[Thrombosis of the intracranial sinuses and veins accompanied by cerebral attacks of vascular origin].
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Cerebrovascular Disorders↗
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Superior orbital fissure syndrome in a latent type 2 diabetic patient.
Although isolated cranial nerve palsies are common in diabetic patients, multiple, simultaneous cranial neuropathies are rare. We describe the second case of a complete superior orbital fissure syndrome including the optic nerve in a middle-aged Papuan man with newly diagnosed diabetes mellitus. The differential diagnosis included septic cavernous sinus thrombosis and Tolosa Hunt syndrome, and management was initially directed at excluding these serious, treatable conditions.
Adult↗
Raised intracranial pressure presenting with spontaneous periorbital bruising: two case reports.
The venous drainage of the orbit is known to be via the ophthalmic and vortex veins which communicate with the cavernous sinus. We describe two patients with raised intracranial pressure presenting with periorbital bruising. In one patient dural venous sinus thrombosis was demonstrated and it is suspected that the cause of the raised intracranial pressure may have been the same in the second. We suggest that the abrupt rise of pressure in the cerebral venous system was transmitted via the cavernous sinus to the orbital venous system.
Adult↗
[Endocranial complications of acute and chronic otitis media in children and adolescents].
BACKGROUND: After introduction of antibiotics endocranial complications in otitis media are less common, but there are still diagnostic and therapeutic problems. PATIENTS: 124 patients (5 months-16 years) underwent mastoidectomy. The number, type and therapy of otitic complications is presented. RESULTS: Nine percent of the patients showed up with endocranial complications. Besides lateral sinus thrombosis (five patients), meningitis (five patients) and epidural abscess (five patients), one cerebral and one cerebellar abscess was found. Four patients developed more than one complication. THERAPY: A complete mastoidectomy was performed with exploration of the dura and punction of the lateral sinus. In several cases these procedures gave the first diagnostic hint for endocranial complications. CONCLUSION: The occurrence of endocranial complications in the era of antibiotics should not be underestimated. Cholesteatoma is still a main risk factor for severe complications. If there is any doubt, further imaging studies (CT, MRI) are necessary. Diagnosis and therapy makes a close cooperation between neurosurgeon and ear surgeon and other specialties mandatory.
Acute Disease↗
Acute onset of abducens nerve palsy in a child with prior history of otitis media: a misleading sign of Gradenigo syndrome.
Gradenigo syndrome in children during otitis media is a very rare complication since the use of antibiotics: nevertheless, it must be taken into account in case of otitis media, abducens nerve paralysis and facial pain in regions innervated by the first and second division of trigeminal nerve. We report the case of a 4-year-old boy whose neurological signs and clinical history prompted us to entertain a diagnosis of Gradenigo syndrome, which was not confirmed by CT and MRI findings, revealing otomastoiditis and sinus thrombosis.
Abducens Nerve Diseases↗
[Neuroradiological studies and findings in stroke].
This overview is about today's radiologic diagnostic possibilities in acute stroke. Despite many improvements in MR technology, CT is still the method of choice for most of these patients. Contrary to a long existing opinion, CT is a good diagnostic instrument even in the early phase of acute ischemic stroke. In combination with the new helical CT technique [CT angiography] all important questions regarding early therapeutic decisions can be answered. New MR perfusion techniques are just on the way to clinical application. Invasive angiography is only rarely indicated in acute ischemic stroke. The diagnosis of intracerebral hemorrhage is also mainly CT-based. MR and DSA are mandatory for further evaluation of the etiology of the hemorrhage. Nowadays, DSA is not longer mandatory for the diagnosis of cerebral venous sinus thrombosis. In some patients CT is already diagnostic; the combination of different MR and MRA techniques nearly always allows a definite diagnosis or exclusion of a venous thrombosis.
Brain Ischemia↗
Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients.
