Presence Of Thrombosis Research Articles

Total Basilar Artery Thrombosis Presenting with Recurrent Transient Ischemic Attacks (TIAs): A Case Report

<p><strong>Background</strong>: Managing acute ischemic stroke in patients with significant comorbidities, such as hypertension, heart failure, and substance abuse, presents unique challenges. Timely intervention is critical, but the risk of complications and poor prognosis is high.<br /><strong>Case Presentation</strong>: A 46-year-old male with a history of smoking, drug abuse, poorly controlled hypertension, and dilated cardiomyopathy with an ejection fraction of 25%-30% presented with sudden left-sided weakness, facial droop, and dysarthria. The initial National Institutes of Health Stroke Scal score was 6. Computed tomography (CT) brain showed no acute infarctions but revealed chronic lacunar infarctions and atrophy. CT angiography identified significant vascular abnormalities, including right internal carotid artery attenuation and non-visualization of both intracranial vertebral and basilar arteries. Intravenous thrombolysis (tPA) led to initial improvement, but recurrent strokes or transient ischemic attacks (TIAs) followed, leading to intubation and mechanical ventilation. Magnetic resonance imaging revealed evolving infarctions in the pons and cerebellum. A basilar artery thrombectomy was successfully performed, but postoperative complications included spontaneous pneumothorax and femoral artery pseudoaneurysm, requiring further interventions. Due to extensive posterior circulation infarction, the patient had a poor neurological prognosis and was placed on do not resuscitate status.<br /><strong>Conclusion</strong>: This case highlights the complexities of treating acute ischemic stroke in patients with substantial comorbidities. While interventions such as thrombolysis and thrombectomy are critical, they carry risks. A multidisciplinary approach is necessary to balance immediate treatment with considerations of long-term prognosis and quality of life. </p>

Spontaneous thrombosis of unruptured berry aneurysm presenting as facial palsy

Spontaneous thrombosis of saccular unruptured intracranial aneurysm (UIAs) is a known occurrence in giant aneurysms. However, spontaneous complete or partial thrombosis of non-giant aneurysms is a rare event in the natural history of UIAs that can be discovered incidentally on advanced neuroradiologic studies. They occasionally present with ischemic stroke, which is rare entity. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients were limited. We present a documented case of this unusual entity a case of non-giant intracranial aneurysm with spontaneous thrombosis presenting as Upper motor neuron type of facial palsy due to acute ischemic stroke.

S27 A Rare Presentation of Cerebral Venous Thrombosis as a Complication of Infantile Inflammatory Bowel Disease in a 17-Month-Old Infant

S27 A Rare Presentation of Cerebral Venous Thrombosis as a Complication of Infantile Inflammatory Bowel Disease in a 17-Month-Old Infant

Good outcome in a rare presentation of simultaneous cerebral superficial and deep venous thrombosis with cortical vein thrombosis post thrombectomy: A case report

Good outcome in a rare presentation of simultaneous cerebral superficial and deep venous thrombosis with cortical vein thrombosis post thrombectomy: A case report

Pulmonary Embolism and Deep Vein Thrombosis Presenting as Anxiety, Akathisia, and Aggression in a Bipolar Patient: A Case Report From Iran

Pulmonary Embolism and Deep Vein Thrombosis Presenting as Anxiety, Akathisia, and Aggression in a Bipolar Patient: A Case Report From Iran

Comparison of Interobserver Agreement between the 4T and the HIT Expert Probability (HEP) Scores: We Agreed Not to Agree

