Trombosis venosa y de senos cerebrales en recién nacidos y niños / Venous and cerebral sinus thrombosis in newborns and children

Resumen Introducción : La trombosis de venas y senos venosos cerebrales (TVSC) constituye una causa conocida, aun que subestimada de ictus en la infancia. Su diagnóstico requiere un alto índice de sospecha, una correcta in terpretación de la neuroimagen e interrelación entre el clínico y el radiólogo. Objetivo : Analizar las manifestaciones clínicas, fac tores de riesgo y neuroimagen de recién nacidos (RN) y niños menores de 15 años con TVSC. Métodos: Estudio descriptivo, retrospectivo, multi céntrico, de una serie consecutiva de casos de menores de 15 años que ingresaron por TVSC entre el 1 de enero del 2010 y el 1 de marzo de 2022. Resultados : El estudio incluyó 51 pacientes: 39% con síntomas agudos y 59% subagudos. En los RN predomi naron síntomas encefalopáticos y convulsiones, mien tras en los niños elementos de hipertensión endocranea na (HTEC). Se identificaron factores de riesgo en el 90% de los casos. La resonancia magnética con angiografía en tiempo venoso confirmó el diagnóstico en el 80%, siendo el seno recto el más afectado en RN y el seno lateral en niños. Se encontraron complicaciones hemorrágicas en 30.5%, siendo más frecuentes en los RN. Se inició anti coagulación en el 82% sin complicaciones. Las secuelas estuvieron presentes en 44.4% de RN y 37.9% de niños, siendo más frecuentes y graves en los RN. Conclusiones : Para realizar un diagnóstico precoz es fundamental pensar en TVSC en RN con síntomas en cefalopáticos y/o convulsiones y en mayores con clínica de HTEC en presencia de enfermedades predisponentes o desencadenantes.

Abstract Introduction : Cerebral venous sinus thrombosis (CVST) is a well-known, although underestimated, cause of stroke in childhood. Its diagnosis requires a high index of suspicion, a correct interpretation of neuroim aging studies and an interrelation between clinicians and radiologists. The clinical features, risk factors and neuroimaging of children under 15 years of age with CVST were analyzed. Methods : multicenter, retrospective, descriptive, study of a consecutive series of cases of children under 15 years of age, who were admitted due to CVST between January 1st, 2010, and March 1st, 2022. Results : The study included 51 patients: 39% with acute symptoms and 59% with subacute symptoms. Newborns predominantly presented encephalopathic symptoms and seizures, while children exhibited signs of intracranial hypertension (ICH). Risk factors were 96 identified in 90% of the cases. Magnetic resonance with angiography in venous time confirmed the diagnosis in 80% of the patients, with the straight sinus being the most affected in newborns and the lateral sinus in chil dren. Hemorrhagic complications were found in 30.5%, being more frequent in newborns. Anticoagulation was initiated in 82% without complications. Sequelae were present in 44.4% of newborns and 37.9% of children, being more frequent and severe in newborns. Conclusions : To make an early diagnosis, it is essen tial to consider CVST in newborns with encephalopathic symptoms and/or seizures, and in children with signs of ICH in the presence of predisposing or triggering conditions.

Intracranial Magnetic Resonance Venography of Superior Sagittal Sinus, Straight Sinus and Cerebral Venous Channels: Normal Anatomy and Variations in North Indian Population

The intracranial dural venous sinuses can be injured leading to thrombosis with in the dural sinuses causing headache, abnormal vision, weakness of the face and limbs on one side of the body, and seizures.Magne?c Resonance Venography (MRV) is one of the preferred methods of evalua?on of the cerebral venous sinus anatomy, varia?ons and pathology, par?cularly in the diagnosisof venous sinus thrombosis. The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian popula?on which can help to avoid poten?al pi?alls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Aim:The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian popula?on, which can help to avoid poten?al pi?alls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Materials:The present study was undertaken in the Departments of Anatomy and Radiodiagnosis at a North Indian ter?ary care teaching hospital over a period of two years. Magne?c Resonance Venograms (MRV) of pa?ents a?ending the radiology department were used to study the normal anatomy and varia?ons in the dural venous sinuses. 50 MRV scans of which 26 were of females and 24 of male, were included in the study. Anatomical varia?ons and varia?ons in drainage of the dural venous sinuses were assessed and sta?s?cal analysis was done. Results:For both superior sagi?al sinus drainage and straight sinus drainage, the propor?on of veins draining in right and le? transverse sinuses and confluence of sinuses was significantly different in the two age groups (p<0.001) in both males and females. Par?al spli?ng of superior sagi?al sinus in anterior one third or posterior one third was also seen. Sta?s?cally significant findings were observed regarding the laterality for vein of Labbe & vein of Trolard. Conclusion:MR venography is an excellent diagnos?c technique to visualise anatomy and anatomic varia?ons of venous sinuses as observed in our study. The par?al spli?ng of superior sagi?al sinus in either anterior one third or posterior one third as seen in our study, can cause misdiagnosis of thrombosis. Hence, knowledge of normal anatomy and anatomic varia?ons in the intracranial venous sinuses is very important to diagnose cerebral venous sinus thrombosis accurately.

