Case Of Cerebral Venous Thrombosis Research Articles

P.029 Endovascular therapy for cerebral venous thrombosis: an international survey

Background: Cerebral venous thrombosis (CVT) is a rare cause of stroke, with 10–15% of patients experiencing dependence or death. The role of endovascular therapy (EVT) in the management of CVT remains controversial and practice patterns are not well-known. Methods: We distributed a comprehensive 53-question survey to neurologists, neuro-interventionalists, neurosurgeons and other relevant clinicians globally from May 2023 to October 2023. The survey asked about practice patterns and perspectives on EVT for CVT and assessed opinions regarding future clinical trials. Results: The overall response rate was 31% (863 respondents from 2744 invited participants) across 61 countries. A majority (74%) supported use of EVT for certain CVT cases. Key considerations for EVT included worsening level of consciousness (86%) and other clinical deficits (76%). Mechanical thrombectomy with aspiration (22%) and stent retriever (19%) were the most utilized techniques, with regional variations. Post-procedurally, low molecular weight heparin was the predominant anticoagulant administered (40%), although North American respondents favored unfractionated heparin. Most respondents supported future trials of EVT (90%). Conclusions: Our survey reveals significant heterogeneity in approaches to EVT for CVT, highlighting the necessity for adequately powered clinical trials to guide standard-of-care practices.

Identifying risk factors for cerebral venous thrombosis in an intensive care unit: Interest in early anticoagulant treatment

Thrombosis of the dural venous sinus or cerebral veins (CVT) of particular anatomical location of venous thrombosis with a complete or partial occlusion. Treatment of CVT with Heparin followed by VKA is recommended by current guidelines. Material and methods: We conducted a descriptive cohort study, of CVT recorded at the University Hospital Centre Lamine Debaghine Bab El Oued (Algeria) from April 2020 to December 2023. Results: We reported 16 cases of cerebral venous thrombosis (CVT) that were admitted to the intensive care ward from April 2020 to December 2023. It represents 7.4% of neurologic deficiency consultation in the emergency department in the studied period. The mean age of our population is 37.38. we found a preponderance in the female population. The aim of our study is to highlight the importance of early anticoagulation. Discussion: We found that early administration of anticoagulant therapy within the first 24 hours reduced mortality and outcomes in the study population. Our results were consistent with most studies reported in the literature. Conclusion: the introduction of the precocial anticoagulation impacts the mortality and outcomes in CVT however, more studies on the exact timing of introduction are required to define the right timing.

Safety of pregnancy after cerebral venous thrombosis: A case-control study.

Since pregnancy is considered one of the major risk factors of cerebral venous thrombosis (CVT), the safety of pregnancy in women of childbearing age and a previous history of CVT, is concerning in terms of prevention, family planning, and management. This study aims to estimate the prevalence of pregnancies among women of childbearing age with previous CVT, evaluate the pregnancy-associated risk of CVT recurrence, and explore the maternal and fetal outcomes among CVT women in comparison with pregnant women without a history of CVT. A retrospective, case-control study was conducted at the Obstetrics Departments of King Fahad Medical City Hospital, Saudi Arabia. It included all women with a history of CVT diagnosed in the last 5 years (cases), as well as CVT history-free pregnant women (control). The prevalence of pregnancy after CVT was estimated and the prepartum and postpartum parameters of the two groups were compared. Fifty women with CVT and 100 controls were included. Among the 50 CVT cases, 28 (56.0%) have been pregnant. The incidence of pre-eclampsia was significantly more frequent in CVT women (7.1% vs. 0.0%, p = 0.047); however, only one case of deep vein thrombosis (3.6%) was reported in CVT patients versus none in controls (p = 0.219). CVT women delivered at a lower gestational age (mean [SD] = 36.9 [3.5] weeks) compared with controls (38.3 [1.4] weeks) (p = 0.006). No significant differences in other pregnancy or delivery outcomes were observed between the two groups. More than half of women of childbearing age with a history of CVT opt for pregnancy after the CVT episode, with no major additional risk for pre or postpartum complications.