Background: Diagnosis of heparin induced thrombocytopenia (HIT) is challenging. The 4T score is the principal scoring system for HIT. The HIT Expert Probability (HEP) score, based on expert opinion, was proposed in 2010. Both scores have a very high sensitivity, being capable of ruling out HIT in low-risk individuals. However inter-observer agreement (IOA) of HEP score in comparison to the 4T score remains uncertain. Aim: This study aimed to compare IOA between the 4T and the HEP score among hospitalized patients. Specific objectives: Comparison of IOA between the 4T and the HEP score in the 1-whole cohort 2-non-ICU 3- ICU Identify which item of the score have the lowest IOA (magnitude of thrombocytopenia, timing of thrombocytopenia, existence of other causes of thrombocytopenia, presence of thrombosis) Methods: Patients: This is a retrospective study at a single tertiary hospital. All inpatients 16 years or older who have been tested for HIT between June 2019 to end of June 2021 were included. Patients were excluded if the reason for sending HIT was a repeat test. Data were collected retrospectively by manual chart review. Assessment of HEP score and 4Ts score: Two hematologists rated the HEP score and 4Ts score independently for every patient. The score's calculation was blinded between observers and, they were blinded to the HIT Eliza result. Low 4Ts score is defined as score less than 4 and for HEP score if less than 3. HIT test was done using Stago Asserachrom HPIA-IgGAM ELISA with level of < 0.4 considered negative. Statistical analysis: Continuous variables are reported as mean ± standard deviation (SD) or median (interquartile range; IQR), as appropriate. Categorical variables are reported as frequency and percentage. The Kappa coefficient (к) with 95 % confidence interval (CI) was used to assess the IOA of 4T score and HEP score, it was calculated for the individual risk categories - low vs high score in: 1-the whole patients 2-ICU 3- non-ICU We also calculated the IOA for each item of the score, magnitude of thrombocytopenia, timing of thrombocytopenia, existence of other causes of thrombocytopenia, presence of thrombosis (as total score). A P-value less than 0.05 was considered significant. Statistical analyses were performed using SAS version 9.4 (SAS institute, CARY, NC, USA). The study was approved by the local ethical board. Informed consent was waived. Results: After exclusion of the repeat test (13), 302 patients were included in this study. Median age 66 years old. Most common reason for request was thrombocytopenia 288 (95%). HIT ELISA ≥ 0.4 in 34 (11%). Inter-observer agreement: All patients: We found similar IOA between the 4T score and the HEP score к (95 % CI) of 4T score was .14(-0.13-0.41, P < 0.01), compared 0.17(-0.16-0.5, P < 0.01) in the HEP score. Non-ICU patients: The IOA was similar between the 4T score and the HEP score, к of 4T score was 0.24(0.11-0.38, P < 0.01) compared 0.17(0.03-0.31 P < 0.01) in the HEP score. ICU patients: The IOA of 4Tscore was lower than HEP score к of 4T score was -020(-0.20.16, P = 0.83) compared 0.16(-0.037-0.37, P = 0.86) in the HEP score. Among the four individual items of 4T score, “existence of other causes of thrombocytopenia” achieved the lowest к with 0.03 and 0.1 in 4Tscore and HEP score respectively. Conclusion: In this retrospective study, we found a lower interobserver agreement of the 4T score compared to the HEP score in ICU patients. The poor IOA of the 4T score in ICU patients is attributed to worse agreement in (existence of other causes of thrombocytopenia item). Ascertaining the cause of thrombocytopenia in ICU patients is challenging and the 4T score seems to depend on physician gestalt rather than objective points. Our data suggests that the HEP score is the preferred score in in patients with critical illness.

Impact of intracoronary imaging-guided percutaneous coronary intervention on procedural outcomes among patients with cardiogenic shock

