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Extension of intracranial thrombosis after unilateral dissection of the internal jugular vein.

OBJECTIVE: Resection of the internal jugular vein can be necessary in cases of radical neck dissection or even in cases involving benign neoplasms such as glomus tumors. According to the triad described by Virchow (ie, stasis of blood flow, damage to the endothelium, and changes in hemostasis), the development of a thrombosis in the venous vessels superior to the resected internal jugular vein seems to be possible. The aim of this study was to determine the extension of possible intracranial thrombosis after wound healing. DESIGN: A total of 17 patients requiring resection of the internal jugular vein were evaluated prospectively using magnetic resonance imaging and 2-dimensional (time-of-flight) magnetic resonance angiography after the surgical treatment. Preoperative magnetic resonance images were obtained in all 17 patients for staging purposes as well as to exclude preoperative thrombosis of the internal jugular vein. Sixteen patients had malignant tumors, and 1 patient had a glomus tumor. RESULTS: Intracranial thrombosis with thrombosis of the sigmoid sinus was found in 4 patients, and thrombosis of the transverse sinus was found in 3 patients. There were no complications such as intracranial hemorrhage or signs of increased intracranial pressure in any patients. There was no evidence of intracranial thrombosis in 10 cases. In these cases, thrombosis of the venous vessels superior to the resected vein ranged from none to complete thrombosis of the superior bulb of the internal jugular vein. After unilateral resection of the internal jugular vein, the venous blood leaves the brain mainly via the venous network of the contralateral side of the neck. CONCLUSIONS: Although intracranial thrombosis of the sigmoid or transverse sinus seems to occur more frequently than was previously thought, intracranial complications such as venous infarction or increased intracranial pressure appear to be very rare. After unilateral radical neck dissection, the venous blood leaves the brain mainly via the venous system of the other side of the neck and the ipsilateral collateral veins.

Aged↗

Antiepileptic drugs for the primary and secondary prevention of seizures after intracranial venous thrombosis.

BACKGROUND: Intracranial venous thrombosis (ICVT) commonly presents with seizures in the acute period, and some patients may develop recurrent seizures in the long term. The prophylactic use of antiepileptic drugs (AEDs) for the management of post-ICVT seizures is controversial and there is currently no consensus on the optimal management of post-ICVT seizures. OBJECTIVES: To assess the effects of AEDs for the primary and secondary prevention of seizures related to ICVT.(1) Do AEDs reduce the likelihood of seizures in patients who have had an ICVT but have not had a seizure?(2) Do AEDs reduce the likelihood of further seizures in patients who have had an ICVT and at least one seizure? SEARCH STRATEGY: We aimed to identify relevant studies in the Cochrane Epilepsy Group and Cochrane Stroke Group Trials Registers. We also undertook specialised searches of the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE, and checked the reference lists of articles retrieved from the searches. SELECTION CRITERIA: We considered all randomised and quasi-randomised controlled trials in which patients were assigned to a treatment group (that is, receiving at least one AED) or control group (receiving placebo or no drug). DATA COLLECTION AND ANALYSIS: Both review authors independently screened and assessed the methodological quality of the studies. If studies had been included, then one review author would have extracted the data and the other would have checked the extracted data. MAIN RESULTS: No relevant studies were found. AUTHORS' CONCLUSIONS: There is no evidence to support or refute the use of antiepileptic drugs for the primary or secondary prevention of seizures related to intracranial venous thrombosis. Well-designed randomised controlled trials are urgently needed to inform practice.

Anticonvulsants↗

[Intracranial venous thrombosis].

Thrombosis of intracranial sinuses and veins is a rare but potentially lethal syndrome. It often affects young adults, but occurs in all ages. It is frequently seen in association with hormonal changes (puerperium, pregnancy and the use of oral contraceptives), inflammatory bowel disease, cancer, and various states of hypercoagulability, or as a consequence of infection. The clinical picture is extremely variable and the diagnosis can be difficult unless one specifically searches for it. The combination of magnetic resonance imaging and magnetic resonance angiography is a powerful and non-invasive tool for diagnosing the syndrome. Treatment with heparin (and for the septic form antibiotics) improves the outcome.

Anti-Bacterial Agents↗

Differential diagnosis of patients with intracranial sinus venous thrombosis related isolated intracranial hypertension from those with idiopathic intracranial hypertension.

In patients presenting with intracranial hypertension without hydrocephalus, mass lesions, and with normal cerebrospinal fluid (CSF) composition (pseudotumor cerebri syndrome), the diagnosis of intracranial sinus venous thrombosis (ISVT) has crucial etiological, therapeutic and prognostic implications. Utilizing two well-defined groups of pseudotumor cerebri patients, one with magnetic resonance imaging (MRI) or angiography confirmed ISVT (17 patients) and the other in whom ISVT has been excluded (idiopathic intracranial hypertension [IIH], 27 patients), we investigated the characteristics that might be helpful in distinguishing them. No clinical or auxiliary findings differed between the ISVT and IIH groups except for female gender and lower CSF protein level, which were significantly associated with the latter. While the syndrome pseudotumor cerebri could be due to multiple causes including ISVT, the term IIH should be restricted for patients with isolated intracranial hypertension attributable to no other neurological or systemic disease. Since CT frequently misses ISVT, patients with pseudotumor cerebri syndrome should undergo MRI and MR venography before being labeled as IIH. We conclude that Modified Dandy's Diagnostic Criteria of pseudotumor cerebri, formulated prior to MRI era, can no longer be applied for the diagnosis of IIH.

Adolescent↗