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PubMed1980

Bilateral thrombosis of the transverse sinuses: microsurgical revascularization with venous bypass.

The present paper reports a case of intracranial hypertension secondary to thrombophlebitis of the two transverse sinuses and internal jugular veins in which microsurgical revascularization was attempted. This was carried out by means of a bypass graft inserted between the right transverse sinus and the superficial jugular vein. As early as the first post-operative week, intracranial pressure improved and visual disorders regressed. This type of venous revascularization using microsurgical techniques should contribute to more successful and lasting results in cases of sinus occlusions of thrombophlebitic, traumatic or tumorous origins.

Adolescent↗
PubMed1998

Renal involvement in Behçet's disease: review of 9 cases.

We describe clinical data on 9 patients with Behçet's disease with renal involvement (8 males, one female) and results of kidney biopsies in 4 patients. Renal involvement occurred in 9 of 120 patients (7.5%) followed at our center. Proteinuria was present in 8 patients (6 with quantitative 24 h urine protein with a range of 0.32-3.11 g/day, mean 1.7 g/day); hematuria occurred in one patient. Impaired renal function was encountered in 2 patients at presentation and in another patient at a later date. Major vascular involvement (major venous and/or arterial thrombosis) was present in 4 patients and sagittal sinus thrombosis in another patient. Measurement of complement C3, C4, and CH50 and immunologic tests for anticardiolipin, antineutrophil cytoplasmic, and antistreptococcal antibodies did not indicate a clear association with renal involvement. Kidney biopsies were performed in 4 patients. Mesangial proliferative changes were observed in 3 patients and evidence of immune complex deposition by immunofluorescence and electron microscopic examination was present in 2 patients. Amyloidosis was present in one patient who had vascular involvement and presented with nephrotic range proteinuria.

Adolescent↗
PubMed2005

[Rhinocerebral mucormycosis].

INTRODUCTION: Mucormycosis is a rare and acute fungal infection which is frequently lethal. The rhinocerebral form is usually seen in diabetics, but other localizations may occur in severely immunocompromised subjects. OBSERVATION: We report the case of a sphenoidal sinusitis associated with a probable cavernous sinus thrombosis and carotid artery thrombosis with middle cerebral artery territory infarction. Diagnosis was made on histological examination following sphenoidotomy. Early medical and surgical treatment led to a good outcome. CONCLUSION: The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome.

Aged↗
PubMedDate not supplied

Thrombosis of intracranial venous sinuses: aetiology, clinical findings and prognosis of 56 patients.

Cerebral venous thrombosis may occur as a complication of infectious and noninfectious processes. In this study 56 patients with angiographically proven cerebral venous thrombosis (CVT) affecting dural sinuses are being reported. Sixty-one percent of the patients were female and 60% were below 30 years of age. Sixty-four percent of the patients had lateral sinus thrombosis and in 26.8% of the cases a septic focus has been found. The diagnosis is established by serial angiography and clinical findings. CVT is not a rare disease while the clinical diagnosis may be difficult because of the variable modes of onset. As the CT findings are found to be non-specific, angiography remains as the best diagnostic tool. Early diagnosis, controlled intracranial pressure, and appropriate antibiotic treatment may reduce the mortality and morbidity rates due to CVT.

Adult↗
PubMed2001

Cerebral venous thrombosis in young adults: 2 Case reports.

Cerebral venous thrombosis (CVT) is a disease with multiple known etiologies that present with a remarkably wide spectrum of clinical signs and symptoms. We present a case of a 34-year-old man with a history of meningeal symptoms for 1 week after receiving a lumbar injection for lower back pain. He subsequently developed dense right hemiplegia and global aphasia. Head magnetic resonance imaging revealed superior sagittal sinus thrombosis. The patient was started on intravenous heparin but deteriorated neurologically. Urokinase infusion directly into the superior sagittal sinus was performed, with striking functional and neurologic improvement. Lupus anticoagulant was positive. We also present the case of a 24-year-old pregnant woman who developed an acute onset of meningeal symptoms and resultant left hemiparesis. Head magnetic resonance angiography revealed thrombosis of right transverse and sigmoid sinuses. Protein S deficiency was found. She was started on intravenous heparin, then enoxaparin, with improvement in symptoms. These cases demonstrate that CVT can be a cause of stroke in young patients with hypercoagability disorders, and a heightened awareness of CVT will promote optimal medical care and functional outcomes. Excellent functional recovery is likely with early recognition and treatment of the underlying etiology, as well as successful lysis of the clot.

Adult↗
PubMed1991

Intracranial vascular abnormalities: value of MR phase imaging to distinguish thrombus from flowing blood.

