Part Of Superior Sagittal Sinus Research Articles

An Unusual Case of Headache: Joining the Dots in the Emergency Room

Headache is one of the commonest presenting complaints in the Emergency Room. In the young population with no significant history of any medical condition or trauma, it seldom raises suspicion of an ominous etiology. In this case report we present an unusual case of a young unmarried female presenting to the ED with acute onset headache and vomiting. After initiation of primary treatment, the patient was subjected to MRA and MRV of the brain which was suggestive of thrombosed mid part of Superior Sagittal Sinus, right Sigmoid and right Transverse sinus. On eliciting the SAMPLE history of the patient, the risk factor of polycystic ovarian syndrome and intake of Norethisterone for Abnormal Uterine Bleeding was known. Provisional diagnosis of Norethisterone induced Cerebral Venous Sinus Thrombosis was considered and patient was initiated on treatment with Enoxaparin (Low Molecular weight Heparin) followed by long term NOAC and lifetime avoidance of Norethisterone and other prothrombotic drugs.

Vascular Manifestations of Tuberculous Meningitis: MR Angiography and Venography Study.

Purpose The purpose of this study is to evaluate magnetic resonance (MR) angiography (MRA) and venography (MRV) findings in tuberculous meningitis (TBM). Methods Thirty consecutive patients of clinically diagnosed TBM were enrolled. Apart from T2-weighted imaging, T1-weighted imaging (T1WI), diffusion-weighted imaging, susceptibility-weighted imaging, fluid-attenuated inversion recovery, and postcontrast T1WI, time-of-flight (TOF) MRA and postcontrast MRV were done in all the patients. MRV was done after intravenous administration of gadolinium-based contrast agent followed by postcontrast T1WI. MRA and MRV findings were analyzed. Results Mean age of the patients was 33.13 ± 14.93 years. Duration of symptom was 34.90 ± 33.82 (range: 10–150) days. Out of 30 patients, 11 were categorized as definite TBM and 19 probable TBM. Eighteen (60%) were grade I, 7 (23%) grade II, and 5 (16%) grade III TBM based on severity. MR abnormalities were in varying combinations of leptomeningeal enhancement in 24 (80%), pachymeningeal in 2, both in 3, tuberculomas in 13 (43.3%), ventriculitis in 1, hydrocephalus in 16 (53.3%), and infarcts in 10 (33.3%) patients out of which the tubercular zone infarct in 9 patients. TOF MRA showed arterial abnormality in 13 patients. Anterior cerebral artery and middle cerebral artery have commonly involved vessels. Dural sinus thrombosis was noted in two patients. Both were female. One patient had subacute thrombus in the posterior part of superior sagittal sinus, left transverse sinus, and proximal right transverse sinus. The second patient had a filling defect in the transverse sinus. Conclusion In TBM, there is predominant arterial involvement causing infarcts which are usually seen in the tubercular zone. However, occasionally, there may be venous involvement causing cerebral venous sinus thrombosis.

Case report of coexistence of two variant anatomy, hypoplastic rostral superior sagittal sinus and hypoplastic right side transverse sinus and internal jugular vein

Both the hypoplasia of rostral part of superior sagittal sinus and right transverse sinus are uncommon normal variant, so the frequency of occurrence of both in one person is more less. This is what have reported here.

A rare complication in a child undergoing chemotherapy for Hodgkin lymphoma - multiple cerebral venous sinus thrombosis

Introduction. Risk factors for thrombotic events in patients receiving treatment for Hodgkin lymphoma are not well known. Administration of some cytostatic medication, especially via central venous catheter, corticosteroids, and hyperlipidemia can present some of them. Case outline. A case of a 15-year-old boy that had been newly diagnosed with Hodgkin lymphoma is presented here. Chemotherapy according to vincristine, etoposide, prednisone, and doxorubicin (OEPA) protocol was introduced a month before headache and vomiting occurred, so subsequently, brain computer tomography was performed, and reviled laminar subdural pseudo-hemorrhage in the right occipital region. After performing magnetic resonance imaging (MRI) venous thrombosis of the posterior part of superior sagittal sinus, right transverses, and sigmoid sinus were presented. Low-molecular-weight heparin (LMWH) and anti-edematous therapy was immediately initiated. Two weeks later, the patient resumed the second cycle of chemotherapy combined with LMWH, as the previous symptoms of intracranial hypertension resolved. Two years later, MRI showed an almost complete resolution of the finding. The boy was in good clinical condition. Conclusion. Although administration of oral corticosteroids, could be rarely a risk factor per se for cerebral sinus venous thrombosis in Hodgkin lymphoma patients, it remains an important treatment option. Adequate and prompt diagnostics and therapy are mandatory in cases of wide intracranial venous thrombosis as the prevention of possible intracranial hypertension and even fatal outcome.