Abstract Background Intracoronary imaging (ICI), including intravascular ultrasound (IVUS) or optical coherence tomography (OCT), is known to correlate with a reduction in rates of cardiac death after percutaneous coronary intervention (PCI), driven by lower rates of reinfarction and stent thrombosis. [1,2] However, there are limited data around its utility amongst patients with acute coronary syndrome (ACS) and cardiogenic shock, who are inherently at a high risk of stent thrombosis. Aims To examine the frequency of utilisation of ICI among ACS patients with cardiogenic shock, and their subsequent outcomes, in a national cohort of PCI procedures over a six-year period. Methods All PCI procedures for ACS patients with cardiogenic shock in England and Wales between 2014 and 2020 were retrospectively analysed, stratified into two groups: ICI and non-ICI groups. Multivariable logistic regression analyses were performed to examine the odds of in-hospital major adverse cardiovascular and cerebrovascular events (MACCE; composite of all-cause mortality, acute stroke/transient ischaemic attack (TIA), and reinfarction) and major bleeding (BARC 3-5) in the ICI-guided group, compared with the non-ICI group, as well as predictors of receipt of ICI-guided PCI. Results Of 15,738 PCI procedures performed between 2014 and 2020, 1,240 procedures (7.9%) were ICI-guided. Overall, the rate of ICI use amongst those with cardiogenic shock has more than doubled from 2014 (5.7%) to 2020 (13.3%). The ICI-guided group were predominantly younger, males, with a higher proportion of non-ST elevation ACS and stent thrombosis. The rate of MACCE was significantly lower in the ICI-guided group compared with the non-ICI group (29.8% vs. 38.2%, p<0.001), driven by lower rate of all-cause mortality (28.6% vs. 37.0%, p<0.001). (Figure 1) There were no differences for other secondary outcomes between groups. In multivariable analysis, the odds of MACCE and all-cause mortality in those undergoing ICI-guided PCI remained significantly lower than in the non-ICI group (OR 0.65 95% CI 0.56, 0.76 and OR 0.65 95% CI 0.55, 0.75, respectively, p<0.001 for both). (Figure 2). Advanced age (OR 0.98) and STEMI presentation (OR 0.54) negatively correlated with ICI use while stent thrombosis presentation (OR 2.66), previous PCI (OR 2.02), intervention on LMS (OR 4.19) and proximal LAD lesions (OR 1.62) and need for calcium modification (OR 2.13) positively correlated with increased ICI use. Conclusion The utilisation of ICI among patients with cardiogenic shock has more than doubled over a 6-year period on a national level but remains significantly under-utilised, with less than 1-in-6 patients in receipt of ICI-guided PCI in 2020. ICI use is associated with a prognostic benefit in terms of reduction of in-hospital MACCE and all-cause mortality in this high-risk patient group and should be more frequently utilised to increase their long-term survival.Figure 1.In-hospital crude outcomesFigure 1B.Adjusted odds ratios (OR)

Increased Risk of Thrombosis in Patients with Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine-metabolic disorder in reproductive age women, with an estimated prevalence of 6-12% of assigned female at birth women in the US. We identified a pattern in our coagulation diagnostic management team, wherein women with PCOS had increased rates of and repeated histories of thrombotic events, such as strokes, heart attacks, pulmonary embolisms, and deep vein thromboses. However, clinical coagulation assays on these PCOS patients with repeated thrombotic events were all within the normal reference range. Our goal was to investigate the validity of this pattern and its occurrence in both local and national populations. This was accomplished by 1) Determining the incidence rate of thrombosis in PCOS and 2) Analyzing clinical presentations of thrombosis in PCOS. Methods/Study populations : Analyses on the rate of thrombotic events in PCOS patients locally at UTMB and in the US were performed on the TriNetX health research network. Using the incidence and prevalence and compared outcomes analytic functions on TriNetX, we determined the rate of thrombosis from 2013-2018 and explored patient characteristics. We further analyzed thrombosis in PCOS with the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) method. Through the compare outcomes analysis on the TriNetX platform, we looked at PCOS and control patients who experienced thrombotic events between 2013-2018 and analyzed clinical presentations that occurred in the 90 days prior to the index event. Patient queries included the diagnostic code for PCOS, ICD10 E28.2, women age 15-75, who had a clinical encounter since 2013. Exclusion criteria included inherited thrombotic disorders, smoking history, and human immunodeficiency virus. Events of interest included myocardial infarctions, cerebral infarctions, pulmonary embolisms, arterial embolisms and thrombosis, and portal vein thromboses. Statistical analysis: For evaluating statistical significance of the rate of thrombosis, we performed a compare outcome analysis on the UTMB network, with propensity score matching for current age. A Kaplan-Meier Analysis and a student's t-test were performed on the number of instances/events, and statistical significance was defined as a p-value <0.0001. Results:Between 2013-2018, the incidence rate of thrombosis in PCOS patients was 4.35% with 5.36% prevalence, this was statistically significantly higher than the control cohort at 2.66% incidence and 3.5% prevalence. The incidence rate of thrombosis in PCOS increased dramatically in post-menopausal women. Of the 60 outcomes investigated, 24 were determined to be statistically significant between control and PCOS, 22 symptoms and 2 procedures. Discussion: This is the first study to analyze the rate of thrombotic events in PCOS. We identified significant presentations and gaps that could assist in the early detection of thrombotic events in PCOS. However, the mechanisms of thrombosis in PCOS are unknown and are poorly detected with current clinical assays. Future studies will examine clinical assays in the detection of thrombosis in PCOS and investigate thrombotic mechanisms in PCOS.

