Venous Infarction Research Articles

A Case Report Symptoms Improvement of Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, a life-threatening disorder that occurs in approximately 0,5-1% of all stroke incidents. Various clinical presentations, risk factors, and neuroimaging findings of this disease may cause a delay in the early diagnosis and treatment of CVT. We discuss a case of a 34-year-old female who was admitted to the emergency room (ER) with the onset of a generalized tonic-clonic seizure with a progressive headache in the occipitotemporal region. Based on head CT, there was multiple hyperdense and cerebral venous infarction in the posterior left parietal lobe. D-dimer evaluation, there was an increasing level of D-dimer (>10.000 ng/mL). The patient was treated with the primary therapy heparin. After 15 days of being hospitalized, the patient was discharged without any sequelae.
 Keywords: CVT, heparin, stroke

P1695: CEREBRAL VENOUS THROMBOSIS AND ANTITHROMBOTIC THERAPY: A SYSTEMATIC REVIEW

Background: Cerebral venous thrombosis (CVT) is a cause of stroke especially in the young. The anticoagulant treatment remains controversial as it prevents neurological deterioration, new venous infarcts and death but there is a risk of bleeding complications Aims: The aim of the study was to systematically review the available studies on the efficacy and safety of anticoagulant therapy in CVT Methods: A literature search was performed (PubMed) by a combination of the terms: 1. cerebral vein thrombosis 2. cerebral venous thrombosis 3. antithrombotic therapy 4. anticoagulant therapy 5. heparin 6. warfarin 7. VKA 8. DOAC. The references of the studies were checked to obtain additional studies. The search included studies: a) related to humans b) in English and c) period:1991-2021. The following data were extracted: study characteristics (year of publication, country, study-type, sample size), demographic characteristics, type/dose of anticoagulant therapy, median follow-up, major bleeding complications, other complications during follow-up. The inclusion criteria were: 1) CVT confirmed by imaging (angiography,CT,MRI,MRV) 2) any type of anticoagulation 3) sample size>5 & 4) age>16 years Results: 25 studies were included with a total number of 2320 patients. The percentage of female patients was 70%. The age ranged 16-86 years. A total of 6 RCT, 9 prospective observational studies, 9 retrospective observational studies and 1 ambidirectional observational study were detected. Based on the limited data the anticoagulant therapy appears safe and effective, as in the acute phase it improves the clinical outcome. It is recommended that patients with acute CVT are treated with heparin. It is not contraindicated even in hemorrhagic infarcts but should be used with caution in extensive hemorrhagic infarcts, in-depth localization of the infarct and coma. LMWH appears to be associated with better outcome and fewer new intracranial hemorrhages than UFH. There is no study evaluating the role of antiplatelets. There are also insufficient data on the optimal duration of anticoagulation therapy. The use of DOAC is not recommended for the treatment of CVT, especially in the acute phase, due to the poor available evidence. Nevertheless, the limited data on the use of DOAC in the treatment of CVT imply adequate safety and efficacy. There is no study comparing different DOAC for CVT treatment. There are also insufficient data to support the use of thrombolysis in patients with CVT, as only case-reports and patient-series have been published. There is only 1 RCT in which “high-risk” patients were randomized to intravascular thrombolysis or heparin-controlled treatment. According to the European Guideline for the diagnosis and management of CVT it is not possible to provide recommendation for thrombolysis. It is suggested though not to use thrombolysis in patients with acute CVT with a low risk of poor outcome. The present systematic review highlights the lack of adequate data on optimal anticoagulation therapy in CVT Summary/Conclusion: Anticoagulant therapy for CVT appears to be safe and effective. It is recommended that patients with acute CVT are treated with heparin even cases with bleeding elements at diagnosis. LMWH appears to be associated with better outcomes and fewer new intracranial hemorrhages. The position of DOACs is an object of future research. Thrombolysis in CVT should be reserved for high-risk patients. Given the low incidence of the disease the cooperation of centers at international level is necessary. The subject of anticoagulant therapy in the treatment of CVT remains open for further research

Susceptibility Weighted Imaging: An Effective Auxiliary Sequence That Enhances Insight Into the Imaging of Stroke