ABO blood group associated with cerebral venous thrombosis after Oxford-AstraZeneca COVID-19 vaccination: a case-control study.

To determine whether blood group influences development of cerebral venous thrombosis (CVT) after administration of the coronavirus disease 2019 (COVID-19) AstraZeneca ChAdOx1-S vaccine. A case-control study. Univariate and multivariate logistic regression was used to determine the association between blood type and COVID-19 vaccination status. Vaccinated and unvaccinated patients recruited from the international Bio-Repository to Establish the Aetiology of Sinovenous Thrombosis study and the Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group. All patients were of European descent and age and sex matched. Cases (n = 82) were patients ≥18 years old who suffered a CVT within 28 days of a first dose of ChAdOx1-S vaccine. Controls (n = 441) were unvaccinated CVT patients ≥18 years old. All patients were of European descent. Frequency of blood type and ABO allele distribution by vaccination status. Blood group O was found to be more prevalent among CVT patients with vaccine-induced thrombotic thrombocytopenia (VITT-CVT) after ChAdOx1-S vaccination compared with unvaccinated CVT cases (43% vs. 17%, respectively, p < 0.001). Blood group A was less prevalent, though still high, in the vaccinated group compared with the unvaccinated group (47% vs. 71%, respectively, p < 0.001). No significant differences were observed in the VITT-CVT non-ChAdOx1-S vaccine group and unvaccinated pre-COVID-19 CVT group for blood group. Blood group O is more prevalent among patients with VITT-CVT after ChAdOx1-S vaccination compared with unvaccinated cases, independent of well-established CVT risk factors. A larger dataset may be able to determine whether those of blood groups B and/or AB may be safely vaccinated with the low cost, readily available and easily transported ChAdOx1-S rather than adopting a complete ban.

Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy.

Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update.

Cerebral venous thrombosis (CVT) is a rare cause of stroke, particularly in young adults. Several known thrombophilic conditions may lead to an increased CVT risk. Interestingly, few cases in the literature have reported an association between CVT and thyrotoxicosis. Here, we describe the case of a young woman with CVT and concomitant thyrotoxicosis, without any other known prothrombotic conditions. We also performed a literature review of CVT cases and hyperthyroidism, searching for all articles published in peer-reviewed journals. We identified 39 case reports/case series concerning patients with CVT associated with thyrotoxicosis, highlighting, in most cases, the association with additional known prothrombotic factors. We then discussed the possible mechanisms by which hyperthyroidism could underlie a pro-coagulative state resulting in CVT. Thyroid disease might be a more common prothrombotic risk factor than expected in determining CVT. However, in most cases, a coexistence of multiple risk factors was observed, suggesting a multifactorial genesis of the disorder. We hope that this work may alert clinicians to consider thyrotoxicosis as a potential risk factor for CVT, even in patients who apparently have no other pro-coagulative conditions.

Cerebral sinovenous thrombosis as a cause of subdural hemorrhage in the pediatric population: Is there a correlation?

Cerebral sinovenous thrombosis is an increasingly recognized cause of stroke in children and neonates. Its true incidence appears to be underestimated. Despite being a rare event, certain studies have found a correlation between subdural hemorrhage and cerebral sinus thrombosis. The literature suggests that spontaneous cerebral sinovenous thrombosis in the pediatric population may lead to the occurrence of a subdural hemorrhage. In this report, we present a case of cerebral venous thrombosis associated with chronic subdural hematoma and review the literature to highlight the importance of these conditions. An 11-year-old boy was admitted in the neurosurgery department with headache and a neurological examination without changes. The imaging studies identified a heterogeneous subdural collection in the fronto-temporo-parietal region. The patient underwent surgical drainage of the subdural hematoma, and the procedure was performed without complications. The magnetic resonance and angiography showed an extensive thrombosis of the superior sagittal sinus, extending downward to the occipital sinus and partially to the right transverse sinus. Appropriate management in the diagnosis and an early treatment of dural sinus thrombosis associated with subdural hemorrhage can reduce the risk of recurrence and improve the clinical outcome.

