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PubMed2006

Inferior vena cava thrombosis causing acute cauda equina syndrome. Case report.

The authors report a case of a 16-year-old girl who presented with a 1-week history of progressive low-back pain, buttock paresthesias, and bilateral lower extremity pain and weakness. Magnetic resonance (MR) imaging and MR venography studies of her lumbar spine revealed engorgement of the epidural venous plexus and mild compression of the cauda equina. A lower extremity and pelvic venogram revealed occlusive thrombosis of the femoral and iliac veins as well as of the inferior vena cava (IVC). The patient required an IVC thrombectomy due to progressive symptoms, after which she improved and returned to baseline status in 1 week. Imaging studies afterwards showed resolution of the venous engorgement and decompression of the cauda equina. This is the second published report of an association between IVC thrombosis and cauda equina syndrome.

Acute Disease↗
PubMed1990

Vascular malformations of the spinal cord and dura.

Current techniques of diagnosis and treatment allow for earlier detection, precise delineation of the vascular anatomy, and, most important, successful treatment of most patients with spinal AVMs. Magnetic resonance imaging is useful in the initial assessment of patients with progressive myelopathy but cannot replace myelography or arteriography in screening patients who may have a spinal AVM. The most common variety of spinal AVM is a dural arteriovenous fistula. Dural arteriovenous fistulas cause cord injury by producing venous congestion, and symptoms can be reversed by elimination of venous congestion of the spinal cord. Dural arteriovenous fistulas can be treated successfully by interrupting the arteriovenous fistula either in the dura or by disconnecting the dural fistula from the coronal venous plexus in the subarachnoid space. This can be done by interrupting the medullary vein that drains the arterial blood from the dural fistula into the coronal venous plexus of the spinal cord. Stripping of the engorged venous network on the surface of the spinal cord is unwarranted and may cause further cord injury. In dural arteriovenous fistulas embolization is often beneficial in patients with acute neurologic deterioration, to permit time for stabilization and improvement in spinal cord hemodynamics and in cord function before neurosurgical intervention is undertaken. Embolization also may be indicated in patients with intradural spinal AVMs in which surgery cannot be performed safely. Although embolic occlusion does not permanently occlude most intradural AVMs, it often permits stabilization of neurologic function and may be repeated later if neurologic dysfunction returns or progresses. Although the outcome after treatment is dependent on the type and location of the spinal AVM, as in most treatable neurologic disorders the functional outcome of patients with spinal AVMs is directly related to their neurologic condition at the time of treatment. Patients with minimal dysfunction, and with easily accessible AVMs, such as dural arteriovenous fistulas, have the greatest chance for useful recovery or stabilization. Since these patients represent the largest number of patients with spinal AVMs, they must be diagnosed and treated early to achieve the best possible outcome.

Arteries↗
PubMed1989

[A case of venous dural sinus thrombosis presenting dementia syndrome. An autopsy case].

We report clinical and pathological features of a case of dementia syndrome due to dural sinus thrombosis. In three years before admission, the patient, a 64-year old man, had had four convulsive attacks; scattered calcification shadows were disclosed by plain CT. Ten months before the admission, he complained of progressive memory disturbance and dyscalculia. General physical examination showed no remarkable abnormalities except for bruit at the left mastoid process. Although his time orientation was poor, he was otherwise fully awake. Neurologically, memory disturbance, finger agnosia, and dyscalculia were observed. Right Barré's sign, and exaggerated right patellar tendon reflex were observed. Plain X-ray CT revealed calcification-like, scattered high-density areas in the floor of the cerebral cortical sulci. Enhanced CT showed abnormal vessel high-density areas in both the cerebrum and brainstem. Cerebral angiography showed thrombosis of bilateral transverse sinuses, arterio-venous fistula in the left transverse sinus, and remarkably dilated cortical veins over both cerebral hemispheres. Positron emission tomography revealed misery perfusion areas in bilateral cerebral hemispheres. We presume that the mass effect of venous engorgement and chronic ischemia due to the arterio-venous fistula caused the dementia syndrome. These clinical manifestations were improved by amantadine and the patient was discharged. During follow-up, he died of subarachnoid hemorrhage, and an autopsy was performed. Pathological findings were as follows: 1) cortical and subcortical multiple-infarction in the cerebrum, 2) hematoma in the subarachnoid space, 3) venous dilatation of the cortical veins and pseudocalcification of their walls, and 4) thrombus in the transverse dural sinus.

