Intracranial Sinus Thrombosis Research Articles

Peripartum Neurological Injuries and its Outcomes

Aim: To study the peri-partum neurological injury and its outcomes. Study Design: Cross sectional study Place and duration of study: Department of Neurosurgery & Department of Obstetrics & Gynaecology, Peoples Medical University Hospital, Nawabshah from 1st July 2022 to 30th June 2023. Methodology: Two hundred and fifty women having a high risk of neurological disorders were included. A high-risk pregnancy was defined with the one having increased threat to fetal morbidity as well as risk of disability presented through clinical symptoms of each case. Biochemical analysis using 5cc blood was conducted for testing positive free beta human-chorionic-gonadotropin in addition to neurological assessment and Doppler ultrasound. A well-designed questionnaire was adapted for extracting information regarding gravidity, parity, gestational hypertension and diabetes, complete clinical history including neurological symptoms, mortality rate mode of delivery and foetal disorders through modifying-ranking-scale of mother. Results: The mean age, gravidity and parity of the study participants was 29.33±1.2, 2.2±1.7 and 2.1±2.0 respectively. Significant number of neurological disorders was observed in before and after pregnancy. Majority of the participants were underwent C-section (62%). Highest ratio of full-term births were reported followed by preterm and abortion. There were 20% those cases who received severe headache post delivery time, on clinical diagnosis out of those 20% cases there were 3% those having subdural hematoma formation. Congenital disorders were observed in only 1 neonate. Obstetric and neurological profile of each patient with each neurological condition was also assessed. Conclusion: The neurological conditions were frequently reported during pregnancy. Seizures, migraine, cerebral venous and intracranial hypertension and sinus thrombosis were reported by majority of the study participants. Keywords: Neurology, Anesthesia, Pregnancy, Neuropathy

Ten-Year Analysis of Complications Related to Simple Basilar Skull Fractures in Children Presenting to a Trauma Center.

Head trauma is a common presenting complaint among children requiring urgent medical attention, accounting for more than 600,000 emergency department (ED) visits annually, 4% to 30% of which identify skull fractures among the patient's injuries. Previous literature shows that children with basilar skull fractures (BSFs) are usually admitted for observation. We studied whether children with an isolated BSF have complications precluding them from safe discharge home from the ED. We performed a retrospective review of ED patients aged 0 to 18 years given a simple BSF diagnosis (defined by nondisplaced fracture, with normal neurologic examination, Glasgow Coma Score of 15, no intracranial hemorrhage, no pneumocephalus) during a 10-year period to identify complications associated with their injury. Complications were defined as death, vascular injury, delayed intracranial hemorrhage, sinus thrombosis, or meningitis. We also considered hospital length of stay (LOS) longer than 24 hours or any return visit within 3 weeks of the original injury. Of the 174 patients included in the analysis, there were no deaths, cases of meningitis, vascular injury, nor delayed bleeding events. Thirty (17.2%) patients required a hospital LOS longer than 24 hours and 9 (5.2%) returned to the hospital within 3 weeks of discharge. Of those with LOS longer than 24 hours, 22 (12.6%) patients needed subspecialty consultation or intravenous fluids, 3 (1.7%) had cerebrospinal fluid leak, and 2 (1.2%) had a concern for facial nerve abnormality. On the return visits, only 1 (0.6%) patient required readmission for intravenous fluids because of nausea and vomiting. Our findings suggest that patients with uncomplicated BSFs can be safely discharged from the ED if the patient has reliable follow-up, is tolerating oral fluids, has no evidence of cerebrospinal fluid leak, and has been evaluated by appropriate subspecialists before discharge.

