Development Of Cerebral Venous Thrombosis Research Articles

Anti-inflammatory Effect of Batroxobin Combined With Anticoagulation in Patients With Cerebral Venous Thrombosis.

Inflammation is pivotal in the pathogenesis and development of cerebral venous thrombosis (CVT). Herein, we aimed to assess the anti-inflammatory effects of batroxobin combined with anticoagulation in CVT. Participants were categorized into the batroxobin group (batroxobin combined with anticoagulation) and the control group (anticoagulation only). Regression analysis was employed to explore the association between the number of episodes of batroxobin administration and the fluctuation of inflammatory indicators, as well as the proportion of patients with inflammatory indicators that were reduced after batroxobin use. Twenty-three cases (age: 39.9 ± 13.8 years, female: 39.1%) in the batroxobin group and 36 cases (40.3 ± 9.6 years, 52.8%) in the control group were analyzed. Compared to the control group, batroxobin combined with anticoagulation significantly decreased fibrinogen (P < .001), platelet-lymphocyte ratio (PLR) (P = .016) and systemic immune-inflammation index (SII) (P = .008), and increased the proportion of the patients with lower fibrinogen (P < .001), neutrophil-lymphocyte ratio (NLR) (P = .005), PLR (P = .026), and SII (P = .006). Linear analysis showed that as the number of episodes of batroxobin administration increased, the fibrinogen (P < .001), the PLR (P = .001), and the SII (P = .020) significantly decreased. Logistic regression analysis showed as the number of episodes of batroxobin administration increased, the ratio of the patients with decreased NLR (P = .008) and PLR (P = .015), as well as SII (P = .013), significantly increased. Batroxobin could decrease NLR, PLR, and SII in CVT. The effect was related to the number of episodes of batroxobin administration. Besides reducing fibrinogen and indirect thrombolysis effects, this may be another critical benefit of batroxobin for CVT.

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.

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.

Trombosis venosa cerebral en adultos: cohorte de 35 casos de un hospital terciario

ObjectiveTo describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). Patients and methodsThis retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. ResultsA total of 35 patients were included, with a median age at diagnosis of 50.3 (± 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins. During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients). Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. ConclusionsIn our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding.

Cerebral venous thrombosis in adults: a case series of 35 patients from a tertiary hospital

ObjectiveTo describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). Patients and methodsThis retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. ResultsA total of 35 patients were included, with a median age at diagnosis of 50.3 (+/- 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins.During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients).Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. ConclusionsIn our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding.

Clinical course and diagnosis of cerebral vein and sinus thrombosis associated with COVID-19 in young and middle-aged patients

Cerebral venous thrombosis (CVT) is a form of cerebrovascular disorders that is difficult to recognize, it is potentially a life threatening condition and requires timely anticoagulant therapy. In the era of the COVID-19 pandemic, there is a steady increase in CVT (4.2% vs. 0.5–1%). At the same time, mortality in patients with CVT on the background of COVID-19 significantly exceeds the mortality in patients with CVT without COVID-19 (45.5% vs. 15%). Objective: to study the clinical course of CVT, to determine the diagnostic value of radiological methods and the significance of genetic risk factors for thrombosis in the development of CVT in young and middle-aged patients against the background of COVID-19. Material and methods. Seven patients were examined: six women (five of them of reproductive age) and one man, aged 26 to 57 years (mean age 37 years). The main clinical and neurological manifestations of CVT, the results of laboratory examination, neuroimaging, and the data of molecular genetic analysis of risk factors for thrombosis were analyzed. Results. The course of COVID-19 was severe in one case, and moderate in the rest of cases. The interval between the onset of COVID-19 symptoms and the development of CVT ranged from 7 to 25 days. In three cases CVT had an acute course and was accompanied by the development of a stroke (in two cases, hemorrhagic stroke was noted, in one case, multifocal ischemic stroke), in other cases, a subacute course of CVT was noted. Genetic risk factors for thrombosis were identified in all patients.Conclusion. The diagnosis of CVT in the era of the COVID-19 pandemic is particularly difficult, since the most common symptom of CVT – headache (90%) – can be regarded as a manifestation of COVID-19. At the same time, timely diagnosis of CVT and immediate initiation of anticoagulant therapy are associated with a relatively favorable prognosis.

