Hyperthyroidism and cerebral venous sinus thrombosis: One case report and literature review / 中华内分泌代谢杂志

This article reports a case of hyperthyroidism complicated with cerebral venous sinus thrombosis(CVST). A 33-year-old woman patient was admitted to the Department of Endocrinology due to hyperthyroidism. She developed convulsions of the legs, unconsciousness, and " epileptic" seizures in the early morning of the next day and was transferred to the Department of Neurology. The patient′s clinical manifestations and laboratory tests suggested hyperthyroidism, Graves′ disease complicated with CVST formation, internal jugular vein thrombosis, and venous acute cerebral infarction. After standard treatment for hyperthyroidism, anticoagulation, and reduction in intracranial pressure were given, the patient′s condition improved. After 3 months of follow-up, the patient had a good prognosis. Until now, 41 patients with hyperthyroidism complicated with CVST have been described in case reports. For patients with hyperthyroidism presenting with headaches, especially those with severe neurological symptoms such as epilepsy or hemiplegia, clinicians should be vigilant and conduct appropriate imaging evaluations to assess the possibility of CVST. Once the diagnosis of CVST is confirmed, treatment for both hyperthyroidism and CVST should be initiated simultaneously to achieve a favorable prognosis.

Two cases of intractable mycoplasma pneumoniae pneumonia complicated with intracranial venous sinus thrombosis / 中国综合临床

Mycoplasma pneumoniae pneumonia (MPP) complicated with cerebral venous sinus thrombosis (CVST) is rare.We retrospectively analyzed the clinical data of two patients with refractory mycoplasma pneumoniae pneumonia (RMPP) complicated with CVST who were hospitalized in Xi′an children′s Hospital from December 2018 to April 2019, inquired the relevant literature, analyzed the clinical diagnosis and treatment characteristics, and discussed the diagnosis and treatment measures of RMPP complicated with CVST.Two cases were 6-year-old girls with fever and cough as the main symptoms.After physical examination, the respiratory sounds of the affected lung decreased, and the sounds of phlegm and dampness could be heard in both lungs.Mycoplasma pneumoniae (MP) antibody and RNA were positive.Chest CT showed lobar pneumonia with a large number of pleural effusion.The effect of macrolide antibiotics anti infection treatment was not good.Headache symptoms occurred during the course of the disease, and serum D-dimer increased significantly.Brain MRI showed CVST, including 1 case with lower extremity pain, and B-ultrasound showed right lower extremity arterial embolism.After anti infection, thrombectomy, anticoagulation and symptomatic treatment, 2 cases were discharged.When children with MPP, especially those with RMPP, have extracranial thrombosis and/or neurological symptoms, accompanied by elevated serum D-dimer, the possibility of CVST should be considered, and brain MRI examination should be performed in time to confirm and actively treat, which can reduce or avoid the occurrence of sequelae.Thrombosis may be related to excessive inflammatory reaction and vascular endothelial injury caused by MP infection.

The study of intermediate-term survival of the patients with cerebral venous sinus thrombosis

@#Objective: This study aimed to investigate the intermediate survival of patients with cerebral venous sinus thrombosis (CVST). Methods: This is a retrospective study recruiting patients with a definite diagnosis of CVST who were referred to teaching hospitals of “Shiraz University of Medical Sciences” from 2007 to 2017. Follow-up phone calls were conducted in March 2019 till June 2019. All-cause mortality, mortality due to CVST, and CVST recurrence were investigated. Results: Of the total of 301 patients, 213 (70.8%) were female. Patients’ age ranged from 1 to 95 year with a mean of 39.9 year. Intermediate follow-up (mean 46.9, 95%CI: 43.6-50.2 months) was done. Intermediate term mortality was 12.3%, mostly from CVST, and largely occurred within the first month. Age was a significant risk factor for survival (HR=1.056, 95%CI:1.037-1.075). The difference was not statistically significant in males in comparison to females (HR=1.3, 95%CI:0.67-2.60, P=0.41). Patients with recurrent CVST hada higher risk of mortality (HR=9.14, 95%CI:4.70-17.89, P<0.001). There was statistically higher risk of mortality in patients with deep vein thrombosis (DVT) (HR=8.97, 95%CI: 4.32-18.61, P<0.001). Although the risk of death for patients using oral contraceptives (OCPs) was 16% higher, this was not statistically significant (HR=1.16, 95%CI: 0.52-2.55, P= 0.21). Conclusions: Intermediate-term mortality was 12.3%, and associated with older age, recurrent CVST and DVT. The reasons for these findings need further investigation.

