scholarly journals Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis

2020 ◽  
Author(s):  
Eduardo Soriano-Navarro ◽  
Vanessa Cano-Nigenda ◽  
Fernanda Menéndez-Manjarrez ◽  
Esmirna Farington-Terrero ◽  
Juan José Méndez-Gallardo ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Decompressive Craniectomy ◽  
Cerebral Venous Thrombosis ◽  
Cerebral Oedema ◽  
Therapeutic Option ◽  
Midline Shift ◽  
Sagittal Sinus ◽  
Life Saving ◽  
Venous Infarcts

Introduction: Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment. Patient and methods: We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed. Results: At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3. Discussion: Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.

scholarly journals Decompressive craniectomy in hemorrhagic cerebral venous thrombosis: clinicoradiological features and risk factors

2017 ◽  
Vol 127 (4) ◽  
pp. 709-715 ◽  
Author(s):  
Si Zhang ◽  
Hexiang Zhao ◽  
Hao Li ◽  
Chao You ◽  
Xuhui Hui
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Decompressive Craniectomy ◽  
Surgical Outcomes ◽  
Cerebral Venous Thrombosis ◽  
Lesion Volume ◽  
Venous Involvement ◽  
Life Saving ◽  
Potential Risk Factors ◽  
The Mean

OBJECTIVEDecompressive craniectomy (DC) is a life-saving treatment for severe hemorrhagic cerebral venous thrombosis (CVT). However, the correlations between the clinicoradiological features and surgical outcomes of this disease are not well established. Therefore, the authors endeavored to analyze the potential risk factors for this more severe subtype of CVT and to provide more evidence regarding the benefits of DC in patients with hemorrhagic CVT.METHODSThe clinical features, radiological findings, and surgical outcomes of patients with severe hemorrhagic CVT who had undergone DC treatment in the period from January 2005 to March 2015 were retrospectively analyzed, and the risk factors for this disease were evaluated.RESULTSFifty-eight patients, 39 females (67.2%) and 19 males (32.8%), with a mean age of 39.7 ± 12.5 years, were included in this study. The mean duration from symptom onset to surgery was 3.3 ± 1.9 days, and 21 patients experienced acute courses. On neuroimaging, the mean mass lesion volume was 114.7 ± 17.7 ml. Nine patients had bilateral lesions, and 7 patients had deep CVT. According to their hemorrhagic proportion, cases were divided into hemorrhage-dominated (27 [46.6%]) and edema-dominated (31 [53.4%]) groups. After 6 months of follow-up, 56.9% of patients had achieved a favorable outcome, and 8 patients had died. The hemorrhage-dominated lesions (p = 0.026) and deep cerebral venous involvement (p = 0.026) were significantly associated with a poor outcome.CONCLUSIONSIn patients suffering from severe hemorrhagic CVT, DC is an effective life-saving treatment that is associated with favorable outcomes. Hemorrhage-dominated lesions and deep cerebral venous involvement have a significant impact on the outcome of this disease.

scholarly journals Decompressive craniectomy in patients with cerebral infarction due to malignant vasospasm after aneurysmal subarachnoid hemorrhage

2012 ◽  
Vol 03 (03) ◽  
pp. 251-255 ◽  
Author(s):  
Saffet Tuzgen ◽  
Baris Kucukyuruk ◽  
Seckin Aydin ◽  
Fatma Ozlen ◽  
Osman Kizilkilic ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Decompressive Craniectomy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Results ◽  
Cerebral Infarct ◽  
World Federation ◽  
Life Saving

ABSTRACT Aim: The authors present their experience and the clinical results in decompressive craniectomy (DC) in patients with vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods: Between 2002 and 2010, six patients underwent DC due to cerebral infarct and edema secondary to vasospasm after aneurysmal SAH. Four patients were male, and two were female. The age of patients ranged between 33 and 60 (mean: 47,6 ± 11,4). The follow up period ranged between 12 to 104 months (mean: 47,6 ± 36,6). The SAH grading according World Federation of Neurosurgeons (WFNS) score ranged between 3 to 5. Results: Last documented modified Rankin Score (mRS) ranged between 2 to 6. One patient died in the following year after decompression due to pneumonia and sepsis. Two patients had moderate disability (mRS of 4) and three patients continue their life with minimal deficit and no major dependency (mRS score 2 and 3). Conclusion: DC can be a life-saving procedure which provides a better outcome in patients with cerebral infarction secondary to vasospasm and SAH. However, the small number of the patients in this study is the main limitation of the accuracy of the results, and more studies with larger numbers are required to evaluate the efficiency of DC in this group of patients.

