Cerebral vein thrombosis due to meningococcal meningitis

Bacterial meningitis is a life-threatening condition and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous and sinus thrombosis (CVST) is an uncommon type of these complications, especially in meningococcal meningitis. The initiation of anticoagulant in septic thrombosis is controversial. A 35-year-old man was admitted to a hospital with fever and confusion. The diagnosis of N. meningitidis meningitis was established. Antimicrobial regimen (ceftriaxone) was continued. On the 3rd day, the patient's consciousness was improved; however, according to the patient's headache on day 7, brain imaging was performed which revealed a cerebral thrombosis in transverse and sigmoid sinuses. Although initiation of anticoagulant is controversial in septic thrombosis, the anticoagulant treatment also was started. Control brain magnetic resonance venogram done revealed complete resolution of cerebral CVST after 2 weeks. CVST as a complication of meningococcal meningitis should be considered. Anticoagulant treatment may be considered in the management of septic cerebral thrombosis if there are no contraindications. The use of anticoagulant needs further studies.

Persistent fetal superficial middle cerebral vein: an anatomical study / 대한해부학회지

The superficial middle cerebral vein (SMCV) drains the venous blood from most of the superolateral surface of the brain and drains typically into the cavernous sinus as mentioned in standard textbooks. But the drainage of the SMCV is variable as indicated by various radiological studies. Although variations in the drainage of the SMCV exist, there is a shortage in the literature providing cadaveric evidence for the same. The present study was designed to identify the variations in the drainage pattern of the SMCV in fetal cadavers. During the dissection of formalin-fixed full-term fetuses, deviation in the drainage of the SMCV was observed in five out of 30 cases. In three out of 30 specimens (10%), SMCV was observed draining into superior petrosal sinus; and in two specimens (6.6%) into the transverse sinus. In the remaining specimens, the SMCV drained directly into the cavernous sinus. Knowledge of the variations noted in the present study is essential, not only for diagnosing several diseases involving the cavernous sinus or paracavernous sinuses but also in surgeries of paracavernous sinus lesions and endovascular treatment of arteriovenous fistulas. The SMCV and superior petrosal sinus can be a venous refluxing route in patients with arteriovenous fistulas.

Correalation between injury of draining veins around meningiomas in superficial middle cerebral vein areas and postoperative cognitive changes / 中国基层医药

Objective@#To explore the correalation between change of postoperative cognitive function and injury of the draining veins around meningiomas in superficial middle cerebral vein areas, to discuss the importance and protection method of draining veins around meningiomas in order to guide the microneurosurgery.@*Methods@#From July 2013 to July 2017, the clinical data of 54 patients with superficial middle cerebral vein areas meningiomas(tumor group) in the Central Hospital of Guangdong Nongken were retrospectively analyzed.And 52 healthy volunteers were selected as the control group.The preoperative and postoperative cognitive function and meningiomas peritumoral edema(MPE) were assessed by the Montreal Cognitive Assessment(MoCA) and CT/MRI.@*Results@#The scores of visuospatial and executive[(3.23±1.27)points], order[(2.52±1.27)points], memory[(2.20±1.14)points], attention[(4.71±0.97)points], language[(2.19±0.74)points], abstract[(1.43±0.63)points], location[(5.83±0.42)points], total[(22.06±0.33)points] in the tumor group were significantly lower than those in the control group[(4.83±0.38)points, (3.0±0.02)points, (3.5±1.04)points, (5.98±0.14)points, (2.54±0.50)points, (1.88±0.38)points, (5.98±0.33)points, (27.83±0.16)points](t=4.504, 6.116, 9.338, 2.782, 4.509, 2.390, 8.670, all P<0.05). According to the injury of the draining veins around meningioma, 54 patients were divided into the two groups, 43 cases in the no-injuried group, 11 cases in the injuried group.There were no statistically significant differences between the no-injuried group and injuried group in all measurements before operation(all P>0.05). Both no-injuried group and injuried group had decline in MoCA and increase in MPE at 5 days after surgery.Both no-injuried group and injuried group had rise in MoCA[(26.35±0.36)points vs.(22.00±0.67)points] and decrease in MPE[(23.95±4.34)cm3 vs (44.64±9.68)cm3] at 30 days after surgery(t=5.944, 2.098, all P<0.05). The MoCA[(22.59±0.31)points vs (26.35±0.36)points] was obviously increased and the MPE[(87.84±12.78)cm3 vs.(23.95±4.34)cm3] was obviously increased in 30 days after operation in no-injuried group(t=7.289, 5.014, all P<0.05), but the injuried group had just the opposite.@*Conclusion@#Injury of the draining veins around meningiomas in superficial middle cerebral vein areas can lead to cognitive dysfunction and compromise the quality of postoperative life in patients, every effort should be undertaken to preserve the draining veins around meningioma.