Rapid change of estrogen levels induce reversible cerebral vasoconstriction syndrome and cerebral venous sinus thrombosis: A report of two cases

@#Reversible cerebral vasoconstriction syndrome (RCVS) presents with characteristic clinical, brain imaging, and angiographic findings. The most common clinical feature of RCVS is a severe acute headache, which is often referred to as a thunderclap headache owing to the nature of its presentation. It may occur spontaneously or may be provoked by various precipitating factors. We present two cases of RCVS concomitant with cerebral venous sinus thrombosis (CVST). Patient 1 was a 42-yearold woman admitted to our hospital with severe headache radiating to the neck, with associated vomitting. She had a history of ovarian cancer and underwent an operation for resection of the tumor a month prior to presentation. After resection, her estradiol (E2) levels were reduced from 288 pg/ ml to 31 pg/ml (normal range, 0-49 pg/ml). Initial imaging upon admission to our hospital revealed left posterior convexity subarachnoid hemorrhage. Magnetic resonance angiography (MRA) showed findings consistent with RCVS affecting the left posterior cerebral artery. Magnetic resonance venography (MRV) showed CVST of the left transverse and sigmoid sinuses. Single photon emission computed tomography (SPECT) showed a left posterior ischemic lesion. These findings improved following treatment with nimodipine and anticoagulant. Patient 2 was a 39-year-old woman presented with holocranial headache associated with vomiting. She was diagnosed with an ovarian tumor. She underwent an operation three months prior to presentation. After tumor resection, her E2 level decrease from 193 pg/ml to 19 pg/ml (normal range, 0-49 pg/ml). MRA confirmed the presence of a vasospasm involving the right anterior cerebral artery. MRV confirmed the presence of thrombosis involving the superior sagittal sinus. She was discharged on postpartum day 31 without neurological deficits after treatment with anticoagulants. At 3 month follow-up, both MRA and MRV were within the normal limits. In conclusion, this is the first report of two women diagnosed with RCVS with concomitant CVST following ovarian tumor resection. The rapid change of perioperative E2 levels may have contributed to the development of CVST and RCVS.

Deficiencia de cobalamina C de inicio temprano: presentación de caso clínico / Early onset cobalamin C deficiency: clinical case presentation

Cobalamin C (CblC) deficiency is an autosomal recessive disorder caused by mutations of the MMACHC gene that results in impaired synthesis of the methylcobalamin and adenosylcobalamin co-factors. This brings an impaired conversion of dietary cobalamin and therefore dysfunction of two key enzymes generating hyperhomocysteinemia, hypometionimemia and methylmalonic aciduria. It is the most common intracellular metabolism disorder of cobalamin. The early clinical form is the most frequent disorder and appears as a multisystemic disease with developmental delay, failure to thrive, and ocular, renal and hematological involvement during the first year of life. The thromboembolic events are associated with small vessel involvement, generating thrombotic microangiopathy responsible for renal involvement and pulmonary thromboembolism. The late-onset form is characterized by leukoencephalopathy, psychiatric disorders, subacute degeneration of the spinal cord, and thromboembolic events of medium to large vessels. The treatment currently available increases the survival of the patient and improves growth, neurological manifestations, biochemical, hematological profile and hydrocephalus. We present the neonatal debut of a case of CblC deficiency that appeared as a multisystem disease with initial neurological, ocular and hematological manifestations. The onset of symptoms was acute, a characteristic that is not frequent in CblC. The patient started treatment early, but in an unsatisfactory fashion, which led to increased neurological deterioration. Due to MRI images performed during the evolution of his condition, a superior and transverse sagittal sinus thrombosis, a rare manifestation of the disease, was observed.

