Facial pain associated with vein of Trolard thrombosis Case report Neurology.

Cerebral venous thrombosis is a rare condition, with identified and described risk factors mainly associated with prothrombotic states, with a wide variety of symptomatology based on the site affected, the most common being intracranial hypertensive syndrome, focal or encephalopathy. Cortical veins of the superficial system are among the least frequently affected veins. The following describes a case of painful facial symptoms progressing to a focal syndrome associated with a history of chronic oral contraceptive use, with thrombosis of vein of Trolard detected and successfully treated with oral anticoagulants.

IgG4-Related Disease of Temporal Bone Presenting as Unilateral Mastoiditis and Cerebral Thrombosis in a 22-Year-Old Man.

BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a rare autoimmune disease that can affect multiple organs and manifest itself as a mass at any region of the body. Due to its several differential diagnoses, investigation and treatment are still challenging. Therefore, imaging, serology, and histopathology are required to confirm the diagnosis. The involvement of the temporal bone is an uncommon presentation, often mistaken for malignancy, with vague symptoms. Therefore, we present a 22-year-old Brazilian man, diagnosed with IgG4-related disease, manifesting with unilateral mastoiditis, sensorineural hearing loss, cerebral venous sinus thrombosis, and a mass in the left temporal bone. CASE REPORT A 22-year-old Brazilian male patient first presented with coughing and precordialgia. Chest scans showed pleural effusion and diffuse areas of ground-glass opacity. A year later, the patient developed severe headache, along with aural fullness, facial pressure, and otorrhea. Imaging detected cerebral thrombosis with failure in the filling of the transverse and left sigmoid sinuses and pachymeningeal thickening in the right cerebral hemisphere, with contrast enhancement. Pure tone audiometry showed thresholds consistent with severe sensorineural hearing loss in the left ear. The patient underwent mastoidectomy with removal of large amounts of inflammatory tissue that were sent to histopathological analysis with compatible signs of IgG4-RD. Corticosteroids and rituximab completed the treatment. CONCLUSIONS Early recognition and appropriate treatment of IgG4-RD are imperative to avoid complications and serious irreversible organ damage. This report has presented an atypical case of IgG4-RD of the left temporal bone that was diagnosed and managed according to current guidelines.

Reporte de caso: trombosis cerebral en el embarazo / Case report: cerebral thrombosis in pregnancy

La trombosis venosa cerebral en el embarazo se manifiesta como un accidente vascular cerebral de tipo venoso, infrecuente. El diagnóstico y tratamiento anticoagulante precoz disminuye la morbimortalidad. El objetivo de este trabajo de investigación es describir los signos, síntomas y estudios complementarios que guiaron al diagnóstico y tratamiento del caso, trombosis cerebral en el embarazo, de una paciente en el consultorio Conmed, La Paz ­ Bolivia, en el año 2021. El caso trata de una mujer de 32 años de edad en periodo de gestación, refiere presentar hace 1 semana cefalea, náuseas y vómitos, presenta desvanecimiento quedando somnolienta, el examen físico indica compromiso neurológico, motivo de su internación. El hemograma reporta anemia; la TC y RM de cráneo imagen nodular focal hipodensa en región frontal derecha y área hiperintensa en seno longitudinal superior, respectivamente; indicando sospecha de trombosis venosa del seno longitudinal superior. Se empieza tratamiento profiláctico con enoxaparina evolucionando favorablemente. Se realiza una venorresonancia confirmando el diagnostico, continuando tratamiento con enoxaparina. Las manifestaciones clínicas son diversas, siendo las más comunes: Cefalea, náuseas, vómitos. El criterio estándar para diagnosticar trombosis venosa cerebral es la combinación de imagen por resonancia magnética y la venografía por resonancia magnética. La anticoagulación (enoxaparina) es la terapia de primera línea en el manejo de trombosis venosa cerebral en el embarazo. En conclusión, la trombosis venosa cerebral es una entidad infrecuente, con manifestaciones clínicas variables; la tomografía, resonancia magnética, venorresonancia determinan el diagnóstico definitivo y la anticoagulación (enoxaparina) es el tratamiento de primera línea.

