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PubMedDate not supplied

Dural sinus thrombosis and venous infarction associated with antiphospholipid antibodies: MR findings.

OBJECTIVE: Our goal was to describe the neuroradiologic findings in hemorrhagic venous infarction related to a hypercoagulable state caused by antiphospholipid antibodies (aPA). MATERIALS AND METHODS: Magnetic resonance imaging was performed on two patients with superior sagittal thrombosis related to the presence of aPA. RESULTS: A parenchymal region of hyperintense signal due to hemorrhagic venous infarction was demonstrated in both patients, along with abnormal signal within the thrombosed superior sagittal sinus. CONCLUSION: Hemorrhagic venous infarction may result from the hypercoagulable state related to aPA. The presence of these antibodies should be considered in the setting of otherwise unexplained dural sinus thrombosis and/or venous infarction.

Adult↗
PubMed2002

Diffusion-weighted magnetic resonance imaging in superior sagittal sinus thrombosis.

BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) has shown high sensitivity in the diagnosis of acute arterial strokes. The pathophysiology of cerebral venous thrombosis with associated venous stroke appears to differ from that of arterial strokes. The purpose of this study was to describe DWI findings in venous strokes. METHODS: The authors reviewed 3 adults with superior sagittal sinus thrombosis who underwent DWI and magnetic resonance imaging within 24 hours of symptom onset. DWI was obtained at 1.5 T using the multishot echo planar technique (TR = 8000, TE = 97, field of view = 30 x 19 cm, slice thickness = 6.0 mm, interslice gap = 0.5 mm, matrix 128 x 128, NEX = 1). The diffusion gradients were applied in 3 orthogonal directions with 3 increasing b values (0-1000 s/mm2) to create average (trace) DWI images. Apparent diffusion coefficient (ADC) values were calculated on a pixel-by-pixel basis and displayed as ADC maps. RESULTS: DWI showed hyperintensities in patients 1 and 2 and hypointensity in patient 3 in corresponding to parenchymal lesions on conventional images. As compared to the homologous uninvolved location in the contralateral hemisphere, ADC values were decreased (0.53 x 10(-3) mm2/s [patient 1] and 0.68 x 10(-3) mm2/s [patient 2]) and increased (1.1 x 10(-3) mm2/s [patient 3]). The ADC ratio of the lesion in the involved to uninvolved side was 88% (patient 1), 81% (patient 2), and 120% (patient 3). CONCLUSION: Acute cerebral venous strokes may contain cytotoxic edema and/or vasogenic edema on DWI scans. DWI may be helpful in diagnosing cerebral venous thrombosis in cases with cryptic presentations.

Adult↗
PubMedDate not supplied

Puerperal superior sagittal sinus thrombosis.

A 31-year-old woman became unconscious shortly after delivery of a stillborn fetus in the thirty-sixth week of gestation. Tonic-clonic seizures and deepening coma occurred soon after delivery. Despite intensive supportive therapy, the patient died three days after delivery. A superior sagittal sinus thrombosis and extensive bilateral cerebral infarction were found on necropsy.

Adult↗
PubMed2000

Cerebral dural sinus thrombosis in acute lymphoblastic leukemia with early diagnosis by fast fluid-attenuated inversion recovery (FLAIR) MR image: a case report and review of the literature.

Cerebral dural sinus thrombosis (CDST) is a very rare complication of acute lymphoblastic leukemia (ALL) in adult patients. A 23-year-old man with ALL developed dizziness, headache, diplopia, limb weakness, and a sensation of fullness in his head after his second induction chemotherapy with doxorubicin, prednisolone, and vincristine. Examinations of the peripheral blood, bone marrow, and cerebrospinal fluid showed no recurrent leukemic cells. Magnetic resonance (MR) imaging of the brain disclosed unexpected CDST at the left transverse sinus, which was seen only on the fast fluid-attenuated inversion recovery (FLAIR) sequence. His symptoms were relieved soon after treatment with heparin. MR imaging with FLAIR performed a second time 7 days later showed complete disappearance of the thrombosis. The patient was treated continuously with oral anticoagulant therapy and the symptoms did not recur. CDST can be diagnosed in its early phase by MR studies with FLAIR images. Anticoagulant therapy can be administered safely without precipitating the occurrence of infarction hemorrhage at such an early stage of CDST.

Adolescent↗
PubMed1996

Cerebral venous sinus thrombosis associated with systemic multiple hemangiomas manifesting as chronic subdural hematoma--case report.