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.

Reporte de caso: trombosis venosa cerebral en un paciente con virus de inmunodeficiencia humana / Case report: cerebral venous thrombosis in a patient with human immunodeficiency virus infection

Resumen La trombosis venosa cerebral (TVC) es una presentación clínica poco común del tromboembolismo venoso caracterizada por cefalea, crisis convulsivas, déficits neurológicos focales y papiledema. El diagnóstico es confirmado con Tomografía axial computarizada (TAC) de cráneo y Resonancia magnética nuclear (RMN) cerebral. La TVC tiene una relación importante con el virus de inmunodeficiencia humana (VIH), ya que los pacientes VIH positivos cursan con hiperviscosidad san guínea, alteraciones de factores anticoagulantes endógenos y riesgo de sobreinfección, entre otros; que predisponen a estados protrombóticos y lesión vascular como lo es la TVC. El tratamiento de la TVC es terapia anticoagulante, por lo general se utiliza heparina no fraccionada o heparina de bajo peso molecular para la fase aguda y anticoagulantes orales como la warfarina para el mantenimiento posterior. Reportamos el primer caso documentado de TVC en un paciente VIH positivo en Colombia.

Abstract Cerebral venous thrombosis (CVT) is a rare clinical presentation of venous thromboembolism characterized by headache, seizures, neurological deficits and papi lledema. The diagnosis is confirmed using computed tomography scan (CT scan) and magnetic resonance imaging (MRI) of the brain. CVT has an important relationship with the human immunodeficiency virus (HIV) given that HIV-positive patients may present with blood hyperviscosity, irregular levels of endogenous anticoagulation factors and risk of sepsis among others, that predispose to prothrombotic states and vascular injury such as CVT. The treatment of CVT is anticoagulant therapy, generally unfractionated heparin or low molecular weight heparin for the early phase and oral anticoagulants such as warfarin for the late phase. This case reports the first documented case of CVT in an HIV positive patient in Colombia.

Cerebral venous thrombosis in multi-ethnic patients from Malaysia

@#Background & Objectives: The literature on cerebral venous thrombosis (CVT) in South East Asia is limited. The objectives were to evaluate the clinical profile, predisposing factors and clinical outcome of the CVT patients in Malaysia. Methods: We conducted a retrospective descriptive study of the CVT patients admitted to the neurology ward. The clinical presentation, predisposing factors, radiological findings, treatment and prognostic characteristics were evaluated from the charts. Clinical outcome on discharge and six months was measured by Modified Rankin Scale (mRS) scores. Poor outcome and good outcome was defined as Modified Rankin Scale (mRS) scores of 3-6 and 0-2 respectively. Results: Forty nine CVT patients who presented between 2007 and 2017 were recruited. The mean age was 43.51±16.52. The patients consisted of 39 Malaysians (13 Indians, 12 Malays, 12 Chinese, one Iban, one Eurasian descent), and ten non-Malaysians. Thirty (61.2%) patients were women. The most common presenting complaint was headache (75.5%). Six percent had multiple risk factors, whereas 51% had idiopathic CVT. The most common predisposing factors were oral contraceptive pill use (18.4%), followed by infection (12.2%), especially central nervous system (CNS) infection (6.1%); 11.8% had prothrombotic disorder. The most common location for CVT was superior sagittal sinus (83.7%). On neuroimaging, 77.6% had parenchymal lesions, 53.1% had venous infarcts and 38.8% had intracerebral haemorrhage, one patient had CVT complicated by rare venous collateral channels. Poor outcome on discharge and at six months was 38.8% and 33.3% respectively. On univariate analysis, female gender (p=0.002), seizures (p=0.037) and cerebral oedema (p=0.018) were associated with poor functional outcome. On binary logistic regression, female gender (OR=14.50, 95% CI 2.10-99.94,p=0.003) and seizures (OR=6.54, 95% CI 1.33-32.07, p=0.017) were associated with poor outcome. Conclusion: The CVT patients in this study had a higher proportion of CNS infections. Poor outcome was independently associated with female gender and seizures.

