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Objectives: Patients with cerebral venous thrombosis (CVT) may present with early intracerebral hemorrhage (EICH). The objective of this study was to identify predictors for EICH in CVT patients via a systematic review and meta-analysis of observational studies. Additionally, we aimed to evaluate the clinical outcomes associated with the presence of EICH in these patients., Methods: Literature search on PubMed, EMBASE and Cochrane Library databases from inception up to 1 February 2024 was conducted. Five studies with predictors of EICH were included in qualitative synthesis and meta-analysis., Results: Pooled analysis demonstrated a statistically significant association between female gender and EICH (odd ratios (OR) = 1.51, 95 % confidence interval (CI) = 1.23-1.85, p < 0.01). The ICH patients had higher likelihood of seizures (OR = 3.07, 95 % CI = 1.69-5.58, p < 0.01), focal neurological deficits (OR = 4.07, 95 % CI = 2.57-6.44, p < 0.01), and decreased level of consciousness (OR = 3.89, 95 % CI = 2.53-5.87, p < 0.01). Superior Sagittal Sinus thrombosis was associated with higher likelihood of EICH (OR: 1.49, 95 % CI 1.05-2.13, P = 0.03). No statistically significant association was demonstrated between presence of EICH and pregnancy, presence of hematological diseases or thrombophilia, or other site of venous thrombosis (deep venous system, or multiple sinuses involvement). Furthermore, patients who exhibited early EICH were notably less likely to attain a favorable functional outcome (mRS 0-2) (OR: 0.28; 95 % CI 0.16-0.49; p < 0.001)., Conclusion: This meta-analysis demonstrates that among CVT patients, female patients with new onset seizures, focal neurological deficits and decreased level of consciousness are more likely to present with EICH., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Females are at higher risk than males for a multitude of cerebrovascular conditions, both common and rare; partially resulting from a complex interplay between differing process involving genetics, hormonal influences, common cerebrovascular risk factors among others. Specific topics including cervical artery dissection, cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, migraine, along with these disorders in the setting of pregnancy, puerperium and oral contraceptive utilization. Epidemiology, pathophysiology, presentation, basics of management and outcomes are presented, with sex differences throughout., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening event with significant neurologic and visual morbidity. In this study, we report on the natural history and visual outcomes of papilledema in children with CVST., Design: Retrospective case series., Methods: Patients with CVST evaluated by the Department of Ophthalmology between 2000 and 2023 were included. Records were reviewed for presence and course of papilledema, treatment, and final visual outcomes following papilledema resolution., Results: The study included 35 patients with a mean age of 9 ± 5 years and 40% were female. The most common risk factors for CVST were infection (69%), dehydration (26%), and hypercoagulability (23%). 31 patients (89%) had papilledema. Of these patients, 9 (29%) had progression of papilledema despite treatment, 17 patients (55%) did not have progression, and 5 patients (16%) lacked follow-up records. Initial Frisén grade among all cases was 2 ± 1, and cases with progression reached a grade of 4 ± 1 between 10 and 32 days following initial identification. Most patients (97%) were treated with anticoagulation and 100% required acetazolamide and/or lumbar puncture. Among 26 patients with follow-up, papilledema resolved in 107 ± 128 days. Fifty-four percent of patients had permanent ophthalmic sequelae. An initial Frisén grade ≥3 (odds ratio 7.54, 95% confidence interval 6.53-8.70, P< .001) was significantly associated with eventual optic atrophy., Conclusions: Children with CVST are at high risk for ophthalmologic sequelae. Papilledema can progress despite appropriate therapy. Our results highlight the importance of ophthalmologic follow-up during treatment course to prevent irreversible vision loss., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: The COVID-19 pandemic saw one of the fastest developments of vaccines in an effort to combat an out-of-control pandemic. The 2 most common COVID-19 vaccine platforms currently in use, messenger RNA (mRNA) and adenovirus vector, were developed on the basis of previous research in use of this technology. Postauthorization surveillance of COVID-19 vaccines has identified safety signals, including unusual cases of thrombocytopenia with thrombosis reported in recipients of adenoviral vector vaccines. One of the devastating manifestations of this syndrome, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), is cerebral venous sinus thrombosis (CVST). This review summarizes the current evidence and indications regarding biology, clinical characteristics, and pharmacological management of VITT with CVST., Observations: VITT appears to be similar to heparin-induced thrombocytopenia (HIT), with both disorders associated with thrombocytopenia, thrombosis, and presence of autoantibodies to platelet factor 4 (PF4). Unlike VITT, HIT is triggered by recent exposure to heparin. Owing to similarities between these 2 conditions and lack of high-quality evidence, interim recommendations suggest avoiding heparin and heparin analogues in patients with VITT. Based on initial reports, female sex and age younger than 60 years were identified as possible risk factors for VITT. Treatment consists of therapeutic anticoagulation with nonheparin anticoagulants and prevention of formation of autoantibody-PF4 complexes, the latter being achieved by administration of high-dose intravenous immunoglobin (IVIG). Steroids, which can theoretically inhibit the production of new antibodies, have been used in combination with IVIG. In severe cases, plasma exchange should be used for clearing autoantibodies. Monoclonal antibodies, such as rituximab and eculizumab, can be considered when other therapies fail. Routine platelet transfusions, aspirin, and warfarin should be avoided because of the possibility of worsening thrombosis and magnifying bleeding risk., Conclusions and Relevance: Adverse events like VITT, while uncommon, have been described despite vaccination remaining the most essential component in the fight against the COVID-19 pandemic. While it seems logical to consider the use of types of vaccines (eg, mRNA-based administration) in individuals at high risk, treatment should consist of therapeutic anticoagulation mostly with nonheparin products and IVIG.

