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]
Gastrointestinal
- Recurrent Vomiting
A 2-year-old boy with new-onset nephrotic syndrome developed recurrent vomiting, apathy and papilloedema. Superior sagittal sinus thrombosis was diagnosed on cranial CT and MRI. [ncbi.nlm.nih.gov]
Cardiovascular
- Vein Disorder
(C0235502) Concepts Disease or Syndrome (T047) SnomedCT 95461006 English THROMBOPHLEBITIS CEREBRAL VEIN, Thrombophlebitis cerebral vein, Thrombophlebitis of cerebral vein, Thrombophlebitis of cerebral vein (disorder), cerebral; thrombophlebitis, thrombophlebitis [fpnotebook.com]
Musculoskeletal
- Arm Weakness
Neurologic examination showed left arm weakness and sensory loss, blurring of the left optic disc, and bilateral Babinski signs. [ncbi.nlm.nih.gov]
Neurologic
- 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]
Severe cases can evolve to SEIZURES or COMA. [fpnotebook.com]
- Altered Mental Status
A 30-year-old man presented with altered mental status after a motorcycle collision, and subsequently developed respiratory distress. [ncbi.nlm.nih.gov]
Mental Status, Seizures, Headache) VI. [fpnotebook.com]
mental status, possibly transient global amnesia, visual disturbances, alexia. [ispub.com]
mental status or GCS Male Age >37 years CVT affects the deep venous system References and Links LITFL CCC — Thrombophilia screen Journal articles Alvis-Miranda HR, Milena Castellar-Leones S, Alcala-Cerra G, Rafael Moscote-Salazar L. [lifeinthefastlane.com]
mental status, focal neurologic deficits, coma, and/or death because of venous infarction of the bilateral thalami and basal ganglia.[ 6 ] Typical MRI findings are high signal intensity and swelling of the bilateral thalami, internal capsules, and basal [surgicalneurologyint.com]
- Excruciating Headache
She also complained of excruciating headache. A FDG PET scan was done an hour after intravenous administration of 444 MBq (12 mCi) of F-18 FDG, on a dedicated PET scanner. [ncbi.nlm.nih.gov]
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]
Case Report: A 32-year-old man with lymphoblastic lymphoma received treatment with daunorubicin, vincristine, and prednisone. He developed postural headache and severe nausea and vomiting after a diagnostic lumbar puncture. [scholars.northwestern.edu]
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]
Great Cerebral Vein of Galen) Findings: Cortical Vein Thrombosis (Superficial Cerebral Vein Thrombosis) Findings: Cavernous Sinus Thrombosis Labs Diagnostics Differential Diagnosis Imaging Management Complications Prognosis References Extra: Related Bing [fpnotebook.com]
Etiology
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]
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]
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
Epidemiology Accounts for 0.5 to 1% of all Cerebrovascular Accidents Female gender in two thirds of cases Younger patients (mean age 33 years old) III. [fpnotebook.com]
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]
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]
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]
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]
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]
Epidemiology Pathophysiology Risk Factors Precautions Findings: General Findings: Transverse Sinus Thrombosis Findings: Superior Sagittal Sinus Thrombosis Findings: Sigmoid Sinus Thrombosis Findings: Deep Venous Cerebral Thrombosis (e.g. [fpnotebook.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]
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]