Cerebral venous thrombosis: recent advances and need for an Asian registry.
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Asian People↗
Biomedical subjects
Ayeesha K Kamal
Publications and source records attributed to Ayeesha K Kamal.
Incidence and epidemiology of cerebral venous thrombosis.
Cerebral venous sinus thrombosis is a disorder whose epidemiology has changed over the past few decades. It is no longer regarded as a uniformly fatal disease. CVST is not a rare disorder. It may have a differential geographic distribution with a higher incidence in the Asian world. It is a disease of neonates, younger women and men, often a hypercoagulable state, either acquired (e.g., cancer) or a genetic prothrombotic condition may be present. Outcome is not uniformly dismal and prognostic criteria that detect patients with a poor outcome have become available from prospective studies. There is a paucity of well designed large scale epidemiologic studies focused on venous thrombosis from regions where it is relatively frequent (South Asia, Middle East). The newer epidemiologic data derived from a Caucasian database; suggest a better overall prognosis, younger age at distribution than arterial stroke.
Cerebral Veins↗
Pathophysiology of cerebral venous thrombosis--an overview.
Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g., hemiparesis and global signs due to raised ICP from an obstructed venous system--papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations.
Cerebral Veins↗
Thrombolytic therapy in cerebral venous sinus thrombosis.
The use of thrombolytic agents to rapidly lyse the clot has emerged as a therapeutic modality, in concert with interventional neuroradiologic approaches to deliver the agent locally at the site of thrombosis. There are no randomized, double blind, placebo, controlled trials to support thrombolysis as a first line therapy in patients with cerebral venous sinus thrombosis compared to standard therapy using anticoagulation with weight based dose adjusted unfractionated Heparin. Numerous case reports and a single non randomized trial have shown that it is comparatively safe and may rescue patients who are deteriorating despite anticoagulation with unfractionated Heparin. Consideration must be given to the use of thrombolysis in this group. This is an approach that must be restricted to centers with considerable experience in neurointerventional therapy.
Cerebral Veins↗
Heparin in the treatment of cerebral venous thrombosis.
Cerebral venous thrombosis (CVT) is a potentially life-threatening condition requiring rapid diagnosis and urgent treatment. Heparin anticoagulation is the time-honoured treatment, and is advocated in all cases of CVT, irrespective of etiology or presence of haemorrhage. The supportive evidence is largely observational; data from randomized placebo-controlled trials shows a nonsignificant trend favouring heparin. Current practice is to begin heparin (unfractionated or low-molecular weight) immediately on confirmation of the diagnosis. Newer antithrombotic agents such as ximelagatran may offer advantages over heparin and need to be investigated in the treatment of CVT.
Anticoagulants↗
Complications associated with cerebral venous thrombosis.
Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided. The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary embolism. In the chronic stages of CVT, one may encounter dural AV--fistula, progressive psychiatric disease, residual epilepsy and recurrence. Cerebral venous sinus thrombosis is associated with unique acute and chronic complications, some of them may be avoidable, e.g. pulmonary embolism. The chronic complications are rare but are potentially treatable, e.g. dural AVFistula nidus obliteration with intervention.
Cerebral Veins↗
Isolated deep venous thrombosis--case series, literature review and long term follow up.
Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are reported. Even when one patient required intubation and mechanical ventilation for stupor, both had excellent neurologic recovery. Over 6 years of follow up there has been no recurrence. In spite of stupor at presentation, complete recovery is possible without long term recurrence.
Adult↗
Ethmoid abscess with findings simulating Weber syndrome.
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Brain Abscess↗
Diffusion tensor imaging in the diagnosis of primary lateral sclerosis.
PURPOSE: To evaluate the utility of MR diffusion tensor imaging in diagnosing primary lateral sclerosis (PLS). MATERIALS AND METHODS: Five patients who met clinical criteria for a diagnosis of PLS, and two patients with possible PLS of less than three years duration and eight normal volunteers were studied using MR diffusion tensor imaging. RESULTS: All seven patients showed decreased diffusion anisotropy and increased diffusion constant in the PLIC, with complete separation from a normal control group, including patients early in the course of the illness. CONCLUSION: Quantitative diffusion tensor imaging appears to be a useful test to detect upper motor neuron damage and hence to help to establish the diagnosis of PLS.
Adult↗
Temporal evolution of diffusion after spontaneous supratentorial intracranial hemorrhage.
BACKGROUND AND PURPOSE: The evolution of apparent diffusion coefficient abnormalities during supratentorial intracranial hemorrhage in normal appearing brain tissue has not been described. Recent investigations using diffusion imaging have revealed increased apparent diffusion coefficient in perihematomal tissue. We report brain tissue abnormalities beyond the visibly abnormal region ipsilateral and contralateral to the hematoma. This preliminary effort should generate meaningful clinical prognostic indicators for moderate size hemorrhages in large scale studies. METHODS: Using the neurology patient encounter database at a tertiary care hospital, we retrospectively identified patients who presented with acute focal neurologic deficits, had CT scans of the head that confirmed spontaneous intracranial hemorrhage, and had a MR images obtained within the first 6 hr to 30 days postictus. The regions identified as targets of this investigation were the hemorrhage and surrounding T2 signal intensity abnormality and the visibly normal supratentorial cerebral tissue. RESULTS: Ninety-five patients were admitted during a period of 25 months. Fifteen patients met the criteria for the study. Elevated whole brain diffusion was shown as early as 6 hr after intracranial hemorrhage. This increase in diffusion was comparable in both hemispheres. Diffusion values in the lesion (hematoma plus T2 signal intensity abnormality) increased slowly with peak increases noted 2 to 3 days after the ictus. CONCLUSION: Diffuse early cerebral response occurs in normal appearing brain tissue both ipsilateral and contralateral to the visibly abnormal hematoma, manifested by increased apparent diffusion coefficient. This response is present before the local response is fully developed. Supratentorial intracranial hemorrhage results in an early diffuse brain response with increased apparent diffusion coefficient in normal appearing brain.
Adult↗
Quantitative diffusion-weighted MR imaging in transient ischemic attacks.
BACKGROUND AND PURPOSE: The risk of stroke after a transient ischemic attack (TIA) is high. Appropriately directed therapies may reduce this risk. However, sensitive means of detecting the presence of subtle neuronal ischemia are lacking. We investigated the potential use of quantitative diffusion-weighted (DW) MR imaging in the detection of deficits produced by transient cerebral ischemia. METHODS: Twenty-eight patients who came to the stroke service from the emergency room of a tertiary teaching hospital with the final diagnosis of transient cerebral ischemia underwent conventional MR imaging, MR angiography, and DW MR imaging within 24 hours of presentation. Fifteen patients had normal conventional DW images confirmed by a staff neuroradiologist and neurologist. For these patients, absolute quantitative diffusion values were subsequently calculated for the clinically relevant brain region and were compared with the values calculated for the corresponding contralateral unaffected brain region. Thirteen patients had conventional DW images positive for lesions and were not studied. RESULTS: Quantitative DW imaging enabled detection of abnormal decreases (9-26%, P <.05) in the diffusion constant in brain regions suspected to be clinically involved by ischemia, when compared with the contralateral clinically unaffected brain tissue as well as with two other internal controls. CONCLUSION: Quantitative DW imaging depicts diffusion deficit in patients with TIA. Quantitative DW imaging may have better sensitivity compared with conventional DW imaging in detecting transient cerebral ischemia.
Adult↗