OBJECTIVE: In recent years, dural arteriovenous fistulas (DAVFs) have been primarily thought to be acquired lesions, formed after sinus thrombosis. The pathogenesis of DAVF, however, is still controversial. We have studied histopathological aspects of DAVFs in resected specimens obtained from nine patients, to obtain clues to the pathogenesis of DAVFs. METHODS: Histological comparison was made among nine DAVF cases and five control cases without venous sinus disease. In addition, the relationship between the clinical course and histological aspects was investigated. RESULTS: The essential abnormality found was a connection between the dural arteries and the dural veins within the venous sinus wall, through small vessels averaging approximately 30 microns in diameter. By using several staining methods, we confirmed that the vessels were part of the venous system; we named these dilated venules "crack-like vessels." CONCLUSIONS: The development of abnormal communications between dural arteries and dural veins (crack-like vessels) is regarded as the essential part of the pathogenesis of DAVFs, and sinus thrombus is not thought to be an essential lesion of DAVFs. It might be postulated that sinus hypertension caused by stenocclusive disease of the venous sinuses triggers the development of fistulous connections between arteries and veins in the dural wall, which may result in increasingly dilated venules and the formation of DAVFs.
Adult↗
Upper body venous thrombosis associated with ovarian stimulation: case report and review of the literature.
Thromboembolic events are a serious complication of assisted conception treatment. Thrombosis may be either arterial or venous but the latter is far more common. This phenomenon is more frequent in the lower limb, but several cases of upper extremity thrombosis have been described in the literature. Although the aetiology of these thromboembolic disorders is not fully understood, the mechanism is thought to be due to a hypercoagulable state associated with haemostasis and thrombophilia. Predisposing factors seem to be hyperoestrogenism, ovarian hyperstimulation syndrome, a hereditary hypercoagulable state and multifoetal pregnancy. We report a case of superior sagittal sinus thrombosis that developed in a patient following successful assisted conception in the absence of evident risk factors. In the current literature, the site of thrombosis, possible predisposing factors, oestrogen levels, number of foetuses, maternal and foetal outcomes, and management of thrombosis were analysed.
Adult↗
Contraceptive-related cerebral venous thrombosis with profuse vaginal bleed.
INTRODUCTION: Women on hormonal therapy for menorrhagia are at risk for cerebral venous thrombosis. CASE REPORT: This scenario may become complicated when there is profuse vaginal bleed with the withdrawal of hormonal therapy. There are no reports describing the possible therapeutic approaches in this clinical situation. RESULTS: A 42-year-old female with a history of uterine fibroids and menorrhagia taking an estrogen-progesterone combination pill presented with seizure clusters. Neuro-imaging showed lateral sinus thrombosis and biparietal hemorrhagic infarcts. Withdrawal of the contraceptive pill was associated with profuse vaginal bleed, leading to hemodynamic instability and the need for multiple blood transfusions. As an emergent procedure to stop the vaginal bleeding, the patient was implanted with a levonorgestrel intrauterine system; with this, vaginal bleed stopped within 12 hours with hemodynamic stability. Subsequently, the patient was treated with unfractionated heparin followed by warfarin (target international normalized ratio: 2.5-3). She made a good neurological recovery. CONCLUSION: This case illustrates that LNG-IUS can be an innovative choice for local hormonal therapy in a patient with OCP-related cerebral venous thrombosis and simultaneous vaginal bleeding.
Adult↗
[Dura mater arteriovenous fistula and lateral sinus occlusion].
It is rare to find an arteriovenous fistula of the dura mater associated with a venous sinus occlusion, but this may provide evidence of an etiology. In the case reported, the malformation was probably of congenital origin, the sinus thrombosis having occurred secondarily to the venous stasis adjacent to the fistula.
Aged↗
Extensive radiculopathy: a manifestation of intracranial hypertension.
We report two patients with severe radiculopathy due to elevated intracranial pressure (ICP) resulting from idiopathic intracranial hypertension (IHH) in one, and cerebral venous sinus thrombosis (CVT) in the other. Our aim is to document this unique association, which escaped diagnosis in both patients.
Adult↗
Indirect carotid cavernous fistula presenting as pulsatile tinnitus.
This paper reports a case of spontaneous indirect carotid cavernous fistula that presented with pulsatile tinnitus, left-sided temporal headache and left-sided ptosis. The pulsatile tinnitus, its aetiology and investigation are discussed. The importance of pulsatile tinnitus is highlighted, with a discussion of carotid-cavernous fistulas. This case illustrates that clinically silent cavernous sinus thrombosis can give rise to spontaneous indirect carotid cavernous fistula. Magnetic resonance imaging angiography was used in diagnosis. Treatment ranges from observation, as in our case, to transvenous endovascular techniques.
