Presentation
A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery. [ncbi.nlm.nih.gov]
Entire Body System
- Fever
A two and half year-old-male child, known case of steroid responsive nephrotic syndrome presented with fever and vomiting of acute onset. [ncbi.nlm.nih.gov]
She denies recent trauma, fevers, neck stiffness, substance abuse, IVDA, ill contacts, and foreign travel. Her medication list is notable only for an estrogen containing oral contraceptive. [emdocs.net]
There was no associated fever, sinus congestion, neck stiffness, or visual or focal neurological symptoms. There was no family history of migraine or other headache disorder. The patient had begun his third year of law school 3 weeks earlier. [accessemergencymedicine.mhmedical.com]
It was not accompanied by fever, vomiting, nor seizure. A week later, he started having mild blurring of vision and intermittent binocular diplopia. [asean-endocrinejournal.org]
- Pseudotumor
We present a 35-year-old woman with a recent diagnosis of pseudotumor cerebri who presented with headache, emesis, and blurring of vision. [ncbi.nlm.nih.gov]
CVT can mimic the syndrome of idiopathic increased intracranial pressure (so-called pseudotumor cerebri). CVT is an important diagnosis to recognize, as anticoagulation is indicated to prevent further clot formation. [casemed.case.edu]
The spectrum of adverse outcomes in CVT includes the following: Death Temporary or permanent neurologic impairment and disability Epilepsy Hydrocephalus Chronic venous outflow obstruction resulting in chronic headache and/or pseudotumor cerebri Vision [clinicaladvisor.com]
Neurology was consulted, and after evaluation, they stated her headaches were possibly due to pseudotumor cerebri or a worsening of her chronic baseline migraine headaches. However, no papilledema was noted on physical exam. [omicsonline.org]
"Thrombosis of the dural venous sinuses as a cause of pseudotumor cerebri". Ann. Surg. 134 (3): 376–86. doi : 10.1097/00000658-195113430-00009. PMC 1802934. PMID 14869026. ^ Paul Richter. [en.wikipedia.org]
- Sepsis
For example, dehydration, facial skin/ear infection, sepsis, various iv drugs (for example, ecstasy), oral contraceptives, high altitude, dry weather, malignancy, pregnancy and the puerperium. [radiology.ucla.edu]
[…] sensitivity of 95%. 4 MRV may be utilized if CTV is not available, however sensitivity decreases in the subacute setting: thrombus signal diminishes after 3 weeks (subacute presentation). 4 Treatment: Address the underlying etiology if possible (e.g. sepsis [emdocs.net]
The underlying condition, particularly sepsis, malignancy, and paroxysmal nocturnal haemoglobinuria adversely affect outcome. 8 Twelve per cent of patients suffer a recurrence of CVST and 14% a different form of venous thrombosis. 27 Seizures rarely occur [pmj.bmj.com]
Cardiovascular
- Hypotension
Initial presentation suggested spontaneous intracranial hypotension (SIH) since there was no history of epidural or spinal anesthesia, or trauma or surgery to her back or neck. [ncbi.nlm.nih.gov]
Cerebral venous thrombosis in spontaneous intracranial hypotension. Headache 2008;48:1511-9. DOI PubMed 11. Yoon KW, Cho MK, Kim YJ, Lee SK. Sinus thrombosis in a patient with intracranial hypotension: a suggested hypothesis of venous stasis. [nnjournal.net]
Intracranial hypotension Isolated cortical venous thrombosis has been associated with intracranial hypotension syndrome, but only rarely. [emedicine.medscape.com]
Other Causes Although rare, other causes of CVST include intracranial hypotension, hydrocephalus, and the use of certain drugs and supplements (eg, corticosteroids, high doses of vitamin A). [mdedge.com]
We speculate that intracranial hypotension during the operation might have decreased venous flow and contributed to straight sinus thrombosis. [surgicalneurologyint.com]
- Vascular Disease
Volume 1 covers the visual sensory system, the autonomic nervous system, the ocular motor system, the eyelid, facial pain and headache, and nonorganic disease. Volume 2 covers tumors, the phacomatoses, and vascular disease. [books.google.com]
diseases (especially Systemic Lupus Erythematosus) ● Antiphospholipid antibody syndrome ● Malignancy ● Adjacent infectious processes (e.g., otitis, mastoiditis, sinusitis) Patients typically present with a prominent headache. [casemed.case.edu]
diseases like lupus, Wegener’s granulomatosis, and Behcet syndrome Obesity Low blood pressure in the brain (intracranial hypotension) Inflammatory bowel disease like Crohn’s disease or ulcerative colitis What are the symptoms of cerebral venous thrombosis [hopkinsmedicine.org]
