Cerebral venous sinus thrombosis presenting as intracerebral hemorrhage and subarachnoid hemorrhage: A case report

@#We present a 66-year-old male presenting with sudden onset of headache. Medical decompression was done and neuroimaging of plain cranial CT angiogram (CTA) and CT venogram (CTV) showed components of subarachnoid hemorrhage, intracerebral hemorrhage and hyperdense appearance of the superior sagittal sinus and proximal left transverse sinus. The following were done to look for etiologic factors: 1. fungal swab to determine the cause of the intracerebral hemorrhage secondary to venous thrombosis as the patient presented with a chronic history of sinusitis, 2. coagulopathy workup to look for a hypercoagulable state, and 3. workup for systemic disease of autoimmune in etiology. Anticoagulation was safely initiated within several days given the regression of the intracerebral hemorrhage along with stable findings of subarachnoid hemorrhage. Here we report cerebral venous sinus thrombosis rarely presenting as acute subarachnoid hemorrhage and intracerebral hemorrhage.

Trombosis de senos venosos cerebrales una manifestación extrapulmonar de COVID-19: Reporte de caso / Cerebral venous sinus thrombosis, an extrapulmonary manifestation of COVID-19: A case report

Resumen La trombosis de senos venosos cerebrales es un evento infrecuente en la población pediátrica y sus manifestaciones clínicas pueden variar dependiendo de la localización y extensión de la lesión, etiología o grupo etario (1); así mismo, la asociación de esta patología con virus es poco común, sin embargo, se han repor tado casos de trombosis de senos venosos en pacientes adultos con SARS-CoV-2 en relación con los mecanismos de lesión endotelial y respuesta inflamatoria que desencadena mecanismos procoagulantes. A continuación se presenta el primer caso reportado en Colombia de un caso de trombosis venosa cerebral en un lactante previamente sano, que debuta con un cuadro infeccioso gastrointestinal que resuelve y una semana después se presenta con cefalea y paralisis del VI par craneal derecho. Se documentó por angioto mografía trombosis del seno venoso sagital con extensión a senos transversos; los laboratorios fueron negativos para otras causas sistémicas y con prueba de anticuerpos para coronavirus positiva.

Abstract Cerebral venous sinus thrombosis is infrequent in the pediatric population and its clinical manifestations may vary depending on the anatomical location and the extent of the lesion, etiology or age group(1). The association of this pathology with viruses is uncommon, however, cases in adults with SARS-Cov2 have been reported triggered by procoagulant mechanisms due to endothelial injury and inflammatory response. The following article is the first reported case in Colombia of cerebral venous thrombosis in a previously healthy child, who debuted with gastrointestinal infectious disease and a week later with headache and sixth right cranial nerve palsy . The diagnosis of sagittal venous sinus thrombosis with extension to transverse sinuses was documented in a computed tomography angiography; laboratories for systemic diseases were negative and antibodies for coronavirus were positive.

Trombose venosa cerebral em paciente com câncer colorretal sob quimioterapia com 5-Fluorouracil infusional (esquema de Gramont) associado a bevacizumabe / Cerebral vein thrombosis in colorectal cancer patient under chemotherapy with 5-FU de Gramont regimen plus bevacizumab

Introdução: A trombose venosa cerebral constitui entidade clínica rara, respondendo por menos de 1% dos casos de AVC. Está associada a trombofilias hereditárias, infecções parameníngeas, traumatismos, além de vasculites, câncer e a própria quimioterapia. Relato do caso: Paciente de 59 anos com adenocarcinoma colônico sob quimioterapia com 5-Fluorouracil infusional (esquema de Gramont) associado a bevacizumabe apresentou quadro de tontura em desequilíbrio, déficit de força em membro inferior, cefaleia e convulsões, sendo constatada trombose venosa cerebral. Evoluiu com reversão total dos déficits neurológicos com anticoagulação. Conclusão: Enfatiza-se papel do câncer e da própria quimioterapia na etiopatogenia da trombose venosa cerebral em paciente sem aparente trombofilia hereditária e outros fatores tipicamente implicados na gênese desta rara condição.

Bi-Coronal Separated Skull Fracture: A Unique and Fatal Type of Traumatic Head Injury in Infancy: A Case Report / 대한신경손상학회지

The infantile skull is malleable, and its sutures are tightly adhering to the underlying dura and venous sinus. These characteristics, in association with the small amount of total blood volume, can result in a specific fatal type of skull fracture, which is unique to infancy. The authors report a case of this injury, and stress the need to pay attention to the possibility of massive bleeding during operation in infants. A 23-month-old female baby presented with semicomatose mentality after sustaining injuries by falling from a second-floor. Plain skull films showed bi-frontal skull fracture crossing the midline. Computed tomography revealed an acute subdural hematoma along the right convexity with severe brain edema. In the emergency operation, the scalp incision exposed massive bleeding from the fracture site. The bleeding was identified as arising from the lacerated and widely separated sagittal sinus beneath the fracture. The patient entered hypovolemic shock immediately after the scalp incision, and died from severe brain edema two days after the trauma and surgery. This case implies that special care should be paid during the operation of patients that have skull fracture overlying the venous sinus, especially when the fracture line is separated.

