Study on relationship between venous system and white matter hyperintensitiy in cerebral small vessel disease / 中国综合临床

White matter hyperintensity (WMH) is one of the major imaging markers of cerebral small vascular disease, which is prevalent in the elderly. At present, the pathogenesis of WMH is not clear, most of the previous studies focused on the arterial system, but the role of the venous system in WMH is attracting more and more attention. Small venous collagen hyperplasia, downstream intracranial venous dilatation and internal jugular venous reflux may be involved in the formation and development of white matter hyperintensity.

Deep medullary veins and cerebral small vessel disease / 国际脑血管病杂志

Cerebral small vessel disease (CSVD) refers to a series of pathological, imaging and clinical syndrome caused by various etiologies affecting cerebral arterioles, venules and capillaries. The main imaging features of CSVD include white matter hyperintensities, cerebral microbleeds, lacunar cerebral infarction, enlarged perivascular space, and brain atrophy. Deep medullary veins (DMVs) are small parenchymal veins around the lateral ventricle, which participate in the venous return from deep white matter veins to subependymal veins. In recent years, more and more studies have shown that DMVs are closely associated with the occurrence and development of CSVD. This article reviews the role of DMVs in CSVD, and provides ideas for further exploring the pathogenesis and imaging markers of CSVD.

Clinical significance of asymmetrically prominent veins sign on susceptibility-weighted imaging in patients with acute ischemic stroke / 国际脑血管病杂志

Asymmetrically prominent veins sign (APVS) displayed by susceptibility-weighted imaging (SWI) can noninvasively reflect the dynamic changes of brain tissue in patients with acute ischemic stroke (AIS). It provides blood flow and metabolic information from the perspective of pathophysiology, which is helpful to evaluate the clinical condition and outcome of patients with AIS. This article reviews the clinical significance of the presence of APVS on SWI in patients with AIS.

Trombosis venosa cerebral y COVID-19: ¿Asesino silencioso durante la pandemia? / Cerebral venous thrombosis and COVID-19: A silent killer during the pandemic?

RESUMEN Trombosis venosa cerebral (TVC) es una rara condición clínica caracterizada por una obstrucción de los senos venosos durales o de las venas corticales cerebrales que desencadena hipertensión intracraneal y síntomas tales como cefalea, crisis epilépticas y coma, entre otros. Se ha asociado como complicación neurológica del síndrome respiratorio agudo severo (SARS-CoV-2) del Coronavirus 2. Objetivo: Describir los casos reportados de TVC en pacientes con Enfermedad por Coronavirus 2019 (COVID-19). Material y Métodos: Se realizó una búsqueda bibliográfica en PubMed para recabar sólo los reportes de caso en los que los pacientes con COVID-19 desarrollaron TVC. Resultados: Se analizaron reportes de 13 pacientes y se recabó información sobre sexo, edad, comorbilidades, severidad del COVID-19, tipo de TVC, tratamiento recibido, complicaciones y desenlace final. Conclusión: TVC asociada a COVID-19 se puede presentar en pacientes con características variadas, suele tener complicaciones graves y en algunos casos, un desenlace mortal.

SUMMARY Cerebral venous thrombosis (CVT) is a rare clinical condition that consists of an obstruction of the dural venous sinuses or the cerebral cortical veins, triggering intracranial hypertension and symptoms such as headache, seizures and coma among others. CVT has recently been associated as a neurological complication of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Objective: To describe reported cases of CVT in patients with Coronavirus Disease 2019 (COVID - 19). Material and Methods: A literature search was conducted on PubMed to collect only case reports of patients with COVID-19 who developed CVT. Results: Report of 13 patients were analyzed and information was collected about sex, age, comorbidities, severity of COVID-19, type of CVT, treatments received, complications and the final outcome. Conclusion: CVT associated with COVID-19 can occur in patients with varied characteristics, often with serious complications and in some cases, a fatal outcome.

Role of cerebral veins in ischemic stroke / 国际脑血管病杂志

The pathophysiology of ischemic stroke involves the vascular neural network. Cerebral vein is an indispensable part of vascular neural network, which can provide effective drainage pathway and maintain sufficient cerebral perfusion. More and more evidence have shown that the normal function of cerebral venous drainage system may be as important as arterial perfusion for the outcome of patients with ischemic stroke. However, compared with the cerebral artery system, the cerebral venous system has not attracted enough attention. This article reviews the anatomy of cerebral venous system, the imaging changes after ischemic stroke, and the possible mechanisms of cerebral venous system involved in ischemic stroke and its related complications.