Aptamer conjugated Si nanowire network/poly(pyrrole)-NTA structure for electrochemical sensing

The current study describes the design, analytical characterization, and testing of aptamer sensors based on Si nanonets (Si NN) for thrombin electrochemical detection. Si nanonets are thin sheet arrays of randomly aligned Si nanowires with controlled and programmable properties that may be transported and integrated on a variety of substrates. Si nanonets were placed onto a commercial glassy carbon working electrode to create our aptasensor. Then they were functionalized by conductive pyrrole polymerization, which was followed by aptamer bioreceptor grafting. Electrochemical detection of thrombin was carried out after optimizing the electrode properties. On the one hand, cyclic voltammetry analyses demonstrated a linear association between the acquired current and the logarithm of thrombin concentration from 5 nmol L−1 to 2 µmol L−1. Impedance measurements, on the other hand, revealed a linear relationship between the charge transfer resistance as well as the impedance modulus. Thus, for the first time, Si nanonet thin sheets were used as constitutive nanoporous parts of electrodes capable of detecting thrombin at concentration limits of 5 nM, considered as a risk factor or presence of thrombosis. This demonstrates the concept of using this type of nanomaterial to detect molecules of biological interest.

The Flow Volume and Resistance Index of Patent Arteriovenous Fistulas, With Proper Function, Compared to Unhealthy Arteriovenous Fistulas, Using Spectral Doppler

Objective: This study was designed to use sonography and evaluate arteriovenous fistulas (AVFs) in dialysis patients. The aim was to determine criteria for distinguishing between patent AVFs with proper function (healthy) and unhealthy AVFs. Materials and Methods: This study enrolled 106 dialysis patients with an AVF. All fistulas were evaluated using spectral Doppler and grayscale sonography, assessing parameters such as draining vein diameter, distance of the venous vein from the skin surface, feeding artery diameter, presence of thrombosis, and fistula stenosis. Subsequently, Doppler criteria such as flow volume (FV) and resistance index (RI) were measured and compared between healthy and unhealthy AVFs. Results: This cohort’s spectral Doppler findings demonstrated lower FV and higher RI, in unhealthy AVFs, compared to healthy ones (283.5 ± 101.26 mL/min vs 1383.43 ± 756.76 mL/min; P = .006) and (0.55 ± 0.33 vs 0.37 ± 0.14; P = .004) respectively. Conclusion: The spectral Doppler and grayscale sonographic imaging made it possible to evaluate AVF performance and determine its quality. In this cohort, a decreased FV, increased RI, and decreased draining vein diameter were observed in unhealthy AVFs. These results would suggest that sonographers and clinicians should pay close attention to these parameters when assessing the function of an AVF, for patients undergoing hemodialysis.

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

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

Prognostic factors in patients with cerebral sinus venous thrombosis presenting with hemorrhage and papilledema