Musculoskeletal
- Bilateral Leg Weakness
In addition, thrombosis of the superior sagittal sinus classically presents with bilateral leg weakness, as the superior sagittal sinus is midline. [casemed.case.edu]
- Leg Weakness
In addition, thrombosis of the superior sagittal sinus classically presents with bilateral leg weakness, as the superior sagittal sinus is midline. [casemed.case.edu]
Neurologic
- Headache
The signs and symptoms of intracranial pathology in patients with dural puncture headache, in addition to their postural headache, are discussed. [ncbi.nlm.nih.gov]
- Seizure
This case also extends the clinical spectrum of cerebral sinus thrombosis to include recurrent transient ischemic attacks alternating with seizures. [ncbi.nlm.nih.gov]
- Meningism
Magnetic resonance imaging (MRI) showed superior sagittal sinus (SSS) thrombosis and meningeal enhancement. An epidural blood patch was performed and enoxaparin was prescribed for 6 months. He has remained asymptomatic. [scholars.northwestern.edu]
[…] infections (e.g.sinusitis, otitis media, meningitis, head and neck infections) mechanical injury to the sinuses or jugular veins (e.g. trauma, venous catheterisation, neurosurgical procedures) drugs (e.g. androgens, IV immunoglobulin) haematological [lifeinthefastlane.com]
Meningeal signs were present. Nonenhanced CT of brain showed hyperdensities in the interhemispheric fissure, bilateral frontoparietal convexities and left Sylvian fissure which were not enhancing on contrast [Figure - 4] A. [annalsofian.org]
- Focal Neurological Deficit
Recurrent transient focal neurologic deficit is an extremely rare manifestation in superior sagittal sinus thrombosis and the mechanism is unknown. [ncbi.nlm.nih.gov]
Depending on what other sinuses are thrombosed, there can be a multitude of other focal neurological deficits. Seizures are not uncommon. In addition, blockage of venous outflow commonly results in intracranial hypertension. Papilledema may be seen. [casemed.case.edu]
Fundi were normal and there were no cranial nerve palsies or focal neurological deficits. Meningeal signs were present. [annalsofian.org]
- Aphasia
In the right image, note the bright signal seen in the left posterior temporal lobe, indicating a subacute hemorrhage, the cause of the patient's receptive aphasia. Cerebral venous thrombosis (CVT) is an uncommon cause of stroke. [casemed.case.edu]
During subsequent hours generalized seizures, right hemiplegia, and aphasia developed. [stroke.ahajournals.org]
Similar Ideas Coaching Aphasia Multiple Intelligences Psicologia Medicine Forward Áreas funcionais Neuroscience Nurses Students Yoga La Digestion Pide Blood Vessels Alternative Medicine Mental Health Forward Infografía Neurociencias: Sistema nervioso [pinterest.es]
Lateral Sinus Headache Hemoanopia, contralateral weakness and aphasia Deep Cerebral Venous( internal cerebral vein, vein of Galen and straight sinus) Result in rapid deterioration, secondary to thalamic or basal ganglion infarction. [resus.com.au]
After clipping the cerebral aneurysm, she had delayed emergence from anesthesia, total aphasia, and right hemiparesis. [surgicalneurologyint.com]
Workup
Further workup for an underlying cause of sinus thrombosis disclosed symptoms and signs fulfilling the diagnostic criteria for Behcet's disease. [ncbi.nlm.nih.gov]
During this inpatient visit, a thrombophilia workup revealed a homozygous 4G/4G genotype. [mdedge.com]
No conditions that could result in CVT were found despite an extensive etiologic workup. He was treated with heparin followed by oral anticoagulant and he significantly improved. [annalsofian.org]
A hypercoagulability workup performed which included Factor V, Prothrombin Gene mutation, homocysteine; Protein C&S, ATIII, ACE, Fibrinogen, Anti-beta 2 glycoprotein, Anti-Cardiolipin, and Lupus screen were all negative. [omicsonline.org]
(See Workup.) Left lateral sinus thrombosis demonstrated on magnetic resonance venography (MRV). This 42-year-old woman presented with sudden onset of headache. Physical examination revealed no neurologic abnormalities. [emedicine.medscape.com]
Treatment
Sinus thrombosis resulting after endovascular or surgical treatment of dural arteriovenous fistulous connections has been reported in literature and is considered a possible complication of treatment. [ncbi.nlm.nih.gov]
Clinical outcome is typically dependent on the timeliness of diagnosis and definitive treatment. [ajnr.org]
Prognosis