Cerebral venous sinus thrombosis (CVST) is more common in women than in men, possibly due to gender-specific risk factors in young adults. The purpose of this study was to investigate whether the clinical and radiological findings, other risk factors, and clinical course of CVST associated with pregnancy and puerperium differ from those of other CVST cases. We retrospectively reviewed patients diagnosed with CVST in our hospital between September 2007 and December 2019. The risk factors, clinical and radiological characteristics, and follow-up data for female patients with CVST were compared between cases associated with pregnancy and puerperium with those of other cases. A total of 50 female patients with CVST were included in the study. Twenty-four (48%) cases occurred during pregnancy and puerperium. The mean age of the pregnant or puerperal patients was lower than that of the other patients (p = 0.007). There was no significant difference between the groups in terms of clinical and neuroradiological findings or presence of any additional risk factors including hereditary thrombophilia. There was also no difference in terms of in-hospital mortality rates and modified Rankin Scale (mRS) scores at 6 months between the groups. The clinical presentation of CVST and the frequencies of the presence of other risk factors including genetic thrombophilia in pregnant and puerperal patients were similar to those of non-pregnant female patients. Screening for additional risk factors, especially genetic thrombophilia, should therefore not be neglected in CVST occurring during pregnancy and puerperium., (© 2020. Belgian Neurological Society.)

Purpose: This study aims to test the validity of a new quantitative scoring instrument-the Venous Occlusion Image Score (VOIS), and assess the diagnostic and prognostic value of VOIS for cerebral venous sinus thrombosis (CVST)., Methods: The VOIS divided the major cerebral venous sinuses and internal jugular veins into nine parts of interest. CT venography and DSA source images and reconstruction were extracted from the database, then interpreted and scored independently according to VOIS by a panel of three reviewers. Inter-observer and intra-observer reliability were determined using the intraclass correlation coefficient (ICC) and the kappa coefficient (κ). The primary outcome was the 3-month functional outcome and evaluated by modified Rankin Scale (mRS). The sensitivity and specificity of VOIS for the primary outcomes were computed. Logistic regression was applied to evaluate the association between the score on VOIS and the primary outcomes., Results: Fifty-six patients with CVST were included in the study. For 16 patients underwent cerebral CTV and DSA, excellent interobserver agreement was observed for DSA (ICC=0.90, 95%CI = 0.87 - 0.92, P < 0.001), and CTV (ICC = 0.92, 95%CI = 0.84 - 0.93, P < 0.001). The κ coefficient of agreement for the two radiology measures was 0.88 (95%CI = 0.79-0.92), indicating good inter-method agreement. For 56 patients followed up by CTV, baseline VOIS value correlated inversely with the severity of stroke on the National Institutes of Health Stroke Scale (r = -0·53, P < 0·001), and modified Rankin Scale (r = -0·59, P < 0·001). Baseline CTV-VOIS value predicted functional outcome (P < 0·05)., Conclusion: VOIS may serve as a convenient and reliable method in the treatment guidance and outcome prediction of patients with CVST., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To determine factors at hospitalization of cerebral venous thrombosis (CVT) which determine outcome at one year., Methods: This was an ambispective study with outcome at one year follow up. Patients angiographically proven as CVT were included in study and functional modified Rankin Scale (mRS) determined at one year. They were dichotomized into "good" outcome (mRS 0-1) and "poor" outcome (mRS 2-6). Variables at admission were compared on univariate and then by cox proportional hazard regression for significance. Complications during follow up period were also compared., Results: One hundred and seventy five patients were included, data of 71 was collected prospectively. One hundred and seventeen (66.9%) had "good" outcome while 58 (33.1%) had "poor" outcome. Univariate analysis showed poor outcome associated with age < 30 years, female sex, focal deficit, GCS ≤ 12, ≥3 sinuses involved and intracerebral haemorrhage. On Cox proportional hazard regression only GCS ≤ 12 was significant. Around 96% had complete/ partial recanalization at 6 months. Over one year, the complications included dural AV fistula in 10 (5.7%), intracranial hypertension in 4 (2.3%), venous thromboembolism in 6 (3.4%) and arterial infarct in 4 (2.3%). Proportions with complications in each group were similar. At one year 41 patients (25.2%) were continued on anticoagulation and 97 (55.2%) on antiepileptic drugs. Proportion in each group were similar., Conclusion: In patients with CVT, GCS ≤ 12 at admission was a predictor of poor functional outcome (mRS 2-6) at one year. During this period, complications were few and similar in the both the groups., Competing Interests: Declaration of Competing Interest None, (Copyright © 2021 Elsevier Inc. All rights reserved.)

Cerebral cortical vein thrombosis (CCVT) is a rare type of cerebral venous thrombosis, which is frequently combined with cerebral venous sinus thrombosis (CVST). We aimed to compare the difference of clinical features between the isolated and the combined subtypes of CCVT. A literature search was conducted utilizing the PubMed Central and EMBASE databases to identify studies up to Dec 2019. Clinical manifestations, presumable risk factors, imaging modalities, radiological findings, treatment, and prognosis in patients with CCVT were recorded. 335 publications were identified (n = 325, 141 males and 184 females, mean age 40.24 ± 16.26 years). Headaches (46.8%), motor/sensory disorders (43.3%), and seizures (42.5%) were commonly seen. Pregnancy/postpartum (n = 29), oral contraception use (n = 15), fertility drug use (n = 4) ranked the top three comorbidities of CCVT in female patients, while for general populations, thrombophilia, invasive interventions in the cerebrospinal system, as well as malignancy, would be the common risk factors. MRV and DSA were more likely to confirm diagnosis. More than 30% of CCVT presented brain lesions, including infarction (6.5%) and hemorrhage (24.0%). Isolated CCVT was prone to develop hemorrhagic infarction while combined CCVT was more likely to have ischemic lesions. More than 90% of the patients acquired good outcomes at discharge or short-term follow-up (within one year). There is a difference between Isolated CCVT and CCVT combined CVST on the sites and types of brain lesions. MRV and DSA may contribute to the final diagnosis. Most patients acquired complete or partial recovery of clinical symptoms or imaging presentations after long-term anticoagulation (3-6 months).

