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

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

Pseudotumor cerebri in a case of ulcerative colitis with sagittal sinus thrombosis

Thromboembolic events are a known complication of Inflammatory Bowel Disease [IBD] especially during disease relapse, more commonly in deep veins of extremities and lung, and rarely as Cerebral Sinovenous Thrombosis [CSVT]. We describe an 11 year old male patient with 3 months history of Ulcerative Colitis [UC] who presented as pseudotumor cerebri due to superior sagittal sinus thrombosis during an acute exacerbation of his colitis, that was successfully treated with heparin and then warfarin. In any known cases of UC presenting as acute severe headache, consider CSVT and request brain MRI and MRV to facilitate the diagnosis and early treatment

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

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

Eletroventilação em paciente com hipotrofia da musculatura respiratória por trombose de seio venoso sagital: relato de caso / Eletroventilation in patients with hypertrophy of the respiratory musculature thrombosis of sagittal venous sinus: case report

Justificativa e objetivos: A trombose de seios venosos cerebrais é uma patologia pouco freqüente que apresenta taxas de morbimortalidade entre 5% e 25% em que o paciente apresenta quadro de cefaléia, convulsões, alterações motoras e sensitivas. A sua incidência sugere que ela pode corresponder a 5% das causas de doença cerebrovascular hemorrágica em doentes com idades inferiores a 40 anos, sendo mais frequente em mulheres com idades compreendidas entre 20 e 35 anos. A eletroventilação é um método não-invasivo usado para produzir respiração artificialmente. Sua praticidade é demonstrada pela aplicação de trens de pulso por eletrodos estrategicamente posicionados na superfície do músculo. O objetivo deste estudo foi apresentar um paciente com diagnóstico de trombose seio venoso sagital, que recebeu eletroventilação. Relato de Caso: Paciente do sexo masculino, 10 anos, com diagnóstico de trombose de seio venoso sagital, recebeu eletroventilação. Conclusões: Houve progressiva melhora na função respiratória durante os 30 dias de eletroventilação. Os resultados sugeriram sua eficácia no trofismo muscular e na abreviação do desmame da ventilação sem intercorrências...

Background and objectives: The cerebral venous bay thrombosis is a rare pathology that presents morbimortality between 5 and 25% which patients have headaches, convulsions, sensitives and motor modifications. Its incidence suggest it correspond 5% of hemorrhagic vascular brain pathologies in diseased under 40 years old, and frequently in womens of ages between 20 and 35 years old. The eletroventilation is a non-invasive method, used to make artificial breath. Its practicity is demonstrate with application of pulse trains by electrodes put strategily on muscle surface. The study objective was to present a patient with diagnostic of sagital venous bay thrombosis who received eletroventilation. Case Report: A male patient, 10 years old, with diagnostic of sagital venous bay thrombosis, received eletroventilation. Conclusions: It was a better progressive in breath function throughout 30 days of eletroventilation. The results suggest that efficacy in a muscular trofism and to shorten the ventilation weaning...

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

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

Superior sagittal sinus thrombosis: subtle signs on neuroimaging

<p><b>INTRODUCTION</b>The aim of this study was to review the clinical, computed tomography (CT) and magnetic resonance imaging (MRI) diagnosis and the frequency of positive neuroimaging findings in patients with cerebral venous thrombosis (CVT) involving the superior sagittal sinus.</p><p><b>MATERIALS AND METHODS</b>A clinical and radiological database of patients with final diagnosis of CVT was compiled from the inpatient hospital information service of a tertiary neurological hospital over 5 years. CT and MRI studies in 22 patients were retrospectively examined for direct signs of venous sinus thrombosis and for complications of CVT. The diagnosis of CVT before and after CT and MRI was reviewed.</p><p><b>RESULTS</b>Clinical diagnosis of possible CVT was suspected in only 1 patient. When the diagnosis was not suspected, CT diagnosis was difficult and there was a high false negative rate of 52.6%. MRI fared better, but the false negative rate was still 11%. Directs signs of venous sinus thrombosis such as the triangle sign, empty delta sign on CT and loss of the normal flow voids on MRI, could be retrospectively detected in 57.9%, 100% and 100% of patients respectively. Although 4 patients presented with subarachnoid haemorrhage, these direct signs were present in 3 patients.</p><p><b>CONCLUSION</b>Clinical diagnosis of CVT is rarely suspected before CT and MRI, and although subtle positive signs are often present, these may not be appreciated unless there is a high index of suspicion or image review at multidisciplinary team meetings.</p>

Trombosis venosa de seno longitudinal superior. A propósito de un caso / Cerebral venous thrombosis of the superior longitudinal sinus. Case report

La trombosis venosa cerebral es una causa rara de enfermedad cerebrovascular, de etiología infecciosa o no infecciosa; con un esprectro clínico variado, de difícil diagnóstico clínico y con discrepancias en el tratamiento. En este trabajo se presenta el caso de un paciente joven, sexo masculino, con una trombosis venosa de seno longitudinal superior de causa multifactorial, realizándose tratamiento anticoagulante y anticomicial con evolución favorable.