Imitador De Ictus Debido A Trombosis Venosa Cerebral / Stroke Mimic Due To Cerebral Venous Thrombosis

RESUMEN Introducción: Un imitador de ictus es toda aquella patología no vascular que se presenta como un ictus isquémico agudo. La presentación clínica, factores epidemiológicos, el tiempo de inicio, la distribución vascular y la disponibilidad de pruebas de imagen, son factores que ayudan a diferenciarlos. Caso clínico: Presentamos un caso, de una mujer de la tercera edad que fue llevada a urgencias por hemiparesia izquierda de cinco horas de evolución. La evolución clínica y las pruebas complementarias permitieron excluir el diagnóstico de ictus isquémico agudo. La semiología fue explicada por una parálisis de Todd prolongada que se comportó como imitador de ictus en la fase aguda y las crisis epilépticas se produjeron en el contexto de una trombosis venosa cerebral. Comentarios: Los imitadores de ictus, al contrario del ictus isquémico agudo, ocurren en pacientes más jóvenes, tienen menos factores de riesgo vascular, menor puntuación de NIHSS, menos afasia y disfagia. Las principales causas son crisis epilépticas y síncopes. Deben considerarse también migrañas, neoplasias, alteraciones tóxicas o metabólicas, encefalopatías y trastornos funcionales. Realizar un estudio neurovascular completo y pruebas dirigidas nos permitirán el diagnóstico.

ABSTRACT Introduction: A stroke mimic is any non-vascular pathology that presents as an acute ischemic stroke. The clinical presentation, the epidemiological factors, the time to onset, vascular distribution and the availability of imaging tests are factors that help to differentiate them. Case report: We present a case, of a woman of the third age who was taken to the emergency department due to a five-hour history of left hemiparesis. The clinical evolution and the supplementary tests allowed to exclude the diagnosis of acute ischemic stroke. The semiology was explained by a prolonged Todd's palsy that behaved as a stroke mimic at the acute phase and the seizures occurred in the context of a cerebral venous thrombosis. Comments: Stroke mimics, in contrast to acute ischemic stroke, occur in younger patients, have fewer vascular risk factors, lower NIHSS score, less aphasia and dysphagia. The main causes are seizures and syncope. Migraines, neoplasms, toxic or metabolic alterations, encephalopathies and functional disorders should also be considered. To perform a complete neurovascular study and directed tests will allow us to make the diagnosis.

Trombosis venosa cerebral en la Unidad de Cuidados Intensivos Neurológicos del Instituto Nacional de Neurología y Neurocirugía / Brain venous thrombosis in the unit of neurological intensive care of the National Institute of Neurology and Neurosurgery / Trombose venosa cerebral na Unidade de Terapia Intensiva Neurológica do Instituto Nacional de Neurologia e Neurocirurgia