A 69-year-old man with uncontrolled type 2 diabetes presented to an outside hospital with altered mental status. He progressed from being argumentative to encephalopathic and agitated by the evening with urinary frequency, urinary urgency, nausea, and vomiting. His vital signs were normal, and he had no focal neurological deficits on presentation. He was generally encephalopathic, only groaning with no ability to follow commands. He was found to have diabetic ketoacidosis on initial labs. A left parietal hypodensity on CT Head was found, and he was positive for Sars-COV-2., (© 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Introduction: Fetal dural sinus thrombosis (DST) is a rare condition. Although numerous case reports exist, the findings appear heterogenous and providing accurate patient counselling remains challenging., Methods: A systematic literature review was conducted in accordance with PRISMA guidance., Results: Thirty-one studies including 78 patients were included in this review. No association with maternal or neonatal coagulopathy, infection or trauma was found. The average gestational age at diagnosis was 25 weeks (range 17-34 weeks). Approximately half of foetuses affected were female (48.7%); one quarter were male (25.6%) and one quarter had no sex stated (25.6%). Termination of pregnancy was chosen in 25.6% of cases (20/78). In continuing pregnancies,10.3% (6/58) experienced a perinatal death. Antenatally, the majority of lesions either decreased in size (38.5%) or completely resolved (32.7%). The neonatal or childhood outcome was normal in 88.0% of survivors (44/50). The average age at follow up was 16.4 months, ranging from birth to 6 years., Conclusion: This review found that 10% of DST cases experience in-utero or neonatal death. In survivors, the majority of cases reduce in size or completely resolve in pregnancy and 85% are reported to have a good outcome. However, further evidence is needed regarding long-term neurocognitive sequelae., (© 2020 John Wiley & Sons, Ltd.)

Background: Recent studies have noted concern for increased thromboembolic events in the setting of Coronavirus Disease 2019 (COVID-19). Cerebral venous sinus thrombosis (CVST) is a form of thromboembolism that has been observed as a neuro-ophthalmologic complication of COVID-19., Methods: Review of the scientific literature., Results: In this article, we report an overview of CVST epidemiology, clinical presentation, diagnostics, disease pathophysiology, and management in the setting of COVID-19., Conclusion: CVST is an uncommon thromboembolic event with variable phenotypes and multiple etiologies. Neurologic complications can be severe, including significant visual deficits and death. Current observations suggest that the risk of CVST may be profoundly impacted by this novel COVID-19 pandemic, thus prompting increased attention to disease presentation, pathogenesis, and management.

Background: IgM nephropathy is a rare disease with variable clinical presentations and is an unusual cause of nephrotic syndrome. Histopathological findings typically include mesangial hypercellularity with IgM and complement deposition, though the spectrum may range from normal glomeruli through to focal and segmental glomerulosclerosis. Thromboembolism is a well recognised complication of nephrotic syndrome, but cerebral venous sinus thrombosis is rarely described., Case Presentation: This is the case of a 23-year-old male presenting with the nephrotic syndrome, whose initial renal biopsy was consistent with minimal change disease. Complete remission was achieved with prednisone, however multiple relapses and steroid dependence prompted re-biopsy, the results of which were more consistent with IgM nephropathy. His last relapse was complicated by cerebral venous sinus thrombosis. He then received rituximab and a weaning course of prednisone to again enter remission., Conclusions: This case highlights the need to consider IgM nephropathy in the differential diagnosis of nephrotic syndrome. Additionally, it emphasises the risk of thrombosis in patients with severe nephrosis.

Background: Cerebral venous sinus thrombosis (CVST) often presents with acute seizures, and recurrent seizures may also be seen in the long term in some patients. The purpose of this retrospective study was to investigate the frequency and type of acute seizures and to define the risk factors., Methods: Sixty-two patients diagnosed with CVST between September 2007 and October 2018 were retrospectively evaluated for the occurrence of acute seizures. Seizures which developed as a presenting symptom or occurred within 2 weeks of diagnosis were defined as acute seizures. Demographic, clinical, and radiologic characteristics were compared between patients with or without acute seizures., Results: Twenty (32.3%) of the 62 CVST patients had acute seizures. Univariate analysis revealed a significant association between acute seizures and aphasia (P=0.03), motor deficit (P<0.001), sensory deficit (P=0.018), severe (≥3) modified Rankin Scale scores on admission (P=0.017), sagittal sinus thrombosis (P=0.037), cortical vein thrombosis (P<0.001), supratentorial lesions (P<0.001), and hemorrhagic lesions (P<0.001). Multivariate regression analysis identified supratentorial lesions (P=0.015, odds ratio: 9.131, 95% confidence interval: 1.525-54.687) and cortical vein thrombosis (P=0.034, odds ratio: 5.802, 95% confidence interval: 1.146-29.371) as independent factors for acute seizures. Although 25% of patients with acute seizures had recurrent seizures during hospitalization, only 2.6% of the 38 patients with long-term follow-up had recurrent seizures., Conclusions: Approximately one third of patients with CVST had acute seizures. Cortical vein thrombosis, supratentorial, and especially hemorrhagic lesions were the most significant risk factors associated with acute seizures. Although seizure recurrence may occur early in the course, long-term recurrence is rare in CVST.

Despite the well documented increased risk of thrombosis in patients with cancer and during chemotherapy, cerebral venous sinus thrombosis (CVT) remains a rare entity. We present a rare case of cerebrospinal fluid (CSF) rhinorrhoea secondary to a left transverse sinus thrombus which occurred 2 years previously during chemotherapy for breast cancer. The patient underwent a three-layer repair using Neuro-Patch, septal cartilage and middle turbinate pedicle flap and was started on acetazolamide. There was no recurrence at 1-year follow-up. Raised intracranial pressure secondary to cerebral venous occlusion can erode the base of skull and predispose to CSF leaks. Despite the theoretical risk, there have been no cases reported where CSF leaks have occurred following chemotherapy induced CVT. We describe the first case and discuss pathophysiology and management., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST)., Design: Retrospective observational case series., Methods: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes., Results: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Frisén grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisén grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits., Conclusions: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST)., Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients., Results: The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter., Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to disclose., (Copyright © 2020. Published by Elsevier Ltd.)