La deficiencia de cobalamina C (CblC) es un defecto autosómico recesivo causado por la mutación del gen MMACHC, que resulta en la síntesis alterada de los cofactores metilcobalamina y adenosilcobalamina. Esto trae aparejado una disfunción de dos enzimas claves, lo cual genera hiperhomocisteinemia, hipometionimemia y aciduria metilmalónica. La presentación clínica de la deficiencia de CblC es heterogénea, y varía desde las formas de inicio temprano graves y potencialmente mortales, hasta los fenotipos más leves de inicio tardío. La forma clínica temprana es la más frecuente y se manifiesta como una enfermedad multisistémica, con restricción del desarrollo, restricción del crecimiento y alteraciones oculares, renales y hematológicas durante el primer año de vida. Las manifestaciones tromboembólicas están asociadas con el compromiso de pequeños vasos, lo que causa microangiopatía trombótica, responsable de compromiso renal y de tromboembolismo pulmonar. La forma tardía se caracteriza por leucoencefalopatía, trastornos psiquiátricos, degeneración subaguda de la médula espinal y eventos tromboembólicos de medianos o grandes vasos. El tratamiento disponible actualmente aumenta la supervivencia de la enfermedad y mejora el crecimiento, las manifestaciones neurológicas, el perfil bioquímico y hematológico y la hidrocefalia. Presentamos el debut neonatal de un caso de deficiencia de CblC que se manifestó con compromiso inicial neurológico, ocular y hematológico. El comienzo de los síntomas fue agudo, característica que no es frecuente en la deficiencia de CblC. El tratamiento se inició tempranamente, pero en forma insatisfactoria, con evolución de deterioro neurológico. En la evolución de su enfermedad en las imágenes de resonancia magnética, se puso de manifiesto trombosis de los senos sagital superior y transversos, una rara manifestación de la deficiencia de CblC.

Spectrum of neurological disorders during pregnancy and postpartum period from a tertiary hospital

Background: Pregnancy and puerperium are states of hypercoagulability. This predisposes women in these phases to increased risk of cerebrovascular diseases. These neurological complications are important causes of maternal and foetal morbidity and mortality. These must be recognized and managed to decrease their burden on maternal and child health.Methods: The aim of this study was to consider the occurrence of neurological complications in pregnancy and puerperium and to analyse the clinical and radiological spectrum of them. This was a prospective study carried out with 1200 patients from January 2014 to August 2015.Results: Of the 1200 women, 87(7.25%) were diagnosed to have neurological complications. Overall mortality was 11.4%. Eclampsia (63.2%), Cerebral Venous sinus Thrombosis (CVT) (18.3%) and Posterior Reversible Encephalopathy Syndrome (PRES) in (8%) accounted for the majority of cases (Table 1). Eclampsia carried a significant mortality rate of 12.7% whereas CVT and PRES had favourable outcomes. Imaging of CVT revealed involvement of deep venous system in 12% and haemorrhagic infarcts in 69%.Conclusions: The commonest neurological complications seen in this cohort were eclampsia, cerebral venous thrombosis and posterior reversible encephalopathy syndrome. Hence a physician needs to bear in mind the common neurological complications that can occur during pregnancy and puerperium to avert poor pregnancy outcomes for both mother and child.

Follow Up Study (Short Term and Long Term Outcome) in Patients with Cerebral Venous Sinus Thrombosis after Treatment and Discharge from Hospital

Introuction: Study aimed to follow up the cases of cerebralvenous thrombosis over short term and long term aftertreatment and discharge from hospital.Material and methods: This prospective observational studywas carried out in the department of Neurology, at Bombayhospital Indore. 75 patients included in this study, who wereadmitted between July 2010 to June 2013. Patients of all agegroups and both sexes were included in this study. Patientswere followed up to 12 months after treatment and dischargefrom the hospital.Result: Total 75 patients were taken. M: F ratio was 1:1.4 andmean age was 36 yrs. The short term outcome and response tothe treatment were good and comparable.Conclusion: Overall prognosis of cerebral venous thrombosisis good in terms of recovery, low rate of neurological sequelae,low risk of recurrence and long term follow up. Chronicanticoagulant treatment is necessary to prevent recurrence ofthrombosis.