Case Report of Chronic Nitrous Oxide Abuse Presented with Cerebral Venous Thrombosis: (P9-4.006)

<h3>Objective:</h3> We present a unique case of nitrous oxide abuse presented with B12 deficiency symptoms and cerebral venous thrombosis. <h3>Background:</h3> Nitrous oxide is being used as a recreational drug. It’s unknown side effects and low-price account for its rising popularity. In the paper, we discuss the link between nitrous oxide, vitamin B12 deficiency, and the development of cerebral venous thrombosis. <h3>Design/Methods:</h3> A 33-year-old female, with a past medical history of anxiety, presented to the emergency department with a five-day history of BLE weakness, generalized numbness, and confusion. The patient appeared lethargic, disoriented, and confused. Gait evaluation showed sensory ataxia with a positive Romberg sign. No other neurological deficits were elicited. Patient denied usage of drugs or alcohol. A head CT showed a possible thrombus in the left transverse and sigmoid sinuses. This was confirmed by a computed tomography angiography (CTA) of the head and neck. Lab results showed elevated homocysteine and methylmalonic acid levels with decreased B12. Upon further discussion with the patient, she disclosed the use of Nitrous Oxide recreationally for about six months. Treatment included IM B12 1,000 mcg daily for 4 weeks, then monthly until future follow up. Patient was advised to avoid further use of Nitrous oxide. <h3>Results:</h3> Chronic Nitrous oxide abuse can present as cerebral venous thrombosis (CVT). Though unusual, it needs to be included among possible complications/ presentations. <h3>Conclusions:</h3> We recommend conducting an extensive workup on CVT, which includes homocysteine and B12 levels. <b>Disclosure:</b> Ms. AlNaser has nothing to disclose. Dr. Kebbeh has nothing to disclose. Shauna Cheung, MD has nothing to disclose.

Clinical and diagnostic features of course of cerebral venous thrombosis during COVID‑19 pandemic

Relevance. During the COVID‑19 pandemic, there has been an increase in the frequency of cerebral venous thrombosis (CVT) by 30–60 times. At the same time, the development of CVT does not depend on the severity of COVID‑19. Diagnosis of CVT during the COVID‑19 pandemic is particularly difficult, since the most common symptom of CVT, headache, can be regarded as a manifestation of COVID‑19. A wide range of clinical symptoms and low alertness of doctors leads to late diagnosis and verification of CVT.Purpose of the study. To analyze the features of clinical manifestations and neuroimaging signs of CVT against the background of COVID‑19. Patients and methods. We examined 70 young and middle-aged patients with COVID‑19 of varying severity, who underwent inpatient treatment in angio-neurological and re-profiled infectious diseases departments of North-Western State Medical University n. a. I. I. Mechnikov (Saint Petersburg, Russia) at the age of 18 to 59 years (38.5 ± 11.58), of which 49 (70 %) women and 21 (30 %) men.Results. The most common neurological symptom in patients with CVT due to COVID‑19 was diffuse headache. The severity of COVID‑19 and the degree of lung damage did not correlate with the severity of CVT. In 32 (46 %) cases, CVT was accompanied by the development of venous stroke: ischemic – in 13 (19 %) patients, hemorrhagic – in 7 (10 %), ischemic stroke with hemorrhagic impregnation – in 12 (17 %) patients. According to the localization of the thrombus, thrombosis of the left transverse sinus was most often noted – in 39 (57 %) cases.Conclusions. The leading symptom in all patients with CVT was headache, which was not relieved by taking conventional analgesics, which caused clinical alertness of doctors. Early diagnosis of CVT ensured the immediate start of anticoagulant therapy and contributed to positive dynamics in all patients in the form of regression of neurological deficit and improvement in general condition.