Trombosis de senos venosos posterior a analgesia peridural para trabajo de parto / Thrombosis of veined breasts after analgesia peridural for work of labor

Paciente de 18 años de sexo femenino quien consultó por cuadro de 20 días de evolución de cefalea global con predominio en región frontal tipo peso, de intensidad 10 /10 durante la bipedestación, que mejora con la posición de cubito y nuevamente se presenta al intento de sentarse. No mejora con la ingesta de AINES. No hay fiebre, vomito, o alteraciones visuales (fotopsias ni escotomas) niega otra sintomatología asociada. Refiere que la cefalea inicia 6 a 8 horas posterior a la colocación de analgesia peridural para trabajo de parto vaginal; el embarazo cursa sin complicaciones, y siempre se ha mantenido con estas características ya descritas. Dentro de los antecedentes de importancia, como dato positivo es, G2P2A0C0 y el parto anterior hace un año y medio en el cual también recibió analgesia peridural sin ninguna complicación; en la revisión por sistemas no se encuentran más datos adicionales. Al examen de ingreso FC 76 X min. TA 110 / 70 FR 16 T 36, 7 C, SPO2 92por ciento (FIO2 0,21), mucosas húmedas normocrómicas, orofaringe sin alteración, no dolor en la palpación de senos paranasales, cuello sin ingurgitación yugular, no adenomegálias, no soplos en cuello, tórax sin retracciones, ruidos cardiacos rítmicos, no taquicárdicos, murmullo vesicular simétrico sin agregados, mamas congestivas secretantes, sin eritema ni ulceración. Abdomen blando ruidos intestinales positivos sin dolor, útero 4 cm...

Superior sagittal sinus thrombosis and Budd-Chiari syndrome due to paroxysmal nocturnal hemoglobinuria managed with transjugular intrahepatic portosystemic shunt: a case report.

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We report a patient with PNH complicated by intracranial venous thrombosis and Budd-Chiari syndrome, who was managed with transjugular intrahepatic portosystemic shunt. CASE PRESENTATION: A 26-year-old man presented with thrombosis of the superior sagittal and right sigmoid sinuses. Initial investigations did not reveal any underlying cause. Nine months later, he developed hepatic venous thrombosis. At this time, Ham test was positive. Flow cytometry confirmed the diagnosis of PNH. The patient was treated with transjugular intrahepatic portosystemic shunt; one episode of stent blockage one month later was managed successfully with balloon dilatation and restenting. CONCLUSION: PNH should be considered in patients with unexplained venous thrombosis. Thrombosis in these patients needs to be managed with prolonged anticoagulation. For Budd-Chiari syndrome in patients with underlying PNH, transjugular intrahepatic portosystemic shunt may be a good option but caution is needed to prevent stent occlusion.

Superior sagittal sinus and torcula thrombosis in minor head injury.

A 27-year-old man suffered a relatively minor trauma. He developed signs of raised intracranial pressure three days after injury. Investigations revealed superior sagittal sinus and torcular thrombosis.

Importancia de la resonancia magnética nuclear y de la tomografía computada en el diagnóstico de las trombosis venosas cerebrales / MRI and CT in cerebral venous thrombosis

Propósito. La enfermedad veno-oclusiva es una alteración neurológica de difícil diagnóstico clínico y que presenta una alta morbimortalidad si no se hace un diagnóstico precoz y preciso. Con la aparición de la Tomografía Computada Helicoidal (TCH) y de la Angiorresonancia Magnética Nuclear (ARMN), se ha logrado un cambio radical en el diagnóstico de las trombosis venosas cerebrales. Material y método. Se estudiaron catorce pacientes con sospecha clínica neurológica de trombosis venosa cerebral, utilizando métodos no invasivos, la TCH y la RMN. Resultados. En todos los casos se llegó al diagnóstico etiológico confrontando los hallazgos clínicos y radiológicos, sin necesidad de un método invasivo confirmatorio posterior. Conclusión. Nuestros resultados fueron satisfactorios para el diagnóstico de certeza, sin utilizar métodos invasivos. Ante un paciente con sospecha de trombosis venosa cerebral el estudio neurorradiológico en la urgencia es fundamental. Con el fin de tener una conducta menos agresiva, recomendamos el empleo en primera intención de la TCH y/o ARMN con sus respectivos métodos angiográficos