Thalamic Hemorrhagic Stroke in the Term Newborn: A Specific Neonatal Syndrome With Non-uniform Outcome

2017 ◽  
Vol 32 (8) ◽  
pp. 746-753 ◽  
Author(s):  
Laura Merlini ◽  
Sylviane Hanquinet ◽  
Joel Fluss
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Hemorrhagic Stroke ◽  
Late Onset ◽  
Predicting Factors ◽  
Anterior Thalamus ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Deep Cerebral Venous Thrombosis

Background: Neonatal thalamic hemorrhagic stroke is related to cerebral sinus venous thrombosis and associated with neurological sequelae. Predicting factors are however lacking. Methods: Clinical and radiological findings at onset and on follow-up of 5 neonates with thalamic hemorrhage stroke are described. Results: All neonates presented with abrupt lethargy, ophistotonos, irritability and/or seizures. The thalamic hemorrhagic stroke was most often unilateral (4/5), involving the posterior/entire thalamus in 3 cases and the anterior thalamus in 2. Cerebral venous thrombosis was identified in a single patient. At follow-up, children with unilateral anterior thalamic hemorrhagic stroke demonstrated thalamic atrophy without neurological symptoms, whereas children whose thalamus lesion was extensive exhibit a porencephalic cavity and presented with late-onset epilepsy. Discussion: Although deep cerebral venous thrombosis is probably the cause of neonatal thalamic hemorrhagic stroke, its radiological evidence is challenging. Outcome seems dependent of the size and location of thalamic hemorrhagic stroke. Epilepsy is a frequent morbidity after thalamic hemorrhagic stroke.

scholarly journals Specific Polymorphism 4G/5G Gene for PAI-1 as a Possible Cause of Cerebral Venous Thrombosis: A Case Report

2017 ◽  
Vol 18 (2) ◽  
pp. 169-173
Author(s):  
Tatjana Boskovic Matic ◽  
Aleksandar Gavrilovic ◽  
Snezana Simovic ◽  
Dejan Aleksic ◽  
Katarina Vesic ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Plasminogen Activator ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Plasminogen Activator Inhibitor ◽  
Plasminogen Activator Inhibitor 1 ◽  
Sagittal Sinus ◽  
Clinical Center ◽  
The Impact ◽  
Activator Inhibitor

AbstractThrombosis of veins and venous sinus (CVT) is the rare cerebral vascular disorder which makes less than 1% of all strokes. Thrombosis of veins and venous sinuses is picturesquely called “мајоr neurological forger” since it is characterized by very varied clinical picture. Among the various causes of CVT, which can be of infective or non-infective nature, the congenital hyper coagulations especially stand out, diagnosis is based on highly sophisticated diagnostic tests.We present the case of a female patient, 36 years old, who was hospitalized at the Clinic for Neurology in Clinical Center because of the diffuse headache she had for the last few days, with milder right-sided hemiparesis and one generalized tonic-clonic epileptic seizure. With nuclear magnetic resonance (MR/2D venography) the thrombosis of the upper and lower sagittal sinuses is confirmed. By appropriate laboratory tests, as well as by confirmatory immunological and genetic analyses, the impact of the most of the factors is excluded which can contribute to the occurrence of venous thrombosis. The only pathological findings which indicated the possible congenital thrombophilia as the cause of the sagittal sinus thrombosis was the determination of the specific polymorphism of the 4G/5G gene for plasminogen activator inhibitor 1.According to our knowledge, this is the first decribed case of the possible impact of the specific polymorphism of the 4G/5G gene for plasminogen activator inhibitor of 1 on the development of cerebral venous thrombosis.

scholarly journals Cerebral Venous Thrombosis in a Patient with Immune Thrombocytopenia, an Apparent Paradox