The interpretation of conventional spin-echo and gradient-echo MR images of intracranial vascular lesions can be complex and ambiguous owing to variable effects on image intensity caused by flowing blood or thrombus. MR phase images, obtained simultaneously with conventional-magnitude images, are useful for evaluating proton motion (i.e., blood flow), and therefore can simplify the diagnosis of the presence or absence of thrombosis within a vascular structure or lesion. Fourteen patients with a variety of intracranial vascular abnormalities (aneurysms, superior sagittal sinus thrombosis, neoplasms adjacent to venous sinuses, and vascular malformations) were evaluated with conventional MR and phase imaging for the presence of blood flow. The phase images correlated with angiography in all cases. Phase imaging was not necessarily better than conventional spin-echo imaging in all cases, but it simplified the evaluation of thrombus vs blood flow in many. In three of five aneurysms, the phase images were diagnostic for evaluating lumen patency whereas the conventional images were ambiguous. Phase imaging was advantageous for detecting tumor invasion of the venous sinus when venous blood was enhanced by gadopentetate dimeglumine. A laminar flow phantom experiment determined the lower limits of sensitivity of phase imaging to be 0.5 cm/sec in the slice-select and 2.5 cm/sec in the read gradient directions. Phase imaging is a simple, reliable technique that can distinguish thrombosis from flowing blood within intracranial lesions. It is easily performed and adds no additional time to the MR examination.

Adolescent↗
PubMed1999

[Cerebral venous thromboses].

UNLABELLED: VARIABLE EXPRESSION: The clinical expression of cerebral venous thrombosis varies widely. The only manifestation may be an intracranial hypertension if the thrombus is limited to the superior longitudinal sinus or a predominant lateral sinus. Thrombosis of cortical veins, alone or in association with a sinus thrombus causes venous infarction. PROGNOSIS: Deep venous thrombosis generally leads to coma with signs of intracranial hypertension. However, partial or complete recovery is possible, even with a severe initial presentation, underlining the importance of early diagnosis and treatment. DIAGNOSTIC METHODS: Magnetic resonance imaging (MRI) coupled with magnetic resonance angiography (MRA) can usually confirm the diagnosis without conventional angiography. ETIOLOGICAL DIAGNOSIS: Cerebral venous thrombosis often follows prethrombotic conditions. Infectious causes only account for 10% of the cases and no cause can be identified in about 1 out of 5 cases. TREATMENT: Anticoagulation is indicated even in case of venous infarction with spontaneous bleeding. Thrombolysis can be proposed, particularly for deep venous thrombosis.

Anticoagulants↗
PubMed1989

Orbital cellulitis: review of 23 cases from Saudi Arabia.

We studied a total of 23 patients with orbital cellulitis and/or orbital abscess over a period of four years in Saudi Arabia. The study showed a high rate of abscess formation (12/23) and surgical intervention (17/23). Twelve out of 23 patients were 18 or more years of age. Furthermore, 12 of 23 (52%) patients had blind eyes on admission and remained blind after treatment, and one patient died of cavernous sinus thrombosis. Only 7/23 (30%) had a predisposing cause of primary sinus disease. This study of orbital cellulitis in a developing country presents a variation in disease pattern from previous reports and suggests that delay in the initiation of antibiotic therapy may lead to serious complications which may be life threatening. The course and outcome of orbital cellulitis may vary, depending on the predisposing factor, time of onset, associated systemic disease, or delay in initiation of treatment.

Abscess↗
PubMed2003

Heparin treatment in cerebral sinus and venous thrombosis: patients at risk of fatal outcome.

We performed a retrospective analysis of 79 patients with cerebral sinus venous thrombosis, who were treated with a fixed regimen of dose-adjusted intravenous heparin, to determine predictors of a fatal course. The parameters investigated were the state of consciousness and the presence of intracranial haemorrhage (ICH) at the start of heparin treatment, involvement of the internal venous system, mean delay from initial symptom to stupor or coma and from initial symptom to hospital admission, focal neurological deficits, mean intracranial circulation time (ICT) on conventional angiography, and age and sex distribution. Mortality rate was 10% in this series (8/79). There was a strong link between the outcome and the level of vigilance: 53% of the patients with stupor or coma at the start of the heparin therapy died (8/15), whereas all of the 64 patients with no more than mildly impaired vigilance survived (p < 0.00001). Furthermore, mean age and mean ICT were significantly higher in the group of patients who died. There was a statistical trend (p = 0.056) for ICH to be more frequent in cases with fatal outcome, but there was reason to assume that ICH represented an epiphenomenon of a severe course rather than an independent predictor. Other investigated parameters were not linked with a fatal outcome.

