Cerebral Venous Sinus Research Articles

Anabolic androgen steroids cardiovascular impact. Literature review

Introduction and Purpose: The use of anabolic steroids is widespread. They can be administered either therapeutically or by individuals looking to enhance their athletic performance. This review aims to summarize the scientific understanding regarding the link between the use of AASs and the incidence of cardiovascular complications. Materials and methods The literature available in PubMed and Google Scholar databases was reviewed using the keywords. Description of the state of knowledge: A lot of studies suggest that AASs can be harmful to the cardiovascular system. It has a wide range of long-term and often irreversible consequences. AASs cause myocardial hypertrophy which results in systolic and diastolic disfunction. They disrupt lipid metabolism, act as vasoconstrictors, and promote the calcification of blood vessel walls, thereby increasing the risk of heart attack and stroke. By promoting blood clotting, they increase the incidence of pulmonary embolism, deep vein thrombosis, and cerebral venous sinus thrombosis. The effect on the occurrence of hypertension is not definitively proven. However, a very dangerous consequence of using anabolic steroids is the increased risk of life-threatening arrhythmias -especially ventricular arrhythmias- which can lead to sudden cardiac death. Conclusion: The use of anabolic steroids increases the risk of arrhythmias, heart attacks, and thromboembolic complications, ultimately leading to a higher risk of sudden cardiac death. However, the cause-and-effect relationship is not always clearly captured, and further research is necessary to draw appropriate conclusions.

The Risk of Venous Thromboembolism in Children With Inflammatory Bowel Disease.

Recent studies of children with inflammatory bowel disease (IBD) demonstrate an increased venous thromboembolism (VTE) risk. However, estimates of risk are variable and case numbers are limited. The aim of this study was to provide national estimates of the risk of VTE in children with IBD. Hospital Episode Statistics was used to identify patients diagnosed with either IBD or VTE before reaching 18 years of age between 2001 and 2019. Populations and subgroups are described, and the risks of developing VTE in the general and IBD populations were calculated. Children with VTE following a diagnosis of IBD or in the previous 6 months (n = 85) and with VTE without IBD (n = 4160) were studied. The absolute risk in children with IBD was 9.42 (95% confidence interval [CI], 7.4-11.4) per 10 000 patient-years, compared with 0.18 (95% CI, 18-0.19) in children without IBD. Between 6 months prior to and 1 year following IBD diagnosis was the highest absolute risk period for VTE (18.0; 95% CI, 13.7-22.4). The relative risk of VTE in children with IBD vs children without IBD was greatest in younger patient groups: the relative risk for the age band 0 to 8 years was 96.5 (95% CI, 51.8-179.9) and for 9 to 11 years was 153.1 (95% CI, 81.2-288.8) vs 14.3 (95% CI, 10.3-20.0) for 15 to 17 years. Cerebral venous sinus thrombosis represented 17.6% of pediatric VTE events in IBD patients compared with 4.2% in children without IBD (P = .001). This study confirms the increased risk of VTE in children with IBD compared with children without IBD. The time of greatest VTE risk was around diagnosis. Cerebral venous sinus thrombosis was significantly more common in children with IBD than other children.

Cerebral venous sinus thrombosis and exploration of prognostic factors: a case series