ЦЕРЕБРАЛЬНЫЙ ВЕНОЗНЫЙ ТРОМБОЗ У ЖЕНЩИН РЕПРОДУКТИВНОГО ВОЗРАСТА: ПРИЧИНЫ И ОСОБЕННОСТИ ТЕЧЕНИЯ

Cerebral venous thrombosis (CVT) is a brain lesion due to impaired blood circulation, caused by thrombosis of the intracranial veins and sinuses, leading to an increase in hydrostatic pressure in the proximal veins and capillaries, as a result of which cerebral edema and ischemia develop, and, consequently, cerebral infarction is formed. CVT is especially common in women aged 20 to 35 years, which is largely due to the course of pregnancy and the postpartum period, as well as the use of oral contraceptives. Disturbances in the hemostasis system play a key role in the pathogenesis of these thromboses. Data have appeared on the impact of a novel coronavirus infection on the development of cerebral venous thrombosis, both directly, influencing the mechanisms of thrombosis, and indirectly through the mechanisms of inflammation and endothelial lesion. The article analyzes possible factors in the development of cerebral venous thrombosis, discusses mutually potentiating mechanisms in the presence of several significant prothrombotic diseases in women of reproductive age.

Homocystinuria Presenting as Ectopia Lentis and Thrombotic Manifestations in Two Siblings: A Case Series

AbstractHomocystinuria (HCU) is an autosomal recessive metabolic disorder due to a defect in cystathionine beta synthase activity which results in homocysteine accumulation in the body. We report a case series of two siblings,11-year-old girl and 3-year-old boy, studied retrospectively. They were born to a nonconsanguineous parents and diagnosed as a case of HCU based on the presence of ectopia lentis and development of cerebral venous thrombosis and infarction. Child who presented late with paresis had delayed developmental milestones with low intelligence quotient (IQ), while the second child diagnosed at a younger age had relatively normal IQ and cognitive development. Serious clinical sequelae such as life-threatening thromboembolic events at a young age and mental retardation can be prevented by early screening and prompt treatment of the patients detected to have HCU.

Diagnostics of cerebral venous thrombosis associated with COVID-19 in young adults: clinical characteristics and imaging patterns

Introduction. Cerebral venous thrombosis (CVT) is relatively rare, but leads to the development of cerebral venous infarction, intracranial hemorrhage, followed by severe disability and death. Due to the epidemiological situation caused by COVID-19, the incidence of CVT is increasing.Aims and objectives: to analyze clinical, laboratory instrumental and neuroimaging (multislice computed tomography (MSCT), MSCT — with intravenous contrast, magnetic resonance imaging of the brain (MRI) and MRI venography) data that confirmed the development of CVT in patients with COVID-19.Methods. Data of 5 young adults with cerebral venous thrombosis (CVT) associated with COVID-19 are presented.Results. Аmong 5 reported cases of COVID-19, two patients presented with venous infarcts (hemorrhagic and ischemic), 3 patients developed encephalopathy syndrome without acute cerebral infarction.Conclusion. Possibilities of modern imaging technologies permitted to timely diagnosis cerebral venous thrombosis associated with COVID-19, that can lead to immediate initiation of therapy and to prevent the development of cerebrovascular complications during the COVID-19 pandemic.

Церебральний венозний тромбоз (клінічний випадок)

Тромбоз мозкових вен і венозний тромбоз мозкових синусів зустрічається рідко (до 1 % від усіх випадків інфарктів мозку). За даними ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis, 2004), захворюваність щорічно становить 3–4 випадки на 1 млн у дорослих. Летальність при даному захворюванні становить від 5 до 30 %. Міжнародне дослідження тромбозу мозкових вен та венозних синусів (ISCVT) визначало частоту оклюзій за локалізацією так: поперечний синус — 86 %, верхній сагітальний синус — 62 %, прямий синус — 18 %, кортикальні вени — 17 %, внутрішні яремні вени — 12 %, вена Галена і внутрішні мозкові вени — 11 %. Основними факторами ризику розвитку тромбозу мозкових вен і венозного тромбозу мозкових синусів у популяції є інфекційні запальні процеси (отити, мастоїдити, синусити, септичні стани) і неінфекційні причини: черепно-мозкова травма, пухлини, хірургічні втручання в ділянці голови та шиї, а також імплантація кардіостимулятора чи постановка центрального венозного катетера. Захворювання, що сприяють даній патології: порушення гемодинаміки (застійна серцева недостатність, зневоднення організму), захворювання крові (поліцитемія, серпоподібноклітинна анемія, тромбоцитопенія) і коагулопатії (синдром дисемінованого внутрішньосудинного згортання крові, дефіцит антитромбіну, протеїну С і S), а також тромбофілітичні стани, пов’язані з вагітністю, родами та прийомом пероральних контрацептивів, антифосфоліпідний синдром, системні васкуліти. При цьому в 15 % випадків причина розвитку синус-тромбозу залишається невстановленою. Венозний тромбоз мозкових синусів характеризується дуже різноманітним клінічним перебігом, складною діагностикою, різноманітною етіологією і прогнозом. Одним з ускладнень тромбозу синусів є інсульт, що спостерігається приблизно в 30 % хворих та часто призводить до смерті хворого. У статті подано опис клінічного випадку церебрального венозного тромбозу, що ускладнився несумісним із життям двопівкульним субарахноїдально-паренхіматозним крововиливом.