Adolescent↗
PubMed1998

Sinusitis-associated epidural abscess presenting as posterior scalp abscess--a case report.

Complications of paranasal sinusitis constitute true surgical and medical emergencies. These complications appear to be more prevalent and seem to present in a more fulminant manner in the pediatric age group. The most common complication of paranasal sinusitis is orbital cellulitis followed collectively by all the intracranial complications. These include meningitis, subdural empyema, intracerebral abscess, epidural abscess and rarely cavernous or superior sagittal sinus thrombosis. We report the case of a 7-year old boy who presented with posterior scalp cellulitis and abscess as a complication of minimally symptomatic paranasal sinusitis. A combined neurosurgical and otolaryngologic approach was required to treat a unilateral ethmoid and frontal sinusitis associated with an epidural abscess abutting the length of the superior sagittal sinus and a posterior subgaleal abscess. The pertinent anatomy allowing for the development of this disease process is discussed. The danger of neurologic sequellae resulting from thrombosis of the superior sagittal sinus is emphasized. Aggressive treatment utilizing a multi-disciplinary surgical approach as well as broad spectrum antibiotics is paramount to obtain the best chance for a full recovery.

Abscess↗
PubMed1994

Venous sinus occlusive disease: MR findings.

PURPOSE: To study MR patterns of venous sinus occlusive disease and to relate them to the underlying pathophysiology by comparing the appearance and pathophysiologic features of venous sinus occlusive disease with those of arterial ischemic disease. METHODS: The clinical data and MR examinations of 26 patients with venous sinus occlusive disease were retrospectively reviewed with special attention to mass effect, hemorrhage, and T2-weighted image abnormalities as well as to abnormal parenchymal, venous, or arterial enhancement after intravenous gadopentetate dimeglumine administration. Follow-up studies when available were evaluated for atrophy, infarction, chronic mass effect, and hemorrhage. RESULTS: Mass effect was present in 25 of 26 patients. Eleven of the 26 had mass effect without abnormal signal on T2-weighted images. Fifteen patients had abnormal signal on T2-weighted images, but this was much less extensive than the degree of brain swelling in all cases. No patient showed abnormal parenchymal or arterial enhancement. Abnormal venous enhancement was seen in 10 of 13 patients who had contrast-enhanced studies. Intraparenchymal hemorrhage was seen in nine patients with high signal on T2-weighted images predominantly peripheral to the hematoma in eight. Three overall MR patterns were observed in acute sinus thrombosis: 1) mass effect without associated abnormal signal on T2-weighted images, 2) mass effect with associated abnormal signal on T2-weighted images and/or ventricular dilatation that may be reversible, and 3) intraparenchymal hematoma with surrounding edema. CONCLUSION: MR findings of venous sinus occlusive disease are different from those of arterial ischemia and may reflect different underlying pathophysiology. In venous sinus occlusive disease, the breakdown of the blood-brain barrier (vasogenic edema and abnormal parenchymal enhancement) does not always occur, and brain swelling can persist up to 2 years with or without abnormal signal on T2-weighted images. Abnormal signal on T2-weighted images may be reversible and does not always indicate infarction.

Adolescent↗
PubMedDate not supplied

Dural sinus occlusion: evaluation with phase-sensitive gradient-echo MR imaging.

The purpose of this study was to evaluate the usefulness of limited-flip-angle, phase-sensitive velocity imaging with gradient-recalled-echo (VIGRE) MR when combined with spin-echo MR in the diagnosis of dural sinus thrombosis. The VIGRE sequence consists of a rapid single-slice acquisition, 50/15/2 (TR/TE/excitations), and 30 degrees flip angle. At each slice position, a total of four images were reconstructed; these consisted of one magnitude image and three images sensitive to proton motion in each orthogonal direction. The flow direction and flow velocity (cm/sec) were obtained from each of the phase images, and results were correlated with data obtained from a phantom experiment. In normal controls, dural sinus velocities ranged from a mean of 9.9 to 14.4 cm/sec for the transverse and superior sagittal sinuses, respectively. Three patients with proved dural sinus occlusion were studied with spin-echo images at 1.5 T. Three-dimensional time-of-flight MR angiography was also performed in one patient. The presence of dural sinus occlusion was determined by the lack of flow void on the spin-echo images, the absence of phase shift on the VIGRE study, and the presence of retrograde flow on the phase image in the sinus proximal to the occluded segment. Time-of-flight angiography overestimated the extent of the thrombosis caused by spin saturation. Follow-up VIGRE studies detected the formation of collateral flow in one patient and recanalization with the establishment of normal antegrade sinus flow in the other. We conclude that phase-sensitive MR imaging is helpful in establishing the diagnosis and extent of dural sinus occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