Trombosis del seno venoso cerebral durante el puerperio / Cerebral venous sinus thrombosis during puerperium

Resumen: ANTECEDENTES La trombosis del seno venoso cerebral es un trastorno cerebrovascular caracterizado por obstrucción parcial o total de uno o más senos venosos o venas cerebrales. OBJETIVO Conocer la incidencia y las causas de la trombosis del seno venoso cerebral en el puerperio. MATERIAL Y MÉTODO Estudio retrospectivo, observacional y descriptivo en el que se revisaron expedientes de pacientes obstétricas ingresadas en el servicio de Medicina Interna del Hospital Dr. Aurelio Valdivieso en un periodo de cinco años (2009-2014) que manifestaron clínica y radiológicamente el diagnóstico de trombosis del seno venoso cerebral. RESULTADOS Se encontraron seis pacientes con promedio de edad de 23 años con el diagnóstico de trombosis del seno venoso cerebral, las seis cursaban en periodo de puerperio. Las causas ocasionales fueron: tres por síndrome de anticuerpos antifosfolipídicos primario; una tenía trombofilia primaria por deficiencia de proteína C, un caso se debió a administración de hormonal oral y un caso fue idiopático. En relación con el tratamiento, todas recibieron anticoagulación con buena respuesta. CONCLUSIÓN Encontramos que la trombosis del seno venoso cerebral se observa en nuestro medio por lo menos una vez al año, la causa más frecuente es autoinmunitaria del tipo síndrome de anticuerpos antifosfolipídicos.

Abstract: BACKGROUND Cerebral venous sinus thrombosis is a cerebrovascular disorder characterized by partial or complete blockage of one or more venous sinuses or cerebral veins. MATERIAL AND METHOD A retrospective, observational and descriptive study was done in which records of obstetric patients admitted to the Internal Medicine service of Hospital Dr. Aurelio Valdivieso, Oaxaca, Mexico, were reviewed in a period of five years (2009-2014), who had a clinical and radiological diagnosis of cerebral venous sinus thrombosis. RESULTS Six patients were found, with an average age of 23 years with the diagnosis of cerebral venous sinus thrombosis, six were enrolled in the postpartum period. Occasional causes were: three primary antiphospholipid antibodies syndrome, one had protein C deficiency, one case was receiving oral hormonal and one case of idiopathic etiology. In relation to treatment, all received anticoagulation with good response. CONCLUSION Cerebral venous sinus thrombosis presented in our midst at least once a year, the most common cause is autoimmune antiphospholipid antibodies syndrome/cerebral venous sinus thrombosis type.

Papilledema revisiting after sinus angioplasty of chronic cerebral venous sinus thrombosis

This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting). After the resolution of CVST, patients developed the recurrence of symptoms which on digital subtraction angiography revealed dural arteriovenous malformation (DAVM). DAVM and papilledema resolved with endovascular embolization. This case series highlights a need of constant monitoring of CVST cases after the endovascular intervention.

Postpartum Superior Sagittal Sinus Thrombosis: A Case Report / 대한신경손상학회지

Cerebral venous sinus thrombosis (CVST) is a rare disease. Early diagnosis and treatment are important, as CVST is potentially fatal. Pregnancy and puerperium are known risk factors for CVST. Here, we report the case of a patient who developed superior sagittal sinus thrombosis after a normal vaginal delivery. A 20-year-old woman presented with a headache and seizures two days after a normal vaginal delivery. Initially, brain computed tomography (CT) showed a subarachnoid hemorrhage in the right parietal lobe and sylvian fissure, together with mild cerebral edema. CT angiography revealed superior sagittal sinus thrombosis. Multiple micro-infarctions were seen on diffusion-weighted magnetic resonance images. An intravenous infusion of heparin and mannitol was administered immediately. Two days after treatment initiation, the patient showed sudden neurological deterioration, with left-sided hemiplegia. Brain CT showed moderate brain edema and hemorrhagic densities. Emergency decompressive craniectomy was performed, and heparin was re-administered on post-operative day (POD) 1. On POD 9, the patient's mental state improved from stupor to drowsy, but the left-sided hemiplegia persisted. CT angiography showed that the superior sinus thrombosis had decreased. Superior sagittal sinus thrombosis is an uncommon complication, with an unfavorable outcome, after delivery. Timely diagnosis and treatment are important for preventing neurological deterioration.