Hemodynamics of cerebral bridging veins connecting the superior sagittal sinus based on numerical simulation

BackgroundThe physiological and hemodynamic features of bridging veins involve wall shear stress (WSS) of the cerebral venous system. Based on the data of cadavers and computational fluid dynamics software pack, the hemodynamic physical models of bridging veins (BVs) connecting superior sagittal sinus (SSS) were established.ResultsA total of 137 BVs formed two clusters along the SSS: anterior group and posterior group. The diameters of the BVs in posterior group were larger than of the anterior group, and the entry angle was smaller. When the diameter of a BV was greater than 1.2 mm, the WSS decreased in the downstream wall of SSS with entry angle less than 105°, and the WSS also decreased in the upstream wall of BVs with entry angle less than 65°. The minimum WSS in BVs was only 63% of that in SSS. Compared with the BVs in anterior group, the minimum WSS in the posterior group was smaller, and the distance from location of the minimum WSS to the dural entrance was longer.ConclusionThe cerebral venous thrombosis occurs more easily when the diameter of a BV is greater than 1.2 mm and the entry angle is less than 65°. The embolus maybe form earlier in the upstream wall of BVs in the posterior part of SSS.

PP13.13 – 2289: Delayed diagnosis of neuro-Behçet's disease: Report of 3 cases

Objective Behcet's disease is a rare chronic, relapsing multisystem vascular inflammatory disease of unknown cause in young adulthood. Only 8% of Behcet's disease cases are children. Methods We report 3 pediatric cases diagnosed as neuro-Behcet's disease, presenting with symptoms and signs of intracranial hypertension such as headache and papilledema due to cerebrovascular thrombosis. Case 1: A 16 year-old boy was admitted with a throbbing headache. Three months prior he was evaluated with fever of unknown origin, weight loss, and headache, however no specific etiology was discovered. His brain magnetic resonance venography revealed venous thrombosis in the right transverse sinus, in the sigmoid sinus extending to jugular bulbus and in the posterior part of superior sagittal sinus. When carefully questioned he had history of recurrent oral and genital ulcers. HLA B51 and patergy tests were positive. Case 2: A 14-year old boy was admitted with vertigo and headache. He was hospitalized elsewhere in a pediatric neurology clinic with 6th cranial nerve palsy and venous thrombosis, 3 years before. He had been suffering from aphthous lesions in relapsing and remitting manner for 4 years. His brain magnetic resonance venography revealed venous thrombosis in the right sigmoid sinus. Patergy test was negative, however, HLA B51 was positive. Case 3: A 17-year old boy was admitted with a headache and weight loss. His brain magnetic resonance venography revealed diffuse venous thrombosis in the superior sagittal sinus and in bilateral transverse sinuses. His father had established Behcet's disease. HLA B51 and patergy tests were positive. Results Cerebrovascular thrombosis is one of the diverse manifestations of neuro-Behcet's disease. Conclusion All of the three cases' diagnoses were delayed. The presence of intracranial hypertension related to a cerebral venous thrombosis in an adolescent boy should alert pediatric neurologists about the diagnosis of neuro-Behcet's disease.

Cerebral venous sinus thrombosis with internal jugular venous thrombosis in a male patient with nephrotic syndrome

Cerebral venous sinus thrombosis with internal jugular vein thrombosis is not reported as a complication in nephrotic syndrome. We report a 40-year-old male with nephrotic syndrome, who had headache during his hospitalization. Conventional diagnostic tests showed extensive thrombosis at the proximal part of superior sagittal sinus, left cortical vein, left sigmoid-transverse sinus and left internal jugular vein. The patient underwent medical treatment and was discharged in good health after 2 weeks. The aim of this study is to report a novel case of cerebral venous sinus thrombosis with internal jugular venous thrombosis in a male patient with nephrotic syndrome.