Delayed headache after COVID-19 vaccination: a red flag for vaccine induced cerebral venous thrombosis

BackgroundHeadache is a frequent symptom following COVID-19 immunization with a typical onset within days post-vaccination. Cases of cerebral venous thrombosis (CVT) have been reported in adenovirus vector-based COVID-19 vaccine recipients.FindingsWe reviewed all vaccine related CVT published cases by April 30, 2021. We assessed demographic, clinical variables and the interval between the vaccination and onset of headache. We assessed whether the presence of headache was associated with higher probability of death or intracranial hemorrhage.We identified 77 cases of CVT after COVID-19 vaccination. Patients’ age was below 60 years in 74/77 (95.8%) cases and 61/68 (89.7%) were women. Headache was described in 38/77 (49.4%) cases, and in 35/38 (92.1%) was associated with other symptoms. Multiple organ thrombosis was reported in 19/77 (24.7%) cases, intracranial hemorrhage in 33/77 (42.9%) cases and 19/77 (24.7%) patients died. The median time between vaccination and CVT-related headache onset was 8 (interquartile range 7.0–9.7) days. The presence of headache was associated with a higher odd of intracranial hemorrhage (OR 7.4; 95% CI: 2.7–20.8, p < 0.001), but not with death (OR: 0.51, 95% CI: 0.18–1.47, p = 0.213).ConclusionDelayed onset of headache following an adenovirus vector-based COVID-19 vaccine is associated with development of CVT. Patients with new-onset headache, 1 week after vaccination with an adenovirus vector-based vaccine, should receive a thorough clinical evaluation and CVT must be ruled out.

Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants.

For infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the "consensus" opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis and cortical vein thrombosis is a false mimic. This article contends that this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury and is the result of a poor radiologic evidence base and misinterpreted data. Underdiagnosis of thrombosis is the result of rapid clot dissolution and radiologic under recognition. A pre-existing/chronic subdural hemorrhage predisposes to development of venous sinus thrombosis/cortical vein thrombosis, triggered by minor trauma or an acute life-threatening event such as dysphagic choking, variably leading to retinal and subdural hemorrhages and neurologic decline. These conclusions are based on analysis of the neuroradiologic imaging findings in 11 infants, all featuring undiagnosed cortical vein or venous sinus thrombosis. Subtle neuroradiologic signs of and the mechanisms of thrombosis are discussed. Subarachnoid hemorrhage from leaking thrombosed cortical veins may be confused with acute subdural hemorrhage and probably contributes to the development of retinal hemorrhage ala Terson's syndrome. Chronic subdural hemorrhage rebleeding from minor trauma likely occurs more readily than bleeding from traumatic bridging vein rupture. Radiologists must meet the challenge of stringent evaluation of neuro imaging studies; any infant with a pre-existing subdural hemorrhage presenting with neurologic decline must be assumed to have venous sinus or cortical vein thrombosis until proven otherwise.