Aim: To evaluate the utility of susceptibility-weighted imaging (SWI) sequence in stroke imaging and assess supplemental information provided by SWI in an acute stroke scenario.Materials and methods: In this study, the appearance of cerebrovascular stroke on the SWI images were analyzed in 50 patients who presented with acute-onset neurological symptoms.Results: Brain MRI with SWI was performed on 50 patients presenting with acute neurological symptoms. The majority were males, 32/50 (64%) and 18/50 (36%) were females. Most of the patients were in the age group > 60 years (36%), followed by 50-60 years (22%). Most of the patients had bilateral pathology, 20 (40%). The majority of patients had supratentorial lesions 34 (68%). Among 50 patients, the majority of patients had arterial stroke 20 (40%) and cerebral venous sinus thrombosis (CVST) 20 (40%) followed by amyloid angiopathy five (10%), and five (10%) had hypertensive microhemorrhage. Among the 20 patients with arterial stroke, the majority had middle cerebral artery (MCA) thrombosis 10 (50%) and among the 20 patients with venous thrombosis, eight (40%) patients had hemorrhagic infarcts. SWI was better as compared to computed tomography (CT) (P<0.05) in the detection of hemorrhagic transformation of arterial infarct, cerebral hemorrhagic venous sinus thrombosis, hemorrhagic venous infarct, hypertensive microhemorrhage, and cerebral amyloid angiopathy.Conclusion: SWI is a useful imaging sequence that provides additional information on stroke patients. SWI requires only an additional three-four minutes to perform and can be easily incorporated into standard stroke protocol. SWI can identify various features such as hemorrhage, intraarterial thrombus, or concomitant microbleeds that are of prognostic value and affect therapeutic decisions.

An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review).

(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.

Thrombosed Developmental Venous Anomaly as a Rare Cause of Brain Stem Venous Infarction.

HomeStrokeVol. 53, No. 7Thrombosed Developmental Venous Anomaly as a Rare Cause of Brain Stem Venous Infarction No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextThrombosed Developmental Venous Anomaly as a Rare Cause of Brain Stem Venous Infarction Stephanie B. Syc-Mazurek, MD, PhD, Nathan A. Seven, MD, Saumya M. Shah, MD, John J. Chen, MD, PhD and Zafer Keser, MD Stephanie B. Syc-MazurekStephanie B. Syc-Mazurek Correspondence to: Stephanie B. Syc-Mazurek, MD, PhD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9549-6648 Department of Neurology (S.B.S.-M., N.A.S., J.J.C., Z.K.), Mayo Clinic, Rochester, MN. Search for more papers by this author , Nathan A. SevenNathan A. Seven Department of Neurology (S.B.S.-M., N.A.S., J.J.C., Z.K.), Mayo Clinic, Rochester, MN. Search for more papers by this author , Saumya M. ShahSaumya M. Shah Department of Neurology (S.B.S.-M., N.A.S., J.J.C., Z.K.), Mayo Clinic, Rochester, MN. Search for more papers by this author , John J. ChenJohn J. Chen Department of Neurology (S.B.S.-M., N.A.S., J.J.C., Z.K.), Mayo Clinic, Rochester, MN. Department of Ophthalmology (S.M.S., J.J.C.), Mayo Clinic, Rochester, MN. Search for more papers by this author and Zafer KeserZafer Keser https://orcid.org/0000-0001-6415-0874 Department of Neurology (S.B.S.-M., N.A.S., J.J.C., Z.K.), Mayo Clinic, Rochester, MN. Search for more papers by this author Originally published6 May 2022https://doi.org/10.1161/STROKEAHA.122.038314Stroke. 2022;53:e253–e254"Thrombosed Developmental Venous Anomaly as a Rare Cause of Brain Stem Venous Infarction." Stroke, 53(7), pp. e253–e254FootnotesFor Sources of Funding and Disclosures, see page e254.Correspondence to: Stephanie B. Syc-Mazurek, MD, PhD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email syc-mazurek.[email protected]edu

Use of intra-dural thrombolysis in a case of extensive pediatric Cerebral Sinus Venous Thrombosis (CSVT) and Venous infarction (P14-5.002)

Use of intra-dural thrombolysis in a case of extensive pediatric Cerebral Sinus Venous Thrombosis (CSVT) and Venous infarction (P14-5.002)

Radiological Spectrum of Cerebral Venous Sinus Thrombosis in Soldiers at High Altitude: A Four-Year Analysis