Cerebral venous thrombosis.

Cerebral venous sinus thrombosis (CVT) consists of partial or complete occlusion of a sinus or a cerebral vein. CVT represents 0.5-1% of all strokes and is more frequent in young women. This review discusses particular aspects of CVT diagnosis and management: decompressive craniectomy (DC), anticoagulation with direct oral anticoagulants (DOACs), CVT after coronavirus-disease 19 (COVID-19) and Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).

Headache at the chronic stage of cerebral venous thrombosis.

BACKGROUND: Headache is the most frequent symptom of cerebral venous thrombosis (CVT) but there is limited information about the frequency and phenotype of headache, weeks to months after cerebral venous thrombosis (post-cerebral venous thrombosis headache, PCH). OBJECTIVE: To assess the frequency, characteristics and predictors of PCH. METHODS: In this cross-sectional study, the frequency and characteristics of PCH were assessed in cerebral venous thrombosis survivors. Patients were interviewed between six months and five years after the cerebral venous thrombosis diagnosis. Clinical and imaging characteristics at the time of cerebral venous thrombosis diagnosis, as well as history of headache prior to cerebral venous thrombosis were compared in subjects with (GroupPCH) and without PCH (Groupcontrol). RESULTS: Subjects (n = 100; 82% women) were assessed, on average, at 1.1 ± 1.6 years of follow-up. PCH was present in 59% of the patients, phenotypes of tension-type-like headache were present in 31/59 (52.6%) and of migraine-like headache in 16/59 (27.1%). History of primary headache prior to cerebral venous thrombosis was significantly more common (OR: 6.4; 95% CI: 1.7-36.3) in GroupPCH (33.9%) than in Groupcontrol (7.3%). CONCLUSION: PCH was present in more than half of the patients. History of prior headache may be a risk factor for PCH. Prospective studies are required to confirm these findings and determine mechanisms, as well as interventions for prevention and treatment of PCH.

Trombosis de seno venoso asociada con infección por SARS-CoV-2 / Cerebral venous thrombosis associated with SARS-Cov-2 infection

RESUMEN INTRODUCCION: La trombosis del seno venoso se considera una de las causas más infrecuentes de enfermedad cerebrovascular (ECV), prevalente en la edad joven. Suele tener un inicio insidioso, lo cual dificulta su diagnóstico y el inicio oportuno del tratamiento, y se encuentra asociada con múltiples factores de riesgo, incluyendo estados de hipercoagulabilidad, como en aquellos pacientes que cursan con infección por SARS-CoV-2. REPORTE DE CASO: Se presentan dos casos clínicos de pacientes con alteraciones neurológicas, diplopia y estatus epiléptico, en quienes se documentó por medio de la sintomatologia y de estudios imagenológicos, trombosis venosas extensas de localización infrecuente, se descartaron las principales etiologías asociadas, y el único nexo asociado fue la infección por SARS-CoV-2. Ambos pacientes recibieron tratamiento con anticoagulación parenteral, al que respondieron de forma exitosa, por lo cual se logró el alta posteriormente con anticoagulación oral. DISCUSIÓN: Es imprescindible el conocimiento de esta enfermedad, asociada con una alta sospecha diagnóstica, dadas sus manifestaciones clínicas variadas y su asociación cada vez más frecuente con infección por covid-19.

ABSTRACT INTRODUCTION: Venous sinus thrombosis is considered one of the most infrequent causes of cerebrovascular disease (CVD), prevalent in young people. It usually has an insidious onset which difficult its diagnosis and timely initiation of treatment and is associated with multiple risk factors including hypercoagulable states, as in those patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection. CASE REPORT: The following are 2 clinical cases of patients with neurological alterations, diplopia, and status epilepticus, in whom extensive venous thrombosis of infrequent location was documented through symptomatology and imaging studies, ruling out the main associated etiologies, with the only associated nexus: SARS-CoV-2 infection. Both patients received treatment with parenteral anticoagulation, responding successfully and were subsequently discharged with oral anticoagulation. DISCUSSION: It is essential to be aware of this disease associated with a high diagnostic suspicion given its varied clinical manifestations and its increasingly frequent association with COVID-19 infection.

