Cerebral Venous Thrombosis Research Articles

Deciphering changes in the incidence of hemorrhagic stroke and cerebral venous sinus thrombosis during the coronavirus disease 2019 pandemic: A nationwide time-series correlation study.

Hemorrhagic stroke and cerebral venous sinus thrombosis (CVST) are associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination. We aimed to investigate changes in the incidence of hemorrhagic stroke and CVST in South Korea before and during the coronavirus disease 2019 pandemic and the factors associated with these changes. We conducted a nationwide time-series study using population-based databases between 2007 and 2022. The real-world and forecasted incidences of acute non-traumatic subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and CVST during the pandemic period (2020-2022) were estimated and compared with the pre-pandemic period (2007-2019). The prevalence of conventional risk factors was measured using time-series data. Finally, a time-series correlation analysis was performed to examine the temporal association between conventional risk factors, SARS-CoV-2 infection, and SARS-CoV-2 vaccination. The incidence of hemorrhagic stroke (SAH and ICH) was lower during the pandemic than during the pre-pandemic period. This observed decrease was associated with a reduction in the prevalence of conventional risk factors but not with SARS-CoV-2 infection or vaccination. The incidence of CVST was higher during the pandemic than during the pre-pandemic period, which may be temporally related to SARS-CoV-2 vaccination (Pearson correlation coefficient [r] = 0.349, P = 0.031). We report reassuring evidence of hemorrhagic stroke associated with SARS-CoV-2 infection and vaccination. However, awareness of CVST may be required for future vaccine rollouts and SARS-CoV-2 outbreaks.

Clinical Significance of D-dimer Level and Numeric Rating Scale with Amount of Sinus Involvement in Cerebral Sinus Thrombosis Patients.

Cerebral venous sinus thrombosis (CVST) is a cerebral vascular disorder that currently occurs quite often and has very varied clinical symptoms. Headache is the main symptom most commonly found in patients with CVST and multiple sinus involvement often have a more severe prognosis and poor clinical outcome. This study aimed to learn the relationship between D-dimer level, numeric rating scale (NRS), and amount of sinus involvement in CVST patients. This study was a retrospective observational analytic study with a cross-sectional approach using medical records and supporting data (D-dimer level and imaging finding) on patients diagnosed with CVST at Dr Hasan Sadikin Hospital Bandung. Sixty-five CVST patients met the study criteria with mean age of 47 years and mostly female (76.9%). Patients with single sinus involvement had a median initial NRS of 4 (range 2-6) and multiple sinus involvement was higher at 8 (range 5-9). Statistical test results showed a significant difference between D-dimer level, NRS and amount of sinus involvement (P<0.001). D-dimer level, NRS, and amount of sinus involvement are associated with amount of sinus involvement in CVST patients. Involvement of multiple sinus will cause higher NRS with higher D-dimer level.

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

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

Evolution and advances in endovascular mechanical thrombectomy of cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis (CVST) is a rare type of stroke and standard treatment involves anticoagulation. However, for some special CVST patients who are ineligible for anticoagulation or refractory to conservative treatment, endovascular treatment (EVT) may be an effective option. Mechanical thrombectomy (MT) is a commonly used treatment. Compared with anticoagulation treatment alone, MT may result in additional procedure-related complications, however, many studies have shown that it has a high rate of vessel recanalization and lower incidence of related complications in arterial large vessel occlusion stroke. In addition, the applicability of MT in children, patients with deep cerebral thrombosis, and patients with bleeding before treatment has been reported. MT combined with intravascular thrombolysis (IVT) and other multimodal therapeutic strategies, also has a good curative effect, and further research is needed to compare and optimize different treatment strategies. Owing to the low incidence of CVST, randomized controlled clinical trials with a large sample size to explore the safety and effectiveness of MT are scarce. In addition, devices specifically designed for cerebral venous sinus and effective endovascular therapies are currently not well-established. This article summarizes different endovascular instruments and multimodal therapies for cerebral venous thrombosis. We also discuss the limitations, prospects, prognostic factors, and applications in special cases of interventional thrombectomy.

Extensive Cerebral Venous Sinus Thrombosis during COVID-19 Infection in a Patient with Autoimmune Hyperthyroidism: A Case Report

Abstract Cerebral venous sinus thrombosis (CVST) in the setting of coronavirus disease 2019 (COVID-19) is an uncommon phenomenon with increasing incidence. CVST is an uncommon subtype of stroke caused by thrombotic occlusion of the cerebral veins. We report the case of an adult women with headache, fever, nausea, vomiting, and no known autoimmune diseases. Diagnostics revealed elevated infammatory and hypercoagulability markers, free T4, low TSHs, and positive SARS-CoV-2 PCR. Neuroimaging demonstrated a thrombosis of the superior sagittal sinus, both right and left transverse sinus extending into the right jugular vein. A diagnosis of CVST with associated COVID-19 and hyperthyroidism was established. In patients with suspected COVID-19, especially in the presence of causes of hypercoagulability and presence of atypical features, venous sinus thrombosis needs to be kept in mind in making the differential diagnosis. Follow-up examination revealed complete symptomatic resolution and regression of thrombosis.