Sinus pericranii associated with syntelencephaly: a case report

BackgroundSinus pericranii is a rare cranial venous malformation resulting in a subcutaneous mass due to abnormal communication between intracranial and subperiosteal/interperiosteal veins. To date, to the best of our knowledge, there are no reports of sinus pericranii associated with syntelencephaly, a subtype of lobar holoprosencephaly. We herein report a case of sinus pericranii associated with syntelencephaly. This report can provide us better understanding of the etiology of sinus pericranii, the potential risks, and the treatment options for these patients.Case presentationA 2-year-4-month old female patient who received the diagnosis of syntelencephaly as a neonate presented with a subcutaneous mass in the parietal region. The mass was soft, nonpulsatile, 3 × 2 cm in size, and showed enlargement in the lying position. Color cranial Doppler ultrasound, head magnetic resonance imaging (MRI), and cerebral angiography revealed a dilated vessel passing through the parietal bone and forming a communication between the superior sagittal sinus and scalp veins. Based on these findings, sinus pericranii was diagnosed. The head MRI also showed coronal craniosynostosis, a tight posterior fossa. At age 2 years and 7 months, the patient underwent a transection of the sinus pericranii and the mass resolved without any complications or recurrences for more than 2.5 years to date.ConclusionSinus pericranii is a rare cranial and venous malformation sometimes accompanied by brain malformations or craniosynostosis that may become more apparent as the brain and skull develop. Since this condition can be complicated by intracranial hemorrhage and sinus thrombosis, early detection is necessary to determine the treatment options. Physicians should be alert to the possibility of this condition if they observe a soft cranial mass that appears to decrease in size in the sitting position and bulge in the lying position.

P.144 Dural arteriovenous fistulas with associated intracranial tumors: review of literature

Background: Intracranial dural arteriovenous fistulas (DAVF) are relatively rare vascular malformations. While the pathophysiology of their formation is unknown, they are believed to be acquired lesions related to intracranial venous hypertension and dura sinus thrombosis. There have been rare reports of intracranial tumors associated with DAVF. Here we complete a systematic search of the literature. Methods: A systematic PRISMA search of the literature was conducted to identify papers in which an intracranial tumor was associated with sinus thrombosis and DAVF. 24 relevant studies were identified and analyzed, along with a case illustration. Results: A total of 38 cases of DAVF formation with concomitant intracranial tumor were identified. The median age was 60, the majority of tumors being meningiomas (71%), and involved primarily the transverse sigmoid sinus (52%) and superior sagittal sinus (16%). The most cases involved an occlusion (39%) or partial occlusion (24%) of the related sinus. The DAVF were classified as Borden Types I (35%), II (32%) or III (24%). Endovascular treatment was the most common intervention (56%), followed by a combined approach (28%) vs surgery alone (16%), all reporting resolution. Conclusions: This highlights that DAVFs can be rarely associated with intracranial tumors, and highlights the patterns of these lesions and their treatments.

The management of elevated intracranial pressure and sinus vein thrombosis associated with mastoiditis: the experience of eighteen patients.

Cerebral sinus vein thrombosis (CSVT) associated with acute mastoiditis is a rare complication of acute otitis media. Elevated intracranial pressure (ICP) frequently occurs secondary to CSVT. The study aims to review the 5years of experience of four medical centres to treat sigmoid sinus thrombosis and elevated intracranial pressure in children. Patients with CSVT that developed secondary mastoiditis from 2016 through 2021 were evaluated in four centres from Turkey. Patients diagnosed with a preceding or synchronous mastoiditis and intracranial sinus thrombosis were included in the study. Magnetic resonance imaging (MRI), magnetic resonance venography (MRV), ICP measurements, ophthalmological examinations, thrombophilia studies and treatments for increased ICP have also been recorded. The study group comprises 18 children. Twelve patients were diagnosed with right-sided, six patients with left-sided sinus vein thrombosis. All of the patients had ipsilateral mastoiditis. The most common presenting symptoms were fever, ear pain, headache, visual disorders and vomiting. The most encountered neurologic findings were papilledema, strabismus and sixth cranial nerve palsy. ICP was over 20cm H2O in eleven patients. Anticoagulant treatment, antibiotics, pressure-lowering lumbar puncture and lumboperitoneal shunt were among the treatment modalities. Elevated ICP can damage the brain and optic nerve irreversibly, without treatment. For treating elevation of ICP associated with cerebral sinus thrombosis, pressure-lowering lumbar puncture (LP), acetazolamide therapy, optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF)-shunting procedures are suggested in case of deteriorated vision.

Cerebral venous thrombosis and Covid 19: Literature review

Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

Expression Level of IL-17 in Peripheral Blood of Patients with Late Pregnancy and Diagnosis of Maternal-Fetal Tolerance Based on Brain MRI Image Segmentation Algorithm.