BackgroundThis study examined the etiology, treatment response, and prognosis of patients with cerebral venous sinus thrombosis (CVST) at a single institution.MethodsThis retrospective study included patients diagnosed with CVST between January 2016 and December 2020 at Baotou Central Hospital. The data were collected from patient charts, including sex, age, comorbidities, pregnancy, smoking, alcohol drinking, symptoms at onset, radiological location, examinations, Glasgow coma scale (GCS) at admission, National Institutes of Health stroke scale (NIHSS) at admission, modified Rankin scale (mRS) at admission, and treatments.ResultsThe study included 31 patients (13 males and 18 females) aged 39.0 (interquartile range, 30.0–53.0) years. Three (9.7%) patients had a history of hypertension, one (3.2%) had a history of stroke, four (12.9%) had thrombotic disorders, six (19.4%) were pregnant (including three who delivered), four (12.9%) were smoking, and four (12.9%) were drinking alcohol. The GCS at admission was 15.0 (IQR, 15.0–15.0), the NIHSS at admission was 0.0 (IQR, 0.0–2.0), and the mRS at admission was 0.0 (IQR, 0.0–0.0). The patients were grouped according to their mRS (>0 vs. 0); there were no significant differences between the two groups regarding the patient characteristics (all p > 0.05). Only an NIHSS of >0 at follow-up was associated with a 3-month mRS >0 (p < 0.001).ConclusionThe median age of the patients with CVST was 39 years. The majority were female (58%), 13% had thrombotic disorders, and 19% were or were recently pregnant. Only a NIHSS of >0 at follow-up was associated with a 3-month mRS >0.

Enhanced T-cell activation and chemokine-associated function in CD14-positive cells from venous sinus blood in sub-acute cerebral venous sinus thrombosis

BackgroundPatients with sub-acute cerebral venous sinus thrombosis experience (SA.CVST) severe symptoms compared to two other venous sinus-related diseases, including chronic cerebral venous sinus thrombosis (C.CVST) and idiopathic intracranial hypertension (IIH).ObjectiveThis study aimed to determine whether the different immune reactions in different venous sinuses are related.MethodsStagnant blood in the cerebral venous sinuses was extracted by passing a microcatheter and CD14-positive cells were sorted by magnetic beads and subjected to RNA-seq sequencing.ResultsCompared to patients with IIH, 128 genes were significantly down-regulated and 373 genes were significantly up-regulated in the sub-acute CVST samples. The functions of these genes were mainly focused on “immune response”, “T cell activation” and “plasma membrane”. Gene Set Enrichment Analysis (GSEA) showed T cell survival and activation-related function significantly unregulated in sub-acute CVST. On the other hand, there were 366 genes down-regulated in chronic CVST and 75 genes up-regulated in chronic CVST. In functional annotation, these differently expressed genes were enriched in the “extracellular region”, “chemokine-mediated signaling pathway” and “immune response”. GSEA analysis confirmed that chemokine-related functions were all up-regulated in sub-acute CVST and monocyte-macrophage adhesion functions were also significantly up-regulated.ConclusionThis study suggested the CD14-positive created an activated immune response in sub-acute CVST.

Enoxaparin Failure in Patient With Cerebral Venous Sinus Thrombosis and Prothrombin G20210A Mutation: Case Report.

Cerebral venous sinus thrombosis (CVST) is a rare, serious, and complex cerebrovascular disease. The prothrombin G20210A mutation is the second most common inherited thrombophilia and is considered to be one of the etiologies of CVST. The optimal heparinoid medication for treatment remains a topic of debate. This case report describes a young woman with CVST who did not respond to low-molecular-weight heparin (LMWH). The patient was initially treated with LMWH; however, her symptoms and clot burden in the sagittal sinus worsened, and coagulation studies showed no evidence of therapeutic anticoagulation despite good compliance. Unfractionated heparin was then initiated, and the patient's symptoms improved dramatically within 24 hours, along with the recanalization of the cerebral venous sinuses. Genetic testing revealed a heterozygous mutation in the prothrombin gene (G20210A). This mutation is a known risk factor for CVST. However, it is unclear why the patient did not respond to LMWH but responded appropriately to unfractionated heparin. This case report highlights the potential for LMWH resistance in patients with CVST and prothrombin gene mutations. These findings also emphasize the importance of close monitoring of coagulation parameters and clinical response in patients with CVST receiving LMWH.