Anatomic morphology analysis of the torcular herophili of the intracranial venous system and its clinical significance to related venous system diseases / 中国脑血管病杂志

Objective: To investigate anatomic and morphological distribution characteristics of the torcular herophili of the intracranial venous system and to provide reference for the treatment and evaluation of common diseases related to the venous system. Method: From January 2016 to July 2018, 2 668 inpatients with cerebrovascular disease related symptoms admitted in Department of Neurology and the other departments, the First Medical Center of the PLA General Hospital were retrospectively recruited. These patients included 1 572 men and 1 096 women. The ages ranged from 11 to 82 years, with an average of (54 ± 14) years old. According to the anatomic morphology and drainage channel of the straight sinus,bilateral or unilateral transverse sinuses,superior sagittal sinus and other blood vessels in the sinus confluence area (occipital protuberance),the anatomic morphology of the torcular herophili from DSA results can be divided into type I (complete torcular herophili type),type II (incomplete torcular herophili type, including II1A,II1B,II2,II3,II4 and II 5 five subtypes), type III (no torcular herophili). Type I refers to venous confluence of the superior sagittal sinus, straight sinus and bilateral transverse sinuses in the occipital protuberance;Type II refers venous confluence of any three of the superior sagittal sinus, straight sinus and bilateral transverse sinuses in the occipital protuberance, and it must contain the superior sagittal sinus and the straight sinus not directly connected with bilateral transverse sinuses; Type III refers to confluence of the straight sinus alone into the one side of the transverse sinus-sigmoid sinus,but without drainage from the contralateral veins and no communication between bilateral transverse sinuses. Results: (1) Among the 2 668 patients admitted to the hospital due to cerebrovascular disease related symptoms and completed DSA examination, the proportion of different anatomic types torcular herophili from high to low was type II 56. 4% (1 504 cases), type I 39. 0% (1 040 cases) and type ID 3.7% (100 cases). (2) Among five subtypes of type II, the proportion of II 1A was 20.4% (544/2 668), II 1B 5. 7% (152/2 668), II2 19. 8% (528/2 668), II3 2. 8% (76/2 668), II4 4. 3% (116/2 668) and II5 3. 3% (88/2 668). (3) The proportion of right dominant drainage was the highest,accounting for 50. 5% (1 348/2 668),followed by bilateral balanced drainage,accounting for 36. 4% (972/2 668). The left dominant drainage was the lowest, accounting for 12. 1% (324/2 668). Conclusions: There are great morphological variations in the sinus confluence of the intracranial venous system. Understanding of the anatomical features of the sinuses and assessment of the drainage characteristics of the venous sinuses could provide references for diagnosis and treatment of venous system diseases.

Cerebral developmental venous anomalies / 国际脑血管病杂志

Cerebral developmental venous anomaly (DVA) is a kind of benign vascular malformation that mainly occurs supratentorially.Its diagnosis mainly depends on imaging examination.It is often misdiagnosed or missed because of low incidence and atypical clinical manifestations.This article reviews the etiology,pathogenesis,clinical manifestations,imaging features,and prognosis of DVA.

Clinical manifestations and imaging features of isolated cortical vein thrombosis:a case series study of 7 cases / 国际脑血管病杂志

Objective To investigate the clinical manifestations and imaging features of isolated cortical vein thrombosis (ICoVT).Methods The data of patients with ICoVT admitted and treated in Shengjing Hospital of China Medical University from 2005 to 2015 were collected.Their clinical manifestations and imaging features were analyzed.Results A total of 104 patients with cerebral venous sinus thrombosis were enrolled.Seven (6.7％) of them with ICoVT were enrolled in the analysis.There were 6 women (85.7％).Their average age was 35 years (range 25-46 years).Headache (n =6;85.7％),seizures (n=5;71.4％),and limb paralysis and numbness (n =4;57.1％) were the most common clinical manifestations.All patients underwent head CT,MRI,and magnetic resonance venography (MRV).Focal cerebral tissue edema (n =5;71.4％) and hemorrhagic infarction (n =3;42.9％) were the most common imaging features.Susceptibility weighted imaging of 3 cases revealed cord-like hypointensity,indicating the formation of venous thrombosis.The clinical symptoms of all patients were relieved after anticoagulant therapy.They were followed up for 1.5 years and no recurrence was observed.Conclusion Headache and seizures are the most common clinical symptoms of IcoVT.Imaging is mostly manifested as focal cerebral edema or hemorrhagic infarction.