Objectives: Cerebral venous sinus thrombosis (CVST) is a rare subtype of stroke that most commonly affects younger women. While most patients treated with anticoagulation therapy have good outcomes, a significant number go on to experience disability. The primary aim of this study was to identify objective, easily reproducible, clinical admission predictors of poor outcome at discharge in patients with CVST., Patients and Methods: This was a retrospective cohort study of adult CVST patients admitted at our comprehensive stroke center between April 2004 and December 2017. The medical records of patients with a CVST discharge diagnosis code were reviewed for diagnosis confirmation and extraction of clinical and demographic admission data. Multivariable logistic regression was used to build predictive models of objective, standardized examination signs and adjusted for confounders. The primary endpoint was modified Rankin Scale score at discharge defined as good outcome (0-2) and poor outcome (3-6). Mortality was the secondary endpoint., Results: A total of 176 CVST patients were identified. Most patients were white (91 %) and female (65 %). The median age was 40 years old. Headache was the most commonly reported symptom (74 %). Intracranial hemorrhage (ICH) was present in 27 % of patients, venous infarct occurred in 22 % of the patients, and 12 % had both. Age (OR = 1.03, 95 % CI 1.01-1.05), abnormal level of consciousness (OR = 4.38, 95 % CI 1.86-8.88), and focal motor deficits (OR = 3.49, 95 % CI 1.49-8.15) were found to be predictive of poor functional outcome. Pre-hospitalization infections (OR = 5.22, 95 % CI 1.51-18.07) and abnormal level of consciousness (OR = 9.22, 95 % CI 2.34-36.40) were significant predictors of mortality. The predictive effect remained significant after adjusting by median PTT level, presence of intracranial hemorrhage, and venous infarct., Conclusions: Age, abnormal level of consciousness, and focal motor deficits identified at admission are independently associated with poor outcome in CVST patients. These frequently prevalent, easily reproducible examination signs represent the first step to develop a clinical prediction tool toward stratifying CVST patients with poor prognosis at admission., (Copyright © 2019. Published by Elsevier B.V.)

Purpose: We conducted a meta-analysis to determine the predictors of early-onset seizure in patients with cerebral venous sinus thrombosis (CVST) and to provide a basis for further clinical trials of prophylactic use of antiepileptic drugs in patients with CVST., Method: The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant observational studies that investigated risk factors for early-onset seizures after CVST were retrieved from Pubmed and Embase databases. Odds ratios (OR) for early-onset seizures were calculated from the pooled data using the random effects model., Results: Six observational studies (combined n = 1244) were included in this meta-analysis. Coma [OR, 2.265; 95% confidence interval (CI) 1.251-4.100], mental status (OR, 3.450; 95% CI 1.150-10.356), motor symptoms (OR, 3.726; 95% CI 2.519-5.514), involvement of cortical veins (OR, 3.574; 95% CI 2.521-5.068), supratentorial lesion (OR, 5.041; 95% CI 3.622-7.015), frontal lobe (OR, 3.481; 95% CI 1.703-7.114), parietal lobe (OR, 3.638; 95% CI 1.911-6.925), hemorrhagic lesions (OR, 2.505; 95% CI 1.485-4.225), and pregnancy (OR, 2.054; 95% CI 1.043-4.048) showed a significant association with early-onset seizures., Conclusion: Involvement of a numer of specific cortical regions in the post-CVST phase may induce early-onset seizures, especially in the setting of concomitant hemorrhagic infarct or cortical vein involvement., (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Dural arteriovenous fistulas (dAVF) are rare vascular malformations accounting for only 10-15% that may lead to life threatening deficits due to hemodynamic changes in blood supply and pressure conditions. We present a 64-year old patient who was admitted with disorientation and aphasia. Following images confirmed an infratentorial dural fistula draining into the straight sinus. Additional findings were progressive thrombosis of the straight sinus, microbleedings and bithalamic edema due changes in hemodynamic conditions and venous congestion. Microsurgery was performed. After treatment improvement in clinical condition was observed and the venous congestion was regressive. Hemodynamic changes due to infratentorial dAVFs may lead to bleedings in deep regions and worsening of clinical condition fastly. Treatment requires carefully planning and visualization of angioarchitecture. Symptoms and hemodynamic changes are reversible after treatment, which are essential for treatment decisions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

To investigate the pathogenesis of somatic solid cancer-related cerebral venous sinus thrombosis (CVST).A total of 174 patients with CVST were recruited from the hospital between January 2006 and December 2017 and divided into two groups: (1) somatic cancer-related CVST group, defined as active somatic solid cancer patients with acute CVST; (2) cancer group (CG), defined as active somatic solid cancer patients without CVST. The cancer group patients were age and gender-matched somatic cancer-related CVST group patients. In addition, the types and amount distribution of cancer in cancer group were also matched with somatic cancer-related CVST group patients.Compared to cancer group patients, somatic cancer-related CVST group patients had more intracranial metastasis, a higher platelet count, higher plasma D-dimer, carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels, a greater platelet to lymphocyte ratio (PLR), and a greater platelet to neutrophil ratio (PNR). The risk for CVST in somatic cancer-related CVST group patients increased independently by 0.7% (odds ratio [OR] 1.007; 95% confidence interval [CI] 1.000, 1.015; P = .047) with a 1 ng/ml increase in D-dimer levels, by 4.6% (OR 1.046; 95% CI 1.011, 1.083; P = .010) with a 1 U/ml increase in CEA, by 2.7% (OR 1.027; 95% CI 1.003, 1.051; P = .025) with a 1 U/ml increase in CA125, and by 10.6% (OR 1.106; 95% CI 1.002, 1.220; P = .045) with a 1 unit increase in PNR.It was suggested that together impacts of elevated plasma D-dimer, CA125, CEA levels, and a greater PNR may lead to hypercoagulability and to trigger the development of cancer-related CVST.

