Primary hyperparathyroidism in pregnancy: a case report highlighting uncommon complication / Hiperparatiroidismo primario en el embarazo: reporte de caso destacando una complicación infrecuente

Abstract Primary hyperparathyroidism (PHPT) is characterized by elevated levels of calcium and parathyroid hormone (PTH). However, the interpretation of diagnostic tests, such as serum calcium and PTH levels, is complex in pregnant women. The aim of this report is to present a case of PHTP in a pregnant adolescent, with a special emphasis on an uncommon complication, as well as diagnostic and treatment strategies. A 17-year-old pregnant female presented with hyper emesis gravidarum and neurological symptoms, leading to the diagnosis of cerebral venous thrombosis. Further investigations revealed hypercalcemia and persistently elevated PTH levels, consistent with PHPT. After local ization studies, the patient underwent an emergency parathyroidectomy with a diagnosis of parathyroid ad enoma. During follow-up, intrauterine growth restric tion and severe preeclampsia developed, necessitating an emergency cesarean section. Both the mother and neonate had favorable outcomes. PHPT is an infrequent condition in the pregnant population, and its diagnosis can be challenging due to the overlap of symptoms with normal physiological changes during pregnancy. The occurrence of uncom mon complications, such as thrombotic phenomena, highlights the need for a comprehensive approach to ensure early detection and management. In most cases, parathyroidectomy is the treatment of choice.

Resumen El hiperparatiroidismo primario (HPTP) se caracteriza por niveles elevados de calcio y hormona paratiroidea (PTH). Sin embargo, la interpretación de pruebas diag nósticas, como los niveles de calcio sérico y PTH, es compleja en mujeres embarazadas. El objetivo de este re porte es presentar un caso de HPTP en una adolescente embarazada, con especial hincapié en una complicación infrecuente, así como en las estrategias diagnósticas y de tratamiento. Una mujer embarazada de 17 años presentó hiperé mesis gravídica y síntomas neurológicos, lo que llevó al diagnóstico de trombosis venosa cerebral. Posterio res investigaciones revelaron hipercalcemia y niveles persistentemente elevados de PTH, consistentes con HPTP. Tras la realización de estudios de localización, la paciente fue sometida a una paratiroidectomía de emergencia con diagnóstico de adenoma de paratiroi des. Durante el seguimiento, se desarrolló restricción del crecimiento intrauterino y preeclampsia grave, lo que resultó en la necesidad de realizar una cesárea de emergencia. Tanto la madre como el neonato evolucio naron favorablemente. El HPTP es una condición infrecuente en la población embarazada y su diagnóstico puede ser desafiante por la superposición de síntomas con los cambios fisiológicos normales del embarazo. La aparición de complicaciones infrecuentes, como fenómenos trombóticos, resalta la necesidad de un abordaje integral para garantizar la detección y el manejo temprano. En la mayoría de los casos, la paratiroidectomía es el tratamiento de elección.

Association of cerebral venous outflow with first-pass effect in anterior circulation large vessel occlusion accepted mechanical thrombectomy / 中华神经医学杂志