Objectives:To study the expression of IL-17 in peripheral blood and its effect on maternal-fetal tolerance in patients with eclampsia in late pregnancy using MRI image segmentation algorithm.Methods:Thirty-nine patients with severe preeclampsia and eclampsia with brain symptoms were examined by cranial MRI. Pregnant women with 32 weeks of pregnancy were selected to detect the percentage of Th17 and Treg cells in CD4 + T lymphocytes and the expression of cytokines IL-17 and IL-10 in peripheral blood.Results:MRI examination was normal in 26 cases, 9 cases showed reversible posterior encephalopathy syndrome, three cases were cerebral hemorrhage, and one case was intracranial cavernous sinus thrombosis. two. Compared with the mild preeclampsia group, the relative number of Thl7 cells increased and that of Treg cells decreased in the severe preeclampsia group (P>0.05).Conclusion:The major types of cerebrovascular diseases (CVD) in severe preeclampsia and eclampsia were reversible posterior encephalopathy syndrome and cerebral hemorrhage. It was speculated that the damage to the blood-brain barrier may play an important role in the pathogenesis. The balance of the number of Th17 cells/the number of Treg cells was more inclined to the Th17 cell-mediated pro-inflammatory state, Treg cell-mediated immune tolerance decreases, and it becomes more obvious with the worsening of the disease.

Otite externa necrotizante com paralisia facial periférica e trombose do seio cavernoso

Otite externa necrotizante (OEN), conhecida antigamente como otite externa maligna (OEM), atinge o conduto auditivo externo, causando otalgia intensa, otorreia fétida, e em casos mais severos, comprometimento dos ossos do crânio e déficit neurológico. O agente etiológico mais comum é a Pseudomonas aeruginosa. Acomete principalmente pacientes idosos, diabéticos e imunodeprimidos. O comprometimento de nervo craniano levando a paralisia facial e trombose dos seios intracranianos são de piores prognósticos. O diagnóstico depende da suspeita clínica inicialmente. Os exames complementares são imprecisos, embora essenciais no seguimento. A abordagem multidisciplinar é sempre recomendada. O objetivo do trabalho é relatar as complicações clínicas de um caso de otite externa necrotizante com paralisia facial que evoluiu para trombose do seio cavernoso, levando ao óbito.

Management of a decompensated acute-on-chronic intracranial venous sinus thrombosis

A 34-year-old female patient presented during the 10th week of her second gravidity with headache, nausea and vomiting 2 weeks before admission. Her medical history was remarkable for a heterozygous factor V Leiden mutation, elevated lipoprotein A, and a cerebral venous thrombosis (CVT) after oral contraceptive intake 15 years before. Magnetic resonance imaging (MRI) suggested acute and massive intracranial sinus thrombosis. Despite full-dose anticoagulation, the patient deteriorated clinically and eventually became comatose. Now, MRI/magnetic resonance angiography revealed vasogenic edema of both thalami, of the left frontal lobe, and of the head of the caudate nucleus, with venous stasis and frontal petechial hemorrhage. She was referred for endovascular treatment. Diagnostic angiography confirmed a complete superficial and deep venous sinus occlusion. Endovascular access to the straight and superior sagittal sinus was possible, but neither rheolysis nor balloon angioplasty resulted in recanalization of the venous sinuses. Monitored heparinization was continued and antiaggregation was initiated. The patient remained comatose for another 5 days and MRI showed progress of the cytotoxic edema. On day 6, infusion of eptifibatide at body-weight-adapted dosage was started. The following day, the patient improved and slowly regained consciousness. MRI confirmed regression of the edema. The eptifibatide infusion was continued for a total of 14 days. Thereafter two doses of 180 mg ticagrelor per os (PO) daily were started. The patient remained on acetylsalicylic acid (ASA), ticagrelor, and enoxaparin on an unchanged dosage regimen. She was discharged home 26 days after the endovascular treatment without serious neurological deficit, with the pregnancy intact. At the 30th week of pregnancy the dosage of ASA was reduced to 300 mg once PO daily. Cesarian delivery was carried out at the 38th week of pregnancy. The newborn was completely healthy. Ultima ratio therapeutic options for severe intracranial venous sinus thrombosis refractory to anticoagulation are discussed, with an emphasis on platelet-function inhibition.

A Case of Deep Vein Thrombosis and Intracranial Sinus Thrombosis: Possible rare complications of childhood abdominal tuberculosis.