Carotid-Cavernous Sinus Fistula↗
Sphenocavernous syndrome associated with Schizophyllum commune infection of the sphenoid sinus.
A 47-year-old diabetic man with chronic renal failure presented with a 1-month history of complete ptosis of the left upper eyelid, left proptosis, and left-sided headache. During the course of the patient's care, other significant diagnoses were excluded, such as orbital inflammatory syndrome, carotid-cavernous syndrome, and cavernous sinus thrombosis. Neuroimaging revealed only minimal left sphenoid sinus disease. Sphenoid biopsy revealed the presence of septate hyphae on Gram staining and produced a fungal culture characteristic of Schizophyllum commune. Minimal sphenoid sinus infection in a patient with chronic medical issues and probable immunosuppression predisposed this patient to fungal rhino-orbital infection. Several weeks of intravenous liposomal amphotericin treatment on an outpatient basis yielded resolution of clinical symptoms.
Amphotericin B↗
Antithrombotic therapy for stroke in young adults.
Stroke in young adults is a markedly heterogeneous disease, and remains an understudied phenomenon. While advances are being made in our understanding of the pathophysiology of its underlying conditions, treatment concerns are controversial, and clinical trials are sorely lacking. This review presents an overview of some of the relevant management issues in hypercoagulable states, migraine, patent foramen ovale, vascular dissection and venous sinus thrombosis.
Adolescent↗
An unusual dural arteriovenous fistula in an infant.
Dural arteriovenous fistula, (AVF), a rare entity, presents most commonly in adults. An 11-month-old boy presented with symptoms of congenital toxoplasmosis associated with an extensive dural AVF of the torcular Herophili and bilateral occlusion of the transverse and sigmoid sinuses. His intracranial venous drainage had become rerouted via the cavernous sinuses to the ophthalmic veins. The relationship of toxoplasmosis and sinus thrombosis to the pathogenesis of dural AVF and their clinical and radiological features are discussed.
Cerebral Angiography↗
[Otitic hydrocephalus. A report of two cases].
Otitic hydrocephalus is one the less common intracranial complications of infectious ear disease, consisting of elevated intracranial pressure without focal neurologic abnormalities other than those due to the elevated pressure. Two representatives cases is discussed in this report, followed by a review of the literature. The clinical course, diagnosis, treatment, and prognosis are outlined. The etiology and the association with lateral sinus thrombosis remains obscure.
Anti-Bacterial Agents↗
A sticky situation.
A 19-year-old woman presented with frontal headaches, papilledema, and binocular horizontal double vision due to a left VI nerve palsy. MRV demonstrated sagittal sinus and bilateral transverse sinus thrombosis. The clinical and neuro-radiologic signs resolved after anticoagulation.
Abducens Nerve Diseases↗
[Cerebral venous thrombosis with familial antithrombin III deficiency].
A case of cerebral venous thrombosis with familial antithrombin III (AT III) deficiency was reported and we discussed the anticoagulant therapy of cerebral venous thrombosis from the viewpoint of AT III. The patient, a 17-year-old boy, was admitted to our clinic with severe bifrontal headache, generalized convulsions and progressive disturbance of consciousness. He developed deep vein thrombosis in his right leg and pulmonary emboli two years earlier when he was placed on heparin and so forth, followed by warfarin sodium. Warfarin was terminated 9 months prior to his recent illness. On neurological examination on admission, he was semicomatous with blurred disc margins, roving eye movements with right abducens nerve palsy, nuchal stiffness and right flaccid hemiplegia. Left carotid angiogram and CT scan revealed extensive superior sagittal sinus thrombosis, complicated with hemorrhagic infarcts in bilateral frontal lobes. When examined for coagulation studies, the patient and his father had decrease in AT III activity and antigen levels. He was treated successfully with antiedematous agents and anticonvulsants during acute phase of illness. He was thereafter placed on warfarin 5-6 mg/day with no further clinical thromboembolic event for 2 years 9 months. There was no neurological abnormality when he was last examined, although he was treated with valproic acid 1,200 mg/day and phenytoin 250 mg/day to control occasional adversive seizures. A coagulation study following infusion of 5,000 units of AT III was carried out. Warfarin was discontinued the day before the study. 0.64 U/kg of AT III administration resulted in a 1% increase in AT III level after the infusion. The biological half life of AT III was 14.4 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