Amantadine↗
PubMed1986

Evaluation of venous distension device: potential aid for intravenous cannulation.

A device designed to augment venous filling by applying a vacuum to the upper extremity during tourniquet application was evaluated. Ten healthy adult male volunteers with clinical normovolemia were studied for changes in forearm volume and dorsal hand vein turgor during use of an elastic tubing tourniquet, a blood pressure cuff tourniquet, and a vacuum-assisted cuff tourniquet. Use of the device for 30 seconds was not associated with petechia formation and resulted in a significant increase in venous turgor, as measured by an ophthalmologic tonometer, in comparison to the other tourniquet techniques (P less than .005). Use for 60 seconds was associated with mild to moderate subjective discomfort in all volunteers and petechiae in all nine white volunteers. All petechiae resolved in three days. Venous engorgement as reflected by volume displacement was significantly greater for the vacuum device and blood pressure cuff tourniquet combination than other techniques at 30 and 60 seconds of tourniquet application (P less than .005). Brief application of a vacuum to the arm during tourniquet use increases venous turgor and engorgement in normovolemic volunteers.

Adult↗
PubMed1981

Correlation of CT scanning and pathologic features of ophthalmic Graves' disease.

Correlating the CT scan features of patients with orbital Graves' disease with histopathologic observations allows one to focus more specifically on the distinguishing features of this disease with future research implications. Both CT scanning and pathologic studies have shown clearly that the extraocular muscles are the primary focus of the disease. Swelling of the extraocular muscles generally occurs within their bellys with sparing of the tendons. This contrast with idiopathic inflammation of the muscles or myositis, which tends to involve the tendon as well. All of the associated findings in orbital Graves' disease probably flow from the enlarged volume of the extraocular muscles: proptosis, bowing of the medial lamina papyracea to accommodate the swollen belly of the medial rectus muscle, venous engorgement from stasis induced by direct compression of the orbital venous drainage, conjunctival and lid swelling, and lacrimal gland enlargement. Both radiographic and pathologic changes in the orbital fat are secondary and comparatively insignificant. While there appears to be no selective inflammation of the optic nerve meninges or the perineural connective tissues, enlargement of the extraocular muscle bellys where they converge at the crowded orbital apex brings about compression of the optic nerve, impairs its function, and causes visual decrease. Lymphocytic and plasmacytic infiltration along with edema within the endomysium of the extraocular muscles leads to the activation of fibroblasts with the production of acid mucopolysaccharides and progressive fibrosis. It is not known what attracts the lymphocytes to the extraocular muscles, why certain extraocular muscles are affected preferentially, why the disease may be asymmetrically unilateral, and whether a defect in T cell or B cell functions (or both) is immunologically at fault.

Exophthalmos↗
PubMed1997

Relative blood volume measurements by magnetic resonance imaging facilitate detection of testicular torsion.

RATIONALE AND OBJECTIVES: The authors determine the utility of relative blood volume measurements (rBV) using a blood pool marker for magnetic resonance imaging (MRI) in detection of early testicular torsion. METHODS: Testicular torsion was induced in rats by counterclockwise 720 degrees rotation and fixation of the testis in the scrotum. MPEG-PL-DTPA-Gd enhanced MRI (30 mumol Gd/kg bolus injection) was performed 1 hour after torsion at 1.5 T using fat-suppressed three-dimensional fast spoiled gradient-recalled sequence for relative blood volume measurement and three-dimensional time-of-flight sequence for MR angiography (MRA). RESULTS: The rBV of the torqued testes was significantly lower (13.3% +/- 13.5%) than that of testes with sham operation (97.7% +/- 5.3%; P < 0.05). Rats with testicular torsion showed larger regions of ischemia than did animals with sham operation (63.4% +/- 13.0% versus 4.0% +/- 2.8% of all pixels in testis; P < 0.01). The MRA of testicular torsion showed engorgement of the distal testicular vein as a sign of venous compression or total disappearance of the testicular vein, indicating arterial insufficiency. CONCLUSIONS: The authors conclude that MPEG-PL-DTPA-Gd can be used to obtain functional (rBV), morphologic (tunica enhancement), and angiographic (venous engorgement, arterial compromise) findings that should improve the diagnosis of testicular torsion in the acute setting.