Guide to the treatment of paediatric strokes. Iberoamerican Academy of Pediatric Neurology

A paediatric stroke is a rare entity that can occur at any age. It may be arterial or venous, ischemic or haemorrhagic, and may occur in the neonatal or paediatric stage of life, as well as in adolescence. Prompt diagnosis means that adequate treatment can be administered and prevents recurrence, minimising the percentage of sequelae. This guide aimed to analyse, prepare and classify the literature currently available in order to determine the best recommendations on the treatment of strokes in paediatric patients. In each section, we attempted to answer the following questions: when should we think in terms of a stroke and thrombosis of the cerebral venous sinuses in a newborn or paediatric patient? What are the recommended complementary studies? Is treatment indicated? What are the recommended treatments? This guide was prepared based on the opinion of experts in the field, in order to determine how the recommendations were assessed according to the 2011 Oxford Levels of Evidence. Finally, the guidelines were reviewed by the scientific committee of the Iberoamerican Academy of Pediatric Neurology for subsequent dissemination.

Dural Venous Sinus Variations Observed in Magnetic Resonance Venography at a Tertiary Care Hospital: An Observational Study

Introduction: The dural venous system, composed of various sinuses, plays a crucial role in draining deoxygenated blood from the central nervous system. Understanding its anatomical variations is essential to differentiate it from pathological conditions like cerebral venous sinus thrombosis. This study aims to evaluate the anatomical variations of the dural venous sinuses using Magnetic Resonance Venography.Methods: An observational, cross-section study was performed in the Department of Radiology from September 2023 to March 2024 after the approval by the Institutional Review Committee (Reference number: 149/080/081(6-11)E2). Magnetic Resonance Venography of 109 adult patients was performed using a 1.5 Tesla MRI scanner. Diameters of the superior sagittal sinus, straight sinus, and transverse sinuses were measured. Variations in transverse sinuses, straight sinus, and confluence were categorized and analyzed. Results: The study included 52 (47.70%) male and 57 (52.30%) female, with median age of 42 (IQR: 30.5 - 56) years. The superior sagittal sinus had the diameter of 6.4±1 mm. Symmetric transverse sinus variant seen was in 80 (73.39%) patients, and left transverse sinus hypoplasia was seen in 20 (18.35%) patients. Variations in the straight sinus and confluence were also documented with a true confluence (type III) was seen in 71 (65.10%) patients.Conclusions: Anatomical variations of the dural venous sinuses as observed in 1.5 Tesla MRI was quite common.

Clinical characteristics and outcomes of cerebral venous sinus thrombosis in patients with antiphospholipid syndrome.

Cerebral venous sinus thrombosis (CVST) is a rare but serious manifestation of venous thrombosis in patients with antiphospholipid syndrome (APS). This study investigated the risk factors, clinical characteristics and prognosis of CVST in APS patients. This retrospective cohort study included all thrombotic APS (tAPS) patients from Peking Union Medical College Hospital (PUMCH) from April 2005 to August 2023. Demographic characteristics, laboratory data and thrombotic risk factors were compared between tAPS-CVST group and tAPS-non-CVST group. Kaplan-Meier survival analysis was utilized to compare the recanalization rate and the recurrence rate. A total of 453 APS patients were enrolled, and 40 (8.8%) APS patients were with CVST. The median age of the APS-CVST patients was 27 (21.25, 32.75) years, and 72.5% were females. In 50% of these patients, CVST was the initial symptom of APS, with headache being the most prevalent clinical symptom (95%). Involvement of more than two venous sinuses were observed in 79.5% of patients, with the transverse sinus (79.5%) and sigmoid sinus (74.4%) being the most commonly affected sites. Oral contraceptives, intracranial infections and malignancy were identified as risk factors of APS-CVST. There were no statistically significant differences in baseline characteristics or the distribution of antiphospholipid antibodies profiles between the two groups. After a median follow-up of 24 (12, 52) months, 21 patients (52.5%) experienced recanalization, and 13 patients (32.5%) had a thrombotic recurrence. Survival analysis indicated that adequate anticoagulant therapy significantly contributed to recanalization (HR 6.27, 95% CI 2.616-15.02, P = 0.003), while continuous anticoagulant therapy was highly effective in reducing the recurrence of thrombotic events (HR 0.14, 95% CI 0.0447-0.4328, P = 0.0007). CVST should be considered in APS patients who experience sudden onset headaches, particularly those with thrombotic risk factors, such as the use of oral contraceptives, intracranial infections and malignancy. Continuous and adequate anticoagulant therapy is pivotal and beneficial for achieving recanalization and prevention of recurrence. Key Points • The prevalence of CVST in patients with APS may be underestimated. • APS-CVST is associated with special risk factors, including pregnancy, intracranial infection, oral contraceptives and tumors. • Long-term and adequate anticoagulation therapy can increase the vascular recanalization rate and reduce thrombosis recurrence.