Cerebral Venous Thrombosis Treated with the Penumbra System(TM) and Various Neurointervention

A 33-year-old male was admitted with severe headache lasting 3 days. He did not have a focal neurologic deficit, but had a high intracranial pressure of 512 mmH2O. Cerebral angiography revealed venous sinus thrombosis that mainly involved the superior sagittal and right transverse sinuses. His headache remained severe after intravenous heparin infusion, and so interventional procedures were performed. Mechanical aspiration with the Penumbra system(TM) and other interventional procedures reopened the outflow of the superior sagittal sinus and effectively ameliorated this patient's headache.

Clinical diagnosis and treatment for superior sagittal sinus thrombosis / 中国基层医药

Objective To discuss the diagnosis and treatment of superior sagittal sinus thrombosis.Methods The early diagnosis and treatment of superior sagittal sinus thrombosis was induced and summarizd,7 cases in our hospital treated from 2005.6 to 2008.9.were analyzed.Results In this investigation,3 cases were puerperal women,and the other 4 had no special medical history.Brain edema of difference degree was found in all cases on CT scans,including sulcus (7 cases),compression of cistern(5 cases) or even disappeared of cistern(2 cases).CT scanning also revealed dense triangle in 2 cases,multiple small encephalomalacia focus of frontal lobe lesions in 3 cases,and sub-arachnoid hemorrhage(SAH) in 2 cases.The digital subtraction angio-grapby(DSA) also was underwent,of 2 superior sagittal sinus not seen,of 4 appear unevenness,of 7 Arterio-venous circulation delayed and of 5 collateral circulation vasodilatation.After treatment,the clinical symptoms and signs of all patients were improved.All of them could be self-supporting.Followed up for 3 years,the mortality was 0,and no one cerebral hemorrhage again.Conclusion The early diagnosis and treatment of superior sagittal sinus thrombosis could reduce the morbidity and mortality, also could improve prognosis.Especially for the one without cerebral hemorrhage,using heparin at the beginning was an effective and safe way.

Thrombosis of the Superior Sagittal Sinus in Behcet's Disease With Vascular and Enteric Involvements

We report superior sagittal sinus thrombosis as a central nervous system presentation of Behcet's disease in a patient with peripheral vascular and enteric involvement. The main symptoms were headache and horizontal diplopia due to intracranial hypertension. T1-weighted MRI with gadolinium enhancement revealed a similar pattern of the "empty delta sign" that is usually seen on brain CT. A magnetic resonance venogram revealed filling defects resulting from the thrombosis. These features are helpful for the noninvasive diagnosis of sagittal sinus thrombosis.

Antiphospholipid syndrome manifesting as papilledema / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To report a rare case of antiphospholipid syndrome presenting as papilledema and sixth nerve palsy in right eye due to superior sagittal sinus thrombosis, and regression of papilledema following anticoagulation and acetazolamide therapy.·METHODS: A 44-year-old Chinese gentleman presented with headache, diplopia and mild blurring of vision. Clinical examination revealed the presence of sixth nerve palsy in right eye and papilledema. There was enlargement of blind spot in the visual fields and red green deficiency in both eyes.Computed tomography and magnetic resonance imaging showed superior sagittal sinus thrombosis. Hematological investigation confirmed the presence of antiphospholipid syndrome as the underlying cause.·RESULTS: The condition was treated successfully in three months with the adjunctive use of anticoagulation and acetazolamide. Reversal of papilledema changes in the optic disc to normal indicates the anatomical recovery, while reduction of enlargement of blind spot to normal size,recovery of red green deficieny to normal colour vision in both eyes and visual improvement after regression of papilledema in right eye indicate functional recovery in this patient.·CONCLUSION: Antiphospholipid syndrome should be considered in the differential diagnosis of papilledema, and oral acetazolamide is an important adjunct therapy to anticoagulation in cases of refractory papilledema to protect the optic nerve from potential damage which results in blindness.

A Case of Eosinophilic Panniculitis Associated With Superior Sagittal Sinus Thrombosis

Eosinophilic panniculitis is characterized by a prominent infiltration of numerous eosinophils in subcutaneous fat, and has been identified in patients with a variety of associated clinical conditions. A case of eosinophilic panniculitis in a 20-year-old woman with a history of atopic dermatitis is reported. She later developed superior sagittal sinus thrombosis, and we stress the importance of systemic evaluations in patients with eosinophilic panniculitis.