Animals↗
PubMed1984

Epidural venous stasis in spinal stenosis. CT appearance.

Computed tomography permits reliable demonstration of the spinal canal and its contents. Measurements of the sagittal diameter of the bony canal do not take into consideration size, shape and state of intraspinal soft tissue structures, i.e. the thecal sac and its own contents, epidural fat and blood circulation pattern. Three particularly illustrative cases were selected in which obvious epidural venous engorgement was visualized in association with spinal stenosis. The authors think that epidural venous stasis occurring in segmental spinal stenosis is a CT sign of clinically significant narrowing of the neural canal. Accurate recognition of the type of lumbar stenosis together with epidural blood flow alterations permits a better understanding of the existing lesions. Thus, a more precise and specific surgical approach is possible.

Adult↗
PubMed2004

Hirudo Medicinalis and the plastic surgeon.

Medicinal leech therapy is an ancient craft that dates back to ancient Egypt and the beginnings of civilisation. The popularity of Hirudo Medicinalis has varied throughout history, reaching such a peak in Europe in the early 19th century that supplies were exhausted. During the latter half of the 19th century, their use fell out of favour, as they did not fit in with the emerging concepts of modern medicine. Leeches have enjoyed a renaissance in the world of reconstructive microsurgery during recent years, and their first reported use in alleviating venous engorgement following flap surgery was reported in this journal [M Derganc, F Zdravic, Venous congestion of flaps treated by application of leeches, Br J Plast Surg 13 (1960) 187]. Contemporary plastic and reconstructive surgeons in units throughout the United Kingdom and Ireland continue to use leeches to aid salvage of failing flaps. We carried out a survey of all 62 plastic surgery units in the United Kingdom and the Republic of Ireland to assess the current extent of use, and to investigate current practice. We have shown that the majority of plastic surgery units in the UK and Ireland use leeches post-operatively and that the average number of patients requiring leech therapy was 10 cases per unit per year. Almost all units use antibiotic prophylaxis, but the type of antibiotic and combination used is variable. We outline current practice and suggest a protocol for the use of leeches. Whilst the use of leeches is widespread, the plastic surgery community has progressed little in defining indications for their use or in achieving an accepted protocol for their application in units throughout the UK and Ireland.

Health Care Surveys↗
PubMed2006

The histopathology of the hypertrophic inferior turbinate.

OBJECTIVE: To analyze the quantitative and qualitative characteristics of the hypertrophic inferior turbinate (IT). DESIGN: A prospective, nonrandomized, controlled, morphometric study. SETTING: University-affiliated hospital. Subjects Seventeen patients with refractory IT hypertrophy and 12 with normal ITs. INTERVENTIONS: Twenty ITs were removed from patients with refractory IT hypertrophy and 14 from patients with normal ITs. MAIN OUTCOME MEASURES: The soft tissue and bony elements and the relative proportions of the soft tissue constituents of the hypertrophic and normal ITs were measured and compared. The Bonferroni correction was used to adjust for multiple comparisons. Qualitative assessment was performed to assess possible pathologic changes in all IT tissues. RESULTS: The hypertrophic ITs were significantly wider. The medial mucosal layer, which thickened from a mean +/- SD of 1.39 +/- 0.28 mm to 2.53 +/- 0.56 mm (P</=.001), made the greatest contribution to the total increase in the width of the IT (64.4%). The enlargement in width of the lateral mucosal layer from 0.91 +/- 0.26 mm to 1.26 +/- 031 mm was of borderline statistical significance. The portion of the medial, lateral, and inferior layers of the lamina propria that houses inflammatory cells enlarged significantly in patients with IT hypertrophy compared with healthy control subjects. The relative proportion of the connective tissue, submucosal glands, and arteries remained unchanged, whereas that of venous sinusoids increased significantly in all aspects of the hypertrophic mucosa. Fibrosis, inflammation, and engorged venous sinusoids were noted in hypertrophic ITs, yet there was no evidence of tissue destruction. CONCLUSION: Understanding the histopathology of the hypertrophic IT is imperative for the development and management of IT reduction surgery.

Adolescent↗
PubMed1983

Spontaneous intracerebral hematoma in carotid-cavernous fistula. Report of three cases.