Cerebral venous thrombosis in reproductive age

Relevance. Cerebral venous thrombosis is a relatively rare pathological condition that often leads to the development of ischemic and/or hemorrhagic stroke.Objective. Describe a clinical case of cerebral venous thrombosis, accompanied by the ischemic stroke with hemorrhagic transformation, in a reproductive age woman taking a combined estrogen-progestin drug from the group of oral contraceptives.Patients and methods. The analysis based on the anamnesis data, clinical, laboratory and instrumental examination of the patient.Results. A clinical case of a 23-year-old patient who had an acute ischemic stroke with hemorrhagic transformation is presented. According to the history data and instrumental methods, the stroke was caused by thrombosis of the cerebral sinuses, which developed on the background of hormonal contraception use. The clinical case is accompanied by MRI images of the patient's brain.Conclusions. The risk of cerebral venous thrombosis in women with hormonal contraceptives use is almost 8 times higher than in those who do not receive hormone therapy. The occurrence of neurological symptoms in women of reproductive age requires a thorough study of the life history, obstetric/gynecological and pharmacological history to establish the fact of estrogen-progestin drugs use for contraception or treatment of hormonal disorders. The described case focuses on the importance of a delicate approach to prescribing hormonal therapy in the treatment of gynecological and other pathological conditions, and indicates the necessity to consider and recommend other contraceptives for young patients.

Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension.

A 38-year-old woman with untreated Graves' disease was admitted to our hospital because of headache and diplopia for 3 months. A neuro-ophthalmic examination showed bilateral papilledema and abducens nerve paralysis. The cerebrospinal fluid pressure was extremely high. Brain magnetic resonance imaging showed cerebral venous thrombosis in the superior sagittal and right transverse and sigmoid sinuses. Laboratory investigations revealed elevated factor VIII and von Willebrand factor levels. The patient recovered after propylthiouracil and anticoagulation therapy. We herein report a rare case of cerebral venous thrombosis with hyperthyroidism presenting as chronic isolated intracranial hypertension. Hyperthyroidism can induce a hypercoagulable state and lead to venous thromboembolism.

Arterial Spin Labelling Magnetic Resonance Perfusion Imaging for the Diagnosis of Acute Cerebral Venous Thrombosis

Abstract&#x0D; &#x0D; Background: Early diagnosis of cerebral venous thrombosis (CVT) is crucial for a favourable prognosis as CVT can lead to severe outcomes. However, certain scenarios, such as during pregnancy, restrict the use of contrast agents, thus rendering conventional magnetic resonance imaging (MRI) methods insufficient for accurate diagnosis. In light of these challenges, our study endeavours to assess the diagnostic potential of the arterial spin labelling magnetic resonance perfusion (ASL-MRP) technique, a contrast-agent–free approach, in the context of CVT diagnosis. &#x0D; &#x0D; Materials and Methods: Between 1 March 2022 and 30 May 2022, patients diagnosed with CVT via contrast-enhanced MR venography in the neurology clinic of our hospital were evaluated through ASL-MRP. Patient-specific demographics, including age, gender, presenting symptoms, underlying causes, impacted cortical sinus structures and MRI findings, were documented. Within the framework of ASL-MRP, an elevation in cerebral blood flow (CBF) detected within the affected sinus and/or neighbouring structures was deemed indicative of pathological conditions.&#x0D; &#x0D; Results: Among the 13 patients included in our study, six were diagnosed with acute CVT, whereas seven were diagnosed with chronic CVT. The assessment of CBF using ASL-MRP revealed CBF elevation in five out of the six cases (83.3%) exhibiting acute CVT. However, no anomalous findings were observed in the ASL-MRP scans of patients presenting with chronic CVT. &#x0D; &#x0D; Discussion: The utilisation of ASL-MRP eliminates the need for contrast agent administration. It is a promising technique in facilitating the diagnosis of acute CVT and distinguishing it from chronic CVT cases.