Intracranial thrombosis after ventriculoperitoneal shunting.

We report a case of intracranial thrombosis (IT) after ventriculoperitoneal shunting (VPS). We reviewed the literature to highlight the importance of considering the possibility of cerebral venous thrombosis following VPS, even though it is a rarely reported complication. A 14-year-old boy underwent distal catheter replacement due to its short size that was detected during a routine consultation. Five days postoperatively, he experienced nausea, vomiting, seizures, and headache. Although a diagnosis of meningitis was considered, diagnosis of IT was eventually confirmed through computed tomography venography and gadolinium magnetic angioresonance. The patient subsequently underwent anticoagulant therapy, which led to complete resolution of symptoms. In this report, we suggest a possible association between VPS and IT, which is a complication that is not commonly reported. The literature suggests that decreased blood flow due to over-drainage of CSF after VPS causes decreased head pressure, culminating in venous stasis and consequent thrombosis. In addition, the literature describes associations between IT and lumbar puncture (LP); therefore, it is important to consider the possibility of IT following these procedures.

COVID-19 (SARS-CoV-2) infection and thrombotic conditions: A systematic review and meta-analysis.

BACKGROUND: COVID-19 is an infectious disease caused by SARS-CoV-2 associated with haematological manifestations (thrombolytic events). AIMS: Considering the high prevalence of the thrombotic scenarios associated with COVID-19, the aim of this study was to perform a systematic review of the available literature, concerning the relation of COVID-19 and the thrombotic events, and identify prognostic factors for these events. MATERIALS & METHODS: PubMed, Web of Science and Scopus databases were searched. Independent reviewers conducted all flow diagram steps. For qualitative analysis, Oxford level of evidence and Newcastle-Ottawa scale were used in the eligible articles. For the prognostic factors, a meta-analysis was conducted to age, number of neutrophils and platelets, and levels of ferritin, C-reactive protein, lactate dehydrogenase and D-dimer. Publication bias was accessed by funnel plot and by trim-and-fill test. Trim-and-fill test was also applied to evaluate meta-analysis bias. RESULTS: Twenty articles were included in the qualitative analysis, and 6 articles were included in the meta-analysis. Case-control studies showed bias related to exposure, and the main bias in cohort studies were related to selection and outcome. All articles received score 4 for the level of evidence. Hypertension and diabetes were the comorbidities more frequently associated with thrombolytic events. Significant results were found regarding D-dimer (P < .0001) and age (P = .0202) for thrombotic events in patients diagnosed with COVID-19. CONCLUSION: Patients older than 60 years, with hypertension, diabetes and D-Dimer values above 3.17 µg/mL, can be considered prognostic factors for developing thrombotic events due to COVID-19.

Cerebral Venous Thrombosis: Review of Diagnosis, Follow-Up, Late Complications and Potential Pitfalls.

Cerebral venous thrombosis is a less common but relevant cause of stroke in adults. The clinical manifestations are nonspecific leading frequently diagnostic delays, so imaging findings are is of vital importance. Conventional imaging modalities, namely computed tomography and magnetic resonance imaging (MRI), allow identification of the thrombus and parenchymal involvement due to venous congestion to a variable degree, but this entity may appears as a nonexpected finding in a nonvenographic study. computed tomography and MRI venographies allow noninvasive confirmation of the diagnosis and adequate characterization of the extent of the thrombus and acute complications, both of them being robust diagnostic techniques. MR venography also can be done without the use of contrast media, which is especially important in certain clinical situations. Cerebral venous thrombosis needs follow-up, and imaging plays a key role in detection of late complications of the disease, including dural arteriovenous fistulas and intracranial hypertension due to veno-occlusive disease. Knowledge of other diseases and conditions that may mimic a thrombus is needed to avoid wrong diagnosis. In this article, we conduct a pictorial comprehensive review of cerebral venous thrombosis, including also the technical aspects of different imaging modalities, diagnosis and acute complications, follow-up, late complications and potential imaging mimics.