Spontaneous intracerebral hematoma associated with carotid-cavernous fistula is rare. Three new cases are presented. In each, the hemorrhage originated in the vicinity of localized intracranial venous engorgement, as demonstrated by cerebral angiography. Rupture of one or several of the distended venous channels from increased back-flow is postulated as the etiology of the intraparenchymal hematomas.

Aged↗
PubMedDate not supplied

The role of dural anomalies in vein of Galen aneurysms: report of six cases and review of the literature.

It is proposed that the vein of Galen aneurysm represents a venous ectasia secondary to an increased flow (usually caused by a deep-seated arteriovenous shunt draining either directly into the vein of Galen aneurysm or into a tributary of the vein of Galen) associated with obstruction of a dural sinus distal to the aneurysm. The closer the venous obstruction is to the vein of Galen, the better the chances are of developing obstructive (noncommunicating) hydrocephalus and the more likely it is that the venous drainage from the rest of the brain will be unaffected. The farther the venous obstruction is from the vein of Galen aneurysm, the better the chances are of developing a communicating type of hydrocephalus. The development of cardiac failure is related to the magnitude of the arteriovenous shunt. Brain damage, seizures, and hemorrhage may be related to the retrograde venous engorgement, causing impaired drainage of the healthy brain. Careful attention should be paid to the venous drainage characteristics of the lesion because the types of dural venous obstructions and anomalies vary from case to case. The term "vein of Galen aneurysm" should be abandoned in favor of the term "vein of Galen ectasia."

Adult↗
PubMed1998

Dural arteriovenous fistulas involving the superior sagittal sinus: acute presentation with intracranial hemorrhage.

BACKGROUND: Intracranial dural arteriovenous fistulas (DAVF) usually drain directly into large dural venous sinuses. Intracranial hemorrhage is therefore unusual with these lesions. Certain subgroups of DAVF may drain into cortical veins causing engorgement, venous hypertension, and hemorrhage. The region of the superior sagittal sinus (SSS), while an unusual location for DAVF, is one in which drainage typically occurs directly into cortical veins. METHODS: We report on three patients with dural arteriovenous malformations of the superior sagittal sinus, all of whom presented with intracranial hemorrhage. Intraparenchymal hemorrhage in two of the cases was surrounded by excessive edema, suggesting the presence of underlying venous hypertension. RESULTS: Interventional treatment of all three of the lesions was accomplished at the time of diagnostic angiography. CONCLUSIONS: SSS DAVF is an uncommon lesion whose presentation is usually with intracranial hemorrhage. Large amounts of edema surrounding an acute hemorrhage may suggest the diagnosis, which usually requires confirmation with angiography. Treatment of SSS DAVF can often be accomplished at the time of diagnostic angiography by embolization using interventional neuroradiologic techniques. When endovascular obliteration of the fistula is not feasible or is incomplete, surgical resection of the DAVF site may be achieved without difficulty.

Acute Disease↗
PubMed2001

Swelling of the leg, deep venous thrombosis and the piriformis syndrome.

BACKGROUND: The piriformis syndrome, which was first described 60 years ago, is a well recognized cause of sciatica, leg pain and low back pain, due to the entrapment of the sciatic nerve in the piriformis and other rotator muscles. Very few complications relating to this syndrome have been described. AIMS: To discuss how the piriformis syndrome may cause venous engorgement in the lower limb, and how the piriformis syndrome should be included as a possible cause of acute deep venous thrombosis in a not initially swollen leg. Both complications can occur independently. METHODS: Two cases of swelling of the leg and acute deep venous thrombosis independently associated with the piriformis syndrome are presented. CONCLUSIONS: Swelling of the leg and deep venous thrombosis are possible complications of the piriformis syndrome that occur due to entrapment of nerves and vessels within the leg, secondary to a severe spasm and hypertrophy of the piriformis and other rotator muscles.

Aged↗
PubMed1993

Regional cutaneous microvascular flow responses during gravitational and LBNP stresses.