A case of Streptococcus gallolyticus subsp. pasteurianus meningitis, unusually occurring in a splenectomized patient and complicated by cerebral venous thrombosis, is described. Following presentation with meningism and diagnosis and management of S. gallolyticus meningitis, the patient presented again with a further 4days of fevers and subsequently developed left-sided paresthesias. Cerebral imaging revealed a venous thrombus in the right frontal cortical veins and left sigmoid sinus. The patient recovered following 4 weeks of intravenous ceftriaxone and anticoagulation with enoxaparin and then warfarin. Apart from the splenectomy, no underlying cause was found. The patient was commenced on life-long prophylactic amoxicillin, given appropriate vaccinations, and anticoagulated with warfarin. After initial difficulties, identification of the causative organism to the subspecies level was confirmed by analysis of short-read whole genome sequencing data. This case demonstrates two features that have not previously been reported for S. gallolyticus subsp. pasteurianus infections: splenectomy as a potential risk factor and that infection may be complicated by cerebral venous thrombosis. The resolution provided by whole genome sequencing was valuable in accurately identifying the bacterial subspecies., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Dural venous sinus thrombosis (DVST) is an increasingly recognized cause of a wide array of neurological symptoms, with outcomes that range from complete recovery to death. The condition of approximately 23% of patients with DVST will worsen after initial presentation, as a result of restricted venous outflow and venous hypertension, but early identification of this subset is challenging. A venous collateral scale (VCS) that grades alternative drainage routes may improve prediction of clinical deterioration., Objective: To examine the ability of the VCS system to accurately identify patients with DVST who will experience clinical worsening, based on their imaging at presentation., Methods: From our institutional database, we identified patients with DVST on dedicated venous imaging between January 2010 and July 2016. A VCS was created and calculated from venous imaging at presentation by two reviewers blinded to subsequent data., Results: The 27 patients who met the inclusion criteria for this study had a median age of 42 years and 14 (52%) were female. Initial symptoms included headache without hemorrhage in 30% and focal deficit in 30%. Transverse sinus occlusion was present in 70% and superior sagittal sinus occlusion in 41%. VCS was 0 in 11%, 1 in 37%, and 2 in 52%. A lower VCS was significantly associated with clinical worsening both from time of initial symptom onset (77% vs 29%, VCS 0-1 vs 2, p<0.05) and during hospitalization (62% vs 0%, VCS 0-1 vs 2, p<0.01). In multivariate analysis, VCS but no other presenting features was significantly associated with in-hospital worsening (OR=2, p<0.01)., Conclusions: The type and quality of venous collaterals influence outcome in DVST. VCS helps to identify patients whose condition is likely to deteriorate and may need additional aggressive interventions., Competing Interests: Competing interests: DSL: consulting fees from Stryker, Covidien, and Zoll (modest). ST: consulting fees from Penumbra, Covidien, Stryker, and Reverse Medical. RJ: consulting fees from Covidien and Stryker., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Cerebral venous thrombosis (CVT) is rare and accounts for 0.5% of all strokes. Its clinical presentation is variable and diagnosis requires a high index of clinical suspicion in conjunction with neuroradiological diagnostic support. Treatment options are limited and are mostly based on consensus. Therefore, familiarity with international guidelines is important. Outcome is often good and most patients make a full recovery, although a small proportion suffers death or disability. Here, we describe the clinical features, risk factors, acute imaging features, management and complications of CVT., (© Royal College of Physicians 2018. All rights reserved.)

Background: Cerebral venous thrombosis is a rare cause of stroke, with a number of well-defined risk factors. However, there exist few studies that describe trends in the prognosis of this disease over time., Methods: A retrospective study was performed on patients diagnosed with cerebral venous thrombosis at the University of Alberta Hospital during two time periods: 1988-1998 (21 patients) and 1999-2009 (40 patients). Signs and symptoms, risk factors, imaging findings, etiologies, treatment modalities, and status at discharge were examined., Results: Headache, nausea and vomiting, focal motor deficit, and seizure were the most common signs and symptoms, and active hormonal contraception was the most commonly identified risk factor between the two cohorts. Hematoma and hyperdense sinuses were the most commonly identified CT findings between groups. Thrombophilia and the use of hormonal contraception were the most frequently identified etiologies between the two cohorts. Treatment was similar, with the majority of patients in both cohorts receiving unfractionated heparin as first-line therapy. Patients in the 1999-2009 cohort were significantly less likely to have a severe deficit or be dead at discharge (odds ratio [OR]=0.178; 95% confidence interval [CI 95%]=0.051, 0.625) and were more likely to have a favorable modified Rankin Scale score of 0 or 1 at discharge (OR=7.98; CI 95%=1.79, 35.71)., Conclusions: Our data indicate a reduction in severe residual symptoms at discharge and improved functional status at discharge for patients presenting with cerebral venous thrombosis from 1999 to 2009, as compared with 1988-1998.

