Right cerebellar stroke with a right vertebral artery occlusion following an embolization of the right glomus tympanicum tumor: Case report with literature review

A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist.

Cerebral venous thrombosis in Saudi Arabia. Clinical variables, response to treatment, and outcome

To investigate cerebral venous thrombosis [CVT] clinical presentations, risk factors, and response to treatment in Saudi Arabia. Retrospective analysis of the King Fahad Medical City, Riyadh, acute stroke database from April 2005 through February 2008 revealed 22 patients with CVT. Hypercoagulable work-up and neuroimaging were performed. Sixteen patients were female [72.7%], and the median age was 35 years. Clinical presentations included: headache [77.3%], seizures [54.5%], focal neurological signs [54.5%], and decreased level of consciousness [50%]. Over two-thirds [n=11; 69%] of female patients had a history of oral contraceptive use, which was the most common risk factor. Protein S deficiency [n=3], antiphospholipid antibody syndrome secondary to systemic lupus erythematosus [SLE] [n=1], rhinocerebral mucormycosis [n=1], leukemia [n=1], non-Hodgkin's lymphoma [n=1], sepsis [n=1], and unknown [n=6] were causes. Affected areas included superior sagittal [n=13], transverse [n=16], sigmoid [n=14], straight [n=6] and cavernous sinus [n=1]; internal cerebral vein [n=2]; vein of Galen [n=3]; cortical veins [n=10]; and internal jugular vein [n=12]. Two patients had quadriparesis, and 2 patients died. The remainder [n=18, 81.8%] improved. Bilateral hemorrhagic presentation or venous infarction, deep venous system thrombosis, and underlying malignancy had less favorable results. Presentations in our series were similar to those in other reports, although altered consciousness and seizures were more common, Cortical vein involvement was also higher than commonly reported. Oral contraceptive use was a primary risk factor in female patients. Outcomes were favorable in 81.8% of patients