A comparative study of intracerebral veins and tributaries by SWI with different slice thicknesses / 中国医师杂志

Objectives To investigate the imaging ability of magnetic sensitive weighted imaging (SWI) scans with 2.0 mm and 1.0 mm slice thickness on intracerebral veins and branches.Methods 47 healthy volunteers were recruited,including 20 males and 27 females,aged 21-45 (30.1 ± 12.93).Two SWI sequences with thickness of 2.0 mm and 1.0 mm were performed in all healthy volunteers.After reconstructed by minimal intensity projection (MIP),the display rate and diameter of intracerebral veins and branches were counted by two doctors.McNemar test and paired t-test were used for statistical analysis.Results (1) The display rates of bilateral internal cerebral veins,papular veins and left ventricular veins were 100％ in both scanning schemes,while the display rates of left and right septal veins,anterior caudate nucleus veins and right ventricular veins on SWI sequence images with 2.0 mm thickness were 90.0％ (left),91.0％ (right) and 87.2％ (right),91.5％,respectively.The display rates on SWI sequence images with 1.0 mm thickness were 97.9％ (left),94.0％ (right),97.9％ (left),95.7％ (right) and 95.7％ respectively.(2) There were significant differences in the diameter of bilateral septum pellucidum veins and bilateral anterior caudate nucleus veins between the two scanning schemes (P ＜ 0.05).While there was no significant difference in the diameter of bilateral internal cerebral veins,bilateral papular veins and bilateral intraventricular veins (P ＞0.05).(3) The displaying rate of veins with diameter ＞0.9 mm was 100％ for both scanning schemes,while the displaying rate of veins with diameter ranging from 0.6-0.9 mm (including 0.6 mm and 0.9 mm) in the two scanning schemes had significant difference (P ＜ 0.05).Conclusions SWI sequence can clearly show the anatomical shape of intracerebral veins and branches.In contrast to SWI of the scan slices thickness of 2.0 mm,the SWI of scan slices thickness of 1.0 mm showed more efficiency in display thinner brain venous.Therefore,using SWI sequence scanning scheme with 1.0 mm slice thickness will be more conducive to observe and study intracerebral veins and branches.

Vein of Galen Aneurysmal Malformation with Transvenous Endovascular Treatment in an Adult: Case Report

Vein of Galen aneurysmal malformation (VGAM) is the result of the direct communication between the arterial network and the median prosencephalic vein. It is a rare vascular congenital malformation representing less than 1% of intracranial abnormalities. This finding is very rare in adults, and it may or may not present symptoms during childhood. Most cases of VGAM can be detected in the fetus by ultrasonography. The referral of pregnant women with fetuses with this condition to centers where better facilities and resources for childbirth and immediate postpartum care are available has resulted in considerable improvement in the prognosis of newborns. Regarding treatment, the endovascular approach to VGAM includes arterial embolization and percutaneous transvenous techniques. The transvenous endovascular treatment was chosen in the case presented in this article.

A malformação aneurismática da veia de Galeno (MAVG) é resultado da comunicação direta entre a rede arterial e a veia prosencefálica mediana. Trata-se de uma malformação vascular congênita rara, que representa menos de 1% das anormalidades intracranianas. Sua ocorrência é muito rara em adultos, e a malformação pode ou não apresentar sintomas durante a infância. A maioria dos casos pode ser detectada em fetos por ultrassonografia. O encaminhamento de grávidas com fetos com esta malformação para centros mais bem estruturados, com recursos para cuidados no parto e pós-parto, tem resultado em considerável melhora do prognóstico de recémnascidos. Quanto ao tratamento, o acesso endovascular à MAVG inclui a técnica de embolização arterial e o tratamento transvenoso percutâneo. O tratamento transvenoso endovascular foi escolhido no caso apresentado neste artigo.