Objective: Cerebral venous sinus thrombosis (CVST) is a life-threatening disease with high misdiagnosis and mortality rates due to its complex etiology and unknown pathophysiology. The present study aimed to establish an animal model suitable for assessing the pathophysiology of CVST and develop treatment methods., Methods: 40% ferric chloride (FeCl3) was administered for 5min followed by thrombin injection to induce superior sagittal sinus thrombosis (SSST). Digital subtraction angiography (DSA) was performed to ensure thrombosis and evaluate the recanalization rate 7days post-CVST. Neurological evaluation, Evans blue injection, 2,3,5-Triphenyltetrazolium chloride (TTC), and hematoxylin-eosin (H&E) staining were used to assess thrombosis and the accompanying brain parenchyma., Results: SSST was detected in all model rabbits, with a thrombus recanalization rate of 10%. Brain infarction, hemorrhage, cell edema, and disruption of the blood-brain barrier (BBB) were also observed., Conclusion: The method of inducing cerebral venous sinus thrombosis by applying 40% FeCl3 and injecting thrombin is feasible and efficient. This experimental model mimics the pathogenesis and pathophysiology of actual CVST., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To study and compare cerebral parenchymal changes and sinuses involvement in CT with MRI and MRV in Cerebral Venous Thrombosis patients., Method: This study was carried out in the Department of Radiodiagnosis, JLN Hospital and Research Center, Bhilai, Chhattisgarh from October 2012 to Nov 2014 and includes fifty patients of all age groups presenting with clinical symptoms of CVT, admitted in Neurology, Neurosurgery, Medicine, Pediatric, obstetric and Gynecology wards. CT, MRI and MRV findings were noted and statistical analysis was done using SPSS (Statistical package for Social science) 17.0 software. Categorical variables are expressed as frequencies and percentages. Sensitivity, Specificity, PPV and NPV of CT were calculated with respect to MRI in the diagnosis of cerebral venous thrombosis and associated brain parenchymal changes., Result: Out of fifty cases of cerebral venous thrombosis, thirty-one were females and nineteen were males. Age range was newborn to seventy-one years with female predominance in young age. Majority of the patients presented with headache (78%) followed by seizures (32%). Out of the total 50 cases, superior sagittal sinus were involved in 24 cases, left transverse sinus in 22 cases, right transverse in 12 cases, left sigmoid in 20 cases, right sigmoid in 13 cases, left internal jugular vein in 12 cases, right internal jugular vein in 7cases, straight sinus in 5cases, superficial cortical veins in 6 cases, vein of Galen in 3 cases and internal cerebral veins in 2 cases. Cerebral parenchymal changes were associated with thrombosis in 26 patients, hemorrhagic infarct in 13 cases, only hemorrhage in 4 cases and only infarct in 5 cases. CT scan was able to diagnose sinus abnormality in 36% and parenchymal abnormality in 42% of cases as compare to 100% and 52% in MRI., Conclusion: In the emergency setting CT scan plays an important role in evaluating patients clinically suspected CVT, whereas MRI combine with MR Venography is the best imaging technique for diagnosis of CVT in patients with equivocal findings on CT.

Background: Frosted branch angiitis is a rare, severe condition. It can be either a primary or a secondary condition and is characterized by rapid deterioration of vision and fulminant retinal vasculitis that manifests as diffuse sheathing of retinal vessels, macular edema, papillitis, vitritis and anterior uveitis. We aimed to describe a case of frosted branch angiitis and cerebral venous sinus thrombosis as an initial neuro-Behçet's disease onset. Diagnosis of Behçet's disease was based on the current 2014 International Criteria for Behçet's Disease and the International consensus recommendation criteria for neuro-Behçet's disease. In addition, a literature review using search parameters of "frosted branch angiitis", "Behçet" and "neuro-Behçet" in the PubMed database is presented., Case Presentation: A 28-year-old Brazilian pardo woman presented to our hospital with abrupt bilateral vision loss associated with recurrent aphthous oral ulcers 6 months before visual symptom onset. A fundus examination showed bilateral widespread retinal vasculitis with venous and arterial white sheathing, optic disc swelling, macular edema, and retinal hemorrhages, leading to the diagnosis of frosted branch angiitis. An extensive systemic workup for retinal vasculitis was uneventful, except for brain magnetic resonance imaging demonstrating cerebral venous sinus thrombosis and lymphocytic aseptic meningitis. A diagnosis of neuro-Behçet's disease was made, and treatment was started with methylprednisolone therapy 1 g/day for 5 consecutive days, followed by oral mycophenolate mofetil and infliximab 5 mg/kg infusion. The patient's response was rapid, with improvement of visual acuity to hand movement and counting fingers by day 7 and final visual acuity of counting fingers and 20/130., Conclusions: Frosted branch angiitis may be associated with infectious, noninfectious, or idiopathic causes. An extensive workup should be done to exclude systemic vasculitis such as Behçet's disease. Treatment with systemic steroids must be promptly initiated in association with specific treatment aimed at inflammation control and blindness risk reduction.