The effect of blood lipids on the comorbidity of multiple large arachnoid granulations

BackgroundCurrently, studies on the formation mechanism for the enlargement of arachnoid granulation (AG) are lacking. The impact of dyslipidemia on the formation of multiple large arachnoid granulations (LAGs) was studied in this research.MethodsThe study included patients diagnosed with cerebral venous sinus stenosis (CVSS) related to LAG. The number of LAGs was assessed via high-resolution black blood magnetic resonance imaging. The relationships between blood lipids and multiple LAGs were explored to evaluate the effects of dyslipidemia on the formation of multiple LAGs.ResultsA total of 163 participants with a diagnosis of LAG were included. The levels of total cholesterol (TC) (P = 0.004) and low-density lipoprotein cholesterol (LDL-c) (P = 0.01) in the multiple LAGs group were greater than those in the non-multiple LAGs group. Multivariate logistic regression analysis revealed that TC (odds ratio (OR), 2.19; 95% confidence interval (CI), 1.26–3.80; P = 0.006) and LDL-c (OR, 2.18; 95% CI, 1.16–4.07; P = 0.02) were independently associated with multiple LAGs.ConclusionsTC and LDL-c are independently related to multiple LAGs, indicating that dyslipidemia may be a potential cause of CVSS. Therefore, monitoring blood lipids may be necessary for patients with LAGs.

Dual-energy CT angiography in detecting underlying causes of intracerebral hemorrhage: an observational cohort study.

CT angiography (CTA) is often used to detect underlying causes of acute intracerebral hemorrhage (ICH). Dual-energy CT (DECT) is able to distinguish materials with similar attenuation but different compositions, such as hemorrhage and contrast. We aimed to evaluate the diagnostic yield of DECT angiography (DECTA), compared to conventional CTA in detecting underlying ICH causes. All non-traumatic ICH patients who underwent DECTA (both arterial as well as delayed venous phase) at our center between January 2014 and February 2020 were analyzed. Conventional CTA acquisitions were reconstructed ('merged') from DECTA data. Structural ICH causes were assessed on both reconstructed conventional CTA and DECTA. The final diagnosis was based on all available diagnostic and clinical findings during one-year follow up. Of 206 included ICH patients, 30 (14.6%) had an underlying cause as final diagnosis. Conventional CTA showed a cause in 24 patients (11.7%), DECTA in 32 (15.5%). Both false positive and false negative findings occurred more frequently on conventional CTA. DECTA detected neoplastic ICH in all seven patients with a definite neoplastic ICH diagnosis, whereas conventional CTA only detected four of these cases. Both developmental venous anomalies (DVA) and cerebral venous sinus thrombosis (CVST) were more frequently seen on DECTA. Arteriovenous malformations and aneurysms were detected equally on both imaging modalities. Performing DECTA at clinical presentation of ICH may be of additional diagnostic value in the early detection of underlying causes, especially neoplasms, CVST and DVAs.