Hyperthyroidism: A Rare Cause of Cerebral Venous Thrombosis

Background: Cerebral venous thrombosis (CVT) accounts for <1% of strokes. In most cases, there is a predisposition to hypercoagulability; however, in about 30% of cases there is no identifiable etiology. Risk factors include pregnancy, puerperium, oral contraceptives, and coagulopathies and rarely hyperthyroidism. To the best of our knowledge there is no reported cases of CVT in uncontrolled hyperthyroidism with no underlying hypercoagulable disorder. We present a case where a woman developed CVT in the setting of uncontrolled hyperthyroidism. Clinical Case: A 24 year-old Caucasian woman was diagnosed with hyperthyroidism during 1st trimester of pregnancy based labs and was treated with propylthiouracil (PTU) 150 mg bid. At 34 weeks of pregnancy her FT4 normalized and PTU was discontinued. Three and half months post-partum she presented with left frontal headache, photophobia, phonophobia and transient visual loss on the right. Physical exam revealed right homonymous hemianopia without meningismus and an enlarged thyroid. Vitals showed BP 108/57 mm of Hg, HR 162 beats/min, RR of 23/min. CT head without contrast showed 8 mm focal hyperdensity along the left tentorium projecting at the left occipital lobe. She developed seizures after admission. MRI brain with and without contrast showed diffusely small left transverse and sigmoid sinus with a focal area of dural sinus thrombosis. MRI venogram of head confirmed CVT. She was started on levetiracetam and low dose heparin drip. Further workup showed: TSH <0.005 UIU/ml with FT4>8 ng/dl, TSH receptor antibodies 11.10 (normal range 0.00 - 1.75 IU/L), thyroid peroxidase antibody >1300 (normal range <=59 u/ml), and thyroid stimulating antibodies 6.85 (0.00 - 0.55 IU/L) suggestive of Graves disease. She was initiated on PTU 200 mg Q8hrs, propranolol 80 mg Q8hrs and lugol’s iodine 5 drops Q8hrs. Hypercoagulable workup except for protein C and S returned unremarkable. Over the next several days, thyroid levels improved significantly. She was discharged home on warfarin and methimazole. Conclusion: The exact pathophysiology of CVT in hyperthyroidism remains unclear. Some proposed mechanisms include increased activity of pro coagulative plasma constituents including Von Willebrands Factor, Factor IX, X, antithrombin, and fibrinogen as well as an increased aPTT and a decrease in thrombolytic factors like t-PA. These changes result in an increased risk of thrombosis. This case demonstrates the potential development of CVT as a result of untreated overt hyperthyroidism. It highlights the importance of treatment and close follow up of Graves’ disease to prevent severe complications. Further studies need to be done to understand the process of coagulation in hyperthyroidism and this could allow clinicians to better identify hyperthyroid patients at risk for clotting.

Postpartum Cerebral Venous Thrombosis—A Single-Center Experience

Background: Cerebral venous thrombosis (CVT) is a rare variant of stroke in the general population, but an important subtype among pregnancy- and puerperium-related cases. Studies describing its risk factors and clinical characteristics are limited. The aim of our study is to disclose these aspects and compare with cases unrelated to pregnancy and puerperium. Materials and Methods: We performed a retrospective analysis including 88 consecutive cases from a tertiary neurology clinic with a diagnosis of CVT. Ten of the 88 cases (11.3%) appeared during the postpartum period. Results: The mean age of the puerperal CVT cases was 26.5 years. The main pregnancy-related risk factors besides puerperium were cesarean delivery (5/10), preeclampsia (2/10), and stillbirth (1/10). General risk factors for thrombosis, i.e., infection, smoking, and primary hypercoagulability, were identified in 50% of cases. Onset was in the first 3 weeks after delivery, with a mean value of 9.6 ± 5.6 days. Headache was present in 90% of postpartum CVT cases and in 76.1% of non-postpartum female cases. Seizures were more frequent in the postpartum group (60% vs. 34.8%). Onset was acute (<48 h) in 50% of postpartum cases and in 30.4% of the non-postpartum female group. The Rankin score at discharge was significantly lower in the postpartum group (0.22 vs. 0.7, p = 0.02), suggesting a more favorable short-term outcome. Conclusions: The early postpartum period represents an important risk for the development of CVT. Cesarean delivery and preeclampsia, besides general risk factors such as infection, smoking, and primary thrombophilia, contribute to enhanced risk. Puerperium-related CVT presents a more favorable outcome compared with CVT with other etiologies.

Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report

BackgroundHeat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain.Case presentationWe encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid–base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient’s level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved.ConclusionsThis case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.