Severe pulmonary tuberculosis (TB) complicated by deep vein thrombosis (DVT) in adults has been reported previously in the medical literature; however, childhood extrapulmonary TB complicated by DVT is rare. We report a 13-year-old girl who presented to the Department of Pediatrics at the Postgraduate Institute of Medical Sciences in Rohtak, India, in 2012 with abdominal TB complicated by DVT and intracranial sinus thrombosis. She was treated with a course of four antitubercular drugs and short-term anticoagulation therapy with a positive outcome over the next six months. To the best of the authors' knowledge, no previous reports have yet suggested a possible association between childhood TB and intracranial sinus thrombosis.

The therapy of intracranial venous sinus thrombosis

The therapy of intracranial venous sinus thrombosis

Strategies in the treatment for intracranial venous sinus thrombosis

Background Cerebral venous sinus thrombosis (CVST) is a special type of cerebrovascular disease with high morbidity and mortality which often has an unpredictable outcome. It is usually misdiagnosed because of different causes and variable clinical manifestations. How to improve the diagnosis and therapy of CVST is always the hotspot in clinic. This article aims to investigate the effective and safe strategies in the treatment for CVST. Methods Clinical data of 52 patients diagnosed with CVST were retrospectively analyzed. These patients were subdivided into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. The patients with mild type were treated with systemic anticoagulant therapy combined with intravenous thrombolysis [continuous intravenous infusion of heparin (12.50-25) × 10 3 U/d for 7-10 d followed by a continuous infusion of urokinase (0.50-0.75) × 106 U/d for 5-7 d]. The patients with severe type were treated with endovascular thrombolysis [injection of urokinase (0.50-1) × 10 6 U, 0.10 × 10 6 U/min via carotid or vertebral artery; or intravenous infusion of urokinase 1 × 106 U/d and heparin 25 × 103 U/d for 5-7 d], and superior sagittal sinus cut-open/intrasinus thrombolysis separately. All the patients took oral warfarin for 6-12 months, and follow-up was performed after operation by the method of magnetic resonance venography (MRV). Results Among the 27 cases of mild type receiving systemic anticoagulant agents and intravenous thrombolysis, 14 were cured; 9 were improved; 4 were ineffective. Among the 22 cases of severe type receiving systemic anticoagulant drugs and endovascular thrombolysis, 18 were cured; 3 were improved; 1 was dead. The left 3 cases with gravis type received superior sagittal sinus cut⁃open/intrasinus thrombolysis and were cured. The period of follow-up was between 6 months and 60 months (the median time was 36 months), and no recurrence happened. Conclusion It was probable to subdivide CVST into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. Different therapeutic strategies were proved to be safe and effective in the treatment of different types.

Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: A safe treatment option?

ObjectiveSeptic thrombosis of the sigmoid and lateral sinus is a rare complication of acute otitis media, mastoiditis and cholesteatoma. Hence, the aim of this chat review was to analyze the demographics, presenting symptoms, diagnosis, and therapeutic management of otogenic sigmoid sinus thrombosis. Especially the role of low molecular weight heparin in the therapy of septic intracranial sinus thrombosis in children should be illuminated. MethodsA retrospective chart review was performed. ResultsSix patients were included in this trial. One patient was treated completely conservatively. All other patients underwent surgical treatment consisting of mastoidectomy (n=5), additional thrombectomy (n=3) and ligation of the internal jugular vein (n=2). All patients received intravenous antibiotics and anticoagulants. Unfractionated heparin was administered for three days after surgery followed by an anticoagulant therapy with low-molecular weight heparin for three months. The activated partial thromboplastin time (aPTT) and the anti-factor-Xa-plasma-levels were monitored during anticoagulation in short term intervals. There were no complications related to the anticoagulant therapy. Recanalization was found in all patients who were treated without thrombectomy or ligation of the internal jugular vein and in the case of complete conservative treatment. ConclusionSimple mastoidectomy combined with broad spectrum antibiotics is the therapy of choice. Our results indicate that anticoagulants represent a safe treatment option if they are administered correctly.

Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature.