ObjectiveThe thromboinflammatory process is considered to play a role in the pathogenesis and prognosis of cerebral sinus vein thrombosis (CSVT). The purpose of the study was to compare the thromboinflammatory parameters between individuals with CSVT and healty controls. Additionally, the study sought to compare these parameters among CSVT subgroups with and without haemorrhage, as well as with and without papilledema. Furthermore, the investigation also aimed to identify which parameters had a more significant impact on the risk of hemorrhage and the development of papilledema in CSVT. MethodsThromboinflammatory parameters were compared retrospectively between the CSVT group of 88 patients and 80 age- and sex-matched healthy controls, and in the CSVT subgroups with (n = 35) /without hemorrhage (n = 53) and with (n = 52) /without papilledema (n = 36) after ethics committee approval. In both groups, parameters contributing to the risk of hemorrhage and papilledema development were determined by univariate and multivariate analyses. ResultsRegarding the risk of hemorrhage in CSVT patients, the most significant factors included hematocrit of <30.2 (%), mean platelet volume of ≤8.9 fL, neutrophil count of >5600, and hsCRP of >9 mg/L. Regarding the risk of papilledema development, the most important risk factors were age of ≤49, presence of vomiting, presence of blurred vision, HDL of >47 mg/dL, and D-dimer of >178 ng/mL. ConclusionIt was suggested that evaluating serum thromboinflammatory parameters, as well as demographic characteristics and neurological examination findings, had a critical role regarding prognosis and predictive factors in CSVT.

S3570 Beckwith-Wiedemann Syndrome: A Rare Presentation of Chronic Portal Vein Thrombosis with Cavernous Transformation Extending to the Superior Mesenteric Vein

S3570 Beckwith-Wiedemann Syndrome: A Rare Presentation of Chronic Portal Vein Thrombosis with Cavernous Transformation Extending to the Superior Mesenteric Vein

Septic pulmonary emboli: a case discussion.

A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.

Fibrinogenolysis and fibrinolysis in vaccine-induced immune thrombocytopenia and thrombosis

BackgroundVaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare syndrome associated with adenoviral vector vaccines for COVID-19. The syndrome is characterized by thrombosis, anti-platelet factor 4 (PF4) antibodies, thrombocytopenia, high D-dimer, and hypofibrinogenemia. ObjectivesTo investigate abnormalities in fibrinolysis that contribute to the clinical features of VITT. MethodsPlasma samples from 18 suspected VITT cases were tested for anti-PF4 by ELISA and characterized as meeting criteria for VITT (11/18) or deemed unlikely (7/18; non-VITT). Antigen levels of PAI-1, factor XIII (FXIII), plasmin-α2antiplasmin (PAP), and inflammatory markers were quantified. Plasmin generation was quantified by chromogenic substrate. Western blotting was performed with antibodies to fibrinogen, FXIII-A, and plasminogen. ResultsVITT patients 10/11 had scores indicative of overt disseminated intravascular coagulation, while 0/7 non-VITT patients met the criteria. VITT patients had significantly higher levels of inflammatory markers, IL-1β, IL-6, IL-8, TNFα, and C-reactive protein. In VITT patients, both fibrinogen and FXIII levels were significantly lower, while PAP and tPA-mediated plasmin generation were higher compared to non-VITT patients. Evidence of fibrinogenolysis was observed in 9/11 VITT patients but not in non-VITT patients or healthy controls. Fibrinogen degradation products were apparent, with obvious cleavage of the fibrinogen α-chain. PAP complex was evident in those VITT patients with fibrinogenolysis, but not in non-VITT patients or healthy donors. ConclusionVITT patients show evidence of overt disseminated intravascular coagulation and fibrinogenolysis, mediated by dysregulated plasmin generation, as evidenced by increased PAP and plasmin generation. These observations are consistent with the clinical presentation of both thrombosis and bleeding in VITT.

Entropy generation optimization for the electroosmotic MHD fluid flow over the curved stenosis artery in the presence of thrombosis

The present study deals with the entropy generation analysis on the flow of an electrically conductive fluid (Blood) with hbox {Al}_2hbox {O}_3-suspended nanoparticles through the irregular stenosed artery with thrombosis on the catheter. The fluid flow can be actuated by the interactions of different physical phenomena like electroosmosis, radiation, Joule heating and a uniform radial magnetic field. The analysis of different shapes and sizes of the nanoparticle is considered by taking the Crocine model. The velocity, temperature, and concentration distributions are computed using the Crank–Nicholson method within the framework of the Debye–Huckel linearization approximation. In order to see how blood flow changes in response to different parameters, the velocity contour is calculated. The aluminium oxide nanoparticles employed in this research have several potential uses in biomedicine and biosensing. The surface’s stability, biocompatibility, and reactivity may be enhanced by surface engineering, making the material effective for deoxyribonucleic acid sensing. It may be deduced that the velocity profile reduces as the nanoparticle’s size grows while depicts the reverse trend for the shape size. In a region close to the walls, the entropy profile decreases, while in the region in the middle, it rises as the magnetic field parameter rises. The present endeavour can be beneficial in biomedical sciences in designing better biomedical devices and gaining insight into the hemodynamic flow for treatment modalities.