Objective: To assess the spectrum of radiological findings of cerebral venous sinus thrombosis (CVST) in soldiers serving at high altitudes.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Combined Military Hospital, Skardu Pakistan, from Jan 2016 to Jan 2020.&#x0D; Methodology: Thirty-three consecutive soldiers evacuated to Combined Military Hospital, Skardu, with radiologically proven cerebral venous sinus thrombosis on CTV brain were enrolled in the study. Plasma D-dimer levels of all the patients were sent to the laboratory, and clinical data were noted.&#x0D; Results: Mean age of patients was 28.88 years ± 5.189 (range 20 to 40 years) with a mean duration of stay at high altitude of 59.8 ± 39.3 days and the average height of deployment as 17094 ± 3285 feet. Left transverse sinus was the most commonly involved sinus in 21 (63.6%) patients, followed by left sigmoid sinus 18 (54.5%) and superior sagittal sinus 16 (48.5%). Sixteen cases demonstrated associated findings of venous infarction on CT brain (48.5%). Headache was the most common clinical presentation 13 (93.9%), followed by vomiting 12 (36.4%).&#x0D; Conclusion: Prolonged stay at high altitude is a key risk factor for cerebral venous sinus thrombosis in young individuals showing a predilection for posteriorly and inferiorly located venous sinuses.

Expression of Concern

Expression of Concern

Cerebral Sinus Venous Thrombosis in Systemic Lupus Erythematosus

Introduction: Cerebral sinus venous thrombosis (CSVT) is a major cause of stroke in young patients. The incidence of CSVT ranging from 1-12 cases per 1 million adults per year. Autoimmune diseases such as Systemic Lupus Erythematosus (SLE) can cause CSVT. The incidence of CSVT involvement in SLE is 1%. It is characterized by thrombosis in the sinuses and veins, which causes various symptoms, such as headache, seizures, motor weakness, and decreased consciousness. Cases: We report a case of a 20-year-old woman with SLE who complained of seizures accompanied by weakness on both sides of the body and a history of headaches. There is an increase in D-dimer, with positive ANA and anti-ds-DNA tests. A non-contrast CT scan of the head showed a lobar venous infarct with hyperdense lesions, a head non-contrast MRI/MRV revealed a dural sinus thrombosis with a deep cortical/subcortical venous infarct, no bleeding was seen. Patients were given Fondaparinux sodium therapy for 5 days, followed by Warfarin sodium for 3-12 months with a target INR of 2.0-3.0, and control SLE by administering immunosuppressants gave better outcomes for patients. Conclusion: The diagnosis of CSVT in this patient was based on clinical suspicion and imaging confirmation, and elevation of D-dimer. Non-contrast CT of the head as an initial examination often shows normal imaging. Still, there is also an image of a hyperdense lesion that usually causes an incorrect diagnosis, resulting in delays in therapy. Anticoagulation in CSVT should still be given even if there is bleeding.

Language lateralization and outcome in perinatal stroke patients with different vascular types

Perinatal stroke affects child’s language development and can change language lateralization. Language generation and comprehension tasks in functional magnetic resonance imaging were used to determine language lateralization in term born children with perinatal left-side arterial ischemic stroke (AIS) (n = 9, mean age (SD) 13.4 (3.1) y.) and periventricular venous infarction (PVI) (n = 12, 11.8 (2.8) y.), and in healthy right-handed controls (n = 30, 11.6 (2.6) y.). Lateralization index was calculated for the Broca and Wernicke areas and correlated with language and cognitive outcomes measured by the Kaufman Assessment Battery for Children II ed.Language outcome in children with perinatal stroke is poorer compared to healthy controls. Children with small AIS lesions and most children with PVI showed left-side language activation. Most children with large AIS lesions and one child with large PVI had language activation reorganized to the right hemisphere. Language reorganization to the unlesioned right hemisphere did not ensure normal language outcome.

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Subpial Hemorrhage : ADistinctive Neonatal Stroke Pattern.

Subpial hemorrhage is arare form of neonatal stroke, still poorly understood. The aim of this study was to characterize acohort of term and preterm neonates with subpial hemorrhages and contribute to abetter knowledge of this condition. Clinical records and magnetic resonance (MR) imaging data of all neonates with subpial hemorrhage followed at apediatric hospital between 2010 and 2020 were retrospectively reviewed. A total of 10 patients were included in the analysis, 40% of whom were term neonates. Operative vaginal delivery was registered in 30%. Temporal was the most common location of subpial hemorrhage (70%), and all patients displayed underlying brain infarction. Acharacteristic yin-yang pattern was present in 90% of the study cohort, and ingurgitation of medullary veins on susceptibility weighted imaging in 80%. Cerebellar microbleeds were observed in 60% of neonates, both term and preterm. When available, MR angiography and venography were unremarkable. Patients' clinical outcome was variable, with early prematurity not associated to worse outcomes. Subpial hemorrhage has adistinctive MR pattern, with underlying parenchymal venous infarction, and can occur in term and preterm neonates. This study results suggest an association between subpial hemorrhage and cerebellar microbleeds but further studies are required to confirm it and better understand the pathophysiology of subpial hemorrhage.