Objective:To explore the association of cerebral venous outflow assessed by CT angiography (CTA) with first pass effect (FPE) in patients with acute anterior circulation large vessel occlusion accepted mechanical thrombectomy (MT).Methods:A retrospective analysis was performed; patients with acute anterior circulation large vessel occlusion accepted MT and CTA in Department of Neurology, Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2021 were consecutively enrolled. Cerebral venous outflow in baseline CTA was evaluated using Cortical Vein Opacification Score (COVES). Patients were categorized into either FPE or non-FPE groups based on recanalization of occluded vessels after initial MT. General information, clinical features, radiological data, and surgery-related data between the 2 groups of patients were collected and compared. Significant variables ( P<0.1) from univariate analysis were included into a multivariable Logistic regression model to explore the relation between COVES and FPE. Predictive value of COVES in FPE was assessed using receiver operating characteristic (ROC) curve. Results:Out of the 143 patients enrolled in this study, 52 were into the FPE group and 91 were into the non-FPE group. Compared with the non-FPE group, the FPE group had higher COVES scores, higher proportion of patients with good cerebral venous drainage (COVES≥3), smaller core infarct volume, and shorter time from femoral artery puncture to vessel recanalization, with significant differences ( P<0.05). Multivariable Logistic regression analysis revealed that COVES was still corelated with FPE after adjusting covariates such as baseline NIHSS scores, core infarct volume, and time from femoral artery puncture to vessel recanalization ( OR=0.730, 95% CI: 0.567-0.940, P=0.015). ROC curve demonstrated that the combined model of COVES with aforementioned factors (COVES scores+baseline NIHSS scores+core infarct volume+time from femoral artery puncture to vessel recanalization) had an area under the curve of 0.757 (95% CI: 0.672-0.841, P<0.001), with sensitivity of 61.5% and specificity of 78.0%. Conclusion:Favorable cerebral venous drainage is an independent predictor for successful FPE in patients with acute anterior circulation large vessel occlusion accepted MT.

Cerebral venous sinus thrombosis presenting as intracerebral hemorrhage and subarachnoid hemorrhage: A case report

@#We present a 66-year-old male presenting with sudden onset of headache. Medical decompression was done and neuroimaging of plain cranial CT angiogram (CTA) and CT venogram (CTV) showed components of subarachnoid hemorrhage, intracerebral hemorrhage and hyperdense appearance of the superior sagittal sinus and proximal left transverse sinus. The following were done to look for etiologic factors: 1. fungal swab to determine the cause of the intracerebral hemorrhage secondary to venous thrombosis as the patient presented with a chronic history of sinusitis, 2. coagulopathy workup to look for a hypercoagulable state, and 3. workup for systemic disease of autoimmune in etiology. Anticoagulation was safely initiated within several days given the regression of the intracerebral hemorrhage along with stable findings of subarachnoid hemorrhage. Here we report cerebral venous sinus thrombosis rarely presenting as acute subarachnoid hemorrhage and intracerebral hemorrhage.

Correlation between enlarged perivascular space and cerebral venous reflux in recent small subcortical infarcts within the lenticulostriate artery territory / 中华神经科杂志

Objective:To summarize the incidence of cerebral venous reflux (CVR) in patients with recent small subcortical infarct (RSSI) and explore its correlation with enlarged perivascular spaces (EPVS).Methods:Patients with RSSI in the lenticulostriate artery admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 were included. The baseline demographic data, medical history, and laboratory results of the patients were collected. CVR was assessed by time-of-flight magnetic resonance angiography. Patients were stratified into 2 groups based on the presence (CVR group) or absence of CVR (non-CVR group), and baseline characteristics as well as laboratory test results were compared between the 2 groups. The location and number of EPVS were evaluated using a visual grading scale, with EPVS with higher scores defined as high-grade EPVS (HEPVS). Simultaneous evaluation of cerebral white matter hyperintensities and lacunar infarctions was conducted, followed by intergroup comparisons. The relationship between EPVS and CVR was studied using multiple Logistic regression analysis.Results:A total of 571 patients with RSSI in the lentiform artery area were ultimately included, including 180 females (31.5%). Their age was (59.37±12.87) years. Among them, 73 patients (12.8%) exhibited CVR based on imaging findings, so the incidence of CVR was 12.8%. In comparison between the CVR group ( n=73) and the non-CVR group ( n=498), the proportion of females [21.9% (16/73) vs 32.9% (164/498), χ 2=3.578, P=0.059] was lower and the proportion of history of smoking [38.4% (28/73) vs 27.7% (138/498), χ 2=3.499, P=0.061] was higher in the CVR group, but without statistical significance. Additionally, the history of alcohol consumption [34.2% (25/73) vs 21.7% (108/498), χ 2=5.621, P=0.018] and the proportion of patients with concomitant HEPVS in the basal ganglia area [41.1% (30/73) vs 25.3% (126/498), χ 2=7.999, P=0.005] was higher in the CVR group with statistical significance. Multiple Logistic regression analysis showed that HEPVS in the basal ganglia region remained independently associated with CVR ( OR=1.988, 95% CI 1.190-3.320, P=0.009). Conclusion:EPVS in the basal ganglia region is significantly associated with CVR in the RSSI population, suggesting that venous dysfunction may be closely related to the formation of EPVS.