Lenticulostriate Brain Aneurysms

Objective Lenticulostriate artery (LSA) aneurysms are rare. Here we present 2 cases of LSA aneurysm, their clinical presentation, diagnosis, surgical treatment, and postoperative follow-up, with a review of the topic. Case Report We report 2 female patients with LSA aneurysms among 194 surgically treated aneurysms in the Santa Paula and São Camilo Hospitals, who underwent the same surgical treatment. The first patient was a 48-year-old, Latin-American woman whose aneurysms were detected incidentally in an angiographic study carried out due to a cavernous sinus thrombosis. Both cerebral angiogram and magnetic angioresonance were performed and showed a left lenticulostriate aneurysm and 2 parasylvian aneurysms. The other case was a 62-year-old, Japanese, hypertensive patient who presented with subarachnoid hemorrhage, Fisher scale 2, and Hunt-Hess classification 2. Her angiogram showed a right LSA, left-middle cerebral artery, and anterior communicating artery aneurysms. No other pathology or infectious etiology was noted. Both patients were treated by opening the sylvian fissure, allowing the visualization of the lenticulostriate vessels and aneurysm clipping. Postoperative angiographies were performed in both cases. During the 2-year follow-up the younger patient remained with just distal right arm paresis and Rankin scale score of 1; the older patient developed normal pressure hydrocephalus, needing peritoneal ventricular drainage. Conclusions LSA aneurysms are uncommon. Subarachnoid hemorrhage and intracranial sinus thrombosis are quite common pathologies; nevertheless, the underlying vascular abnormality is rarely identified. The most common clinical presentation is intraparenchymal hemorrhage. Microsurgical treatment is often the chosen modality of intervention. Elderly people are more likely to develop postoperative complications before and after hospital discharge, which may be associated with microscopic alterations in vessels. They are also at higher risk of more severe vasospasm and the development of hydrocephalus in cases of ruptured aneurysms.

Analysis on the clinical characteristics and treatment of intracranial venous and sinus thrombosis

Objective To explore the clinical characteristics and treatment of intracranial venous and sinus thrombosis. Methods Fourteen patients (2 males and 12 females) with intracranial venous and sinus thrombosis were divided into 2 groups, and were treated with argatroban (argatroban group, n = 8) and heparin (heparin group, n = 6), respectively. Age, pattern of onset, clinical manifestations, imaging characteristics and result of cerebrospinal fluid (CSF) examination were analysed. The improvement of neural function and outcome was compared between 2 groups. Results Intracranial venous and sinus thrombosis could be seen in all age, but especially often occurred in young and middle⁃aged women. The common causes were pregnancy, infection, immunological disorders, etc. Acute or subacute clinical characteristics were headache (71.43%, 10/14), seizure (35.71%, 5/14), asthenia (21.43%, 3/14), and CSF pressure was significantly high in most patients. The imaging findings were cerebral venous and sinus occlusion and cerebral parenchymal impairment (infarction, hemorrhage, brain edema). There were 7 and 5 effective cases in argatroban group and heparin group, respectively (Z = ⁃ 0.067, P = 0.950). In both group, the neural function [National Institute of Health Stroke Scale (NIHSS) score] was significantly improved after treatment (P = 0.007). Conclusion Intracranial venous and sinus thrombosis should be highly suspected in patients who have no common risk factors for stroke, but with acute intracranial hypertensive symptoms such as headache, vomiting, and cortex symmetric infarction on CT scanning. Although cerebral angiography is the golden standard for the diagnosis of intracranial venous and sinus thrombosis, most patients can be early diagnosed by magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). The difference in curative effect is not significant between argatroban and heparin. The patient with intracranial venous and sinus thrombosis may get more benefit, when anticoagulant therapy is given earlier and actively. DOI：10.3969/j.issn.1672-6731.2011.02.015

Individualized endovascular treatment of intracranial venous sinus thrombosis

Objective To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis based on individual condition. Methods Twelve patients with intracranial venous sinus thrombosis were treated with endovascular management according to the severity and course of disease after they failed to respond to anticoagulant therapy. The clinical signs and symptoms,cerebrospinal fluid pressure and arteriovenous circulation time were observed and followed up (including MRV). Intravenous thrombolysis and mechanical thrombus maceration were carried out in all 12 patients,while intravenous thrombolysis, mechanical thrombus maceration in combination with intra-arterial thrombolysis were employed in 3. After the treatment, anticoagulant therapy was carried out for 6 months.The patients were followed up for 12 to 24 months. Results Of the twelve patients, clinical signs and symptoms included slight headache (2 cases), mild hemiplegia (1 case), ambiopia or blurred vision (3 cases). The cerebrospinal fluid pressure returned to under 26 cm H2O (1 cm H2O =0.098 kPa)following treatment from 28 to 38 cm H2O [ mean (32. 4 ±3.0) cm H2O] in preoperative measurement and the arteriovenous circulation time returned to below 10 s in all patients following treatment. Neither recurrence of thrombosis nor new symptoms of neurologic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation with the exception of a subcutaneous bleeding at the venopuncture site. Conclusion Endovascular treatment is effective and safe for patients with intracranial venous sinus thrombosis. Key words: Sinus thrombosis, intracranial; Radiology, interventional; Clinical protocols; Individualized endovascular treatment