Correalation between injury of draining veins around meningiomas in superficial middle cerebral vein areas and postoperative cognitive changes / 中国基层医药

Objective To explore the correalation between change of postoperative cognitive function and injury of the draining veins around meningiomas in superficial middle cerebral vein areas ,to discuss the importance and protection method of draining veins around meningiomas in order to guide the microneurosurgery .Methods From July 2013 to July 2017,the clinical data of 54 patients with superficial middle cerebral vein areas meningiomas (tumor group) in the Central Hospital of Guangdong Nongken were retrospectively analyzed .And 52 healthy volunteers were selected as the control group.The preoperative and postoperative cognitive function and meningiomas peritumoral edema(MPE) were assessed by the Montreal Cognitive Assessment ( MoCA) and CT／MRI.Results The scores of visuospatial and executive [(3.23 ±1.27)points],order[(2.52 ±1.27) points],memory[(2.20 ±1.14) points], attention[(4.71 ±0.97)points],language[(2.19 ±0.74)points],abstract [(1.43 ±0.63)points],location[(5.83 ± 0.42) points],total[(22.06 ±0.33) points] in the tumor group were significantly lower than those in the control group[(4.83 ±0.38)points,(3.0 ±0.02)points,(3.5 ±1.04)points,(5.98 ±0.14)points,(2.54 ±0.50) points, (1.88 ±0.38) points,(5.98 ±0.33) points,(27.83 ±0.16) points] ( t ＝4.504,6.116,9.338,2.782,4.509, 2.390,8.670,all P＜0.05).According to the injury of the draining veins around meningioma ,54 patients were divided into the two groups,43 cases in the no -injuried group,11 cases in the injuried group.There were no statistically significant differences between the no -injuried group and injuried group in all measurements before operation (all P＞0.05).Both no-injuried group and injuried group had decline in MoCA and increase in MPE at 5 days after surgery. Both no-injuried group and injuried group had rise in MoCA [(26.35 ±0.36)points vs.(22.00 ±0.67)points] and decrease in MPE[(23.95 ±4.34)cm3 vs (44.64 ±9.68) cm3 ] at 30 days after surgery ( t＝5.944,2.098,all P＜0.05).The MoCA[(22.59 ±0.31)points vs (26.35 ±0.36)points] was obviously increased and the MPE [(87.84 ± 12.78)cm3 vs.(23.95 ±4.34)cm3] was obviously increased in 30 days after operation in no-injuried group(t＝7.289, 5.014,all P＜0.05),but the injuried group had just the opposite.Conclusion Injury of the draining veins around meningiomas in superficial middle cerebral vein areas can lead to cognitive dysfunction and compromise the quality of postoperative life in patients,every effort should be undertaken to preserve the draining veins around meningioma .

A 37-year-old male with extensive cerebral venous thrombosis: Clinicopathological correlation of a rare case

We present the autopsy findings and differential diagnosis of a 37-year-old immunocompetent male patient who presented primarily with extensive cerebral vein thrombosis and was found to have a rare association with JAK2V617F mutation positivity.

A case of cerebral amyloid angiopathy associated with cerebral venous thrombosis.

Cerebral amyloid angiopathy is a clinical picture which is commonly seen in elderly and progressing with the deposition of amyloid in the cerebral arteries without systemic amyloidosis. We report the first case in the literature, a 71 year-old patient having an association of cerebral vein thrombosis and cerebral amyloid angiopathy presenting with recurrent cerebral hemorrhages. The cause-and-result relationship of this association of cerebral vein thrombosis and cerebral amyloid angiopathy should be investigated.

Application of 320-detector row CT one-stop scanning in valuation of internal cerebral veins and their tributaries / 实用放射学杂志

Objective To observe clinical significance、anatomy and variation of normal internal cerebral veins and their tributa-ries.Methods The studies included 284 sides in 142 patients.The patients were performed with 320-detector Row CT One-stop Scanning.Then,the anatomical features of internal cerebral veins and their tributaries were evaluated.Results The detection rate of internal cerebral veins(ICA)、thalamostriate veins(TSV)、septal veins(SV)、anterior caudate nucleus veins、posterior caudate nucleus veins and lateral direct veins was 100%、100%、98.9%、95.4%、93.7%、48.6%.Type of IA was seen frequently in four types of ICA,the parts of ICV and their tributaries were mirror symmetry,the majorities of ICA were located the same plane.Anterior cau-date nucleus veins were classified four types on basis of these different draining patterns,they were drained to TSV commonly.There was no significant difference between venous angle or false venous angle and type of their draining(P>0.05).There was significant difference between detection rate of lateral direct veins and development of posterior caudate nucleus veins(P<0.05).Conclusion 320-detector Row CT One-stop Scanning was an important method that internal cerebral veins were detected effectively and non-inva-sively,observed anatomy,course and morphological change of ICV.