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Abstract: Cerebral venous thrombosis (TVC) is a potentially devastating state that occurs in young adults, especially women. Less frequent subtype of cerebral vascular disease (EVC), represented only 0.5% in EVC patients. Headache is the most common symptom common. It requires an accurate diagnosis since the pathophysiology and treatment differ from the arterial EVC. The understanding of the risk factors is the key to the prognosis of the TVC. Objective: To determine the prevalence, the main clinical, radiological findings and prognosis of TVC in Neurological Intensive Care Unit. Material and methods: Retrospective, longitudinal and analytical study of an observational nature. All patients admitted to the Neurological Intensive Care Unit of the National Institute of Neurology and Neurosurgery (INNN) with the diagnosis of TVC from January 2010 to July 2019 confirmed by venous phase computed tomography (vein CT) and/or vein were considered MRI (vein MRI), which will have clinical information and cabinet studies, as well as, the evolution, treatment and prognosis at hospital discharge. Results: Of a total of 14 patients, with an average age of 33 years of age. Of which 85.72% (n = 12) were women and 14.28 (n = 2) were men. Headache occurred 50% of cases. The main predisposing cause for TVC was the use of oral contraceptives in 6 patients (42.85%) and puerperium in three patients (21.42%). The delay in diagnosis was an average of 48 hours. The imaging method used for diagnosis in 64.28% of those with computed tomography in venous phase and in 37.71% with vein magnetic resonance. The upper longitudinal sinus was the most affected in 50% of cases. The average stay in the Intensive Care Unit (ICU) was seven days, where 100% of patients received anticoagulation. Three patients (21.4%) developed intracranial hypertension who underwent decompressive craniectomy between the second and fifth day of stay. The days of mechanical ventilation on average were seven days. With an average hospital stay of 20 days. Mortality at hospital discharge was 21.42%. Conclusions: TVC is less frequent than ischemic stroke or intracerebral hemorrhage. The spectrum of the clinic is broad, with pivotal headache. The confirmation of the diagnosis must be performed with CT vein and/or RM vein. The therapeutic intervention within the acute phase is aimed at the recanalization of the thrombosed sinus or sinuses and the prevention of complications; anticoagulation with low molecular weight heparin is the first-line treatment, which has shown an impact on the prognosis of patients. We must keep in mind that thrombolysis and thrombectomy are an option in treatment. In the case of decompressive craniectomy, it is indicated only in cases of malignant venous infarctions. The results after TVC are generally favorable, they also depend on the patient's factors, such as sex and the specific risk factors of women.

Resumo: Trombose venosa cerebral (TVC) é um estado potencialmente devastador que ocorre em adultos jovens, especialmente mulheres. Subtipo menos frequente do acidente vascular cerebral (AVC), representou apenas 0.5% nos pacientes com AVC. Cefaléia é o sintoma mais comum. Exige um diagnóstico preciso, pois a fisiopatologia e o tratamento diferem da AVC arterial, e a compreensão dos fatores de risco é a chave para o prognóstico da TVC. Objetivo: Determinar a prevalência, os principais achados clínicos, radiológicos e prognósticos da TVC na unidade de terapia intensiva neurológica. Material e métodos: Estudo retrospectivo, longitudinal e analítico de natureza observacional. Todos os pacientes admitidos na unidade de terapia intensiva neurológica do Instituto Nacional de Neurologia e Neurocirurgia (INNN) com diagnóstico de TVC de janeiro de 2010 a julho de 2019 confirmados por tomografia computadorizada de fase venosa (Veno-TC) e/ou veno ressonância magnética (veno-RM), que contaram com informações clínicas e estudos de gabinete, bem como a evolução, tratamento e prognóstico na alta hospitalar. Resultados: Do total de 14 pacientes, com idade média de 33 anos. Dos quais 85.72% (n = 12) eram mulheres e 14.28 (n = 2) eram homens. A cefaléia ocorreu em 50% dos casos. A principal causa predisponente para TVC foi o uso de contraceptivos orais em 6 pacientes (42.85%) e puerpério em 3 pacientes (21.42%). O atraso no diagnóstico foi em média de 48 horas. O método de imagem utilizado para o diagnóstico em 64.28% daqueles com tomografia computadorizada na fase venosa e em 37.71% com veno ressonância magnética. O seio sagital superior foi o mais acometido em 50% dos casos. A permanência média na unidade de terapia intensiva (UTI) foi de 7 dias, onde 100% dos pacientes receberam anticoagulação. Três pacientes (21.4%) desenvolveram hipertensão intracraniana submetidos a craniectomia descompressiva entre o segundo e o quinto dia de internação. Os dias de ventilação mecânica foram em média 7 dias. Com internação média de 20 dias. A mortalidade na alta hospitalar foi de 21.42%. Conclusões: A TVC é menos frequente que o AVC isquêmico ou hemorragia intracerebral. O espectro da clínica é amplo, tendo como sintoma principal cefaléia. A confirmação do diagnóstico deve ser realizada com veno TC e/ou veno RM. A intervenção terapêutica na fase aguda visa à recanalização do seio ou seios trombosados e à prevenção de complicações; a anticoagulação com heparina de baixo peso molecular é o tratamento de primeira linha que demonstrou um impacto no prognóstico dos pacientes. Devemos ter em mente que trombólise e trombectomia são uma opção no tratamento. No caso da craniectomia descompressiva, é indicado apenas em casos de infartos venosos malignos. Os resultados após o TVC são geralmente favoráveis, também dependem de fatores do paciente, como sexo e fatores de risco específicos da mulher.