Trombosis séptica de seno cavernoso: reporte de caso / Septic thrombosis of cavernosus sinus: case report

La trombosis séptica del seno cavernoso se conoce como una complicación rara y potencialmente mortal de las infecciones en el área de la cabeza y el cuello. Aunque el uso de antibióticos ha mejorado el pronóstico, todavía es conocida por sus altas tasas de mortalidad y morbilidad. Objetivo: Analizar la presencia de la trombosis séptica de seno cavernoso mediante el estudio de un caso único. Metodología: De tipo observacional, cualitativa y de corte transversal, apoyado con sustento bibliográfico. Resultado: Caso de una paciente joven de sexo femenino que presenta una semana después de tener sintomatología de Covid, cefalea holocraneana, oftalmoplejía derecha, disminución de la agudeza visual, dolor, eritema, edema, tumefacción orbitaria, secreción ocular amarillenta supurativa derecha, se le realiza tomografía de cerebro evidenciándose de forma incidental trombosis del seno cavernoso. Conclusiones: Se determinó que la trombosis séptica de seno cavernoso es un diagnóstico de poca frecuencia y rara. Asimismo, la trombosis del seno cavernoso tiene la tasa más alta de mortalidad. En raras ocasiones, la infección del oído medio puede ser una causa de trombosis séptica del seno cavernoso y la respuesta al tratamiento es deficiente(AU)

Cavernous sinus septic thrombosis is a rare and life-threatening complication of infections in the head and neck area. Although the use of antibiotics has improved the prognosis, it still known for its high mortality and morbidity rates. Objective: To analyze the presence of cavernous sinus septic thrombosis by studying a single case. Methodology: Observational, qualitative and cross-sectional, supported by bibliographic support. Result: Case of a young female patient who presented one week after having symptoms of Covid, holocranial headache, right ophthalmoplegia, decreased visual acuity, pain, erythema, edema, orbital swelling, right suppurative yellowish eye discharge, was performed brain tomography, incidentally showing cavernous sinus thrombosis. Conclusions: It was determined that cavernous sinus septic thrombosis is an infrequent and rare diagnosis. In addition, cavernous sinus thrombosis has the highest mortality rate. In rare cases, middle ear infection can be a cause of cavernous sinus septic thrombosis and response to treatment is poor(AU)

Procesos cognitivos en trombosis de seno longitudinal superior: reporte de caso / Cognitive processes in superior longitudinal sinus thrombosis: case report

INTRODUCCIÓN: la trombosis de seno longitudinal superior es una enfermedad de difícil detección a causa de sus diferentes causas y debido al polimorfismo de sus manifestaciones neurológicas; además es común en el sexo femenino relacionado a los estímulos estrogénicos y otros factores hormonales, pero poco probable en menor de 40 años. PACIENTE: paciente menor de 40 años posterior a presentar dos episodios de accidentes cerebrovasculares isquémicos, se evalúa un año después de la lesión el estado cognitivo y funcional mediante la batería Neuropsi Atención y Memoria y el Inventario de Adaptabilidad Mayo-Portland; los procesos cognitivos afectados en un nivel de clasificación leve fueron la atención y concentración, el funcionamiento ejecutivo; en el estado funcional reportado por el cónyuge sugiere afectación de síntomas clínicos como irritabilidad, ira agresividad, dolores de cabeza, cansancio y reacciones a síntomas menores e interacción inadecuada, estos síntomas no fueron reportados por la paciente sugiriendo posible anosognosia en su proceso de adaptabilidad CONCLUSIÓN: Tras un proceso de lesión cerebral por afectación trombótica, las secuelas cognitivos y funcionales permanecen posterior a la recuperación espontanea, llevando a emplear procesos de rehabilitación.