High-Altitude Exposure and Cerebral Venous Thrombosis: An Updated Systematic Review.

Kharel, Sanjeev, Suraj Shrestha, Samriddha Raj Pant, Suman Acharya, Amit Sharma, Santosh Baniya, and Sanjeeb S. Bhandari. High-altitude exposure and cerebral venous thrombosis: an updated systematic review. High Alt Med Biol. 24:000-000, 2023. Background: High altitude (HA) may increase the risk of cerebral venous thrombosis (CVT). Differentiating it from other HA illnesses is crucial for prompt treatment and better outcomes. We aimed to summarize the clinical data, etiology, and risk factors of this poorly understood entity at an HA. Materials and Methods: A systematic literature search of various databases, including PubMed, Embase, and Google Scholar, was done using relevant keywords; cerebral venous thrombosis; HA, up to May 1, 2022. Results: A total of nine studies, including 75 cases of CVT at HA (3,000-8,848 m), with 66 males and 9 females, were included in this review. Headache and seizure were the most common clinical presentations. Smoking, drinking habits, and the use of oral contraceptive pills (OCP) were the most common risk factors for the development of CVT. Similarly, various underlying hypercoagulable states were also present among cases of CVT associated with HA exposure. Conclusion: Our review concludes that HA exposure can predispose individuals with risk factors such as preexisting hypercoagulable states, smoking, drinking habits, and use of OCP to an increased risk of CVT.

Embolization Using the Novel Menox Liquid Embolic System for Arteriovenous Fistulas

Thrombosis in the brain venous network may be one of the reasons for cerebral infarction related to arterial disease, which becomes a cause of concern as many cases of cerebral venous thrombosis (CVT) lead to mortality.

Unusual Case of Cerebral Venous Thrombosis in a Young Girl with Acute Mastoiditis: A Case Report

Unusual Case of Cerebral Venous Thrombosis in a Young Girl with Acute Mastoiditis: A Case Report

Cerebral Venous Thrombosis Combined with Spontaneous Intracranial Hypotension: A Case Report and Review of the Literature

Several cases of cerebral venous thrombosis (CVT) due to spontaneous intracranial hypotension (SIH) have been reported, with an estimated occurrence rate of 1–2% among patients with decreased intracranial pressure. However, the causal relationship between SIH and CVT as a potential risk factor is not well understood. According to the Monro-Kellie principle, this is thought to be caused by compensatory expansion of the cerebral venous system, damage to the intravenous wall due to changes in cerebral buoyancy, or increased venous blood viscosity. Although anticoagulation therapy is typically the first choice of treatment for patients diagnosed with CVT, considering the potential risk of intracerebral hemorrhage in patients with CVT secondary to SIH is important. We report the case of a patient who developed CVT as a complication of SIH and discuss its mechanisms and treatment options. Early identification and appropriate treatment can lead to successful outcomes and the prevention of potential complications.

Trends in utilization and outcomes of mechanical thrombectomy for cerebral venous thrombosis: A National Inpatient Sample study.