Analysis of Clinical Features, Risk Factors and Laboratory Parameters in Cerebral Venous Thrombosis: A Study of 70 Cases

Introduction: Cerebral venous thrombosis (CVT) has variableclinical presentations mimicking other neurological disorders.There is variation in risk factors for CVT in different areas.Study was done with the aim of analyzing the clinical features,risk factors and laboratory parameters on patients diagnosedwith CVT on Magnetic Resonance Venography (MRV) andMRI.Material and Methods: In this retrospective study, data of70 consecutive patients attending a private neurology centerwith CVT confirmed on MRV and MRI from May 2016 toApril 2019 was analyzed. Laboratory parameters emphasizedwere hemoglobin content, serum homocysteine level and lipidprofile.Results: Out of 70 patients, 48 were men and 22 women inthe age range of 14 to 71 years. Most common presentingsymptom was progressive headache (63 cases,90%) aloneor in combination with other symptoms like vomiting (22cases, 31.42%), hemiparesis (17 cases, 24.28%), ataxia(17 cases, 24.28%) and seizures (15 cases, 21.42%).Hyperhomocysteinemia was seen in 15 cases (21.42%),anemia in total 30 cases (42.85%), and alcoholism in sevencases (10%). Twenty four patients (34.28%) had high densitylipoprotein (HDL) level of less than 40mg/dl, five patients(7.14%) had total cholesterol more than 200mg/dl and threepatients (4.28%) had triglycerides more than 200mg/dl. Onepatient (1.42%) had protein S deficiency.Conclusion: CVT is an uncommon but treatable cause ofstroke in young patients. Due to variety of clinical presentation,a high degree of clinical suspicion is neccessory for correctdiagnosis and early treatment.

Trombosis venosa cerebral: lo que hay que saber / Venous cerebral thrombosis: What you need to know

Resumen La trombosis venosa cerebral representa 0.5% del evento vascular cerebral en el mundo. Sin embargo, la expresión fenotípica de la enfermedad en los países en desarrollo como México muchas veces es subestimada por múltiples factores, entre ellos la falta de sospecha de la enfermedad, la carencia de estudios diagnósticos y el patrón subclínico de la enfermedad. Desde hace más de 30 años se ha considerado a la población mexicana con un factor de riesgo de la aparición de fenómenos protrombóticos en sitios tradicionales; sin embargo, en la última década la prevalencia de trombosis venosa en sitios atípicos, como el sistema venoso cerebral, se ha incrementado. Por lo anterior, es importante para el médico no neurólogo el conocimiento de esta enfermedad, aparentemente no común, en nuestra población.

Abstract Cerebral venous thrombosis represents 0.5% of all strokes in the world. However, the phenotypic expression of the disease in developing countries such as Mexico is often underestimated by multiple factors, including low suspicion of the disease, lack of diagnostic studies and subclinical pattern of the disease. Since more than 30 years, Mexican population has been considered with a risk factor for the development of prothrombotic phenomena in traditional sites; however, in the last decade prevalence of venous thrombosis in atypical sites, such as the cerebral venous system, has increased dramatically, thus, it is mandatory for the non-neurologist physician to know about the disease, apparently uncommon in our population.

Homocistinuria, reporte de un caso / Homocystinuria, Case Report / Homocistinuria, relato de um caso

Resumen: En este artículo se presenta el caso de una niña de 13 años con historia de cefalea de 2 años de evolución, la cual ha sido estudiada por subluxación del cristalino y fenotipo marfonoide. Para llevar a cabo la investigación se realizó una tomografía cerebral simple que evidenció trombosis de varios senos cerebrales. Posteriormente se hospitalizó a la paciente en la unidad de cuidados intensivos, mientras se anticoagulaba con enoxaparina. Se solicitó un estudio para trombofilia junto con homocisteina en sangre, ante la sospecha de homocistinuria. Luego de confirmarse el diagnóstico se recetó piridoxina y ácido fólico, con lo cual la paciente evolucionó de manera satisfactoria y recuperó las funciones perdidas. El seguimiento de este caso para la investigación permitió encontrar una disminución mayor del 20 % de la homocisteina, sin que sus niveles estuvieran por debajo de 50 µmol/L, hecho que hace a la paciente respondedora parcial a la piridoxina.