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.

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.

Epidemiology, pathogenesis, and management of Coronavirus disease 2019-associated stroke / 医学前沿

The Coronavirus disease 2019 (COVID-19) epidemic has triggered a huge impact on healthcare, socioeconomics, and other aspects of the world over the past three years. An increasing number of studies have identified a complex relationship between COVID-19 and stroke, although active measures are being implemented to prevent disease transmission. Severe COVID-19 may be associated with an increased risk of stroke and increase the rates of disability and mortality, posing a serious challenge to acute stroke diagnosis, treatment, and care. This review aims to provide an update on the influence of COVID-19 itself or vaccines on stroke, including arterial stroke (ischemic stroke and hemorrhagic stroke) and venous stroke (cerebral venous thrombosis). Additionally, the neurovascular mechanisms involved in SARS-CoV-2 infection and the clinical characteristics of stroke in the COVID-19 setting are presented. Evidence on vaccinations, potential therapeutic approaches, and effective strategies for stroke management has been highlighted.

Characteristics and influencing factors of intracranial hemorrhagic lesions in patients with intracranial venous sinus thrombosis / 中国医师进修杂志

Objective:To explore the clinical characteristics and influencing factors intracranial hemorrhagic lesions in patients with intracranial venous sinus thrombosis (CVST).Methods:The 108 patients with CVST from January 2013 to December 2020 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. Among them, 46 patients had intracranial hemorrhagic lesions (hemorrhagic lesion group), and 62 patients did not have intracranial hemorrhagic lesions (non hemorrhagic lesion group). The general medical history data, laboratory examination results, imaging examination results, National Institutes of Health stroke scale (NIHSS) score within 24 hours of admission and modified Rankin scale (mRS) score (2 to 6 scores indicating poor prognosis) at discharge (or on the 30th day of hospitalization) were recorded. Multivariate Logistic regression analysis was used to analyze the independent risk factors of intracranial hemorrhagic lesions in patients with CVST and the independent risk factors of prognosis in patients CVST combined with intracranial hemorrhagic lesions.Results:The NIHSS score, neutrophil to lymphocyte ratio (NLR), high sensitivity C-reactive protein (hs-CRP) and the proportions of changes in consciousness, epileptic seizures, poor prognosis, oral contraceptives, congenital protein C or S deficiency in hemorrhagic lesion group were significantly higher than those in non hemorrhagic lesion group: 4 (0, 10) scores vs. 0 (0, 5) scores, 4.62 (2.50, 8.58) vs. 3.46 (2.01, 5.00), 13.1 (5.6, 56.7) mg/L vs. 7.5 (2.8, 18.0) mg/L, 47.8% (22/46) vs. 29.0% (18/62), 39.1% (18/46) vs. 21.0% (13/62), 39.1% (18/46) vs. 21.0% (13/62), 32.6% (15/46) vs. 8.1% (5/62), 30.4% (14/46) vs. 12.9% (8/62), and there were statistical differences ( P<0.01 or <0.05). The incidences of straight sinus and multiple venous sinus thrombosis in hemorrhagic lesion group were significantly higher than those in non hemorrhagic lesion group: 43.5% (20/46) vs. 24.2% (15/62) and 82.6% (38/46) vs. 58.1% (36/62), and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that the oral contraceptives, multiple venous sinus thrombosis and the elevated hs-CRP, NLR were independent risk factors of intracranial hemorrhagic lesions in patients with CVST ( OR = 6.950, 5.182, 1.026 and 1.137; 95% CI 1.453 to 33.243, 1.076 to 24.960, 1.007 to 1.046 and 1.004 to 1.287; P<0.05 or <0.01). Among 46 patients with CVST combined with intracranial hemorrhagic lesions, 28 patients had a good prognosis, and 18 patients had a poor prognosis. The NIHSS score, NLR, hs-CRP and the proportions of oral contraceptives, congenital protein C or S deficiency, changes in consciousness and epileptic seizures in patients with poor prognosis were significantly higher than those in patients with good prognosis: 9 (4, 28) scores vs. 0 (0, 6) scores, 7.43 (3.86, 12.99) vs. 3.3 (1.97, 6.77), 127.0 (96.5, 168.0) mg/L vs. 11.5 (3.3, 33.5) mg/L, 10/18 vs. 17.9% (5/28), 10/18 vs. 14.3% (4/28), 12/18 vs. 35.7% (10/28) and 11/18 vs. 25.0% (7/28), and there were statistical difference ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that the elevated hs-CRP was the independent risk factor of prognosis in patients CVST combined with intracranial hemorrhagic lesions ( OR = 1.046, 95% CI 1.007 to 1.086, P<0.05). Conclusions:The patients with CVST combined with intracranial hemorrhagic lesions have more severe clinical symptoms, and the changes in consciousness, epileptic seizures, poor short-term prognosis are more common. The oral contraceptives, multiple venous sinus involvement and elevated NLR, hs-CRP are independent risk factors in patients with CVST combined with intracranial hemorrhagic lesions; moreover, the elevated hs-CRP is an independent risk factor for poor short-term prognosis in patients with CVST combined with intracranial hemorrhagic lesions.