Cerebral venous thrombosis (CVT) is usually treated with systemic anticoagulation, but mechanical thrombectomy (MT) and local infusion of a thrombolytic agent have been proposed as an alternative therapy. In this study, we analyze National Inpatient Sample (NIS) to determine the trends of MT including discharge other than home (DOTH) and mortality. Healthcare Utilization Program-NIS (HCUP-NIS) was queried between 2005 and 2018 for CVT and MT. Cochran-Armitage test was conducted to assess linear trend of proportion of utilization and DOTH of MT. Multivariable logistic regression was conducted to assess odds of undergoing MT among CVT admissions, odds of in-hospital mortality, and DOTH for all admissions involving MT for CVT. A total of 1331 (1.56%) admissions involved MT out of 85,370 CVT cases. Utilization of MT had an upward trend of 0.13% (p < 0.001) per year. Trend in proportion of incidence of DOTH among MT admission remained stationary (trend: 0.70%; p = 0.417). Patients with cerebral edema (odds ratio [OR]: 4.34; p < 0.001) or hematological disorders (OR: 2.28; p < 0.001) were more likely to receive MT for CVT. Additionally, patients with coma (OR: 3.17; p = 0.023) or cerebral edema (OR: 4.40; p = 0.001) had higher odds of mortality. There was an increasing trend of utilization of MT. Proportions of DOTH among MT procedures, however, remained stable. Patients with greater risk factors, including hematological disorders and cerebral edema, were more likely to undergo MT. Among patients treated with MT, those with coma or cerebral edema were more likely to die.

Transverse and Sigmoid Venous Thrombosis Presenting as Proptosis and Acute Loss of Vision: An Unreported Association

Cerebral venous sinus thrombosis is a rare disorder characterized by thrombosis in the venous channels of the brain. Nonspecific symptoms such as headache, focal neurologic deficits and seizures make this condition difficult to diagnose. We describe a case of cerebral venous thrombosis in the sigmoid and transverse sinuses which presented as reversible, rapid-onset proptosis and loss of vision in a patient of subclinical hypothyroidism. Such an occurrence of proptosis due to thrombosis of the sigmoid and transverse sinuses has never been reported in literature. The diagnosis of cerebral venous thrombosis in this patient was arrived at in a stepwise fashion.&#x0D; Thus, this case in addition to reporting a novel finding, stresses by example, the importance of acute suspicion on part of the physician for timely diagnosis and treatment of this eluding yet reversible disease.

Detection of cerebral cortical vein thrombosis with high-resolution susceptibility weighted imaging - A comparison with MR venography and standard MR sequences.

Comparison of the performance of high-resolution susceptibility weighted imaging with standard MR sequences and MR venography to identify cortical vein clots. A retrospective review of 51 consecutive cases of cerebral venous thrombosis and 27 controls was performed with independent analysis of all MR sequences. Reference standard was obtained with consensus in a separate session by reviewing all MR sequences together. Cortical vein clots were observed in 30 cases including 9 males and 21 females in the age range of 1 month to 70 years (Mean 34.9 ± 20.2 years). Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of susceptibility weighted imaging for the identification of cortical vein clots were 0.93, 1.0, 1.0, 0.96 and 0.97 respectively. For all other sequences, sensitivity ranged from 0.06 to 0.39 and accuracy from 0.60 to 0.73. Combination of all sequences yielded a value of 1.0 for sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of cortical vein clots. Significant result for area under the receiver operating curve was observed only for SWI with a value of 0.91 (p - .000). Susceptibility weighted imaging demonstrates the best sensitivity and accuracy amongstandardMR sequences including MR venography for the detection of early stage cortical vein clots. However, it needs to be interpreted in combination with other MR sequences for the most accurate evaluation of cortical vein clots.