Abstract: This article presents the case of a 13-year-old girl with a 2-year history of headache, which has been studied for lens subluxation and Marfanoid phenotype. To carry out this research, a simple brain tomography was performed that showed thrombosis of several sinuses. Subsequently, the patient was hospitalized in the intensive care unit and anticoagulated with enoxaparin. A study was requested for thrombophilia along with homocysteine in blood, on suspicion of homocystinuria. After confirming the diagnosis, pyridoxin and folic acid were prescribed, with which the patient evolved satisfactorily and recovered lost functions. Follow-up on this case for the research allowed us to find a decrease in homocysteine greater than 20 %, without its levels being below 50 µmol/L, which makes the patient partially responsive to pyridoxine.

Resumo: Neste artigo, é apresentado o caso de uma menina de 13 anos, com história de cefaleia de dois anos de evolução, a qual tem sido estudada por subluxação do cristalino e fenótipo marfanoide. Para realizar a pesquisa, foi tomada uma tomografia cerebral simples que evidenciou trombose de vários seios cerebrais. Em seguida, a paciente foi internada na unidade de tratamento intensivo onde recebeu tratamento anticoagulante com enoxaparina. Foi solicitado um estudo para trombofilia junto com homocisteina em sangue, diante da suspeita de homocistinúria. Após o diagnóstico ter sido confirmado, foram receitados piridoxina e ácido fólico, com os quais o estado da paciente evoluiu de maneira satisfatória e ela recuperou as funções perdidas. O seguimento do caso para a pesquisa permitiu verificar uma diminuição maior de 20% da homocisteina, sem que seus niveis estivessem abaixo de 50 µmol/L, fato que torna a paciente apta parcialmente à piridoxina.

Cerebral venous sinus thrombosis a study to assess clinical profile among female patients in a tertiary care hospital

Background: The Incidence of Cerebral Venous Thrombosis (CVT) is around 3-4 cases among one million population affecting children and young adults. In India the puerperal CVT is 10-12 times more common than western countries. Even though there is apparent “rarity” of the condition but advances in knowledge and available investigation in terms of imaging (CT scan/MRI) diagnosis can be done early for appropriate treatment and decreasing the morbidity and mortality.Methods: A prospective study was conducted at Karnataka Institute of Medical Sciences, Hubli, Karnataka from December 2014 to November 2015. A total of 36 patients were included in the study.Results: Mean age of females in the study was 27.06±9.033years. 75% had seizures, 47.2% had headache, 19.4% had focal neurological deficit, 13.9% had altered sensorium, 8.3% had cranial nerve deficits 5.6% had speech deficits. 72.22% of patients and were in peripartum period and 27.8% were non-pregnant. 72.2% had superior sagittal sinus involvement, 47.2% had transverse sinus, 47.2% had sigmoid sinus, and 13.9% had internal jugular vein and 5.6% straight sinus. 47.2% had single sinus involvement, and 52.8% had multiple sinus involvement. 94.4% patients were managed conservatively and 5.6% were managed by neurosurgical intervention. 94.4% patients survived and 5.6% had mortality.Conclusions: Cerebral venous sinus thrombosis is most common in young females during peripartum period. Early diagnosis, treatment and if necessary neurosurgical intervention has good outcome.

Susceptibility-Weighted MR Imaging for the Detection of Isolated Cortical Vein Thrombosis in a Patient with Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) can be a rare risk factor of cerebral venous thrombosis. We describe a case of isolated cortical vein thrombosis (CVT) secondary to SIH and discuss the value of susceptibility-weighted imaging for the detection of isolated CVT.

Isolated cortical vein thrombosis with subdural hematoma: A case report and literature review / 中国脑血管病杂志

Isolated cortical vein thrombosis is rare. It is easy to be missed or misdiagnosed due to variations of cortical vein anatomy, nonspecific clinical presentation, and lack of any imaging gold-standard of diagnosis. Cerebral venous sinus thrombosis with subdural hematoma is rarer. Because of the side effects of anticoagulation, the optimal therapy for such patients is hard to decide. A 34-year-old puerperal woman who suffered from isolated cerebral cortical venous thrombosis with subdural hematoma was reported and relevant literatures were review, aiming to provide some references for the treatment of this disease.