Analysis of clinical characteristics and risk factors of patients with cerebral venous sinus thrombosis in the puerperium / 中国综合临床

Objective:To investigate the risk factors of cerebral venous sinus thrombosis (CVST) during puerperal period.Methods:This study was a restrospective analysis, A total of 33 puerperal CVST patients admitted to Beijing Tiantan Hospital, Capital Medical University from January 2016 to November 2022 were selected as the observation group, and 61 puerperal healthy women who underwent postpartum follow-up at the same period in the hospital were selected as the control group. The age, body mass index (BMI), smoking history, hypertension history, diabetes history, drug use history and mode of delivery or abortion of the two groups of women were compared and collected, as well as the level of laboratory indicators. The risk factors of CVST in puerperal period were analyzed. The measurement data of normal distribution were represented by two independent samples t test for comparison between groups. The measurement data of non-normal distribution were expressed as M ( Q1, Q3), and the Wilcoxon rank sum test was used for comparison between groups. The count data is expressed as number (%), and the comparison between groups is performed using χ 2 test or Fisher exact probability method. Logistic regression model was established to analyze the risk factors of CVST in puerperal period. Results:BMI, serum LDH, α-HBDH, fasting blood glucose, HCY levels, WBC, NEU, NLR, RDW and MPV in observation group were higher than those in control group [(30.21±4.25) kg/m 2 vs (21.94±3.02) kg/m 2]. 195.15(183.10,240.98) U/L vs 165.75(154.55,184.62) U/L, 166.60(143.10,188.60) U/L vs 124.10(116.30,137.90) U/L, (4.88 ± 0.98) vs (4.25±0.41), 8.35 (7.10, 12.16) μmol/L vs 6.60 (5.30, 7.58) μmol/L, 9.26 (6.56, 11.76) × 10 9/L vs 7.25 (6.23, 8.00) × 10 9/L, and 7.18 (4.66, 8.79) × 10 9/L vs 3.93 (3.25, 4.52) × 10 9/L, 4.13 (2.27,6.55) vs 1.63 (1.16,1.97), 42.80(38.95,47.45) fL vs 40.70(38.95,42.60) fL, (9.52±0.99) fL vs 8.96±0.88 fL], LY and PDW were lower than control group [1.58(1.11,1,96)×10 9/L vs 2.50(2.04,2.91)×10 9/L, 15.60(11.65,16.20) fL vs 16.00(15.80,16.30) fL]. The differences were statistically significant ( t=4.58, P<0.001; Z=4.54, P<0.001; Z=5.56, P<0.001; t=3.38, P=0.002; Z=4.18, P<0.001; Z=3.39, P=0.001; Z=4.92, P<0.001; Z=4.92, P<0.001; Z=4.54, P<0.001; Z=5.56, P<0.001; Z=4.18, P<0.001; Z=4.92, P<0.001; Z=5.87, P<0.001; Z=2.18, P=0.029; t=2.82, P=0.006; Z=4.78, P<0.001; Z=2.52, P=0.012). Multivariate Logistic regression analysis showed that NEU, HCY and α-HBDH were risk factors for puerparal CVST (odds ratios were 3.07, 1.53 and 1.07, respectively, 95% confidence interval: 1.65~5.71, 1.09~2.15, 1.02~1.12, P values were <0.001, 0.014, 0.007, respectively). Conclusions:α-HBDH, HCY and NEU are independent risk factors for puerperal CVST.