Critical Prognostic Factors in Cerebral Venous Sinus Thrombosis: An Observational Study.

Cerebral venous sinus thrombosis (CVST) presents with a wide variety of neurological symptoms in various combinations and has a high mortality rate of up to 50%. Recent advances in neuroimaging and therapeutic interventions have brought it down to 10%-20%. The study aims to identify critical prognostic factors associated with poor outcomes in patients with CVST. All cases of CVST aged >18 years from July 2015 to July 2020 who were not terminally ill and bedridden before the illness were evaluated at the entry point for various risk factors and after 30 days for outcome assessment with the modified Rankin scale (mRS). The outcome was dichotomized, applying mRS <3 as a good outcome, and analyzed with the Chi-square test or the Fischer's exact test in a bivariate analysis to identify associated variables. A total of 149 subjects were studied. Glasgow Comma Scale (GCS) <9 (P<0.001), focal neurological deficits (P = 0.05), the presence of a mass effect (P<0.001), and the need for decompressive hemicraniectomy (P<0.001) were associated with poor outcomes. Age, gender, diagnostic delay, seizures at onset, papilledema, parenchymal lesions, deep sinus involvement, and multiple sinus thrombosis were not associated with a poor outcome. In our study, early diagnosis and treatment of CVST is associated with an overall favorable outcome even in the presence of traditional poor prognostic factors such as age, seizures at onset, deep sinus involvement, and multiple sinus involvement in the face of conventional risk factors. A large country-wide prospective study might help in elucidating the poor prognostic factors.

Cortical Brush Sign: A Novel Finding on Thin-slice 3T Susceptibility-weighted Imaging in Acute Cerebral Infarct and Cerebral Venous Thrombosis.

We observed a new SWI finding, "cortical brush sign," that represents prominent venous structures in the cortex of patients with acute cerebral infarct with or without moyamoya disease and cerebral venous thrombosis. The cortical brush sign disappeared on follow-up SWI in all cases. Cortical brush sign may help to understand the pathophysiology of venous structures in the cortex at acute phase.

Knowledge and Perceptions of Cerebral Venous Thrombosis Among the Adult Population: A Nationwide Cross-Sectional Study in Saudi Arabia.

The current annual incidence of cerebral venous thrombosis (CVT) is 3-4 cases per one million population. CVT manifests itself with varying degrees of clinical presentation that may cause vital or morbid consequences if not treated and managed promptly. Studies have suggested varied levels of CVT public awareness. To assess the level of knowledge and public perception of CVT across the different socio-economic strata of the Saudi Adult population. A descriptive cross-sectional study was conducted using a mixed-method approach (an electronic questionnaire and phone interviews) for collecting the data. A validated questionnaire was distributed to consenting study participants and filled out to the best of their ability. The study setting was a nationwide survey conducted in Saudi Arabia and involved a representative portion of the study population. A total of 1912 participants were included in this study. Overall, the majority of study participants (67.2%) had a low knowledge level of CVT on assessment, and only 2.6% had a high knowledge level of CVT. Younger age, female gender, working adults, higher education level, marital status, Saudi nationals, and place of residency were significantly associated with knowledge of CTV (p < 0.001). This study indicates a lower index of knowledge of CVT which offers an opportunity for much improvement in public perception and awareness of CVT in the study population. Our results can be utilized to target the demographics with the lowest knowledge via the most popular ways to gain information.

ОСТРОЕ НАРУШЕНИЕ МОЗГОВОГО КРОВООБРАЩЕНИЯ В ДЕТСКОМ ВОЗРАСТЕ: КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ И ИНТЕНСИВНАЯ ТЕРАПИЯ