Diagnosis and treatment of five neonatal cerebral venous sinus thrombosis / 中华儿科杂志

Objective@#To summarize the clinical presentations and imaging features of cerebral venous sinus thrombosis (CVST) in 5 newborns.@*Methods@#The clinical data of 5 newborns with CVST admitted to Department of Neonatology of Maternal and Children Hospital of Hubei Province from February 2017 to April 2018 were analyzed retrospectively. The risk factors, clinical presentations, imaging manifestations and treatment of CVST were investigated.@*Results@#Of the 5 full term neonates, 4 were males and 1 female, with 4 aged less than 7 days and 1 more than 7 days; one with the history of maternal gestational diabetes mellitus, one with maternal gestational hypertension. The clinical presentations included seizures (3 cases), fever (3 cases), dehydration (1 cases), lethargy (2 cases), hypoglycemia (2 cases), thrombocytopenia (2 cases). Electroencephalogram (EEG) showed electrical seizures in 3 cases. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) showed 4 cases of intracranial hemorrhage, 3 cases of cerebral parenchymal infarction. For the sites of the thrombi, 4 were in the superior sagittal sinus, 3 in straight sinus, 2 in transverse sinus and 1 in sinus confluence. CT showed intracranial hemorrhage in 2 cases and venous sinus dilatation in 2 cases. Doppler ultrasound showed 2 cases of intraventricular hemorrhage and 2 cases of changes of venous sinus blood flow. Three neonates were treated with anticoagulant and thrombolytic therapy, followed by recanalization of the veins and discontinuing of seizures.@*Conclusions@#Seizure is the main clinical presentation of CVST. The main radiologic manifestations are cerebral infarction and hemorrhage. Timely brain MRI and MRV are helpful in the early diagnosis and treatment of CVST.

Clinical features and phathogenesis of cerebral venous sinus thrombosis in patients with malignancy / 中国医师进修杂志

Objective To investigate the clinical features of cerebral venous sinus thrombosis (CVST)in patients with malignancy as well as its underlying pathogenesis. Methods The clinical data, including clinical presentation, laboratory results, neurological images were retrospectively reviewed in hospital patients with active malignant tumor and cerebral venous thrombosis from January 2006 to December 2016. Results Among the 586 CVST patients, 24 patients (4.10%) were with malignant tumor. Among these 24 patients, there were 8 males and 16 females with an average age of (39.88 ± 21.71) years old. Four patients (16.67%) had the risk factors of cerebral venous sinus thrombosis, while the other 20 patients(83.33%)had not any such risk factors.At the symptom onset of CVST, 22 patients(91.67%) had headache and focal neurological deficit, such as limbs weakness and numbness. The common substyles of malignant tumor were lung cancer (33.33%), breast cancer (29.17%)and acute lymphocytic leukemia(20.83%).Most patients(58.33%)were found to have cerebral metastasis.22 patients (91.67%) had elevated plasma D-dimmer level, and 19 patients (79.17%) had elevated plasma cancer biochemical marker levels.Conclusions Cancer-related CVST had the features including lacking conventional risk factors, elevated plasma D-dimmer and cancer biochemical marker levels.Cerebral metastasis and hypercoagulable state may be responsible for the pathogenesis of CVST.

Establishment of cerebral venous sinus thrombosis model in rabbits by using ferric chloride combined with thrombin injection / 介入放射学杂志

Objective To discuss the establishment of cerebral venous sinus thrombosis (CVST) model in rabbits by local application of ferric chloride at sinuses sagittalis superior (SSS) combined with thrombin injection, and to evaluate its feasibility and application value. Methods A total of 39 New Zealand white rabbits were randomly and equally divided into three groups with 13 rabbits in each group, local application of cotton piece saturated with saline at SSS for 10 minutes was performed for the rabbits of group A, SSS local application of cotton piece saturated with 40％ ferric chloride for 10 minutes was adopted for the rabbits of group B, while SSS local application of cotton piece saturated with 40％ ferric chloride for 5 minutes together with injection of thrombin was carried out for the rabbits of group C. Whole cerebral DSA was performed immediately after modeling to judge if there was formation of thrombosis. Two days after the modeling, every 3 rabbits from each group were sacrificed to make 2, 3, 5-chloride triphenyl tetrazole (TTC) staining. Seven days after the modeling, the remaining 10 rabbits of each group were examined with DSA, the vascular recanalization rates were calculated, and the histopathological examination was made. Results In group B and group C, SSS thrombosis with surrounding cerebral infarction, edema, inflammatory cell aggregation and other pathological changes were observed. The 7-day vascular recanalization rate in group C was strikingly lower than that in group B (10％ vs 70％, P＜0.05). Surrounding cortical vein thrombus and subcortex petechial hemorrhages were obviously seen in group C. Conclusion For the establishment of CVST model in rabbits, local application of ferric chloride at SSS together with thrombin injection is effective and feasible. The thrombus thus induced is quite stable, and its pathogenesis and pathophysiology are quite similar to clinical manifestations. Therefore, this method can be used for basic research and clinical trials of CVST.