Risk factors and early diagnosis strategies for traumatic intracranial venous sinus occlusion / 中国医师进修杂志

Objective To analyze the risk factors for traumatic cerebral venous sinus occlusion (CVSO)and to investigate the strategies of early diagnosis of traumatic CVSO. Methods The clinical data of 212 patients with moderate to severe closed traumatic brain injury from January 2012 to December 2015 were analyzed retrospectively. Logistic regression analysis was used to evaluate the risk factors for traumatic CVSO. Results Of the 212 patients with traumatic brain injury, 16.5%(35/212) patients had CVSO. Ten patients had CVSO of thrombotic type (typeⅠ), 16 patients had CVSO of compression type (typeⅡ), and 9 patients had CVSO of mixed type (typeⅢ). Logistic regression analysis showed that skull fracture (OR = 8.141; 95%CI: 3.224-20.840) and epidural hematoma of crossing venous sinus (OR = 3.179; 95%CI: 1.470-7.037) were the risk factors for CVSO, and the former was more significantly correlated with CVSO. Female gender was the risk factor for CVSO typeⅠ(OR =10.425; 95%CI: 1.831-30.053), epidural hematoma of crossing venous sinus was the risk factor for CVSO typeⅡ(OR = 5.766; 95%CI: 1.885-18.197), and skull fracture, epidural hematoma of crossing venous sinus, and the previous history of vein thrombosis was the risk factors for CVSO type Ⅲ(OR =18.005, 4.596, 11.394; 95%CI: 2.021-58.836, 1.144-19.525, 1.436-46.558). Conclusions In the early diagnosis of traumatic CVSO, the crossing venous sinus fracture line and epidural hematoma should be given attention. Attention should be paid to the history of venous thrombosis. MR venography and CT venography contributes to early diagnosis of CVSO.

Preliminary study of cerebral venous oxygen saturation in healthy people using MR quantitative susceptibility mapping / 中华放射学杂志

of left and right side cerebral cortical veins was 159.16(154.88-164.13)ppb(× 10-9), 164.61(156.23-168.04) ppb, respectively. The median susceptibility (extent) of left and right side thalamostriate veins was 160.51 (152.14-170.06) ppb, 162.48(153.47-173.66)ppb, respectively. Left were less than the right, and the difference was statistically significant (Z=-3.14,-2.02, P<0.05). And the difference of two side of other cerebral venous susceptibility had no statistical significance. The median susceptibility (extent) of right cerebral cortical veins, left thalamostriate veins and right septal veins of 22 male was 166.22(159.21-169.99) ppb, 168.65(159.19-174.45)ppb and 153.42(148.10-161.78)ppb, respectively. The coresponding positions of median susceptibility (extent) of 38 female was 161.10(155.06-167.15)ppb, 157.70(151.53-164.41)ppb and 147.52(142.94- 154.16)ppb, respectively. The susceptibility of right cerebral cortical vein, left thalamostriate vein, right septal vein of male was significantly different from the females (Z=-2.03,-2.20,-2.33, P<0.05). Futhermore, we also found that there had positive correlation between age and right thalamostriate vein(r=0.28,P<0.05). Conclusion The magnetic sensitive of the right thalamostriate vein tends to increase along with the age, and some of peoples had difference with bilateral and age.

Embolismo aéreo venoso en neurocirugía / Venous air embolism in neurosurgery

Venous air embolism is a potentially serious neurosurgical complication. Every neurosurgical procedure is at risk of developing the condition but the sitting and semi-sitting position represent a higher risk. The neuroanesthesiologist plays a key role in the management of the venous air embolism, from diagnosis to treatment. This article reviews the literature on air embolism in terms of its incidence, etiology, diagnosis and therapy.

El embolismo aéreo venoso es una complicacion de neurocirugia que puede llegar a ser potencialmente seria. Todos los procedimientos neuroquirurgicos tienen riesgo de presentarlo, siendo las posiciones sentada y semisentada las que mayor riesgo conllevan. El neuroanestesiologo forma parte primordial en el manejo del embolismo aéreo venoso, desde su diagnostico hasta el tratamiento. Este articulo revisa la literatura relacionada conel embolismo aéreo en cuanto a incidencia, etiologia, diagnostico y terapéutica.