A 35-year-old male was admitted with headache, nausea, and vomiting persisting for 2 days. Computed tomography (CT) revealed a left chronic subdural hematoma. Cerebral angiography demonstrated cerebral venous sinus thrombosis (CVST). He had presented with a subcutaneous mass involving the neck at age 2 years, which was shown to be a cavernous angioma, and thereafter shown signs of consumptive coagulopathy with systemic multiple hemangiomas. Burr hole aspiration of the hematoma was performed. Seventy-two-hours later, he developed clouding of consciousness and right hemiparesis. CT revealed a fresh hematoma in the operated subdural cavity and hemorrhagic diathesis manifested. A frontotemporoparietal large craniotomy was performed to remove the hematoma. Extensive electrocauterization was required. He had a satisfactory postoperative course. Collateral venous pathways, resulting from the CVST due to systemic multiple hemangiomas, may have caused hemodynamic stress in the bridging veins which subsequently induced chronic subdural hematoma.

Adult↗
PubMed2004

Cerebral venous sinus thrombosis in childhood: clinical aspects and neurological and cognitive long-term outcome in three cases.

We report clinical findings, risk factors and neurological and cognitive long-term outcome in three Italian children aged 7, 8 and 5, respectively, who experienced cerebral venous sinus thrombosis (CVST). All children presented with headache, associated to nausea, vomiting and papilloedema. None suffered from epileptic seizures. In two of them a paresis of the sixth cranial nerve with diplopia was found. Diagnosis was confirmed by magnetic resonance imaging angiography (angio MRI) in all cases. In all patients plasma levels of protein C, protein S, antithrombin III (AT III), antiphospholipid antibodies (ApA) and homocysteine were detected. Furthermore, factor V Leiden mutation, prothrombin mutation G20210A and MTHFR mutation were searched for. A Protein C reduction was detected in all patients at onset; this finding, however, was not confirmed at follow-up in all of them. At one-year follow-up, neurological examination was normal in all children and neuropsychological assessment, aimed at excluding linguistic and non-linguistic cognitive deficits, revealed normal performances in two of them. In the third child, cognitive assessment confirmed a previously diagnosed developmental dyslexia.

Child↗
PubMed1997

[Superior sagittal sinus thrombosis and nephrotic syndrome: favorable outcome with low molecular weight heparin].

BACKGROUND: Nephrotic syndrome is known to be associated with thrombosis but rarely of cerebral vessels. CASE REPORT: A 3-year old child with steroid-dependent nephrotic syndrome was hospitalized for drowziness followed by a left hemiparesis. The CTscan showed a superior sagittal sinus thrombosis. The child completely recovered after treatment by low molecular weight heparin (LMWH). CONCLUSION: LMWH could be used for preventing and/or treating thrombosis associated with nephrotic syndrome. Nevertheless, controlled studies are necessary for assessing its efficacy and absence of risk in children.

Anticoagulants↗
PubMed2007

Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report.

Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. Neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of Fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.

Adolescent↗
PubMed2000

Cerebral sinus thrombosis diagnosed by MRI and MR venography in cancer patients.

OBJECTIVE: To report the characteristics of cerebral sinus thrombosis (CST) in cancer patients diagnosed by MRI and MR venography (MRV). BACKGROUND: CST is a complication of cancer with multiple etiologies and variable symptoms at presentation. Most reports in cancer patients were before the use of MRI and MRV, which has simplified the diagnosis of CST. METHODS: The neurology database at Memorial Sloan-Kettering Cancer Center was used to identify cancer patients with a diagnosis of CST between January 1994 and April 1998. RESULTS: Twenty patients were identified. Nine had hematologic malignancies (HMs) and 11 had solid tumors (STs). The median interval from cancer diagnosis to presentation was 4 months for HMs and 20 months for STs. The most common symptom was headache. MRI and MRV correlated in all but three patients, and MRV was more sensitive in four patients. The most frequently involved cerebral sinus was the superior sagittal sinus. Multiple sinuses were affected in 8 of 19 patients. Five patients had a cerebral or subarachnoid hemorrhage and three had infarction. Disorders of coagulation were the most frequent etiology in patients with HM; compression or invasion of the cerebral sinus from dural/calvarial metastasis was the main cause in those with ST. Treatment was directed at the underlying cause. Ten of 20 patients improved clinically and 3 of 6 patients improved radiologically. CONCLUSION: MRI and MRV can diagnose CST accurately in cancer patients. Causes of CST depend on cancer type, and treatment varies with etiology. Most patients have a good outcome.