Application of cerebral venous sinus pressure measurement in guiding stent angioplasty for venous sinus stenosis: evaluation of its curative effect / 介入放射学杂志

Objective To evaluate the efficacy of cerebral venous sinus pressure measurement with a microcatheter in guiding stent angioplasty for the treatment of venous sinus stenosis.Methods A total of 42 patients with idiopathic intracranial hypertension (IIH) complicated by localized venous sinus stenosis were enrolled in this study.Microcatheter venous sinus venography with DSA and venous sinus pressure measurement were performed in all patients.Of the 42 patients,the pressure difference between the distal end and the proximal end of venous sinus ＞12 mmHg was found in 32,for whom balloon dilatation together with stent angioplasty was carried out.The venous sinus pressure was measured again after the treatment.The improvement of postoperative clinical symptoms was evaluated.The occurrence of complications,the symptom relapse and the patency of venous sinus were checked up.Results Successful venous sinus stent angioplasty was achieved in all 32 patients.The symptoms of intracranial hypertension were remarkably relieved,and no procedure-related complications occurred.The postoperative pressure difference between the distal end and the proximal end of venous sinus was significantly different from the preoperative one (P＜0.05),and the pressure showed a parallel correlation with the pressure of lumbar puncture.One week after the treatment,the headache was strikingly rclieved although visual acuity showed no obvious improvement.The patients were followed up for 12 months,no recurrence of clinical symptoms was seen,and magnetic resonance venography (MRV) or DSA examination showed that venous sinus blood flow was unobstructed and no restenosis was detected.Conclusion For the treatment of IIH stenosis complicated by localized venous sinus stenosis,endovascular stent angioplasty is relatively safe and effective,and the cerebral venous sinus pressure measurement with a microcatheter is of clinical significance for the selection of suitable patients as well as for the evaluation of curative effect.

Efficacy of systemic anticoagulation combined with endovascular interventional therapy for cerebral venous sinus thrombosis / 中国脑血管病杂志

Objective To investigate the efficacy of treatment of intracranial venous sinus thrombosis using systemic anticoagulation combined with endovascular intervention.Methods From May 2014 to January 2017,the clinical data of 52 patients with cerebral venous sinus thrombosis diagnosed with DSA and treated with micro catheter thrombolysis at the Department of Neurology,the Second Hospital of Hebei Medical University were analyzed retrospective.The microcatheters were indwelled for 3-14 d.The dosage of urokinase ranged from 10-20 thousand U/h,13 patients were also treated with balloon dilatation,and 1 was also treated with stent-assisted treatment.The results of imaging data and 6-month telephone follow-up were analyzed.The prognosis was evaluated with the modified Rankin scale (mRS) and National Institutes of Health Stroke Scale (NIHSS).Results In 52 patients admitted to hospital,the whole brain DSA showed sagittal sinus thrombosis in 34 cases,transverse-sigmoid sinus transitional zone thrombosis in 31 cases,inferior sagittal sinus thrombosis in 2 cases,straight sinus thrombosis in 3 cases,and cortical vein thrombosis in 14 cases.Angiography before discharge showed complete patency of the venous sinus in 9 cases,most patency in 42 cases,partial patency in 1 cases,the symptoms were relieved,and neurological function scores were improved at discharge in 48 cases.There were no obvious changes in 3 cases,and 1 case aggravated.The mRS and NIHSS scores before and after treatment were compared.The difference was statistically significant (Z =5.45 and 3.03 respectively,all P ＜ 0.05).Forty-eight patients were followed up for 6 months by telephone,no symptoms related to venous sinus thrombosis were found.Three patients died,and 1 died of traumatic intracranial hemorrhage.Conclusions Endovascular intervention is an effective and safe treatment for intracranial venous sinus thrombosis.It can be used as an alternative treatment scheme of internal medicine for patients of ineffective anticoagulation.