Acute cerebrovascular accident (CVA) is a severe condition in children and adolescents with a high risk of disability. A literature review was carried outon intensive stroke care in children and adolescents using databases such as PubMed, Science Direct, and eLibrary. The search utilized keywords suchas "acute cerebrovascular accident", "stroke", "children", "clinical manifestations", and "intensive care". The review includes sources for the last 10years (2014-2024). The inclusion criteria consisted of descriptions of clinical manifestations and intensive care management for stroke in childhood and adolescence. The exclusion criteria referred to articles on the clinical presentation and treatment of stroke in adult patients. The main factors for stroke in childhood include sickle cell anemia, cardiovascular diseases, cancer pathology, and genetic disorders. The manifestations of stroke in children and adolescents have nonspecific clinical features. There are currently no approved protocols for the treatment of stroke in children, and there are insufficient clinical studies for this condition. Therefore, pediatric practice often extrapolates aspects of intensive care for stroke from the adult population. The type of stroke, such as arterial ischemic stroke (AIS) or hemorrhagic stroke (HS), cerebral venous sinus thrombosis, or stroke due to sickle cell anemia, determines the emergency care required for children. Intensive therapy should be carried out in a pediatric intensive care unit (PICU), focusing on stabilizing vital functions and maintaining optimal cerebral perfusion pressure. Developing specific protocols for intensive stroke treatment in children and adolescents is necessary to improve the quality of emergency care for this patient population

Cow's Milk Anemia in Childhood Manifesting as Severe Cerebral Venous Sinus Thrombosis.

We describe a series of 7 toddler-aged children with iron deficiency anemia from excessive cow's milk consumption who presented with cerebral venous sinus thrombosis and no other identifiable risk factors for thrombosis. The deep venous system was involved in 6 patients, 6 had venous infarcts, and 5 have significant neurocognitive sequelae.

Ten-year Causes of Cerebral Venous Sinus Thrombosis in Patients Referred to Ghaem Hospital from 2009 to 2019.

Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disorder characterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple risk factors and casualties, and its epidemiological picture should be investigated. This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebral vein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009 and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinical symptoms and causes were documented and contrasted according to demographics. During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with women accounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followed by seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness (3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). The most commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%), malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factors between the two genders, with the exception that all cases of fasting were in women, and the differences were significant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography (MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the site of the conflict between the two genders (p<0.05). The findings of the present study showed that deep vein thrombosis occurred mainly in women and manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site of involvement.

Post -contrast Three -dimensional MP RAGE T1WI Sequence Compared to Brain MRV Sequence for Diagnosing Brain Sinus Venous Thrombosis.

Dural sinus thrombosis is considered as a one of the clinical and radiological emergencies that require special attention and high index of suspicion and needs combined effort of both the treating physician and the radiologist to obtain proper diagnosis and subsequently proper management. The aim of this article was to compare the accuracy of MRV TOF and post contrast MP-RAGE sequences in diagnosis of cerebral sinus venous thrombosis. After all informed consents were obtained and upon ethical committee approval from the ethical committee in Joradanian Royal medical services in Amman we perform this study as a retrospective study done on 50 patients with cerebral sinus venous thrombosis with 50 pateints control group done at king Hussein medical center in Amman Jordan. The guidelines and regulations of studies conducted in Royal medical services were followed. 68 females and 32 males with age range between 19 and 52 years. All patients underwent brain MRI for evaluation of cerebral sinus thrombosis, all studies were done on seimens skyra 3 Tesla machine with standardized protocol including 2 D TOF MRV, axial T2WI, axial FLAIR, Axial T1, SWI and diffusion weighted images along with 3D MP-RAGE post contrast. Images were reviewed by two well experienced neuroradiologists (Maysoon and Qamar) in separate sessions, each MRI sequence was reported separately without knowing patients name or clinical history. Conclusion: The results for T2 WI, SWI, MRV TOF and MP-RAGE post contrast were reported. We used a confidence level score to standardize the results. Then the results were analyzed using simple statistical methods.

Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation.

Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is nuanced by the risk of new or worsening hemorrhage. Presently, there are no guidelines on the investigation and management of tCVST. Therefore, we conducted a UK- and Ireland-wide practice variation survey. A 17-question survey was sent via Google Forms to neurosurgeons and intensive care doctors of at least ST3 (registrar) level and above in the UK and Ireland and distributed by the Society of British Neurological Surgeons and investigators of the Sugar or Salt trial between May 9, 2023, and September 15, 2023. Data were extracted from the survey for both qualitative and quantitative analyses. There were 41 respondents to the survey, 18 (43.9%) of whom were consultant neurosurgeons. Fifty-four percent of the respondents performed a computed tomography intracranial venogram to investigate for tCVST where there was a skull fracture overlying or adjacent to a venous sinus, whereas 43.9% performed these at the time of TBI diagnosis. Around three-fourth of the respondents anticoagulate for tCVST, largely within 3 days post-TBI. A range of hemorrhagic and thrombotic complications have been observed following decisions to treat and withhold treatment of tCVST, respectively. Around two-third of the respondents conducted follow-up imaging in confirmed tCVST. None of the respondents had an established departmental protocol for the management of tCVST. This UK- and Ireland-wide survey on the management of tCVST revealed a variation in its diagnosis, treatment, and follow-up with no departmental protocol established. The optimal diagnostic pathway, management protocol, and follow-up of patients with tCVST remain unknown and should be the subject of future studies.