2020 ◽  
Vol 13 (2) ◽  
pp. 588-594 ◽  
Author(s):  
Maimoonah A. Rasheed ◽  
Arwa E. Alsaud ◽  
Sania Razzaq ◽  
Afraa Fadul ◽  
Mohamed A. Yassin
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Immune Thrombocytopenia ◽  
Intravenous Immunoglobulins ◽  
Apparent Paradox ◽  
Multiple Line ◽  
Thrombopoietin Receptor ◽  
Thrombopoietin Receptor Agonist ◽  
Venous Infarcts ◽  
Low Platelet Count

We present a paradoxical case of immune thrombocytopenia (ITP) that presented with cerebral venous thrombosis. A 39-year-old female patient diagnosed with chronic ITP, who failed treatment on multiple-line agents, was started on eltrombopag (thrombopoietin receptor agonist), which she was not compliant to. The patient later developed extensive cerebral venous thrombosis, along with venous infarcts, and intracranial and subarachnoid hemorrhage. She was treated with intravenous immunoglobulins as well as steroid therapy and was simultaneously started on anticoagulation. The patient improved clinically and radiologically. This case is among few reported cases which signify that patients with ITP are inherently prone to thrombosis despite low platelet count and treating these patients can be a dilemma. Judicious use of anticoagulation and immunosuppressive therapy is recommended based on available evidence pending further recommendations and guidelines about treatment of thrombosis in ITP.

scholarly journals Combined Hypertrophic Pachymeningitis and Cerebral Venous Thrombosis in a Case of Granulomatosis with Polyangiitis

2019 ◽  
Vol 11 (2) ◽  
pp. 252-255
Author(s):  
Tadahiro Kuribayashi ◽  
Yasuhiro Manabe ◽  
Shunya Fujiwara ◽  
Yoshio Omote ◽  
Hisashi Narai ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Granulomatosis With Polyangiitis ◽  
Laboratory Data ◽  
Brain Magnetic Resonance Imaging ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Hypertrophic Pachymeningitis ◽  
Left Frontal Lobe ◽  
Sagittal Sinus

We report a rare case of hypertrophic pachymeningitis (HP) and cerebral venous thrombosis associated with proteinase-3-antineutrophil cytoplasmic antibody (PR3-ANCA)-positive granulomatosis with polyangiitis (GPA). A 58-year-old male developed left headache after exudative otitis media. The laboratory data were positive for PR3-ANCA. Brain magnetic resonance imaging revealed bilateral paranasal sinusitis, left frontal lobe edema, and a thick dura mater with abnormal enhancement in the frontotemporal lobe. Magnetic resonance venography detected stenosis of the superior sagittal sinus. The patient was successfully treated with glucocorticoid, cyclophosphamide, and apixaban. Contrast neuroimaging should be performed for patients who present with unexplained headache, especially with middle ear and paranasal inflammation. These symptoms should be considered as GPA-related HP and cerebral venous thrombosis.

Cerebral venous thrombosis after caesarean section

2021 ◽  
Vol 86 (5) ◽  
pp. 339-342
Author(s):  
Lucie Drábková ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Caesarean Section ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Interdisciplinary Collaboration ◽  
Contextual Knowledge ◽  
Follow Up Care

Objective: Case report of a patient with cerebral venous thrombosis after caesarean section. Case report: We present a case of a 22-year-old patient after an acute caesarean section, which was complicated by cerebral venous thrombosis. The etiology of the thrombosis was multifactorial. Diagnosis was determined using imaging methods once the neurological symptoms were expressed. Follow-up care for the patient included comprehensive care in the intensive care unit, including a temporary decompresive craniectomy. Conclusion: Cerebral venous thrombosis is a rare disease with a varied clinical manifestation whose development is aff ected by a number of acquired and congenital factors. The incidence is increased in women in the puerperium, but we can also see it in gynecological practice in young contraception users. Contextual knowledge is essential in early dia gnosis as well as using a correct treatment strategy with a multidisciplinary approach and interdisciplinary collaboration. Key words: cerebral venous thrombosis – caesarean section – laparotomy dehiscence – headache

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