Intracranial Dural Sinus Thrombosis: Novel Use of a Mechanical Thrombectomy Catheter and Review of Management Strategies

Management of intracranial dural sinus thrombosis with involvement of multiple sinuses is complex, often involving not only the primary problem (thrombosis) but acute adverse events consequent to the disease. We highlight the novel use of an endovascular device (typically for suction thrombectomy in the peripheral vascular system) used in our patient with a life-threatening multi-sinus thrombosis. As there is no standard treatment yet for cranial sinus thrombosis, our review of the literature highlights some effective management strategies. A 35-year-old woman developed associated complications of cranial sinus thrombosis that included intracranial hypertension caused by an expanding intracranial hematoma, pulmonary embolism treated by placement of filters in superior and inferior vena cava to eliminate intra- and extracranial sources of emboli, and procedure-related retroperitoneal hematoma that necessitated peripheral vascular intervention. After failure of several common devices during mechanical thrombolysis, a thrombectomy catheter (typically for peripheral vascular intervention to aide in the clot removal) was used. Our case highlights the fine balance of anticoagulation and thrombolysis and the proactive, aggressive approach used by our multispecialty team to manage concurrent factors.

Intracranial Venous Thrombosis After Placement of a Lumbar Drain

Lumbar drains are frequently used in clinical neuroscience and are often managed in the neurointensive care unit. Complications are generally rare, and intracranial venous thrombosis (IVT) and infarction has not been reported. We report the case of a 45-year-old woman who developed a cerebrospinal fluid (CSF) leak after spinal surgery. Fifteen hours after placement of a lumbar drain she developed pure alexia and color agnosia caused by left lateral sinus thrombosis with hemorrhagic infarction in the posterior inferior left temporal lobe. We review the literature on the association of IVT with injury to the spinal dura, and we propose a mechanism whereby the lumbar drain may facilitate its development. We found 29 cases in which spinal dural injury was followed by IVT. The association is not coincidental, because nearly all cases were associated with post-dural puncture headache, which occurs in only a minority of cases of dural puncture. Injury to the spinal dura alters the distribution of craniospinal elasticity causing profound intracranial CSF hypotension on assuming the erect posture. This causes acute dilation of cerebral veins resulting in both orthostatic headache and venous stasis. We propose that placement of the lumbar drain and elevation of the head of the bed aggravated intracranial CSF hypotension and facilitated IVT. When a lumbar drain is placed for treatment of a spinal CSF leak, the patient should remain flat in bed. Any patient with post-dural injury headache that intensifies after an initial plateau, persists for longer than a week, or loses its orthostatic character should be evaluated for intracranial sinus or venous thrombosis.

Successful management of an extensive intracranial sinus thrombosis in a patient undergoing IVF: case report and review of literature

To report a successfully managed case of extensive intracranial sinus thrombosis that occurred during an IVF cycle, and to review the literature. Case report and review of literature. University-affiliated teaching hospital. A 38-year-old nulliparous woman who developed severe ovarian hyperstimulation syndrome on luteal day (LD) 5 during an IVF cycle. Hemoconcentration was corrected, ascitis drained, and heparin prophylaxis started. On LD7, the patient complained of severe headache and neck pain. A magnetic resonance imaging (MRI) study of the head showed extensive cortical vein and dural sinus thrombosis, including the superior sagittal sinus and transverse sinuses. The patient was fully heparinized using low-molecular-weight heparin. On LD15 she was discharged home on warfarin, after confirming a negative pregnancy test. Complete thrombophilia work-up was negative. Clinical outcome. Repeat MRI 2 months later revealed patent superior sagittal sinus and transverse sinuses, unremarkable cortical veins, and no evidence of flow obstruction. The patient was asymptomatic, with no neurologic sequelae. Extensive intracranial sinus thrombosis in women undergoing IVF may present with minimal symptoms and can occur in the absence of pregnancy and thrombophilia and despite heparin prophylaxis and correction of hemoconcentration. Medical management was successful and left the patient with no neurologic sequelae.