Hipertensión endocraneana secundaria a trombosis de seno sagital en paciente con síndrome nefrótico / Intracranial hypertension due to saggital vein thrombosis in a patient with nephrotic syndrome

Entre las complicaciones posibles de observar en un paciente con un Síndrome nefrótico, deben considerarse los fenómenos trombóticos tanto venosos como arteriales, incluyendo la trombosis de senos venosos cerebrales. Objetivo:Presentar la evolución de un niño que desarrolló una trombosis de seno longitudinal superior asociada a un Síndrome nefrótico, comparando la evolución de nuestro paciente con los 32 casos descritos en la literatura. Caso clínico: Varón de 14 años que ingresó por síndrome nefrótico descompensado y cefalea moderada, asociado a papiledema bilateral, en el cual el scanner cerebral y la angioresonancia mostraron una trombosis de seno longitudinal superior en etapa aguda. El hallazgo más significativo fue un aumento de la presión intracraneana de hasta 44 cm. de agua. El aumento progresivo de los anticuerpos IgM anticardiolipinas determinó una terapia anticoagulante permanente. Discusión:En el síndrome nefrótico un estado de hipercoagubilidad y otros factores como deshidratación o traumatismos menores, pueden causar trombos en diferentes vasos, incluyendo los senos cerebrales. El seno más frecuentemente comprometido es el seno longitudinal superior. La sintomatología puede ser escasa a pesar de una marcada hipertensión endocraneana, motivo por el cual esta condición puede ser subdiagnosticada si no se realiza una búsqueda dirigida.

Cerebral venous thrombosis in a patient of paroxysmal nocturnal haemoglobinuria following aplastic anaemia.

A young lady who had aplastic anaemia presented for cerebral venous thrombosis after five years of follow up. She was diagnosed to have paroxysmal nocturnal haemoglobinuria. She had received immunosuppressive therapy with methylprednisolone, cyclosporine-A, anti-lymphocyte globulin, danazol and pregnenolone. The relation between aplastic anaemia, paroxysmal nocturnal haemoglobinuria and cerebral venous thrombosis is discussed. The role of immunosuppressive therapy for aplastic anaemia in causation of paroxysmal nocturnal haemoglobinuria is reviewed.

Superior sagittal sinus thrombosis: a rare complication of nephrotic syndrome.

A two and half year-old-male child, known case of steroid responsive nephrotic syndrome presented with fever and vomiting of acute onset. He was diagnosed to have superior sagittal sinus thrombosis on a contrast computerised tomographic scan of brain. Recovery was complete without anticoagulant therapy. Superior sagittal sinus thrombosis is an extremely rare complication of nephrotic syndrome.

Cerebrovascular Diseases Associated with Antiphospholipid Antibodies: Analysis of 45 cases

Lupus anticoagulant (LA) and anticardiolipin antibody (aCL) are circulating immunoglobulins against phospholipids which can result in prothrombotic conditions We present our experience of 45 LA and/or aCL positive stroke patients. I A was tested with a combination of aPTT mixing test, thromboplastin inhibition test, and kaolin clotting time. aCL was measured with ELIZA. There were 33 males and 12 females with their ages ranging from 20 to 76(mean 518) Fifteen patients did not have risk factors for stroke, while 13 had a single, and 17 had multiple risk factors. Hypertension (20 cases) and smoking (14 cases) were the important risk factors while cardiac diseases were found in 9 patients. All patients underwent head CT and/or MRI, which showed multiple infarcts in 18, single infarct in 22, intracerebral hemorrhages in 4, cortical venous infarct in 1 and sagittal sinus thrombosis in 1. Among patients with cerebral infarct, 23 had infarcts in carotid territory, only 7 of whom had large infarcts involving the cerebral cortex. Eleven had strokes in vertebro-basilar territory, and 6 had in both. Overall, 22 patients had relatively small infarcts in carotid territory. Angiogram was performed in 23 patients, which showed normal findings in 14 (most did not have risk factors), internal carotid narrowing or occlusion in 2, proximal MCA narrowing in 2, occlusion of vertebral artery in 1, multiple MCA and ACA occlusion in 1, and venous occlusion in interestingly, one patient showed occlusion of proximal branches of aorta consistent uith Takayasu's disease We conclude that relatively small multiple or single ischemic lnfarcts with negative angiographic findings are the most characteristic findings of antiphospholipid antibody associated stroke, while occasionally observed marked angiographic abnormalities or large cerebral embolic strokes are usually associated with other risk factors Antiphospholipid antibodies seem to play a role in the dlevelopment of cerebrovascular diseases in Korean patients especially in the young age.