Magnetic Resonance Venography for Diagnosis of Cerebral Venous Sinus Thrombosis:A Meta-analysis / 中国医学影像学杂志

Purpose cerebral venous sinus thrombosis (CVST) has no specific manifestations in clinic, it is often misdiagnosed and the treatment is delayed. This paper aims to evaluate magnetic resonance venography (MRV) in the detection of CVST by meta-analysis. Materials and Methods The articles concerning the diagnosis of CVST by using MRV were searched in the databases such as Cochrane Library, PubMed, Embase, Web of Science, CBM, VIP, Wanfang and CNKI. The QUADAS items were used to evaluate the quality of the included studies. The results were analyzed with software Metadisc1.4 and RevMan 5.0. The pooled weighted sensitivity, specificity, and the diagnostic odds ratio were calculated, and complete summary receiver operating characteristic curve (SROC) was drawn. Results Twelve studies of eight articles met the inclusion criteria. The pooled sensitivity, specificity, diagnostic odds ratio and area under SROC curve for the MRV were 0.86 (0.80-0.91), 0.87 (0.83-0.93), 29.65 (12.48-70.47), and 0.9125, respectively. Conclusion MRV can be used as an effective method with its high value in the diagnosis of CVST.

Deep cerebral venous morphology and oxygenation content in patients with multiple sclerosis using susceptibility weighted imaging / 中华放射学杂志

Objective To evaluate the deep brain venous blood oxygen content changes in patients with multiple sclerosis(MS) using susceptibility weighted imaging (SWI), and to explore the ability of SWI in reflecting the clinical condition. Methods Forty-four MS patients were prospectively enrolled in the study. All the clinical-proved patients meeting the McDonald standards (2005 revised) underwent conventional MRI, SWI, and 12 cases of them underwent MRI review from 12 to 16 months interval. all the patients' clinical condition were quantified according to the expanded disability status scale(EDSS). The score was 0.5—6.5. Sixty-five age- and gender- matched healthy volunteers underwent conventional MRI and SWI. The blood oxygen content of the deep brain venous were estimated by the veins phase value, and differential phase values of blood vessels and surrounding tissues (Δφ) were processed with SPIN software. The blood vessels consist of bilateral BV, SMCV, ICV, STV and FMV, PMV, OMV. The difference of Δφvalue in different veins between MS patients and the controls was compared using independent sample t-test, and the Δφ value comparison of MS patients in different time were performed by using paired t test; The correlation ofΔφvalue between MS and EDSS was analyzed using Spearman correlation. Results TheΔφvalue of BV, SMCV, ICV, STV were 856.6 ± 246.4, 600.6 ± 155.2, 965.9 ± 205.4, 844.2 ± 149.7 in MS, and 767.6±145.1, 536.2±123.5, 892.8±156.3, 783.1±148.5 in controls, respectively. TheΔφvalue was higher in MS patients than the controls (t=2.157, 2.303, 2.005, 2.103,P<0.05). The twelve patients'Δφvalues of BV, ICV,STV were 729.4±275.1, 906.1±219.2, 737.2±159.1 in the first time, and 923.2±211.6, 1017.3±211.1, 919.3 ± 165.9 in the second time, and all the values increased in the review of the interval of 12 to 16 months (t=-3.092,-6.420,-3.972,P<0.05). The phase value of PMV and OMV had significant positive correlation with EDSS scores(r=0.638, 0.642,P<0.01). Conclusions The state of hypoxia of the brain parenchyma appears in MS patients, and hypoxia may become worse with the extension of course. The extent of hypoxia can reflect the disability of the patients.

Relationship between brush sign on susceptibility-weighted imaging and cerebrovascular reactivity in patients with acute ischemic Stroke / 国际脑血管病杂志