Cerebral venous thrombosis due to homozygous factor V Leiden mutation

Sir, A 26 year old lady presented with headache, generalized tonic-clonic seizures, right hemiparesis and altered mental status of one day duration. Ten days earlier, she had delivered a live term baby girl by normal vaginal delivery. This was her fourth pregnancy, first and third pregnancies were uneventful. Eight years before this admission, during the postpartum period of second pregnancy she developed pelvic vein thrombophlebitis and bilateral deep vein thrombosis and was treated with anticoagulants, which later were discontinued. At this admission she was afebrile and Glascow coma scale score was 9/15 (E2V2M5). Ocular fundi examination revealed bilateral papilledema and she had right hemiparesis. Contrast computerised tomography (CT) scan of the brain showed filling defects in the posterior part of superior sagittal sinus and right transverse sinus and bilateral parietal infarcts, left more than right suggestive of cerebral venous thrombosis (CSVT). Complete blood picture (except packed blood volume 25.7%), blood biochemistry, and viral markers were normal. She was treated with antiedema measures, anti-epileptic drugs, intravenous unfractionated heparin and supportive measures. Her neurological status worsened with anisocoria requiring ventilation. A repeat imaging showed a large fresh right frontal infarct and severe cerebral edema. She deteriorated further and had a cardiac arrest. A thrombotic workup revealed normal prothrombin, activated partial thromboplastin and thrombin times Factor VIII and fibrinogen levels, Antithrombin III, Protein C functional assay, Protein S (total and free). Ham’s and Sucrose lysis test were negative. Activated Protein C resistance ratio was 1.31(significant if < 2). Diluted Russel’s viper venom test for lupus anticoagulant was negative. Genetic markers for thrombosis using polymerase chain reaction showed homozygosity to Factor V Leiden (FVL) mutation. Methylene tetrahydro-folate reductase (MTHFR) Polymorphism and Prothrombin Gene Polymorphism were not detected. She had activated Protein C resistance due to homozygosity to Factor V Leiden mutation.

Stroke during Pregnancy and Puerperium in Young Females below the Age of 40 Years as a Result of Cerebral Venous/Venous Sinus Thrombosis

One hundred and thirty-eight cases of cerebral venous/venous sinus thrombosis during the puerperium have been studied. Maximum number of cases (112 cases) occurred in the age below 30 years. Signs and symptoms appeared in most of the cases (72 cases) during the first 7 days of post partum period. One hundred and eleven cases were multipara. Commonest signs and symptoms were fever (85 cases); headache (66 cases), convulsions (64 cases), altered consciousness (57 cases), hemiplegia (60 cases), papilloedema (48 cases), etc. Carotid angiography done in 55 cases revealed block in middle part of superior sagittal sinus in 24, and localised, dilated and tortuous cortical veins in 5. A statistically significant rise in serum triglycerides, phospholipids, free fatty acids, blood platelet count, platelet adhesive index, and fall in blood fibrinolytic activity were found as compared with normals. These factors may be playing a role in the etiology of cerebral venous/venous sinus thrombosis during puerperium.

Stroke during pregnancy and puerperium in young females below the age of 40 years as a result of cerebral venous/venous sinus thrombosis.

One hundred and thirty-eight cases of cerebral venous/venous sinus thrombosis during the puerperium have been studied. Maximum number of cases (112 cases) occurred in the age below 30 years. Signs and symptoms appeared in most of the cases (72 cases) during the first 7 days of post partum period. One hundred and eleven cases were multipara. Commonest signs and symptoms were fever (85 cases); headache (66 cases), convulsions (64 cases), altered consciousness (57 cases), hemiplegia (60 cases), papilloedema (48 cases), etc. Carotid angiography done in 55 cases revealed block in middle part of superior sagittal sinus in 24, and localised, dilated and tortuous cortical veins in 5. A statistically significant rise in serum triglycerides, phospholipids, free fatty acids, blood platelet count, platelet adhesive index, and fall in blood fibrinolytic activity were found as compared with normals. These factors may be playing a role in the etiology of cerebral venous/venous sinus thrombosis during puerperium.