Interventions in cerebrovascular emergencies among patients with Paroxysmal nocturnal haemoglobinuria - A word of caution

IntroductionParoxysmal nocturnal haemoglobinuria (PNH) is a clonal hematopoietic disorder, where there is deficiency of glycosylphosphatidylinositol (GPI) anchored proteins in the cell membrane, leading to increased complement sensitivity of red blood cells, intravascular hemolysis and vascular inflammation. Arterial and venous strokes in patients with PNH are a rarity posing significant diagnostic and therapeutic challenges. We report our experience with management of PNH patients with cerebrovascular emergencies. MethodsWe report 2 patients with PNH, one who was previously diagnosed with PNH and had arterial stroke, the other had an index presentation of cerebral venous sinus thrombosis (CVT) and was subsequently diagnosed with PNH. We also present the systematic review of literature reporting similar cases, highlighting the challenges in management. ResultsBoth patients presented to our centre with cerebrovascular emergency. The first patient was a diagnosed with PNH, and presented with left hemispheric infarction caused by thrombosis of middle cerebral artery. He was thrombolysed and underwent mechanical thrombectomy, which was unsuccessful in view of repeated re – thrombosis of the vessel. The patient survived with significant disability. The second patient had severe cerebral venous sinus thrombosis with large right hemispheric hemorrhagic venous infarction. She underwent emergency decompressive hemicraniectomy complicated by massive blood loss and disseminated intravascular coagulation. She subsequently had recurrent life threatening intracranial bleed secondary to platelet transfusions, thrombocytopenia, and use of contrast agents. She progressed to develop Budd Chiari syndrome and was initiated on Eculuzimab. She became transfusion independent, however remained in minimally conscious state and succumbed to sepsis. ConclusionsManagement of arterial and venous strokes is complex in patients with PNH. Invasive procedures and platelet transfusions are to be avoided in acute thrombosis, till robust evidence is available establishing the safety of the same in patients with PNH. Eculuzimab is a promising option, but far from reach for patients in developing countries.

Cerebral Vein Thrombosis during Pregnancy and At the Puerperal Period: Radio-Clinical and Therapeutic Study

Cerebral thrombophlebitis gravidopuerperale is a rare but serious pathology that can engage the maternal-fetal prognosis. It requires early diagnosis and treatment fast. Indeed, much rarer than arterial thromboses, thrombophlebitis are a significant cause of death and stroke. They can occur during pregnancy but most often they occur within a few days to a few months following postpartum. The frequency of peripartum cerebral thrombophlebitis is on average 1/3000 to 1/10000 births, but recently the number of cases recognized seems higher partly because of the more widespread knowledge of the variability of different forms of clinical presentations of cerebral venous thrombosis allowing a diagnosis, and on the other hand the wider use of imaging means more and more effective, in particular MRI. The objective of this study is to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary gravido -puerperal cerebral thrombophlebitis.

Early vertebral artery thrombosis presenting as subclavian steal by virtue of windkessel and venturi effect

Reversed flow in elastic vessels, especially if partially obstructed, is a common phenomenon. Spectral Doppler ultrasound can assess underlying flow dynamics but is technician dependent and needs clinical correlation to avoid misdiagnosis. Vertebral artery backflow can be explained by Windkessel effect, Venturi effect or true Steal syndrome.

The clinical topography of peripherally inserted central catheter-related thrombosis in cancer patients: A prospective and longitudinal observational study based on ultrasound scans every two days

AimsTo delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. BackgroundMost of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. DesignThis is an observational study conducted at West China Hospital, according to the STROBE guidelines. MethodsCancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. ResultsAmong the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P < .001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. ConclusionPICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. Relevance to clinical practiceThe results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. Clinical regestrationClinical Trials ChiCTR1900024890.