A Prospective Study On Cvt In Young Males

Background :Cerebral venous thrombosis (CVT) is one of the common causes of stroke in young people. CVT is a disease with potentially serious consequences and usually affecting young to middle-aged people. Strokes in the young account for nearly 30% of all cases of stroke in India and cerebral venous thrombosis (CVT) accounts for 10-20% of these cases Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term squelae. CVT can be caused by a number of prothrombotic states and disorders of clotting system such as inherited causes like Protein C resistance secondary to Factor V Leiden polymorphism, Protein C and S resistance, and antithrombin III deficiency. Many other etiological factors like drugs ,infections,etc. Aim: To analyse the clinical profile and the outcome of young males with CVT. Methodology: This prospective study was carried out over a period of one year in the Neurology department in whom the diagnosis were confirmed by magnetic resonance imaging (MRI), MRV venogram , plain/contrast CT were included in the study. A total of 42 patients were enrolled for the study in the period of one year. The patients demographic details including the diabetic and hypertensive status along with their family history was obtained by using a detailed questionnaire. Results: Majority of them were between the age group of 18 - 35 years. Headache was found to be the most common symptom followed by nausea vomiting and seizures. Majority of the patients with CVThad a history of alcoholism in this study. In our study exactly 33% were unknown factors, 32% Alcohol, 28% Dehydration, 7% infections. Conclusion: . Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term sequelae

Cerebral venous thrombosis with auto-immune hyperthyroidism

Sudden deterioration of visual functions warrants comprehensive ophthalmic examination with evaluation for systemic association. Cerebral venous thrombosis (CVT) is an uncommon disorder that can present with neurological deficits. We report a young female patient aged 28 years who presented with severe headache and sudden diminution of vision and was subsequently diagnosed with hyperthyroidism and CVT. Management of CVT and hyperthyroidism hastened full recovery of visual functions.

Complicaciones neurológicas en la materna crítica / Neurological complications in critically ill pregnant women

Introducción: Las pacientes obstétricas pueden presentar numerosas complicaciones que ponen en peligro sus vidas con necesidad de ingreso en unidades de cuidados intensivos. Objetivo: Caracterizar clínicamente las maternas críticas con complicaciones neurológicas. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo en el Hospital Clínico Quirúrgico Hermanos Ameijeiras durante el período de enero de 2007 a diciembre de 2016. Para el análisis de los datos se efectuó el cálculo de frecuencias absolutas y relativas, se aplicaron medidas de tendencia central (media) y dispersión (rango) y para conocer la posible asociación entre las variables cualitativas se aplicó el Test de chi-cuadrado con una significación de p<0,05. Resultados: Las complicaciones neurológicas se presentaron en 33,3 por ciento de las pacientes, las más frecuentes fueron: eclampsia (65,7 por ciento), infarto cerebral (9,0 por ciento) y la trombosis venosa cerebral (8,6 por ciento). Las nulíparas (51,4 por ciento) y la edad mayor de 35 años (42,8 por ciento) fueron los factores de riesgo más observados. La hipertensión arterial fue el antecedente patológico personal principal y se evidenció asociación entre las complicaciones neurológicas y la causa directa de la muerte (p=0,00043). Conclusiones: Las complicaciones neurológicas fueron frecuentes en las maternas críticas y constituyen causa directa de muerte. Como complicación más frecuente se presentó la eclampsia(AU)

Introduction: Obstetric patients can present numerous complications that put in danger their lives, and they need of admission in intensive care units. Objective: To characterize in a clinical way the critically ill pregnant women with neurological complications. Methods: An observational, descriptive, retrospective study was conducted in Hermanos Ameijeiras. Clinical-Surgical Hospital during the period from January, 2007 to December, 2016. There was carried out the calculation of absolute and relative frequencies for the analysis of the data; there were applied measures of central (average) trends and dispersion (range), and to know the possible association between the qualitative variables the Chi-square´s Test was performed with a significance of p < 0.05. Results: The neurological complications appeared in 33,3 percent of the patients and the most frequent were: eclampsia (65,7 percent), cerebral infarction (9,0 percent) and cerebral venous thrombosis (8,6 percent). Being a nulliparous women (51,4 percent) and age of more than 35 years (42,8 percent) were the most common risk factors. Arterial hypertension was the main pathological background and the association between the neurological complications and the direct cause of the death (p=0.00043) was demonstrated. Conclusions: The neurological complications were frequent in critically ill pregnant women and they constitute a direct cause of death. The most frequent complication was eclampsia(AU)

Decompressive Hemicraniectomy Versus Medical Management in Cerebral Venous Thrombosis with Signs of Raised Intracranial Pressure