Asleep deep brain stimulation with intraoperative magnetic resonance guidance: a single-institution experience.

Deep brain stimulation (DBS) is traditionally performed on an awake patient with intraoperative recordings and test stimulation. DBS performed under general anesthesia with intraoperative MRI (iMRI) has demonstrated high target accuracy, reduced operative time, direct confirmation of target placement, and the ability to place electrodes without cessation of medications. The authors describe their initial experience with using iMRI to perform asleep DBS and discuss the procedural and radiological outcomes of this procedure. All DBS electrodes were implanted under general anesthesia by a single surgeon by using a neuronavigation system with 3-T iMRI guidance. Clinical outcomes, operative duration, complications, and accuracy were retrospectively analyzed. In total, 103 patients treated from 2015 to 2019 were included, and all but 1 patient underwent bilateral implantation. Indications included Parkinson's disease (PD) (65% of patients), essential tremor (ET) (29%), dystonia (5%), and refractory epilepsy (1%). Targets included the globus pallidus pars internus (12.62% of patients), subthalamic nucleus (56.31%), ventral intermedius nucleus of the thalamus (30%), and anterior nucleus of the thalamus (1%). Technically accurate lead placement (radial error ≤ 1 mm) was obtained for 98% of leads, with a mean (95% CI) radial error of 0.50 (0.46-0.54) mm; all leads were placed with a single pass. Predicted radial error was an excellent predictor of real radial error, underestimating real error by only a mean (95% CI) of 0.16 (0.12-0.20) mm. Accuracy remained high irrespective of surgeon experience, but procedure time decreased significantly with increasing institutional and surgeon experience (p = 0.007), with a mean procedure duration of 3.65 hours. Complications included 1 case of intracranial hemorrhage (asymptomatic) and 1 case of venous infarction (symptomatic), and 2 patients had infection at the internal pulse generator site. The mean ± SD voltage was 2.92 ± 0.83 V bilaterally at 1-year follow-up. Analysis of long-term clinical efficacy demonstrated consistent postoperative improvement in clinical symptoms, as well as decreased drug doses across all indications and follow-up time points, including mean decrease in levodopa-equivalent daily dose by 53.57% (p < 0.0001) in PD patients and mean decrease in primidone dose by 61.33% (p < 0.032) in ET patients at 1-year follow-up. A total of 205 leads were placed in 103 patients by a single surgeon under iMRI guidance with few operative complications. Operative time trended downward with increasing institutional experience, and technical accuracy of radiographic lead placement was consistently high. Asleep DBS implantation with iMRI appears to be a safe and effective alternative to standard awake procedures.

Characteristics of Cerebral Sinus Venous Thrombosis Patients Presenting with Intracerebral Hemorrhage.

Patients with cerebral venous sinus thrombosis (CVST) occasionally present with intracerebral hemorrhage (ICH). In this study, we aimed to identify predictors for ICH in CVST patients. Prospective CVST databases from three academic centers were retrospectively analyzed. CVST patients with and without ICH upon presentation were compared. Among the 404 included patients (mean age 41.8 years, 33% male), 74 (18.3%) had an ICH. The patients with ICH were older (45 ± 20.6 vs. 41.1 ± 18 years, p = 0.045), and were more often pregnant or postpartum women (15% vs. 6%, p = 0.011), or chronically hypertensive (15% vs. 5%, p = 0.001). The ICH patients had higher rates of seizures (60% vs. 15%, p < 0.001), and focal neurological deficits (53% vs. 23%, p < 0.001). The ICH group had lower rates of excellent outcome measured by 90-day mRS 0 (56.7% vs. 80.3%, p < 0.001) and higher rates of 90-day mortality (8% vs. 3%, p = 0.041). Radiological variables associated with ICH included superior sagittal sinus (SSS) thrombosis (63% vs. 36%), isolated cortical vein thrombosis (38% vs. 8%), and presence of venous infarction (34% vs. 7%) (p < 0.001 for all). Upon multivariate analysis, chronic hypertension (OR 3.7, p = 0.027), being either pregnant or postpartum (OR 4.3, p = 0.006), isolated cortical thrombosis (OR 3.5, p = 0.007), and SSS involvement (OR 3.4, p < 0.001) were independently associated with ICH upon admission. In conclusion, among CVST patients, the following present higher for ICH: pregnant or postpartum women, and individuals with chronic hypertension, cortical vein, or SSS involvement.