Adolescent↗
PubMed1995

Magnetic resonance imaging in the early diagnosis of cavernous sinus thrombosis.

A 55-year-old man reported a severe headache of 3 days' duration, left ptosis and left lid swelling before examination. The ocular examination revealed left eye proptosis, severe edema of the left bulbar conjunctiva and lid, increasing intraocular pressure of the left eye and ptosis on the left side with decreased extraocular movement. The right eye was normal. Hematologic studies indicated mild inflammation. An enhanced computed tomography scan revealed proptosis of the left globe and enlargement of the superior ophthalmic vein and cavernous sinus of the left side. Angiography revealed an area of interrupted blood flow in the left cavernous sinus. Enhanced magnetic resonance imaging (MRI) with Gd-DTPA revealed a low-intensity area that was suspected to be a blood clot in the enlarged left cavernous sinus. This case indicates the efficacy of enhanced MRI examination in the early diagnosis of cavernous sinus thrombosis.

Cavernous Sinus↗
PubMed2000

Chronic granulomatous meningitis with multiple cranial nerve lesions hydrocephalus, stroke, sinus thrombosis, and epilepsy.

Most frequently, chronic granulomatous meningitis (CGM) is caused by infectious agents. However, in some cases the cause of CGM remains undetermined. It is unclear whether antimicrobial agents, including antituberculous drugs, are helpful in such cases. We describe a 61-year-old man who had multiple cranial nerve lesions, epilepsy, sinus thrombosis, stroke, and hydrocephalus attributable to CGM. Repeated extensive search for a causative agent in the cerebrospinal fluid (CSF) and the meninges remained negative. Only a single culture of the sputum revealed growth of Mycobacterium tuberculosis, which prompted antituberculous therapy with isoniazid, rifampicin, and ethambutol. After 6 months of therapy, neurologic abnormalities were slightly improved. We conclude that antimicrobial/ antituberculous agents have only a minor short-term effect in long-lasting CGM of undetermined cause.

Aged↗
PubMed2005

[Severe bilateral visual loss as the presenting sign of cerebral venous sinus thrombosis: case report].

Our purpose is to report a case of cranial venous thrombosis causing pseudotumor syndrome, where the principal clinical manifestation was severe bilateral vision loss. A 24-year-old man presented with severe bilateral vision loss, transient obscuration of vision, headache, bilateral papilledema and constricted visual fields. Computed tomography as well as neurologic examination was unrevealing. A lumbar puncture disclosed an increased cerebrospinal fluid opening pressure and complete blood count (CBC) showed increased numbers of platelets. A brain magnetic resonance imaging disclosed characteristic sings of chronic papilledema and suggestive signs of superior sagittal sinus thrombosis. A cranial magnetic resonance venography disclosed thrombosis of superior sagittal, transverse and sigmoid sinuses. The patient was treated with an optic nerve sheath decompression in the left eye, acetazolamide and anticoagulation. His ocular evaluation showed reduction of the papilledema, but severe vision loss remained. Pseudotumor cerebri with severe vision loss can be the presenting sign of cranial venous thrombosis secondary to a potentially life-threatening hematologic disorder.

Adult↗
PubMed1980

Cerebral venous sinus thrombosis due to indwelling transvenous pacemaker catheter.

Venous thrombosis from transvenous cardiac pacemakers may result in thromboembolism and cerebral venous sinus thrombosis. Although uncommon, both are potentially fatal complications. The latter is not well appreciated. The patient described illustrates this entity and the spectrum of venous thrombosis as a complication of intravascular foreign bodies is discussed.

Humans↗
PubMed2000

Overwhelming septic cavernous sinus thrombosis in a woman after combination of high-dose steroid and intravenous cyclophosphamide therapy for lupus nephritis.

There are many treatment methods for lupus nephritis, including high-dose steroids, pulse methylprednisolone, and cyclophosphamide therapy. In cyclophosphamide therapy, there can be some side effects such as nausea, vomiting, and infection. We report on a case receiving a combination of high dose steroid and intravenous cyclophosphamide. Following this, she developed a fever and a protruding right eye, and septic cavernous sinus thrombosis was diagnosed. This complication had never been reported in a patient with systemic lupus erythematosus, and related literature is reviewed.

Adult↗