Background: Cerebral sinovenous thrombosis is unusual in the asphyxiated cooled infants, but reliable data regarding the incidence of this comorbidity are lacking. We assessed the incidence of sinovenous thrombosis in a population of asphyxiated cooled infants by performing routine brain magnetic resonance venography., Methods: All asphyxiated infants who underwent therapeutic cooling at our institution completed brain magnetic resonance venography after rewarming. Assessing the incidence of cerebral sinovenous thrombosis was the primary goal. Secondary analyses included group comparisons for laboratory tests and monitored parameters, relationship between variables, logistic regression models, and receiver operating characteristic curve for cerebral sinovenous thrombosis prediction., Results: Cerebral sinovenous thrombosis was detected in 10 of 37 infants (27%), most commonly affecting the superior sagittal sinus (eight of ten). These infants manifested higher blanket (P < 0.001) and lower esophageal temperatures (P = 0.006), lower platelet counts (P = 0.045), and received more red blood cell transfusions (P = 0.038) than the cooled infants without thrombosis. Blanket temperature was independently associated with cerebral sinovenous thrombosis (P = 0.049), and 32°C/hour was the optimal cutoff value to predict the event (sensitivity, 90%; specificity, 88.5%)., Conclusions: High incidence or cerebral sinovenous thrombosis in neonates treated with therapeutic hypothermia suggests that magnetic resonance venography may be reasonable in many of these children. High blanket temperature may be one variable that helps identify patients at higher risk., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Several studies have demonstrated seasonal and temporal variations in the incidence of arterial stroke; however, for cerebral venous sinus thrombosis (CVST), such study seems lacking. The main aim of this study was to investigate whether there is any seasonal variation for CVST, and association between CVST occurrence and temperature., Methods: This retrospective study was conducted from January 2004 to July 2015 in 2 referral centers for the patients with cerebrovascular disorders. One hundred and sixty-six consecutive patients with a hospital admission or discharge diagnosis of definite CVST were included. The incidence of CVST was compared between high-temperature and low-temperature months., Results: The mean age of patients was 36.71 ± 12.44 and 130 (78.31%) subjects were female. The highest frequency of CVST was seen in 3 months of July to September (1.69/month per year); and the lowest frequency of CVST was seen from December to April (.83/month per year). Additionally, there was a significant correlation between the mean average of temperature in each month and the frequency of CVST occurrence (r = .60, P = .03). Moreover, we found a cluster of patients, mostly females, in whom CVST occurred in cold months and accompanied visible cerebral infarct with higher occurrence of seizure, focal neurological deficit, and loss of consciousness., Conclusions: It seems that the incidence of CVST increases in high-temperature months of the year and dehydration and ensuing consequences may play an important role in such augmentation; however, the visible cerebral infarct is again more observed in low-temperature months., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Although cerebral venous thrombosis/cerebral sinus thrombosis (CVT/CST) remains a relatively uncommon cause of stroke and other neurologic complications, the widespread availability of noninvasive brain imaging has led to an increase in its diagnosis., Purpose: Through a review and description of its epidemiology, clinical features and treatment, to heighten awareness of CVT/CST., Methodology: Via a systematic review of the more recently published medical literature relevant to the topic and focusing in particular on primary sources, we compiled data related to the incidence of CVT/CST and its diagnosis, treatment and prognosis., Results: Thrombosis of a cerebral vein or sinus may occur in individuals of any age and may be caused by a myriad of prothrombotic conditions, both primary and acquired. The clinical presentation of CVT/CST is widely variable, but headache is present in the great majority of cases, and the predominant symptom in many. The headache associated with CVT/CST may be acute, severe, and even "thunderclap" in character, or it may be chronic, pervasive, and of lower intensity., Conclusions: Given its eclectic epidemiology, its potential to produce a highly unfavorable clinical outcome, and evidence suggesting that specific treatment improves outcome, CVT/CST is a disorder whose salient features should be familiar to virtually all clinicians., (© 2016 American Headache Society.)

Background and Purpose: Cerebral venous sinuses thrombosis (CVST) is an uncommon type of stroke with an incidence of 3-4 cases per million. There have been reports of higher incidence of this disease in Iran. Our objective is to describe the incidence, clinical presentation, predisposing factors, and outcomes of CVST at Sina Hospital in Hamadan, west of Iran., Methods: This is a prospective, single-center, longitudinal study of all patients referred to Sina Hospital in Hamadan, west of Iran, between May 2009 to May 2015 who were diagnosed with CVST., Results: In this study, 151 patients were included. There were 118 women and 33 men. The mean age was 37.48 years. The mean incidence rate of CVST in the duration of our study was 13.49 per 1 million. Oral contraceptives, the most common risk factor, were used by 55.1% of women and half of these patients had fasting simultaneously. Fifty-eight patients had more than 1 risk factor. After 12 months' follow-up, 73.1% of the patients were functionally independent (mRS score 0-1). Ten percent were dependent. The overall mortality was 16.9%., Conclusions: The incidence of CVST in Hamadan is higher than the world's average, and overall outcome is worse. It seems that fasting and subsequent dehydration in women with recent use of oral contraceptives make them more susceptible to CVST., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Descending corticospinal tract diffusion-weighted magnetic resonance imaging (MRI) signal is predictive of poor motor outcome in neonatal and childhood arterial ischemic stroke. However, descending corticospinal tract diffusion-weighted MRI signal has not been documented in the setting of cerebral sinovenous thrombosis, and its role is not understood., Objective: We describe a neonate with cerebral sinovenous thrombosis, extensive diffusion restriction, and bilateral descending corticospinal tract diffusion-weighted MRI signal on MRI of the brain. We discuss the underlying mechanisms and implications of these findings in venous ischemia., Conclusion: The prognostic value of descending corticospinal tract diffusion-weighted MRI signal differs when observed in cerebral sinovenous thrombosis from when observed in arterial ischemic stroke. Consequently, caution should be exercised in using descending corticospinal tract diffusion-weighted MRI signal to predict outcome in children with cerebral sinovenous thrombosis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The prognosis of cerebral venous sinus thrombosis (CVST) may be dependent on underlying causes and magnetic resonance imaging findings. We report the clinical, laboratory, and radiologic spectrum, and outcome of consecutive patients with CVST., Methods: Consecutive patients with CVST over the last 15 years were subjected to detailed history, clinical examination, and laboratory tests as per fixed protocol. The diagnosis of CVST was based on MR venography. The magnetic resonance imaging findings and the sinuses involved were noted. The patients were treated with low-molecular-weight heparin or unfractionated heparin for 14 days, followed by oral anticoagulation. Hospital mortality and 3-month outcome (good or poor) were recorded and correlated with various clinical and laboratory parameters., Results: There were 86 patients whose median age was 30 (6 to 76) years; 47 of them were females. Headache was present in 91.9%, vomiting in 68.6%, focal weakness in 53.5%, seizure in 51.2%, and altered sensorium in 53.5%. Female-specific etiology was present in 34%, prothrombotic condition in 62.8%, infections in 19.8%, and malignancy in 2.8%; no cause could be established in 25.6% of patients. Hyperhomocystinemia was present in 45.9% of patients. Five patients died in the unfractionated heparin group. At 3 months, 77 patients were followed up, of whom 68 had complete, 3 had partial, and 6 had poor recovery. The 3-month outcome was related to Glasgow Coma Scale score and type of heparin used., Conclusions: In our study multiple prothrombotic conditions were common, and low-molecular-weight heparin reduces mortality and results in good outcome.