INTRODUCTION: the superior longitudinal sinus thrombosis is a disease difficult to detect because of its different causes and because of the polymorphism of its neurological manifestations; It is also common in females related to estrogen stimuli and other hormonal factors, but unlikely in younger than 40 years. PATIENT: a patient younger than 40 years after having two episodes of ischemic strokes, cognitive and functional status is assessed one year after the injury using the neuropsi battery attention and memory and the mayo-portland adaptability inventory; Cognitive processes affected at a slight level of classification were attention and concentration, executive functioning; In the functional status reported by the spouse suggests involvement of clinical symptoms such as irritability, anger, aggression, headaches, fatigue and reactions to minor symptoms and inadequate interaction, these symptoms were not reported by the patient suggesting possible anosognosia in her process of adaptability CONCLUSIÓN: After a process of brain injury due to thrombotic involvement, the cognitive and functional sequelae remain after spontaneous recovery, suggesting the import of rehabilitation processes.

Cerebral venous thrombosis in Argentina: clinical presentation, predisposing factors, outcomes and literature review.

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare medical condition that primarily affects young adults. The clinical spectrum is broad and its recognition remains a challenge for clinicians. Limited information is available on CVT in Argentina. Our goal was to report the results of the first National registry on CVT in Argentina and to compare clinical presentation, predisposing factors and outcomes with other international registries. MATERIAL AND METHOD: The Argentinian National Registry on CVT (ANR-CVT) is a multicenter retrospective cohort study comprising patients aged 18 and older with a diagnosis of CVT from January 2015 to January 2019. We evaluated demographics, predisposing factors, clinical presentation, and radiological characteristics (e.g. number of involved sinuses, venous infarction or hemorrhage on CT and MRI scans at admission), therapeutic interventions and functional outcomes at discharge and at 90 days. Our results were compared to a literature review of CVT registries. RESULTS: Overall, one hundred and sixty-two patients met the inclusion criteria. The mean age was 42 (±17) years; 72% were women. Seventy percent of patients were younger than 50 years. The most common presenting symptom was headache (82%). The transverse sinus was the most common site of thrombosis (70%) followed by the sigmoid sinus (46%). The main predisposing factor in women was contraceptive use (44%), 3% of the events occurred during pregnancy and 9% during the puerperium. Participants 50 years and older had a higher frequency on malignancy related (7.5% vs. 30%, p = 0.0001) and infections (2% vs. 11%, p = 0.001). The modified Rankin Scale (mRS) ≤2 at discharge was 81% and the rate of mortality at discharge was 4%. At 90 days, the mRS≤2 was 93%. When the ANR-CVT was compared with larger registries from Europe and Asia, the prevalence of cancer among patients with CVT was two to five-fold higher (15% vs. 7% and 3%, respectively; p = 0.002 and p < 0.001). Anticoagulation rates at discharge were also higher (94%) compared to registries from Asia (ASCVT - 68%) or Turkey (VENOST - 67%). CONCLUSION: Participants in the first ANR-CVT had a low mortality and disability at 90 days. Clinical and radiological characteristics were similar to CVT from other international registries with a higher prevalence of cancer. There was a high variability in treatment adherence to guidelines as reflected by anticoagulation rates (range 54.5%-100%) at discharge.

Features of intracranial hemorrhage in cerebral venous thrombosis.

BACKGROUND: Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage. AIM: To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage. METHODS: We performed a retrospective analysis of an international, multicenter cohort of patients with confirmed cerebral venous thrombosis who underwent computed tomography within 2 weeks of symptom onset. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging. RESULTS: We enrolled 260 patients from 10 institutions in Europe and Mexico. The mean age was 42 years and 74% were female. Intracranial hemorrhage was found in 102 (39%). Among them parenchymal hemorrhage occurred in 64 (63%), in addition, small juxta-cortical hemorrhage was found in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Multiple concomitant types of hemorrhage occurred in 23 (23%). Older age and superior sagittal thrombosis involvement were associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracranial hemorrhage (median number IQRInterquartile ratio] of sinuses/veins involved with hemorrhage 2 (1-3) vs. 2 (1-3) without hemorrhage, p = 0.4). CONCLUSION: The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with higher bleeding risk.