Revisiting Virchow’s triad: exploring the cellular and molecular alterations in cerebral venous congestion

BackgroundCerebral venous thrombosis (CVT) is a rare but serious condition that can lead to significant morbidity and mortality. Virchow’s triad elucidates the role of blood hypercoagulability, blood flow dynamics, and endothelial damage in the pathogenesis of CVT. Cerebral venous congestion (CVC) increases the risk of cerebral venous sinus thrombosis and can lead to recurrent episodes and residual symptoms. However, the precise mechanism by which blood congestion leads to thrombosis remains unclear. Our objective was to investigate the cellular and molecular alterations linked to CVC through analysis of the pathological morphology of venous sinus endothelial cells and transcriptomic profiling.ResultsThis study demonstrated a remarkable correlation between CVC and the phenotypic transformation of endothelial cells from an anticoagulant to a procoagulant state. The findings revealed that cerebral venous stasis results in tortuous dilatation of the venous sinuses, with slow blood flow and elevated pressure in the sinuses and damaged endothelial cells of the retroglenoid and internal jugular vein ligation (JVL) rat model. Mechanistically, analysis of transcriptomic results of cerebral venous sinus endothelial cells showed significant activation of platelet activation, complement and coagulation cascades pathway in the JVL rats. Furthermore, the expression of von Willebrand factor (vWF) and coagulation factor VIII (F8) in the complement and coagulation cascades and Fgg and F2 in the platelet activation was increased in the cerebral venous sinuses of JVL rats than in sham rats, suggesting that endothelial cell injury in the venous sinus induced by CVC has a prothrombotic effect. In addition, endothelial cell damage accelerates coagulation and promotes platelet activation. Significantly, the concentrations of vWF, F2 and F8 in venous sinus blood of patients with internal jugular vein stenosis were higher than in their peripheral blood.ConclusionCollectively, our data suggest that CVC can induce endothelial cell damage, which then exhibits a procoagulant phenotype and ultimately increases the risk of CVT. This research contributes to our understanding of the pathophysiology of CVC associated with procoagulant factors and reexamines the components of Virchow’s triad in the context of CVC.

Cerebral venous sinus thrombosis - Current updates in the Asian context.

Background Cerebral venous sinus thrombosis (CVT) is a life-threatening cause of stroke in Asian countries. South Asia, comprising of India, Pakistan and Bangladesh and contributed to 40% of strokes in women. Major CVT registries are from the western nations, which differs from the Asian countries with respect to epidemiology, gender biases and risk factors. This review focusses on the various aspects of relevance in evaluation and management of patients with CVT in the Asian context. Summary The incidence of CVT is higher in Asia than in Western nations. Young age, female gender, especially in pregnancy and puerperal period, and dehydration appear to be the critical risk factors. Tropical infections like malaria, scrub typhus, and flaviviral encephalitis predispose to CVT. There is a higher prevalence of inherited thrombophilia in the Asian cohorts, contributing to prothrombotic states. Anticoagulation and supportive management offer excellent outcomes. Newer anticoagulants are safe and efficacious. In medically refractory cases, endovascular treatment offers modest benefits. Decompressive hemicraniectomy, when done early, offers mortality benefits in patients with large hemorrhagic venous infarctions. Key messages CVT is an important cause of stroke with high-burden in South Asian countries. Establishment of robust registries is the need of the hour; to study the natural history, course and outcomes and to develop management algorithms tailored to the available resources.

Rituximab induced cerebral venous sinus thrombosis in a patient with anti-N-methyl-d-aspartate receptor-antibody encephalitis: a case report and review of literature

BackgroundCerebral venous sinus thrombosis has not been reported in anti-N-methyl-d-aspartate receptor-antibody encephalitis in the absence of an underlying thrombotic state while rituximab induced cerebral venous sinus thrombosis is rarely reported. We report a patient with anti-N-methyl-d-aspartate receptor-antibody encephalitis without a prothrombotic state who developed cerebral venous sinus thrombosis following rituximab treatment.Case presentationA 15-year-old Sri Lankan girl who had been in remission following an episode of anti-N-methyl-d-aspartate receptor-antibody encephalitis 2 years ago, presented with a relapse of anti-N-methyl-d-aspartate receptor-antibody encephalitis characterized by recurrent seizures, mutism, and cognitive abnormalities. Since response was inadequate to first-line immunotherapy, she was administered four doses of rituximab at weekly intervals. Two days after the fourth dose, she developed increasing headaches, and her cranial magnetic resonance venogram confirmed the development of cerebral venous sinus thrombosis. Screening for prothrombotic states were negative. She made an unremarkable recovery following anticoagulation.ConclusionThis case highlights the occurrence of the rare but serious complication of cerebral venous sinus thrombosis following rituximab in the context of anti-N-methyl-d-aspartate receptor-antibody encephalitis and informs the clinician to be wary of new onset headache in patients with anti-N-methyl-d-aspartate receptor-antibody encephalitis treated with immunotherapy.