Neurosurgery in the Treatment of Alcohol Use Disorder: A Systematic Literature Review

AbstractAlcohol abuse has impacts on public health worldwide. Conservative treatment to achieve abstinence consists of detoxification combined with psychotherapy and the use of drugs, but it is estimated that only half of the individuals achieve long-term abstinence with the available treatments. In this sense, neurosurgery appears as a therapeutic proposal. The present study aimed to gather information about the circuitry related to alcohol use disorder (AUD), to describe possible surgical targets, and to establish whether a surgical approach could be a safe and effective treatment option. A systematic review of the literature was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The 14 selected articles analyze ablative operations, deep brain stimulation (DBS), and a new procedure in which the patient is first submitted to repetitive transcranial magnetic stimulation to evaluate their response, and later an implant is surgically positioned on the evaluated target to obtain more lasting results. The most relevant outcomes were found when the anterior cingulate cortex (ACC) and the nucleus accumbens (NAcc) were used as targets, demonstrating a large reduction in alcohol intake and even its cessation. However, important side effects were observed, such as psychotic symptoms, right frontal venous infarction, seizures after implantation in the ACC and a hypomanic period after DBS in the NAcc, which could be reversed. Due to the lack of studies involving the surgical treatment of AUD, more clinical trials are needed to compare targets, to assess surgical techniques, and to estimate the safety of these techniques.

CLINICAL PROFILE, RISK FACTORS AND OUTCOMES IN PATIENTS WITH CEREBRAL VENOUS THROMBOSIS: A STUDY FROM SOUTH TELANGANA, INDIA

BACKGROUND: Cerebral venous and sinus thrombosis is not a rare disease in India and abroad. The present study was undertaken to various clinical and radiological manifestations of the same. METHODS AND MATERIALS: A total 100 patients admitted to SVS Medical college and hospital, Mahabubnagar between September 2013 to September 2020 with a conrmed diagnosis of cerebral venous thrombosis were studied in this study. Detailed clinical examination along with basic investigations including CT/MRI brain and MRV/CTV in all. RESULTS: Headache and seizures are the most common ndings followed by paresis and fever. Alcohol addiction and tobacco consumption were found to be present in 53 and 56% of cases followed by iron deciency in 45, hypertension in 35, pregnancy related cases were only 18. Steroid abuse and hypothyroidism were noted in 18 and 16 instances while evidence of infection was noted in a dozen patients. Cerebral imaging (CT/MRI) revealed venous infarction hemorrhagic or non-hemorrhagic in 67 patients and isolated CVT without infarction in 21 patients. Infarctions were unilateral in 56 patients. Superior Sagittal Sinus in combination with other deep venous sinuses was seen in 54 percent of this study. CONCLUSION: CVST presents in young and equal in frequency in males and females. Headache, seizures are more frequent symptoms. Addiction with alcohol and tobacco are the more frequent risk factors followed by Iron deciency anemia and hypertension. SSS was the most common site of venous sinus thrombosis.

Progressive Myelopathy With Acute Worsening After Steroids and Lumbar Puncture.

We present the case of a 73-year-old woman with a 3-month history of non-traumatic thoracic myelopathy. Initial MRI showed a T6-conus T2 signal hyperintensity. Based on this presentation, and given a personal and family history of autoimmune disease, our patient was first managed as an inflammatory transverse myelitis. Subsequent worsening after lumbar puncture and steroids prompted re-evaluation, ultimately identifying the cause as a thoracic spinal dural AV fistula. Both investigation of possible transverse myelitis with lumbar puncture and empiric treatment with steroids may not only result in diagnostic delays but also precipitate venous infarction and irreversible harm. While the MRI often provides the initial diagnosis, clinical suspicion for this under-diagnosed cause of myelopathy should be raised in older patients with a more progressive thoracic myelopathy with worsening after lumbar puncture and/or steroids. Definitive and time-sensitive treatment by interventional neuroradiology or neurosurgery results in stabilization or improvement of disability in most cases.

