulação de Doença/diagnóstico , Transtornos Somatoformes/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Idoso , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Ética Clínica , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose dos Seios Intracranianos/complicações , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos
20.
World Neurosurg ; 120: e161-e168, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30096502

RESUMO

BACKGROUND: Cerebral venous infarction (CVI) is a rare vascular disease most commonly caused by cerebral venous thrombosis that leads to hemorrhage or infarct formation. A rabbit model of CVI was established by placing a recoverable epidural sacculus to research effects of increased pressure on CVI. METHODS: Rabbits were randomly divided into the following groups: A, CVI; B, 0.2-mL epidural sacculus placed on the basis of CVI; C, 0.4-mL epidural sacculus; D, 0.6-mL epidural sacculus; E, sham operation. Two sacculus-release groups were then added, 8 hours (group F) and 24 hours (group G), on the basis of group D. Brain water content, extent of cerebral infarction, hemorheology indexes, D dimer, and fibrinogen were observed at 8, 24, and 48 hours after surgery. RESULTS: Brain water content was higher in groups A-D compared with group E with the exception of the 24-hour A group. Brain water content was significantly lower in sacculus-release groups compared with the 48-hour D group. Extent of cerebral infarction in group D was significantly higher at 24 and 48 hours compared with groups A and E. Extent of cerebral infarction in sacculus-release groups was significantly lower compared with group D at 48 hours. Hemorheology indexes and fibrinogen were significantly higher in group D compared with groups A and E at corresponding time points and increased with increasing intracranial pressure. CONCLUSIONS: In the rabbit model of CVI, degree of brain edema, extent of cerebral infarction, hemorheology indexes, and fibrinogen increased as intracranial pressure gradient increased, which may promote formation of a hypercoagulable state. Early removal of intracranial hypertension reduced degree of edema and extent of cerebral infarction in rabbits.


Assuntos
Edema Encefálico/fisiopatologia , Infarto Encefálico/fisiopatologia , Veias Cerebrais , Hipertensão Intracraniana/fisiopatologia , Trombose dos Seios Intracranianos/diagnóstico , Animais , Edema Encefálico/etiologia , Infarto Encefálico/etiologia , Infarto Encefálico/metabolismo , Erros de Diagnóstico , Modelos Animais de Doenças , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Hemorreologia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/metabolismo , Pressão Intracraniana , Coelhos , Índice de Gravidade de Doença , Trombose dos Seios Intracranianos/complicações
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