Cerebral venous sinus thrombosis associated with JAK2 V617F mutation-related pre-primary myelofibrosis: a case report and literature review

BackgroundCerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening subtype of stroke. Prompt and appropriate anticoagulation is crucial for improving the prognosis of CVST and preventing its recurrence. Identifying the underlying cause of CVST is decisive for guiding anticoagulant selection and determining treatment duration.Case PresentationA 50-year-old man presented with a 35-day history of headache, nausea, vomiting, and blurred vision. Digital subtraction angiography performed at another facility revealed CVST. A contrast-enhanced black-blood MRI at our center confirmed the diagnosis, which was supported by a high intracranial pressure of 330mmH2O. Laboratory tests showed elevated leukocytes and platelet counts, raising suspicion of an underlying myeloproliferative neoplasms (MPNs). A bone marrow biopsy demonstrated increased megakaryocytes and granulocytes, and genetic testing identified the presence of the Janus kinase 2 V617F (JAK2 V617F) mutation, leading to a diagnosis of pre-primary myelofibrosis (pre-PMF). During hospitalization, anticoagulation with nadroparin calcium and fibrinolytic therapy were initiated. Upon discharge, rivaroxaban and aspirin were prescribed to prevent CVST recurrence and arterial thrombosis.ConclusionThis case highlights the importance of recognizing dynamic changes in routine blood tests that may link CVST to underlying hematological disorders. The JAK2 mutation is not only associated with MPNs but also increases the risk of thrombosis, including CVST. Further investigation is warranted to better understand the mechanisms by which JAK2 mutations contribute to thrombosis and to explore the potential benefits of JAK2 inhibitors in reducing this risk.

Cerebral Venous Thrombosis in a Term Child: A Case Report

Thrombosis of cerebral venous sinuses is a rare condition but can be associated with serious clinical consequences. Pathogenesis of thrombosis of cerebral venous sinus is still not clear. As there is diverse etiology but presentation is subtle, it often leads to delay in the diagnosis. We are reporting the case of a term male neonate born by LSCS (indication obstructed labour with meconium stained amniotic fluid) with diagnosis of severe birth asphyxia, Hypoxic Ischemic Encephalopathy- stage II, probable sepsis, shock and Germinal Matrix Haemorrhage. The magnetic resonance imaging (MRI) of brain and magnetic resonance (MR) venogram done at 2 weeks of age showed superior saggital sinus thrombosis. Baby received anticoagulation therapy and extensive workup was done. Early neuroimaging in all the babies who has neonatal seizures will improve the identification and will warrant early treatment.

Trombóza mozkových splavů jako primomanifestace adenomu příštítného tělíska

Primary hyperparathyroidism (HPPT) is a generalized disorder of calcium-phosphate metabolism resulting from long-term secretion of parathyroid hormone (PTH). The most common cause of PTH overproduction is an adenoma of one or more parathyroid glands. Cerebral venous sinus thrombosis accounts for about 1–2% of cerebral events and its consequence can be focal ischemia with intracerebral hemorrhage. In this article, we describe a unique case report of a patient who was urgently admitted for the progression of a sudden speech disorder and progressive impairment of consciousness on the basis of thrombosis in the cerebral sinuses and intracerebral hemorrhage. Secondary findings at the initial diagnostic process were hypophosphatemia and hypercalcemia with parathyroid hormone elevation.