Large thrombosed portomesenteric venous aneurysm treated with pharmacomechanical thrombolysis combined with TIPS placement

BackgroundAneurysms are rare anomalies of the portomesenteric venous system. Thrombotic complications of these lesions can lead to mesenteric venous ischemia and bowel infarction, potentially requiring surgical intervention. Herein we describe a case of mesenteric ischemia due to a large thrombosed portomesenteric aneurysm treated with endovascular techniques.Case presentationA 37-year-old previously healthy male who presented with abdominal pain to his local emergency department was found to have a thrombosed 12.0 × 5.1 cm portomesenteric venous aneurysm with evidence of mesenteric ischemia on CT. When conservative management with anticoagulation failed, transhepatic pharmacomechanical thrombolysis was initially performed. This was followed by TIPS placement with additional trans-TIPS thrombectomy to improve sluggish portal outflow and prevent re-thrombosis. The patient’s symptoms and imaging findings of ischemia resolved after endovascular therapy. No surgical intervention was required, and the patient was discharged on enoxaparin before being transitioned to apixaban. The TIPS remained patent at 2-year follow-up, with no change in the size of the aneurysm or re-thrombosis noted. The patient’s synthetic liver function was preserved with no evidence of hepatic encephalopathy during the follow-up period.ConclusionsEndovascular therapies may be used to manage thrombotic complications of portomesenteric venous aneurysms, obviating the need for surgical intervention in selected patients.

Efficiency of decompressive craniectomy as a line of management of severe cerebral venous thrombosis.

ObjectiveCerebral venous thrombosis (CVT) is a rare pathology with life threatening consequences, most of these fatal complications are due to raised intracranial pressure due to venous infarction and cerebral swelling, the purpose of this study is to evaluate the efficiency of decompressive craniectomy for favorable outcome.MethodsA retrospective analysis of clinical, radiological and surgical data of patients who underwent decompressive craniectomy for CVT in a tertiary referral hospital between the years 2016 through 2020.ResultsThe study included 7 patients, female predominance was noted (5/7), mean age was 18.14 years. Mean Glasgow coma score (GCS) at surgery was 8.26, good clinical outcome was achieved for the majority of cases 71.4%, and one case of mortality 14.28%.ConclusionsDecompressive craniectomy is a life saving procedure for patients with severe brain swelling as a sequela of CVT, majority of patients (71.4%) showed favorable functional outcome by 6 months postoperatively.

Stroke in Middle Eastern children with cancer: prevalence and risk factors

ObjectiveTo determine the prevalence and to characterize the different types of strokes in children with cancer at the Children’s Cancer Center of Lebanon (CCCL), in addition to assess the factors and clinical findings leading to stroke in children.Methods We retrospectively reviewed the medical records and brain images (MRIs and CTs) of children admitted to the CCCL and diagnosed with cancer between years 2008 and 2017. Brain images were reviewed for the strokes’ onset, size, location, possible origin, its recurrence and type: intracranial hemorrhage (ICH), acute arterial ischemic stroke, and cerebral sinus venous thrombosis (CSVT) with and without venous infarct. Medical charts of the patients were reviewed for age, sex, their type of cancer, the treatment protocol they followed, and abnormal findings on their laboratory studies and neurological exams.ResultsOut of the 905 charts reviewed, twenty-seven children with variable types of cancer had strokes, with a prevalence of 2.9%. Their median age at cancer diagnosis was 9.4 (4.8-13.7) years and the median age at stroke onset was 10.6 (6.7-15.5) years. The median time between the cancer diagnosis and the stroke episode was 6 months. CSVT cases were the most common (60%) followed by acute arterial ischemic (22%) and hemorrhagic strokes (18%), with CSVT being the latest to occur. We observed that the different types of strokes were related to some types of cancer. Of the children that had acute arterial ischemic stroke in this cohort, 83% had brain tumors, of the children who had CSVT, 87.5% had leukemia, and of the children who had hemorrhagic stroke, 40% had leukemia. Neurological abnormalities were more prevalent in acute arterial ischemic stroke (80%). Patients with CSVT recovered better than those with other types of strokes. Strokes recurred in 60% of ischemic strokes. L-Asparaginase was significantly associated with CSVT.ConclusionsThe prevalence of strokes was 2.9% in children with cancer. We were able to identify factors related to the types of the stroke that occurred in children including the type and location of the cancer the type of treatment received, and stroke recurrence.