Evaluation of the cerebral venous variations in infants with susceptibility weighted imaging MR imaging / 实用放射学杂志

Objective To describe the anatomical variants of infants’internal cerebral veins and their tributaries with MR suscep-tibility weighted imaging,and to evaluate the capability in the visualization of cerebral deep veins.Methods 80 healthy infants were enrolled in this study.All the brain images were obtained by a 3D gradient-echo sequence (Enhanced T2 ? weighted angiography-ES-WAN)on a 3.0T MR,which were reconstructed with minimal intensity projection.The septal vein,thalamostriate vein,internal cerebral vein and anterior caudate nucleus veins were evaluated.4 types (ⅠA,ⅠB,ⅡA,ⅡB)were classified based on their rela-tionship with the septal vein-internal cerebral vein junction and interventricular foramen,and 3 types (Ⅰ,Ⅱ,Ⅲ)based on the drainage patterns of the anterior caudate nucleus veins.Results The septal vein,thalamostriate vein and internal cerebral vein could be clearly and continuously visualized in 100% infants,and the visualization rate of the anterior caudate nucleus veins was 88.1%. TypeⅠA and TypeⅠ were most common in the two classification patterns.Conclusion Infants’internal cerebral veins and their tributaries are able to be clearly shown with the minimal intensity projection in susceptibility weighted imaging,which is a good method to evaluate the cerebral deep veins in infants.

Contrast Enhanced Cerebral MR Venography: Comparison between Arterial and Venous Triggering Methods

PURPOSE: To compare the arterial and venous detection sites of triggering methods in contrast-enhanced-MR-venography (CE-MRV) for the evaluation of intracranial venous system. MATERIALS AND METHODS: 41 healthy patients underwent CE-MRV with autotriggering at either the cavernous segment of internal carotid artery with an inserted time-delay of 6 seconds (n = 20) or the superior sagittal sinus without any time-delay (n = 21). 0.1 mmol/kg gadolinium-based contrast material (Magnevist(R), Schering, Germany) was intravenously injected by hand injection. A sagittal fast-spoiled-gradient-echo-sequence ranging from one ear to the other was performed (TR/TE5.2/1.5, Matrix 310x310, 124 sections in the 15-cm-thick volume). 17 predefined venous structures were evaluated on all venograms by two neuroradiologists and defined as completely visible, partially visible, or none visible. RESULTS: The rate of completely visible structures were 272 out of 323 (84%) in the arterial triggering CE-MRV and 310 out of 340 (91%) in the venous triggering CE-MRV. The venous triggering CE-MRV demonstrated an overall superior visualization of the cerebral veins than the arterial triggering CE-MRV (Fisher exact test, p < 0.006). CONCLUSION: CE-MRV using venous autotriggering method provides higher-quality images of the intracranial venous structures compared to that of arterial.

A Case of Deep Cerebral Venous Thrombosis Associated with Iron Deficiency Anemia

Iron deficiency anemia has been rarely reported as a cause of cerebral venous thrombosis but its pathogenic relationship with cerebral venous thrombosis is still unknown. A previously healthy 25-year old woman presented with headache, nausea, vomiting, and slight confusion. A magnetic resonance imaging and venogram revealed an infarction involving the right frontal subcortical white matter and left thalamus, with thrombosis in the internal cerebral vein, the vein of Galen. Etiological investigations for cerebral venous thrombosis disclosed no precipitating factors other than iron deficiency anemia. The patient's symptoms rapidly improved with anticoagulation and no neurologic deficits remained. We report a rare case of deep cerebral vein thrombosis associated with iron deficiency anemia without reactive thrombocytosis.

THE ANATOMY AND CLINICAL SIGNIFICANCE OF THE TERMINAL SEGMENT OF THE SUPERFICIAL MIDDLE CEREBRAL VEIN——WITH TWO VARIANT DURAL VENOUS SINUSES / 解剖学报

The superficial middle cerebral veins (SMCV) of 50 human heads were dissectedunder the operating microscope (10?).There were 122 terminal braches of the SMCV in the specimens and the typesof their drainage can be divided into four:type 1 (41.00%)—drains into the caver-nous sinus;type 2 (24.60%)—drains into the variant venous sinus in the lateralwall of the cavernous sinus;type 3(28.70%)—drains into the variant venous sinus inthe dura of the middle cranial fossa;type 4(5.70%)—drains into other dural venoussinuses.Type 1 may be considered as normal and the others as variant.The two variant dural venous sinuses reported are respectively located in thelateral wall of the cavernous sinus,named“the lateral wall sinus of the cavernoussinus”,and in the dura of the middle cranial fossa,named the“variant sinus ofthe middle cranial fossa”.The former occurred 27% in the specimens and the later25%.We have discussed about the drainage of the SMCV and two variant dural ven-ous sinuses on the embryonic basis and the clinical practice.