Dural sinus thrombosis is a relatively rare syndrome, often with a very poor prognosis. Systemic anticoagulant therapy has produced poor results; therefore rapid recanalization of the affected vessels is essential. [ncbi.nlm.nih.gov]
Links: aetiology pathogenesis clinical features investigations treatment prognosis [gpnotebook.co.uk]
The prognosis of CVT varies, from complete recovery, to residual neurological deficits, to death. Revised 11/29/06. Copyrighted 2006. David C Preston [casemed.case.edu]
Etiology
Neonatal polycythemia and dehydration were thought to be etiological factors. CT scan revealed massive brain edema with slitlike ventricles. Increased density of the torcular Herophili and straight sinus was demonstrated in two cases. [ci.nii.ac.jp]
The etiology of CVT is diverse but most often includes the following: ● Genetic hypercoagulable states (e.g., protein S and C deficiencies, antithrombin III deficiency, Leiden factor V mutation) ● Oral contraceptives ● Pregnancy / puerperium ● Collagen [casemed.case.edu]
Prior to the advent and widespread use of antibiotics in developed nations, CVT was largely due to infectious etiologies such as mastoiditis, orbital cellulitis, and facial cellulitis[2]. Risk Factors Table 1. [eyewiki.aao.org]
Orbital cellulitis is the most common precipitating etiology of septic CSVT – look for headache, fever, and opthalmoplegia. 3 References: Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005; 352:1791-1798. [emdocs.net]
[…] the risk of death or dependency. 11 The duration of anticoagulant therapy in CSVT depends on the etiology as well. [asean-endocrinejournal.org]
Epidemiology
Answer: Cerebral Sinus Venous Thrombosis (CSVT) 1-8 Epidemiology: 1,2 In the U.S., CSVT accounts for < 1% of ischemic strokes and typically affects young people. Estimated incidence: 3-4 cases per million adults and 7 cases per million children. [emdocs.net]
MRV of the Cerebral Venous System (Saposnik 2011) Epidemiology More common in young (median age = 38) women (60-75% of cases) Rare disease: 0.5-1% of all strokes ( Saposnik 2011 ) Mortality: 10-30% ( Williams 2004 ) Risk Factors Virchow’s Triad: stasis [coreem.net]
Epidemiology, endovascular treatment, and prognosis of cerebral venous thrombosis: US Center Study of 152 Patients. J Am Heart Assoc 2017;6:e005480. DOI: 10.1161/JAHA.117.005480. [ Links ] 7. Ruiz-Sandoval JL, Chiquete E, Bañuelos-Becerra LJ, et al. [scielo.org.mx]
Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme – The International Classification of Diseases is the international standard diagnostic tool for epidemiology, health management and clinical purposes. [wikivisually.com]
The rate of recurrence was low (2.8%). [15] In children with CVST the risk of death is high. [16] Poor outcome is more likely if a child with CVST develops seizures or has evidence of venous infarction on imaging. [17] Epidemiology [ edit ] Cerebral venous [en.wikipedia.org]
Pathophysiology
The standard evaluation of patients with intracranial hypertension frequently does not reveal a discrete pathophysiologic process, leading in these cases to classification of the syndrome as "benign." [ncbi.nlm.nih.gov]
[…] straight sinus, and then to the internal jugular vein (IJV) Superficial venous system has numerous anastomses and predominantly drain the SSS and the LS Deep white matter and basal ganglia are drained by the deep venous system toward the vein of Galen Pathophysiology [lifeinthefastlane.com]
[…] polyangiitis (formerly known as Wegener’s granulomatosis) Churg-Strauss syndrome Thromboangiitis obliterans Inflammatory bowel disease Sarcoidosis Other disorders Thyroid disease (thyroiditis, hyperthyroidism, hypothyroidism) General Pathology Add text here Pathophysiology [eyewiki.aao.org]
J Infect, 2004. 48(1): p. 86-90. 7.Filippidis, A., et al., Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurg Focus, 2009. 27(5): p. E3. 8.Karam, C. and S. [degruyter.com]
Prevention
Early and vigilant recognition of superior sagittal sinus thrombosis and prompt anticoagulation with LMWH may prevent further neurological damage. [ncbi.nlm.nih.gov]
Some treatment may focus on preventing the blood clot from getting bigger. [chop.edu]
This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage. This chain of events is part of a stroke that can occur in adults and children. [hopkinsmedicine.org]
CVT is an important diagnosis to recognize, as anticoagulation is indicated to prevent further clot formation. The prognosis of CVT varies, from complete recovery, to residual neurological deficits, to death. Revised 11/29/06. Copyrighted 2006. [casemed.case.edu]