Objective To investigate the relationship between the numbers of deep medullary veins (DMV) beside the ipsilateral lateral ventricle and the stenotic degree of large artery of ipsilateral internal carotid artery (ICA) system and cerebrovascular reactivity (CVR) in patients with acute cerebral infarction showed on susceptibility-weighted imaging (SWI) in middle cerebral artery (MCA) territory.Methods The patients with acute cerebral infarction in MCA territory who underwent SWI,cerebral angiography and the transcranlal Doppler carbon dioxide challenge test during the hospital stay were enrolled retrospectively.According to the numbers of DMV beside the lateral ventricle on SWI,they were classified into 3 grades:Grade 1:DMV ＜5; Grade 2:DMV 5-10; Grade 3:DMV ＞ 10.The correlations of the DMV grades and the degree of ipsilateral ICA/MCA and CVR were analyzed.Results A total of 44 patients with acute cerebral infarction in MCA territory were enrolled.Twenty-four patients were DMV 1,15 were DMV2,and 5 were DMV 3.The mean stenosis degree of the main arteries of the ipsilateral ICA system was 40.52％ ±30.62％.The mean CVR of MCA was 0.41 ± 0.16.The stenosis degrees in the DMA grade 1,2,and 3groups were 31.31％ ± 26.02％,44.93％ ± 31.03％,and 71.76％ ± 26.68％,respectively.There were significant differences among the 3 groups (F=4.589,P =0.018),and the stenosis degree in the DMV grade 3 group was significantly higher than that in the DMV grade 1 group (P=0.014).The CVRs in the grade 1,2,and 3 groups were 0.45 ± 0.12,0.41 ± 0.18,and 0.22 ± 0.12,respectively.There were significant differences among the 3 groups (F=6.179,P=0.005),and the CVR in the DMV grade 3 group was significantly lower than that in the DMV grade 1 group (P =0.006) and in the DMV grade 2 group (P =0.038).Spearman correlation analysis showed that DMV grade was significantly positively correlated with the stenosis degree (rs =0.381,P =0.013),and was significantly negatively correlated with CVR (rs =-0.375,P=0.012).Conclusions The DMV grade in patients with cerebral infarction was positively correlated with the stenosis degree of responsible large artery and was negatively correlated with the MCA CVR in the responsible side.

The relationship of superficial cerebral veins with meningiomas by simulation craniotomy techuique / 中华放射学杂志

ObjectiveTo assess the value of simulation craniotomy (SC) technique in evaluation of superficial cerebral veins(SCVs)and its relationship with convexity,parasagittal and falcine meningiomas.MethodsForty-nineconsecutivepatientswithconvexity,parasagittal,andfalcine meningiomas performed SC technique and three-dimensional contrast enhanced MR venography (3D CE MRV) in a prospective study.The number of SCVs ( diameter ＞ 1 mm) within 2 cm around the margin of tumors detected by two techniques were compared with the paired t test.Furthermore,49 cases were divided into groups according to the tumor largest diameter,position,and dural enhancement.The image quality of SC technique in different groups were analyzed by Wilcoxon test in order to find influence factors.Results The number of SCVs within 2 cm around the margin of tumor in SC was 4.4 ± 1.9,which was significantly less than that on 3D CE MRV (5.1 ± 2.7) ( t =3.131,P ＜ 0.05 ).The relationship between meningiomas and the SCVs was demonstrated well on SC in majority of cases with the score of image quality was 2.5 ±0.7.The score of image quality of 12 patients with obvious dural enhancement was 1.5 ± 0.5,which was significantly lower than that of 37 patients without dural enhancement ( 2.8 ± 0.3 )( Z =- 3.093,P ＜ 0.05 ).The score of image quality of 18 patients with tumor larger than 4 cm in diameter ( 2.2 ± 0.9 )was significantly lowed than that of 31 patients with small tumors (2.7 ± 0.5 ) ( Z =- 2.057,P ＜ 0.05 ).The score of image quality of convexity group ( n =10) and parasagittal and falcine group ( n =39 ) was 2.2 ± 0.9 and 2.6 ± 0.6,and there was no significant difference between different location group ( Z =- 0.604,P ＞ 0.05).ConclusionsSimulation craniotomy can exactly display SCVs avoiding the influence of deep cerebral veins and skull veins.This simple technique can provide useful information about the SCVs and their relationships with cortical structures and tumors for preoperative surgical planning.

Diagnóstico diferencial de malformação vascular encefálica em umacriança: relato de caso / Differential diagnosis in encephalic vascular malformation in a child: case report

Aims: To report a case of encephalic venous malformation, which is not commonly described in the literature, despite its importance as one of the main differential diagnosis in intracranial hemorrhage in children.Case Description: A five-year old girl presented chronic headache and had the first episode of seizure. Possible intracranial alterations were investigated as etiological factors, and an alteration in the Labbé vein was identified, possibly associated to a cavernoma in the left temporal region, which caused the hemorrhage.Conclusions: Primary seizures and headaches are relatively common in children. However, secondary seizures such as those caused by hemorrhage, despite being less common, must be suspected and investigated, as they may lead to severe complications.

