Trombosis venosa cerebral recurrente en el embarazo / Recurrent cerebral venous thrombosis in pregnancy

La trombosis venosa cerebral es una enfermedad poco frecuente, pero de pronóstico potencialmente grave. Debido a los cambios hemostáticos durante la gestación, es una patología que puede asociarse al embarazo. Presenta un amplio rango de signos y síntomas. El diagnóstico y tratamiento precoz mejoran el pronóstico. Presentamos el caso de una mujer de 30 años, que en la semana 8 de gestación acude a Urgencias por cefalea intensa y cuya resonancia magnética reveló una trombosis venosa cerebral. La paciente presentó un segundo episodio en la semana 33, a pesar del correcto tratamiento anticoagulante recibido.

Cerebral venous thrombosis is a rare disease, but with a potentially serious prognosis. It is a condition that can be associated with pregnancy because of the hemostatic changes during gestation. It has a wide range of signs and symptoms. Early diagnosis and treatment improve prognosis. We report the case of a 30-year-old woman, at week 8 of pregnancy, who came to the emergency department for severe headache and whose magnetic resonance imaging revealed a cerebral venous thrombosis. The patient had a second episode at week 33, despite correct anticoagulation received.

Trombosis venosa cortical aislada: Comunicación de dos pacientes / Isolated cortical vein thrombosis: Report of two cases

Isolated cortical vein thrombosis is an uncommon presentation of central venous thrombosis. We report two females, aged 29 and 40 years, with isolated cortical vein thrombosis. Both presented with a focal neurological deficit and focal seizures that became generalized. The diagnosis was made with magnetic resonance imaging. Both had a history of oral contraceptive use. Both had a rapid response to unfractionated heparin. One patient had an antiphospholipid syndrome as a possible etiology. The most common manifestations of this disease are a transient or recurrent neurological deficit, visual disturbances and focal or generalized seizures, usually without intracanial hypertension. Neuroimages show ischemic abnormalities that do not follow an arterial vascular territory, often with an early hemorrhagic component. There is a good clinical response to heparin.

Trombosis venosa cerebral / Cerebral venous thrombosis

La trombosis venosa cerebral representa el 0,5 por ciento de los ictus y afecta con mayor frecuencia a sujetos jóvenes con factores de riesgo congénitos o adquiridos. Tiene manifestaciones clínicas variables que unidas a un estudio de neuroimagen adecuado permiten realizar el diagnóstico. La venografía, por resonancia magnética o tomografía computarizada, constituye la principal prueba de confirmación diagnóstica. En esta revisión se hace énfasis en los aspectos clínicos básicos para su diagnóstico y tratamiento que consiste en el control de los factores causales siempre que sea posible, el tratamiento sintomático, especialmente de la hipertensión endocraneana y el empleo de anticoagulantes.

Cerebral venous thrombosis accounts for 0.5 percent of the stroke and affects more frequently young persons with congenital or acquired risk factors. It has variable clinical manifestations that together with an adequate neuroimaging study allow to make the diagnosis. The venography by magnetic resonance or computerized tomography is the main test of diagnostic confirmation. In this review, emphasis is made on the basic clinical aspects for its diagnosis and treatment, consisting in the control of the causing factors if possible, the symptomatic treatment, especially of endocranial hypertension, and the use of anticoagulants.

Trombosis venosa cerebral puerperal: presentación de un caso / Puerperal cerebral venous trombosis: a case presentation

Presentamos el caso de una puérpera de 8 d que presenta cefalea de 4 d de evolución, asociada a cambios posicionales e hipertensión arterial. Es ingresada con diagnóstico presuntivo de trombosis venosa cerebral puerperal vs. hipertensión puerperal complicada y en menos de 12 h de su ingreso desarrolla un estado convulsivo tónico-clónico generalizado, con necesidad de ventilación mecánica y tratamiento anticonvulsivante, el diagnóstico fue sospechado por estudios de tomografía axial computadorizada y confirmada por angiorresonancia. Se inició tratamiento anticoagulante en dosis terapéutica desde el primer estudio imagenològico y egresó sin secuelas neurológicas. Se revisa el tema y se comentan los elementos que nos llevaron al planteamiento clínico de la entidad.

The article presented the case of a puerpera who, after 8 days of giving birth, suffered headache for 4 days associated to positional changes and blood hypertension. She was admitted to the hospital with a presumptive diagnosis of puerperal cerebral venous thrombosis vs complicated puerperal hypertension. Within 12 hours of admission, she developed a generalized tonic-clonic convulsive state and needed to be mechanically ventilated and treated with anticonvulsive drugs. CAT studies provided the suspected diagnosis whereas magnetic angioresonance confirmed it. Anti-coagulant treatment at therapeutic dose was provided since the first imaging study. She was discharged from hospital without any neurological sequelae. This topic was reviewed and the elements leading us to the clinical statement of the disease were commented on.

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.

Trombose de seio venoso cerebral e trombose sistêmica associadas à mutação do gene 20210 da protrombina: relato de caso / Cerebral and systemic venous thrombosis associated to prothrombin G20210 mutation: case report

Trombose venosa cerebral é entidade de grande gravidade se não identificada e tratada precocemente. As etiologias são diversas e seu reconhecimento pode ditar o tratamento e o prognóstico dos pacientes. Mutações genéticas têm sido envolvidas, principalmente a mutação do gene 20210 da protrombina. Relatamos o caso de homem, 53 anos, admitido em estado de mal convulsivo. Não apresentava antecedentes mórbidos pessoais ou familiares. Negava vícios. Após controle das crises, apresentava papiledema bilateral, e exame neurológico normal. Tomografia computadorizada revelou transformação hemorrágica de área de infarto venoso parieto-temporal direita. Punção lombar com manometria de 500 mmH2O revelou exame de líquor normal. Angiografia por ressonância magnética demonstrou trombose de seio sagital superior, transverso e sigmóide à direita. Mesmo em vigência de anticoagulação, apresentou trombose venosa profunda de membro inferior direito dois meses após o primeiro evento. A investigação etiológica foi totalmente negativa, e teste genético revelou mutação do gene 20210 da protrombina. A anticoagulação foi ajustada para RNI de 3,5 às expensas de 25mg diários de warfarin. Exames de controle revelaram reperfusão da circulação venosa cerebral, e paciente encontra-se assintomático

Heparin in haemorrhagic infarction in cerebral venous sinus thrombosis.

Morbidity and mortality in puerperal cerebral venous thrombosis (CVT) can be reduced by arresting the progression of thrombosis using heparin. However, conventional dose of heparin requires monitoring of coagulation parameters and carries a risk of haemorrhage. The present study involved 56 patients of puerperal CVT with CT evidence of haemorrhagic infarction. Twenty nine of these patients received low dose heparin till 30th post-partum day or symptomatic relief. Their clinical features and severity were similar to 27 patients who did not receive heparin. The mortality and morbidity at discharge was significantly less (P < 0.001) in heparin treated group. There were no haemorrhagic complications. Low dose heparin is safe and effective in cerebral venous thrombosis, even with haemorrhagic infarction.