Background: Mass effect is the major cause of death in cortical venous sinus thrombosis and there is no clear cut the role of decompressive hemicraniectomy. Aims: To study the outcome of patients with large venous infarct and acutely increased intracranial pressure subjected to either conservative treatment or decompressive surgery. Materials & Methods: 20 consecutive patients admitted with moderate to large venous infarct were examined for features of raised intracranial pressure (ICP) . Cranial CT and or MRI and CT venogram or MR venogram and or cerebral DSA were examined for site of Sino venous occlusion. Results: There were 20 patients with 10 each in conservatively and surgically treated group. Cranial CT/MRI head revealed large venous infarct with midline shift and mass effect in all patients. Overall 15 of 16 survivors had good outcome at 3 months without any significant residual deficit irrespective of mode of treatment used. There is no statistical difference between medical and surgical groups in mRS 1 month, 3 months and death with p value 0.651, 0.185 and 0.474 respectively. Conclusion: Patient with large venous infarct with signs of raised intracranial pressure carries good overall outcome with timely care irrespective of conservative or surgical management.

Study to compare CT and MRI evaluation in cerebral venous thrombosis

Introduction: Cerebral venous thrombosis possible causal factors and clinical manifestations are many and varied; imaging plays a primary role in the diagnosis. Aim: The purpose of study was to compare CT and MRI findings, in evaluation of parenchymal abnormalities, recanalization. Materials and methods: It was prospective study done in 42 patients all patients with clinical suspicion of CVT, intracranial vascular malformation, and/or with intracranial hemorrhage of unclear etiology undergone a standardized MR imaging protocol, including the study protocol sequences. Results: Cerebral venous thrombosis was more common in the females; 24(57.2%) out 42 members. 20(47.6%) members had cerebral venous thrombosis. Staging chart showed majority of cases come to hospital at subacute stage; 33 (78.5%) cases. A total of 32 cases out of 42 underwent both CT and MRI. Cerebral venous thrombosis detected by MRI was 100 % in our study and diagnosed 32 out of 32 cases but CT failed to pick up the lesions in six cases. 11 Sites of thrombosis identified in these patients, Superior sagittal sinus thrombosis was most commonly involved in 78.5% cases (33 out 42). Thrombosis identified with clot on T1WI as hyper intense on 78% cases (33 out 42), Iso intense in 11% (5 out 42) and No signal intensity in 9% (4) cases. On T2 WI, hyper intense in (59%) 25 case out 42 cases, iso intensity in (19%) 8 cases, no signal intensity in 9 cases (21%). On FLAIR, clot appears on hyper signal intensity in 28 % (12 case out 42), iso intensity in 26 % (11 case in 42), no signal intensity in (45%) 19 cases. On DWI clot appears on hyper signal intensity in 26% (11) cases, is intensity in 21% (9) cases, no signal intensity in 52% (22) cases. With follow up 9 cases with complete recanalization, 2 cases with partial recanalization, no change in only one case. Conclusion: MR imaging should be used as routine imaging modality for cerebral venous thrombosis.

Imaging diagnosis of cerebral venous and sinus thrombosis:Current status and progresses / 中国医学影像技术

Cerebral venous thrombosis (CVT) is a relatively rare type of cerebrovascular disease.The untypical symptoms make it difficult to diagnose,which frequently results in untimely therapy.Recently,with the emergence of new imaging techniques,the early diagnosis rate of CVT is gradually increasing.The applications of different imaging methods for diagnosis of CVT in recent years were reviewed in this article.

The Analysis of Missed Diagnosis and Misdiagnosis in the First Imaging Diagnosis of Cerebral Venous Thrombosis / 昆明医科大学学报

Objective To improve the detection accuracy of cerebral venous thrombosis (CVT) in the first imaging examination and to guide the treatment and improve the outcome. Methods Imagings of 17 CVT cases were retrospectively analyzed and the missed diagnosis and misdiagnosis reasons were summarized. Results All the 17 cases were taken CT examination. 7 cases were missed diagnosed and misdiagnosed. 2 of 7 cases were diagnosed as subarachnoid hemorrhage. 1 of 7 cases was diagnosed as the left occipital subacute subdural hematoma. 1 of 7 cases was diagnosed as the right frontal and parietal and occipital lobes cerebral hemorrhage. 1 of 7 cases was diagnosed as the left parietal and occipital lobes cerebral hemorrhage and broken into ventricles. 2 of 7 cases were diagnosed as negative. Conclusion To summerize the reasons of missed diagnosis and misdiag aosis of CVT can improve the detection accuracy in the first imaging examination.