The most significant cardiovascular event during the transition to microgravity is the redistribution of vascular transmural pressures that results from the loss of hydrostatic gradients along the length of the body. The well-documented effects of this redistribution include facial venous engorgement, headache, and a significant decrease in leg volume. These effects predominantly represent bulk fluid volume shifts, especially in the venous macro- and microcirculation, where volume is a direct function of pressure, related by the mechanical compliance of the vascular compartment. When considering the effect of gravitational pressure alterations on microcirculatory blood flow and volume, however, this direct monotonic relationship no longer applies. Regional microvascular perfusion is largely a function of local arteriolar tone, which is subject to a variety of central and local controls. Lower body venous pooling during application of footward gravitational stress unloads arterial and cardiopulmonary baroreceptors, increasing sympathetic arteriolar tone to elicit vasoconstriction and a general decrease in microvascular perfusion. The same stimulus also triggers an increase in the levels of circulating vasoactive hormones, such as norepinephrine and angiotensin II, further augmenting arteriolar tone. Vasomotor tone is also mediated by local mechanisms such as myogenic autoregulation and veno-arteriolar reflexes, which enhance microvascular tone in response to elevated local arteriolar and venular pressure, respectively. Due to the regional variability of local hydrostatic pressures, microvascular flow responses to gravitational stress probably vary along the length of the body. Although these differences in local autoregulation have been observed previously during whole-body tilting, they have not been investigated during application of artificial gravitational stresses, such as lower body negative pressure (LBNP) or +Gz centrifugation. Although these stresses can create equivalent G-levels at the feet, they result in distinct distributions of vascular transmural pressure along the length of the body, and should consequently elicit different magnitudes and distributions of microvascular response. In the present study, the effects of whole-body tilting and LBNP on the level and distribution of microvascular flows within skin along the length of the body were compared.

Adult↗
PubMed1985

Incidence, etiology, diagnosis and treatment of cardiac tamponade in the Negev.

The files of 20 patients who required surgical intervention for cardiac tamponade between May 1976 and June 1983 were reviewed. The most frequently implicated etiological factors were viral or idiopathic (8 of 20 cases). Clinical signs of major importance were: tachycardia, 19 of 20; dyspnea, 17 of 20; and venous engorgement, 17 of 20. Valuable bedside examinations were the pulsus paradoxus for the cardiac tamponade of nontraumatic etiology and the central venous pressure examination for traumatic cardiac tamponade. Echocardiography was the most reliable laboratory examination. All patients were treated surgically either through a left thoracotomy or by the subxiphoid approach. Although both methods were equally effective in controlling this life-threatening condition, the latter technique resulted in a lower rate of postoperative complications.

Adolescent↗
PubMed1985

The topographical anatomy of the lumbar epidural space.

Although clinically important, the lumbar epidural space is inconsistently described in textbooks of both anatomy and anaesthetics. This anatomical study of twelve cadavers was performed in an attempt to clarify the description of this region. The dura mater, which possesses a midline fold in a very few cases, is apposed to the walls of the vertebral canal, and attached to them by connective tissue, which is sufficient to allow for displacement of the dural sac during movement of the spine and venous engorgement. Between the dura mater and the vertebral canal is a thin layer of areolar tissue. This contains the internal vertebral venous plexus and a posterior deposit of fat which lies in a recess between the ligamenta flava. These findings are discussed in relation to previous studies in an attempt to arrive at a cohesive description of the epidural region.

Aged↗
PubMed1992

Spontaneous intracerebral hematoma from occult carotid-cavernous fistula during pregnancy and puerperium. Case report.

In most cases, intracerebral hemorrhage during pregnancy or puerperium results from cerebral aneurysms or arteriovenous malformations. The authors present a case of a 30-year-old woman whose symptoms from a traumatic carotid-cavernous fistula had completely resolved 1 1/2 years after the event, but recurred 4 years later, causing two hemorrhages during pregnancy (33rd and 35th week of gestation) and one during the postpartum period (10 days after Caesarean section). Partial thrombosis of the cavernous sinus with obliteration of most of the drainage from the fistula accounted for the resolution of clinical symptoms, but also promoted back-flow to the preserved drainage of superficial cortical veins. The hemodynamic changes and the hormonal effects due to the patient's subsequent pregnancy further aggravated the venous engorgement and finally caused rupture. All three hematomas occurred in the vicinity of the extremely dilated veins, suggesting that back-flow with venous hypertension was the probable cause for the intracerebral hematomas. Spontaneous healing of the carotid-cavernous fistula should be confirmed with cerebral angiography.

Adult↗