[A case of cerebral venous sinus thrombosis following the vaccination with Tozinameran].

A 31-year-old man visited our hospital due to experiencing severe headaches, vomiting, and hypesthesia in the left side of his body. He had no past illnesses and had had no severe headaches before. The symptoms started the day after receiving the coronavirus disease 2019 (COVID-19) vaccination with Tozinameran. An MRI revealed cerebral venous sinus thrombosis and high intensity (DWI & FLAIR) of the right thalamus. Anticoagulant therapy was initiated, and his symptoms improved gradually. The follow-up MRI showed recanalization in a large part of the occluded venous sinuses. Most of the coagulation tests were normal, except for slightly high value of D-dimer, and the polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. Further cases are needed to judge if there is some sort of relationship between the vaccination and the cerebral venous sinus thrombosis.

Comparison of the Physical Characteristics of Support Stents for Cerebral Aneurysm Embolization.

Objective: There is a limited understanding of the characteristics of individual intracranial stents used for aneurysm treatment. We used an experimental model to evaluate the physical characteristics of support stents for aneurysm embolization. Methods: Enterprise 2 VRD 4.0 × 39 mm, Neuroform Atlas 4.5 × 21 mm, and LVIS 4.5 × 32 mm stents were: 1) observed under light microscopy and subjected to measurements of 2) circumferential radial force, 3) strut tension, 4) stent compression, and 5) conformability upon bending. Results: 1) Light microscopy showed a large structural difference between laser-cut (Enterprise 2 VRD, Neuroform Atlas) and braided (LVIS) stents. 2) Within the range of indicated blood vessel diameters, the radial force of Enterprise 2 VRD was higher than that of Neuroform Atlas. An extremely large force was required to decrease the LVIS diameter. 3) Neuroform Atlas easily deformed compared to Enterprise 2 VRD, while LVIS was extended with a smaller traction force than that required for Neuroform Atlas. 4) The compression strength was in the order of Enterprise 2 VRD >Neuroform Atlas >LVIS. 5) Enterprise 2 VRD showed a decreased cell area on the concave side, and Neuroform Atlas showed deformation with overlapping struts on the concave side. LVIS naturally adhered to the wall of the blood vessel model. Conclusion: Laser-cut and braided stents showed different physical characteristics that were visualized and shown as numerical data. These findings improve the understanding of the proper use of these stents in clinical applications.

Lemierre Syndrome Associated with Ipsilateral Recurrent Laryngeal Nerve Palsy: A Case Report and Review.

Lemierre syndrome (LS) is a rare life-threatening disease that is often caused by an acute oropharyngeal infection with a secondary thrombophlebitis of the internal jugular vein. LS rarely manifests as cranial nerve palsy. To the best of our knowledge, this is the second case report of LS associated with recurrent laryngeal nerve palsy. A 66-year-old female presented to a dental clinic with gingivitis and sore throat. Due to moderate periodontitis, her left first upper molar was extracted. A few days later, she subsequently developed a coarse voice and occipital headaches, and was referred to an otolaryngologist. She was diagnosed with left recurrent laryngeal nerve palsy and subsequent left-sided otitis media, and was referred to us for persistent headaches. She intermittently presented with high-grade fever and complained of salty taste disturbance. Her head magnetic resonance imaging (MRI) revealed left mastoiditis, thrombosis in the left transverse and sigmoid sinus, and left internal jugular vein. Her laboratory tests revealed an elevated white blood cell count, levels of C-reactive protein, and D-dimer. No endogenous coagulopathy was confirmed. Although, blood and cerebrospinal fluid culture grew no microorganisms, respectively, the empirically determined antibiotic therapy was initiated. In a week, the patient defervesced and had no headaches despite persistent thrombosis. Early diagnosis and an immediate antibiotic treatment are crucial for LS patients. Anticoagulation therapy was not needed for our patient and is still controversial for LS.

Subarachnoid hemorrhage secondary to a ruptured middle cerebral aneurysm in a patient with osteogenesis imperfecta: a case report.

BACKGROUND: Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders that occur owing to the abnormalities in type 1 collagen, and is characterized by increased bone fragility and other extraskeletal manifestations. We report the case of a patient who was diagnosed with OI following subarachnoid hemorrhage (SAH) secondary to a ruptured saccular intracranial aneurysm (IA). CASE PRESENTATION: A 37-year-old woman was referred to our hospital because of sudden headache and vomiting. She was diagnosed with SAH (World Federation of Neurosurgical Society grade 2) owing to an aneurysm of the middle cerebral artery. She then underwent surgical clipping of the aneurysm successfully. She had blue sclerae, a history of several fractures of the extremities, and a family history of bone fragility and blue sclerae in her son. According to these findings, she was diagnosed with OI type 1. We performed genetic analysis for a single nucleotide G/C polymorphism (SNP) of exon 28 of the gene encoding for alpha-2 polypeptide of collagen 1, which is a potential risk factor for IA. However, this SNP was not detected in this patient or in five normal control subjects. Other genetic analyses did not reveal any mutations of the COL1A1 or COL1A2 gene. The cerebrovascular system is less frequently involved in OI. OI is associated with increased vascular weakness owing to collagen deficiency in and around the blood vessels. SAH secondary to a ruptured IA with OI has been reported in only six cases. CONCLUSION: The patient followed a good clinical course after surgery. It remains controversial whether IAs are caused by OI or IAs are coincidentally complicated with OI.