Aggregatibacter aphrophilus-associated Sphenoid Sinusitis Causing Orbital Cellulitis, Meningitis, and Venous Sinus Thrombosis.

We herein report an 81-year-old woman with no significant medical history who developed a fever, headache, and right eyelid swelling. Magnetic resonance imaging (MRI) showed eye proptosis, sphenoid opacity, enlarged cavernous sinus, and dilated right superior ophthalmic vein (SOV). Subsequent enhanced MRI revealed intraventricular debris and thrombosis in the right SOV and the left transverse and sigmoid sinuses. Blood cultures were positive for Aggregatibacter aphrophilus, as identified by mass spectrometry. The patient responded well to antibiotics, anticoagulants, and surgical drainage of sphenoid sinusitis. To our knowledge, this is the first case of A. aphirophilus sphenoid sinusitis causing orbital cellulitis, meningitis, and venous sinus thrombosis.

IgG4-related hypertrophic pachymeningitis with cerebral venous thrombosis.

IgG4-related hypertrophic pachymeningitis with cerebral venous thrombosis.

Clinicoradiological Features and Long-term Cognitive and Functional Outcome in Patients with Deep Cerebral Venous Thrombosis.

Deep cerebral venous thrombosis (DCVT) can have long-term functional and cognitive sequelae. Although literature exists on cognitive impairment after arterial stroke, cognitive sequelae after cerebral venous thrombosis (CVT) are much less studied. Clinical records of 29 patients diagnosed with DCVT were reviewed. The Modified Telephonic Interview for Cognitive Status (TICS-M) was adapted and validated in the regional language (Kannada) and applied to 18 patients with DCVT, at a mean follow-up duration of 5.32 years. Screening for depression was done via telephonic Patient Health Questionnaire-9 (PHQ-9)-Kannada version, and functional status was screened by applying the modified Rankin Scale (mRS). DCVT had a mortality rate of 10.34% due to acute complications. mRS scores of 0-1 were achieved at follow-up in all patients who survived. Receiver operating characteristic (ROC) analysis revealed a cutoff of ≤44.5 (maximum score of 49) for the diagnosis of cognitive impairment via TICS-M (Kannada version) in DCVT patients. Evidence of cognitive dysfunction was seen in eight patients (42.10%), and three patients (16.66%) had evidence of depression. Survivors of acute DCVT can potentially have long-term cognitive sequelae. Screening for cognitive dysfunction, depression, and functional status can be effectively done using telephonically applied scales that are adapted to the local language. Neuropsychological evaluation and early cognitive rehabilitation can be initiated for patients in whom deficits are identified on cognitive screening.

Case of hypertriglyceridemia-induced subacute pancreatitis and hypertriglyceridemia-triggered transverse sinus thrombosis in a recently diagnosed diabetic patient and the efficacy of management of hypertriglyceridemia with continuous insulin infusion

ABSTRACT A 28-year-old single female diagnosed with transverse sinus thrombosis; she was also discovered to be diabetic with severe hyperlipidemia. She presented by recurrent episodes of diffuse dull aching abdominal pain referred to the back; she was diagnosed with acute pancreatitis with markedly elevated triglyceride (TG) levels. She started medical treatment for hypertriglyceridemia with no improvement. She started four sessions of plasma exchanges with marked improvement of the general condition, abdominal pain and appetite, and TGs declined.While the patient was on plasma exchange she developed catheter related infection so it is stopped and soon triglycerides raised again with recurrence of the abdominal pain and we started insulin infusion with improvement of her condition

A case of hyper-homocysteinemia carrying MTHFR gene polymorphism in cerebral sinus thrombosis and pulmonary embolism

A case of hyper-homocysteinemia carrying MTHFR gene polymorphism in cerebral sinus thrombosis and pulmonary embolism

Bilateral thalamic edema caused by tentorial galenic dural arteriovenous fistula and sinus thrombosis: successful endovascular therapy

Bilateral thalamic edema caused by tentorial galenic dural arteriovenous fistula and sinus thrombosis: successful endovascular therapy

A case of neurofibromatosis type 1 with cerebral venous sinus thrombosis due to iron deficiency anemia associated with gastrointestinal stromal tumor

A case of neurofibromatosis type 1 with cerebral venous sinus thrombosis due to iron deficiency anemia associated with gastrointestinal stromal tumor