Objetivos: relatar um caso de malformação venosa encefálica, não comumente descrito na literatura, apesar de sua importância como um dos principais diagnósticos diferenciais em hemorragia intracraniana em crianças.Descrição do Caso: uma menina de cinco anos de idade apresentava cefaleia crônica e teve o primeiro episódio de convulsão. Possíveis alterações intracranianas foram investigadas como fatores etiológicos, e foi identificada uma alteração na veia de Labbé, possivelmente associada a um cavernoma na região temporal esquerda, o que provocou a hemorragia.Conclusões: convulsões primárias e cefaleia são relativamente comuns em crianças. No entanto, convulsões secundárias, tais como aquelas causadas por hemorragia, apesar de serem menos comuns, devem ser suspeitadas e investigadas, pois podem levar a complicações graves.

Detection of bridging veins draining into superior sagittal sinus by using susceptibility weighted imaging and three dimensional contrast enhancement MR venography / 中华放射学杂志

Objective To use the superior sagittal sinus (SSS) as an example to identify anatomical features of the bridging veins(BVs) draining into the SSS in both susceptibility weighted imaging (SWI) and three dimensional contrast enhancement MR venography (3D-CEMRV) images.Methods A total of 20 healthy volunteers (40 sides) were examined in this study.The venograms of each patient was obtained from SWI (40 sides out of 20 volunteers) and 3D-CE MRV (40 sides out of 20 volunteers).The data were analyzed by t test.Results According to their draining location with respect to the SSS,bridging veins were devided into two groups.Between the anterior group and the posterior group were two segments of the SSS into which few bridging veins drained.Observed by 3D-CE MRV and SWI,the average numbers of the anterior group were 1.9 ± 0.6 and 3.2 + 0.8,respectively,and the average diameters of the anterior group were (3.4 ± 1.1 ) and (2.1 +0.5 ) mm,respectively.These differences between 3D-CE MRV and SWI images were significant ( t =11.23,9.76,P ＜0.0l ).Observed by 3D-CE MRV and SWI,the average numbers of the posterior group were 3.5 + 1.2 and 5.9 ± 1.1,respectively,and the average diameters of the posterior group were ( 3.7 ± 0.9 ) and ( 2.9 ± 0.7 ) mm,respectively.The differences between the two technique were significant as well ( t =11.51,8.47,P ＜ 0.01 ).Conclusion The dural entrance of BVs into the SSS can be identified in both SWI and 3D-CE MRV images.The preoperative venogram by using 3D-CE MRV and SWI is useful to design a individual-tailored surgical approach for the preservation of BVs draining into SSS.SWI outweighs 3D-CE MRV in identifying anatomical features of the dural entrance of BVs into the SSS.

Predictive factors of the outcome of cerebral venous sinus thrombosis a retrospective case series study of 26 patients / 国际脑血管病杂志

Objective To investigate the predictive factors of long-term outcome of cerebral venous sinus thrombosis (CVST).Methods The clinical data of 26 patients with CVST were analyzed retrospectively.The clinical outcome was assessed with the modified Rankin Scale (mRS) at 6 months after symptom onset.Univariate and multivariate analysis were used to determine the independent predictors of the long-term poor outcome.Results The mRS scores for 26 patients with CVST:0 to 1 in 19 cases,2 in 2 cases,3 to 5 in 3 cases,and 6 in 2 cases.19.2％ of patients had poor outcome (mRS score,≥3),and the mortality rate was 7.7％.The survivors did not have any recurrence within 6 months.Univariate analysis showed that disturbance of consciousness,papilloedema,cerebral edema,and cerebral deep venous thrombosis were the possible risk factors for poor outcome,while headache was the main clinical manifestation,which was negatively correlated with the poor prognosis.Multivariate regression analysis showed that disturbance of consciousness was an independent predictor of poor outcome in patients with CVST (odds ratio,48.0,95％ confidence interval 2.311 to 997.176,P =0.012).Conclusions The long-term outcome of the patients was better,disturbance of consciousness was an independent predictor of poor outcome at 6 months after the onset.