Correlation of delayed diagnosis of cerebral venous sinus thrombosis with its clinical symptoms and prognosis / 医学研究生学报

Objective Cerebral venous sinus thrombosis (CVST) is easily misdiagnosed for lack of specificity in its pathogenesis and clinical symptoms and characteristics.This study was to investigate the association of the clinical features of CVST with the time of diagnosis and the impact of diagnostic delay on the prognosis of the disease.Methods We retrospectively studied the clinical data about 94 cases of CVST treated in our hospital from March 2004 to August 2016.According to the interquartile-range time of diagnosis, we divided the patients into four groups, 16 d, and analyzed the correlation between the time of diagnostic delay with the clinical characteristics of the patients.The primary and secondary endpoints were the modified Rankin Scale score (mRS) ≤1 and ≤2 respectively at 3 months after discharge.Results Papilledema, isolated intracranial hypertension syndrome, and Glasgow Coma Score of 14-15 were associated with a longer diagnostic delay than seizure and hemorrhagic or infarction lesions (P<0.05).A significantly higher rate of earlier diagnosis was found in patients with lower levels of albumin and total protein, longer thrombin time, and a higher level of C-reaction protein (P<0.05).However, no significant correlation was observed between the time of diagnostic delay and the prognosis CVST.Conclusion The symptoms and laboratory indexes of the CVST patients at admission can be used as markers for the diagnosis of CVST, which may provide some new idea for its early diagnosis.

Pharmaceutical Care on a Patient with Cerebral Venous Sinus Thrombosis and Epilepsy / 医药导报

Objective To investigate the role of clinical pharmacist in medical therapy for a patient with cerebrovascular disease and epilepsy.Methods One patient was hospitalized due to headache and twitch.Clinical diagnosis was cerebral venous sinus thrombosis and epilepsy.During the treatment,the clinical pharmacist gave suggestion on drug selection of anti-infection and anti-epileptic therapy,assessed drug interaction between omeprazole-escitalopram and mannitoldexamethasone,monitored the adverse drug reaction of valproate,and provided medication education to the patient.Results Physician adopted clinical pharmacist's suggestion.The patient discharged with stable condition.Conclusion The participation of clinical pharmacists in the medication therapy of patients with cerebrovascular disease can reduce the risk of drug use and promote the efficacy and safety of medication.

Evaluation of the correlation between cerebral venous sinus and idiopathic intracranial hypertension with cerebrovascular intervention technique / 介入放射学杂志

Objective To discuss the application of cerebrovascular intervention technique in evaluating the correlation between cerebral venous sinus and idiopathic intracranial hypertension (ⅡH).Methods The clinical data,including complete related clinical signs and symptoms,laboratory results,magnetic resonance venography (MRV) findings,etc.,of 13 ⅡH patients were retrospectively analyzed.Under local anesthesia whole brain DSA was performed,and superselective catheterization of venous sinus was accomplished to perform sectional pressure measurement of sagittal sinus,transverse sinus,sigmoid sinus and jugular vein.Results Cerebral DSA examination revealed that venous sinus stenosis or occlusion was seen in 10 patients (76.9％),including transverse sinus (n=6),sigmoid sinus (n=3),and transverse sinus together with sigmoid sinus (n=l).Superselective pressure neasurement of venous sinus showed that the pressure difference between the two ends of the narrowed venous sinus was up to 120-580 mmH20 in these 10 patients.In 8 patients (61.5％,8/13) the venous sinus stenosis and/or occlusion might be implicated in the occurrence of ⅡH,in 2 patients (15.4％,2/13) the venous sinus stenosis might be secondary to ⅡH,and in 3 patients (23.1％,3/13) the venous sinus stenosis might bear no relationship to ⅡH.Conclusion Cerebrovascular interventional angiography combined with superselective pressure measurement of venous sinus can clearly identify the relationship between ⅡH and venous sinus