Value of optic nerve sheath diameter and optical disk elevation measured by ultrasound in the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis / 中华超声影像学杂志

Objective:To investigate the diagnostic value of ultrasonic measurement of optic nerve sheath diameter (ONSD) and optical disk elevation (ODE) for intracranial hypertension in patients with cerebral venous sinus thrombosis(CVST).Methods:A total of 50 patients with CVST who underwent lumbar puncture and ONSD examination in the Department of Neurology and Emergency Department of Xuanwu Hospital, Capital Medical University from January 2021 to December 2021 were retrospectively enrolled. After lumbar puncture, the patient′s initial intracranial pressure was recorded. Normal ICP was defined as ICP between 80 and 200 mmH 2O, and increased ICP was defined as ICP>200 mmH 2O. Fifty patients with CVST were divided into normal ICP group (14 cases) and increased ICP group (36 cases). The differences of baseline data, ONSD and ODE between the two groups were compared, and the receiver operating characteristic (ROC) curve was generated. The area under the curve (AUC) and the diagnostic cut-off value of ONSD were analyzed. Spearman correlation analysis was used to analyze the correlation between ONSD, ODE, CVST involvement range scores and intracranial pressure. Results:①There were no significant differences in gender, age and body mass index between the normal ICP group and the increased ICP group (all P>0.05). ②The ONSD and ODE in the increased ICP group were higher than those in the normal ICP group, and the differences were statistically significant [(4.83±0.33)mm vs (4.21±0.21)mm, (0.67±0.44)mm vs (0.24±0.29)mm, all P<0.001]. Spearman correlation analysis showed that ONSD and ODE were positively correlated with intracranial pressure ( rs=0.74, 0.51, all P<0.001). ③The extent of CVST involvement in the intracranial hypertension group was higher than that in the normal intracranial pressure group, and the difference was statistically significant [5.0(3.0, 7.5) vs 2.5(2.0, 5.0), P=0.015]. Spearman correlation analysis showed that CVST involvement score was positively correlated with intracranial pressure ( rs=0.43, P<0.001). ④In the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis, the AUC of ONSD was 0.935, the best diagnostic threshold of ONSD was 4.5 mm, the sensitivity was 0.81, and the specificity was 0.93. Conclusions:ONSD and ODE measured by ultrasound are reliable imaging methods to identify intracranial hypertension in patients with CVST.

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.

Immersive photoreal new-age innovative gameful pedagogy for e-ophthalmology with 3D augmented reality

Augmented reality (AR) has come a long way from a science?fiction concept to a science?based reality. AR is a view of the real, physical world in which the elements are enhanced by computer?generated inputs. AR is available on mobile handsets, which constitutes an essential e?learning platform. Today, AR is a real technology and not a science?fiction concept. The use of an e?ophthalmology platform with AR will pave the pathway for new?age gameful pedagogy. In this manuscript, we present a newly innovated AR program named "Eye MG AR" to simplify ophthalmic concept learning and to serve as a new?age immersive 3D pedagogical tool for gameful learning.