A case of convexity non-aneurysmal subarachnoid hemorrhage caused by cerebral sinus thrombosis

BackgroundConvexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management.Case presentationA 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. Two seizures following a severe headache. The patient’s history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 h continued for 3 months, and then replaced by rivaroxaban.ConclusionsThis study highlights the importance of considering CVST as a cause of SAH, emphasizes the role of advanced imaging in diagnosis, and demonstrates a successful treatment approach using both traditional and direct oral anticoagulants. The insights provided in this article can contribute to improving the management of patients with CVST-related SAH.

Anticoagulation strategies in patients with coexisting traumatic intracranial hematomas and cerebral venous sinus thrombosis: an observational cohort study

PurposePost-traumatic cerebral venous sinus thrombosis (ptCVT) is a rare but serious complication of traumatic brain injury (TBI). Managing ptCVT is challenging due to the concurrent risk of traumatic intracranial hematoma (ICH) expansion. Limited data exists on the safety and efficacy of anticoagulation therapy (ACT) in these cases.MethodsThis single-center observational cohort study included adult TBI patients with concurrent ICH and ptCVT. Low-molecular-weight heparin (LMWH) or heparin infusion was used to treat all ptCVTs based on institutional protocols. The outcomes of interest were hemorrhagic and thrombotic complications.ResultsOut of 1,039 TBI-patients admitted between 2006 and 2020, 32 met the inclusion criteria. The median time from injury to ptCVT diagnosis was 24 h. ACT was initiated at a median of 9 h after ptCVT diagnosis. Patients were administered either heparin infusion (n = 8) or LMWH at dosages ranging from 28 to 72% of the therapeutic level (n = 24). There were no hemorrhagic complications, even in patients receiving LMWH at ≥ 50% of the therapeutic dose. Thrombotic complications occurred in 3 patients (9.4%) – two cases of thrombus progression and one venous infarct. The patients who developed thrombotic complications differed from those who did not by having a 17-h delay in ACT initiation after diagnosis or by receiving an initial LMWH dose at 28% of the therapeutic level.ConclusionLMWH at approximately 50% of the therapeutic level was effective for managing ptCVT associated with TBI in our retrospective dataset, with no risk of hematoma expansion. Prospective trials are warranted to confirm these results.

Association between laboratory markers, clinical and radiological findings in patients with idiopathic intracranial hypertension: case–control study

BackgroundIdiopathic intracranial hypertension (IIH) is a disease of raised intracranial pressure. Contribution of inflammatory mediators has been suggested in IIH pathophysiology. The aim of this study was to estimate certain serum inflammatory markers in IIH patients compared to normal subjects. Also, to examine the correlation between these laboratory parameters and the clinical and radiological characteristics of IIH patients.ResultsBody mass index (BMI) was significantly higher among IIH patients compared to controls. Serum LDH, CRP, NLR and PLR were significantly higher, whereas serum iron was significantly lower in IIH patients compared to healthy controls. IIH patients with stenosis in brain MRV had significantly higher mean serum CRP compared with patients with normal MRV. There was a statistically significant positive correlation between serum CRP and the presence of stenosis in MRV, between serum LDH level and grade of papilledema, and between CRP, TIBC, and NLR with BMI.ConclusionsThere is a significant elevation of inflammatory markers in IIH patients. Moreover, cerebral venous sinus stenosis and BMI were positively associated with higher markers of inflammation as CRP, LDH and NLR indicating the role of inflammation in thrombosis and obesity associated with IIH.

Ischemic events are infrequent in patients with ovarian hyperstimulation syndrome

BackgroundCase reports describe arterial thrombosis including ischemic stroke associated with severe ovarian hyperstimulation syndrome (OHSS), but the prevalence of major ischemic events during or shortly after OHSS is unknown. MethodsUsing publicly available administrative datasets in the United States between 2015 and 2020, we conducted two separate cross-sectional studies of patients with OHSS. We included all patients with OHSS. Our study outcome was any hospitalization for acute ischemic stroke, acute myocardial infarction, cerebral venous sinus thrombosis, pulmonary embolism, or acute deep venous thrombosis during the index hospitalization or within 90 days of OHSS diagnosis. Results and conclusionsWe found very few major ischemic events in patients with OHSS.