Cerebral venous pathology and paediatric head injury

Cerebral venous thrombosis (CVT) is increasingly recognised in traumatic brain injury and carries a significant rate of complications leading to secondary brain insults. In general, the rate of complications is dependent on the anatomical location with midline and bilateral CVT associated with a significantly increased 30 day mortality in traumatic brain injury patients. Paediatric trauma related CVT is relatively uncommon (3%) and most cases of post-traumatic CVT in children involve a bone fracture along the adjacent dural sinus, but CVT can occur in the absence of a skull fracture. Older children are more likely to present with post-traumatic CVT and thrombosis occurs acutely, usually 1–5 days following head injury. Venous compromise may involve extrinsic sinus compression in addition to sinus thrombosis. Overlap in symptomology and descriptions of retinal and dural pathology associated with CVT has prompted some to advance CVT as a condition with a potential to mimic paediatric non-accidental head injury. CVT in the setting of NAHI is not uncommon (as much as a third of cases in the author’s experience). In this situation it though almost invariably represents a secondary, post-collapse complication due to venous stasis and a critically ill state with those rare cases showing evidence of CVT predating collapse typically associated with evidence of historic abusive injury. Careful scrutiny of the relevant scientific literature and due attention to clinicopathological features associated with CVT serve to further undermine CVT as a plausible alternative explanation for classic NAHI eye and intracranial pathology.

Challenges in Cerebral Venous Thrombosis Management-Case Reports and Short Literature Review.

Cerebral venous thrombosis (CVT) is a rare type of stroke, with a complex clinical presentation that can make it a diagnostic challenge for the swift initiation of anticoagulation. When a hemorrhagic transformation is added, therapeutic management becomes even more complex. We describe a series of four cases, aged between 23 and 37 years old, with cerebral venous thrombosis. They were admitted to our clinic between 2014 and 2022. All cases presented significant challenges in either diagnostic, therapeutic or etiologic evaluation, at different stages of the disease. Late complications such as epilepsy or depression and other behavioral disorders represent long-term sequelae for the patient. Therefore, through its late complications, CVT is not only an acute disease but a chronic disorder with long-term follow-up requirements. The first case of the series is of a postpartum woman with focal neurological deficit caused by CVT with hemorrhagic transformation that presented multiple thrombotic complications and severe depression. The second case is of a man with extensive cerebral thrombosis who developed bilateral papillary edema under therapeutic anticoagulation treatment. The third case is of a woman with bilateral cavernous sinus thrombosis who later developed depressive disorder and focal seizures. The fourth case is of a pregnant woman in the first trimester presenting with a steep decline in consciousness level secondary to deep cerebral vein thrombosis requiring intensive care and subsequently developing a memory disorder. For a long period of time, due to being underdiagnosed, few things were known about CVT. Nowadays, we have all the tools to diagnose, treat, and follow up cases of CVT.

Decompressive surgery in cerebral venous thrombosis: Asystematic review and meta-analysis.

The efficacy of decompressive surgery (DS) in cerebral venous thrombosis (CVT) patients has been reported in several case reports and case series. We aimed at determining the association of DS compared with medical management and timing of surgery with functional outcome and mortality. We also aimed at determining the prevalence of DS in CVT patients. The literature search was conducted till 7 November 2022 in PubMed, Google Scholar, EMBASE and Cochrane Library databases. Risk of bias was examined using Joanna Briggs Institute scale for case series and case reports. Association of DS compared with medical management and timing of surgery with functional outcome and mortality was determined using odds ratio (OR) and 95% confidence interval (CI). Pooled prevalence of DS in CVT patients with 95%CI was calculated. Heterogeneity was explored using outlier, meta-regression, sensitivity and subgroup analyses. Fifty-one studies consisting of 483 CVT cases with DS were included. The OR of poor outcome with surgery was 0.03; (95%CI: 0.00-0.22) and of mortality with surgery was 0.25; (95%CI: 0.02-2.60) versus that with medical management. Surgery done ≤48 h of admission was significantly associated with less mortality (OR: 0.26; 95%CI: 0.10-0.69). Pooled prevalence of DS in CVT was 12% (95%CI: 8%-17%; I2 = 91%). Revised pooled prevalence after removing outliers was 10% (95%CI: 7%-13%; I2 = 73%). Surgery ≤48 h of admission might decrease mortality in CVT patients and may result in improved functional outcome. Further prospective studies with appropriate control arms are required to confirm its efficacy over medical management.