Cerebral venous sinus thrombosis caused by pegasparaginase: a clinical analysis of 8 cases / 中华神经医学杂志

Objective:To investigate the risk factors and prognoses of cerebral venous sinus thrombosis (CVST) caused by pegasparaginase (PEG-Asp).Methods:A total of 252 children with acute lymphoblastic leukemia (ALL) were treated with PEG-Asp chemotherapy in our hospital from December 2016 to July 2021, including 8 children with CVST. The clinical manifestations, laboratory and imaging features, treatments and prognoses of these children with CVST caused by PEG-Asp were analyzed retrospectively.Results:(1) CVST occurred during induction chemotherapy in 4 children, during re-induction chemotherapy in 3 children, and during consolidation stage in one child. CVST occurred in two children who received PEG-ASP chemotherapy once, in one child who received PEG-Asp chemotherapy twice, and 5 children who received PEG-Asp chemotherapy more than twice. The median time between CVST occurrence and last treatment of PEG-Asp was 20.5 d. (2) The clinical manifestations included paroxysmal headache ( n=4), nausea or vomiting ( n=3), convulsions ( n=2) and persistent blurred vision ( n=1). (3) CVST appeared at the sigmoid sinus ( n=6), transverse sinus ( n=4) and superior sagittal sinus ( n=4), of which one child was complicated with hemorrhage in left frontal parietal and right parietal cortex, and one with reversible posterior encephalopathy syndrome; 8 children were not complicated with thrombus in other parts. (4) Some of the children were complicated with abnormal blood coagulation. When CVST occurred, fibrinogen level decreased in 3 children, anti-thrombin III level decreased in 2 children, and D-dimer level increased in 3 children. (5) Six children were treated with low molecular weight heparin (LMWH), of which, 4 were treated with rivasaban and one with warfarin sequentially. The total course of anticoagulation was 56 d. (6) The symptoms of 6 children disappeared after anticoagulation; Magnetic resonance venography (MRV) showed disappeared thrombus in 4 children and reduced thrombus range in 2 children. One child with intracranial hemorrhage did not use PEG-Asp anymore; 7 accepted PEG-Asp further during follow-up chemotherapy, of which one had CVST recurrence and the range of thrombus was reduced after anticoagulant therapy. Conclusions:When children with ALL develop unexplained neurological symptoms during PEG-Asp chemotherapy, CVST should be highly vigilant. Enhanced MRI and MRV should be performed for early diagnosis. Some children are complicated with abnormal blood coagulation, and LMWH, warfarin and rivasaban are effective. The prognosis is good and there are no sequelae. Most children accepted PEG-Asp again will not have CVST again.

The clinical value of eye-neck integrated ultrasound in idiopathic intracranial hypertension and cerebral venous sinus thrombosis / 中风与神经疾病杂志

@#The clinical presentation of cerebral venous sinus thrombosis （CVST） overlaps with that of idiopathic intracranial hypertension （IIH），but no screening tool exists. We investigated the role of eye-neck integrated ultrasound in the diagnosis and differentiation of IIH and CVST. Methods Twenty IIH patients，25 CVST patients，and 40 healthy controls were retrospectively analyzed.The ultrasonographic optic nerve sheath diameter （ONSD） and hemodynamic characteristics of the internal jugular veins（IJVs）were recorded. The cerebrospinal fluid opening pressure was measured after ultrasonic examination.Results The ONSD was significantly larger in IIH patients than in controls （4.71±0.41 vs. 3.93±0.24 mm，P<0.001）.The ONSD cut off for IIH diagnosis was 4.25 mm （AUC=0.978，95%CI 0.95～1.00，P<0.001，sensitivity：90%，specificity：93%）.In the CVST group，19 （76%） patients had elevated intracranial pressure （ICP）；the mean ONSD was significantly higher in patients with increased ICP than in those without （4.35±0.22 vs. 3.96±0.18 mm，P<0.001）.The mean blood flow volume （BFV） was significantly reduced in CVST patients （404.43±314.73 mL/min） compared to that in controls（680.37±233.03 mL/min，P<0.001） and IIH patients （617.67±282.96 ml/min，P=0.008）. The optimal BFV cut off for predicting CVST was 471.60 ml/min（AUC=0.841，95%CI 0.73～0.95，P<0.001，sensitivity：88%，specificity：72%）.No difference in frequency of IJVVI between patients and controls. Conclusion Eyeneck integrated ultrasound is an easily available bedside technique to assess ICP and hemodynamic characteristics of IJVs.ONSD measurement can identify patients with increased ICP，and reduced IJV BFV may aid the differentiation of CVST and IIH.