Trombosis de senos venosos cerebrales, una manifestación inusual de déficit de proteína S en paciente joven / Cerebral venous sinus thrombosis, an unusual manifestation of protein s deficiency in young patients

Resumen La trombosis venosa cerebral (TSVC) es un tipo de accidente cerebrovascular (ACV) que involucra el lado venoso de la circulación cerebral, incluye trombosis de los senos venosos durales y/o de las venas corticales y profundas del cerebro, es una causa poco común 0,5-1 % de todos los accidentes cerebrovasculares, con una prevalencia estimada en el rango entre 0. 22 a 1,23 / 100.000 / año. Los factores de riesgo para TSVC, están generalmente divididos en riesgos adquiridos (por ejemplo: cirugía, trauma, embarazo, puerperio, síndrome antifosfolípido, cáncer, hormonas exógenas) y los riesgos genéticos (trombofilia hereditaria). Los factores de riesgo más ampliamente estudiados para TSVC incluyen estados protrombóticos, las trombofilias heredadas asociadas con TSVC incluyen deficiencias de antitrombina, proteína C, proteína S (PS), mutación del factor V Leiden y la mutación del gen 20210 de protrombina. La prevalencia del déficit de PS, oscila entre un 0,02 y un 0,03 % en la población general y aumenta hasta un 2 % en pacientes no seleccionados con trombosis. Con una mortalidad cercana al 9 %. El manejo es usualmente médico. Se cita el caso de una paciente de 28 años de edad, con cuadro clínico de cefalea de 1 mes de evolución, con hallazgos en neuroimagen de trombosis de senos transverso y sigmoideo izquierdo con déficit de proteína S.

Summary Cerebral venous thrombosis (TSVC) is a type of stroke (CVA) involving the venous side of the cerebral circulation, including thrombosis of the dural venous sinuses and / or cortical and deep veins of the brain, is a rare cause 0.5-1% of all strokes, with an estimated range between 0. 22 to 1.23 / 100,000 / year prevalence. Risk factors for TSVC, are generally divided into acquired risks (eg, surgery, trauma, pregnancy, postpartum, antiphospholipid syndrome, cancer, exogenous hormones) and genetic risks (hereditary thrombophilia). The most widely studied factors TSVC risk include prothrombotic states, inherited thrombophilia associated with deficiencies TSVC include antithrombin, protein C, protein S (PS), mutation of factor V Leiden mutation and prothrombin 20210 gene. The prevalence of PS deficit ranges between 0.02 and 0.03% in the general population and increases up to 2% in unselected patients with thrombosis. With close to 9% mortality. The operation is usually doctor. It cites the case of a 28-year-old, with clinical symptoms of headache 1 month of evolution with neuroimaging findings transverse sinus thrombosis and left sigmoid with protein S deficiency.

The changing face of CSVT: Time to rethink and intervene

Background: Thrombosis of the cerebral venous sinuses (CSVT) is not an uncommon form of stroke. Usually affects young individuals. Aim: To compare the clinical profile of Cerebral venous thrombosis patients. Materials and methods: It was an observational study, comparing the epidemiological and etiological profile of patients with CVT during two time periods Results: This study group consisted of 130 patients, 63 patients in cohort 1 (2013/14), and 67 Patients in cohort 2 (2015-2016), were male noted in 27% and female were noted in 73% in cohort 1 (2013-14. In cohort 2 (2015-2016) male were noted in 39% and female were 61%.The data in rural were 81.5% and urban were 18.5% in cohort 1 and in cohort 2, Rural were noted in 66% and urban 34%.Common risk factors were postpartum status 31 were noted in cohort 1 and 18 were noted in cohort 2. In MRI brain Parenchymal changes cohort 1 consisted 51 and cohort 2 consisted 38. Headache was the common clinical presentation in the patients and next followed by altered sensorium. Time of onset of symptoms in the both cohorts was at 6-10 days in most of the patients, risk factor associated in both cohorts was postpartum status. Conclusion: CSVT is a multi-factorial condition with gender-related specific causes. Fifty years ago, CSVT was a mortal condition, but with the introduction of neuroimaging, the mortality rates have become minimal. CSVT is effective and economical.