Analyses of Mortality and Prevalence of Cerebrovascular Disease in Colombia, South America (2014-2016): A Cross-Sectional and Ecological Study.

BACKGROUND: Stroke is the second cause of death and the first cause of disability worldwide. However, although numerous reports regarding stroke epidemiology in Latin America have been published, they differ widely in terms of employed methods and end points. This is the first of a series of articles that describes the epidemiology of stroke and other cerebrovascular diseases (CVD) in the nation, as well as their correlation with recognized risk factors and social variables. METHODS: Descriptive analyses were performed using the Colombian vital registration system and social security information system as primary data sources. Rates and ratios were calculated, corrected for under-registration, and standardized. Secondary analyses were made using data from national surveys and government organizations on hypertension, diabetes mellitus, sedentarism, obesity, tobacco and alcohol consumption, and unsatisfied basic needs. Factorial multivariate multiple regression analyses were performed to evaluate correlations. Concentration curves and indices were calculated to evaluate for inequities in the distribution of events. RESULTS: Global CVD had a national mortality rate and a prevalence ratio of 28 and 142 per 100,000 persons, respectively. Nontraumatic intracranial hemorrhage had the highest mortality rate (ie, 15 per 100,000), while cerebral infarction and transitory cerebral ischemia had the highest prevalence ratios (ie, 28 and 29 per 100,000, respectively). Hypertension and tobacco use were the most relevant risk factors for most of the simple and multiple models, and cerebral amyloid angiopathy and nonpyogenous intracranial venous thrombosis were the disease categories with the most socially unequal distribution of deaths and cases (ie, concentration indices of .34 and .29, respectively). CONCLUSIONS: CVDs are a cause for concern in Colombia and a marker of healthcare inequality and social vulnerability. Nationwide control of risk factors such as hypertension and tobacco use, as well as the design and conduct of public policy focused on the vulnerable and medically underserved regions and on standardizing mandatory CVD registries might ease its burden.

Hemorrhagic stroke in a dog with anaplastic carcinoma of the mammary gland

Background: Anaplastic carcinoma of the mammary gland is considered a highly invasive and malignant neoplasia, whichusually leads to neoplastic thrombosis and epidermal ulceration due to invasiveness of lymphatic vessels by tumor emboli.Loss of epidermal barrier predisposes to secondary bacterial infection, mainly by commensal bacteria of the skin, andsepticemia can be observed in cases of systemic dissemination. Neoplastic emboli and septic thrombi can lead to vascularobstruction, which can predispose to infarction in multiple organs. The aim of this case report is to describe a case ofhemorrhagic stroke in a dog with anaplastic carcinoma of the mammary gland.Case: A 12-year-old, mixed breed, female spayed canine presented with mammary tumor with plaque formation, associatedwith skin ulceration which extended to the medial region of pelvic limbs. The animal also displayed neurologic clinicalsigns characterized by stupor, opisthotonos and apathy. Due to poor prognosis, the canine was euthanized and submittedto necropsy. During external examination, the animal was in a good body condition, had moderately pale mucosae, andit was noted a nodular plaque in the abdominal ventral area extending from thoracic to inguinal mammary gland. Themass was firm and white, extensively ulcerated, and extending from the thoracic to inguinal mammary gland. There wasa well circumscribed area of infarction in the spleen and kidney. In the cerebral cortex it was observed an extensive areaof hemorrhage with adhered blood clot from frontal to temporal lobe. There were multiple well circumscribed, firm, andwhite areas in the myocardium. Histologically, the neoplastic proliferation was composed by epithelial cells with high pleomorphism, features of malignancy, and no delimitations, leading to the diagnosis of anaplastic carcinoma of the mammarygland. Admixed with tumor cells there were multiple areas of hemorrhage, necrosis and thrombosis...(AU)