Progress in cerebral venous collagenosis / 中华神经科杂志

Moody and colleagues discovered the presence of venous collagenosis (VC) in periventricular of human brains by pathological study obtained at autopsy in 1995, which was described as a noninflammatory collagenous thickening of venous walls resulting in severe periventricular venous stenosis or occlusion. Due to the lack of specific markers and staining methods, there are few studies of cerebral venous disease, and the pathological features and pathogenesis are still unclear. However, studies have reported that VC is associated with cerebral small vessel disease (CSVD) and Alzheimer′s disease (AD), suggesting that VC may play an important role in exploring and elucidating pathogenesis. The article aims to provide a review of researches on VC pathological features, possible pathogenesis and correlation with CSVD and AD.

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.

Recent advance in diagnosis and treatment of cerebral venous sinus thrombosis / 中华神经医学杂志

Cerebral venous sinus thrombosis (CVST) is a relatively rare cerebrovascular disease. In recent years, in order to further deepen the understanding of the disease, reduce the missed diagnosis rate and misdiagnosis rate, and improve the curative effect, a series of studies on the diagnosis and treatment strategies of CVST have been carried out at home and abroad. It is found that some new imaging technologies can improve the early diagnosis rate of the disease, and some new drugs have emerged to treat the disease. In order to help clinical colleagues to further improve their understanding, this paper briefly reviews this.

Clinical characteristics and therapeutic efficacy of spontaneous intracranial hypotension complicated with cerebral venous thrombosis: an analysis of four cases / 中华神经医学杂志

Objective:To investigate the clinical characteristics and therapeutic efficacy of spontaneous intracranial hypotension (SIH) complicated with cerebral venous thrombosis (CVT).Methods:The clinical data of 4 patients with SIH complicated with CVT admitted to our hospital from March 2014 to April 2020 were retrospectively analyzed. And the clinical data of 35 patients with SIH complicated with CVT were included for summary analysis through literature retrieval (the databases included PubMed, CNKI and Wanfang; retrieval period was from database construction to December 31, 2020).Results:These 4 patients were with onset of orthostatic headache; one was with recurred orthostatic headache after relief, and the other 3 developed persistent headache and epileptic seizure; case 1 was with superior sagittal sinus and cortical vein thrombosis, case 3 was with superior sagittal sinus thrombosis, and other 2 patients were with isolated cortical vein thrombosis. Twenty-six documented cases demonstrated headache changes: 12 patients (46.15%) developed persistent headache, 12 patients (46.15%) showed orthostatic headache persistently, and 2 patients (7.69%) had disappeared headache. The most common new symptoms were epilepsy in 17 patients (48.57%) and limb weakness in 10 patients (28.57%). Totally, these 31 patients (4 patients from our hospital+27 patients from literature retrieval) had hemorrhage after treatment; the percentage of patients having hemorrhage changes in the 17 patients accepted anticoagulant therapy was significantly increased as compared with that in 14 patients accepted other treatments (7/17 vs. 1/14, P<0.05); there were no bleeding changes in 5 patients accepted epidural blood patch and anticoagulant therapy. Conclusions:The clinical features of SIH complicated with CVT are various, and the change of headache is not a reliable marker. In the course of SIH, it is necessary to be alert to the occurrence of CVT if there are new symptoms such as epileptic attack or limb weakness. The etiological treatment of SIH is essential and the hemorrhage risk after anticoagulant therapy should be concerned in patients with SIH complicated with CVT.

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.