The role of mean platelet volume, platelet distribution width and platelet / lymphocyte ratio in development of cerebral venous thrombosis

Amac: Ortalama platelet hacmi (OPH) ve platelet dagilim genisligi (PDG), platelet hacmini gosteren parametrelerdir. Buyuk plateletlerin kucuk plateletlere kiyasla enzimatik ve metabolik olarak daha aktif kabul edilmektedir. Artmis OPH ve PDG degerleri ile arteryel tromboz arasindaki iliski gosterilmistir ancak venoz trombozdaki yeri tam olarak bilinmemektedir. Inflamatuar bir gosterge kabul edilen platelet/ lenfosit oraninin artisinin(PLO) bircok hastalikla iliskisi bilinmekteyken venoz trombozda kullanimi ile ilgili az sayida calisma mevcuttur. Bu nedenle bu calismamizdaki amacimiz OPH, PDG ve PLO degerleri ile serebral venoz sinus trombozu(SVST) arasindaki iliskiyi ortaya koymaktir. Yontem: Calismamiza retrospektif olarak Ocak 2008- Eylul 2016 tarihleri arasinda klinigimizde SVST tanisi ile izlenmis 54 hasta ile benzer yas ve cinsiyete sahip 50 kontrol dahil edildi. Hasta ve kontrol grubu OPH, PDG ve PLO degerleri acisindan kiyaslandi. Bunun yaninda hasta grubu kendi icinde beyin parankimal lezyonu olan ve olmayanlar olarak ikiye ayrilarak OPH, PDG ve PLO’nun prognoz uzerindeki etkisi de degerlendirildi. Bulgular: Hasta grubunda kontrollere kiyasla OPH, PDG ve PLO degerleri daha yuksekken parankimal lezyonu olan ve olmayan hastalar arasinda anlamli fark saptanmadi. Ek olarak SVST gelisimi icin OPH ve PDG degerleri anlamli bagimsiz degiskenler olarak saptanirken ROC analizi ile optimum cut-off degerleri OPH icin 8.85 iken, PDG icin 15.75, PLO icin ise 168.53 olarak tespit edildi. Sonuc: Sonuc olarak, OPH, PDG ve PLO degerleri SVST’li hastalarda kontrollerden daha yuksek bulunmustur ancak prognozu belirlemede etkileri saptanmamistir. Ek olarak, OPH ile PDG yuksekliginin SVST gelisimi icin yeni bir bagimsiz risk faktorleri oldugunu soyleyebiliriz.

The role of mean platelet volume, platelet distribution width and platelet / lymphocyte ratio in development of cerebral venous thrombosis

The role of mean platelet volume, platelet distribution width and platelet / lymphocyte ratio in development of cerebral venous thrombosis

Specific Polymorphism 4G/5G Gene for PAI-1 as a Possible Cause of Cerebral Venous Thrombosis: A Case Report

Abstract Thrombosis of veins and venous sinus (CVT) is the rare cerebral vascular disorder which makes less than 1% of all strokes. Thrombosis of veins and venous sinuses is picturesquely called “мајоr neurological forger” since it is characterized by very varied clinical picture. Among the various causes of CVT, which can be of infective or non-infective nature, the congenital hyper coagulations especially stand out, diagnosis is based on highly sophisticated diagnostic tests. We present the case of a female patient, 36 years old, who was hospitalized at the Clinic for Neurology in Clinical Center because of the diffuse headache she had for the last few days, with milder right-sided hemiparesis and one generalized tonic-clonic epileptic seizure. With nuclear magnetic resonance (MR/2D venography) the thrombosis of the upper and lower sagittal sinuses is confirmed. By appropriate laboratory tests, as well as by confirmatory immunological and genetic analyses, the impact of the most of the factors is excluded which can contribute to the occurrence of venous thrombosis. The only pathological findings which indicated the possible congenital thrombophilia as the cause of the sagittal sinus thrombosis was the determination of the specific polymorphism of the 4G/5G gene for plasminogen activator inhibitor 1. According to our knowledge, this is the first decribed case of the possible impact of the specific polymorphism of the 4G/5G gene for plasminogen activator inhibitor of 1 on the development of cerebral venous thrombosis.