Antiphospholipid antibody syndrome (APS) has been reported to cause elevated intracranial pressure, but usually this is due to cerebral venous sinus thrombosis (CVST). We present a 36-year old man with APS with elevated intracranial pressure with neuro-ophthalmic, renal and hematological involvement without identifiable CVST.

Objective: Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening disease and an animal model for in-depth study of CVST is needed. This study aimed to develop a rat model suitable for studying clinically relevant aspects of CVST and investigating its dynamic pathophysiological changes during a 7-day period., Method: A photothrombosis method was used to create a rat sinus-vein thrombosis model. A spot size-adjustable Diode Pumped Solid State laser (DPSS) combined with thrombin injection occluded the rostral and caudal superior sagittal sinus (SSS). The model was used to evaluate pathophysiological changes at different time points over 7 days. Evans Blue dye injection was used to detect alterations in blood-brain barrier (BBB) permeability. Brain water content was also measured. Moreover, we examined changes in brain infarct volume, neurological function, as well as histology after induction of CVST., Result: CVST in rats significantly altered BBB permeability, consistent with the development of brain edema. It was accompanied by an increase in brain infarct volume and deficits in neurological function that began on day 1, peaked on day 2, and typically improved by day 7 due to the neuroprotective effects of angiogenesis and gliocyte proliferation., Conclusion: In this study, we describe a rat model that produces clinically relevant pathophysiology and pathology that will facilitate evaluation of therapeutic regimens for CVST. Furthermore, our results indicate a period of optimal clinical intervention for patients with CVST, which may reduce the probability of dependency and death., (Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.)

Thrombosis of the cerebral sinuses most often affects younger adults. Headache is a common complaint and can be accom­panied by vomiting and papilloedema. The diagnosis rests on magnetic resonance imaging and the treatment consists of heparin or low-molecular weight heparin followed by vitamin K antagonists for three months or more. In fulminant cases local thrombolysis is administered, while symptomatic treatment for increased intracranial pressure is given. In retrospective analyses this approach has been associated with a good outcome – even in cases treated by decompressive craniectomy.

Objective: To assess the clinical significance of hepatitis B virus (HBV) infection in patients with cerebral venous sinus thrombosis (CVST)., Methods: Twenty-two patients with CVST confirmed by magnetic resonance venography (MRV) or digital subtraction angiography (DSA) and 743 controls with ischemic stroke confirmed by magnetic resonance imaging (MRI) were analyzed retrospectively., Results: Among all researches, HBV surface antigen (HBsAg)-positive rate was high. Six of the 22 (27.3%) confirmed cases had HBsAg. However, HBsAg-positive rate in patients with ischemic stroke was only 45 of the 743 cases (6.1%), closed to the average prevalence in China (∼ 8.6%), but much lower than the positive rate in CVST patients (27.3 vs 6.1%, P  =  0.002). Odd ratio (OR) value between HBsAg-positive CVST patients (27.3%) and HBsAg-positive ischemic stroke patients (6.1%) was 5.78. The OR value between HBsAg-positive CVST patients (27.3%) and average prevalence of HBV infection in China (8.6%) was nearly 3.99. It meant that HBV infection might be a risk factor for CVST. However, there existed no statistically significant difference in HBV surface antibody (HBsAb), HBV e antigen (HBeAg), HBV e antibody (HBeAb), and HBV central antibody (HBcAb)-positive rate. The HBV surface antigen (HBsAg)-positive CVST patients did not show worse liver function. Most of them were inactive HBV carriers., Conclusion: Hepatitis B virus infection may be a risk factor for CVST.

Purpose: Pediatric cerebral sinovenous thrombosis (CSVT) is a potentially life-threatening condition which is usually diagnosed by MRI. We analyzed the signal changes of the thrombus over time and the role of diffusion-weighted/tensor imaging (DWI/DTI) in the diagnosis of CSVT., Methods: Clinical histories were reviewed for risk factors for CSVT, neurologic manifestation, and interval from onset of symptoms related to CSVT to the neuroimaging diagnosis. MRI studies were retrospectively evaluated for the appearance of thrombi on T1- and T2-weighted, fluid-attenuated inversion recovery (FLAIR), DWI/DTI, susceptibility-weighted imaging (SWI), and magnetic resonance venography (MRV) images., Results: Thirty-three children with CSVT were included in this study. Seventy-seven thrombi were found. Seventy-four thrombi could be identified on T1- or T2-weighted images (96 %), 72 thrombi were seen on DWI/DTI (94 %) and 68 on FLAIR (88 %). DWI showed restricted diffusion in 29 thrombi (40 %). Thrombi older than 1 day were more likely to have a T1-hyperintense signal (p = 0.002). No additional correlation between signal intensity and age of the thrombi was found. Intraparenchymal changes secondary to CSVT were seen in 11 children., Conclusion: MR sequences individually are not sensitive enough to provide the diagnosis. DWI/DTI does not provide complementary diagnostic value. Approximation of the age of the thrombus is difficult because of poor correlation between signal intensity and age of the thrombi.

Cerebral venous sinus thrombosis (CVST) is a rare form of stroke. The role of endoplasmic reticulum (ER) stress markers is well documented in arterial stroke but has not been evaluated in venous stroke. The present study has been undertaken to investigate the role of ER stress in rodent model of CVST. For inducing CVST, a cranial window was made to expose superior sagittal sinus (SSS). A strip of filter paper soaked with 40% ferric chloride was applied on exposed cranial window while in sham operated control 0.9% saline was used. Clinical evaluations were done on day 1, 2, and 7 for neurological deficit. Rota rod test and brain infarction volume were also measured. Brain tissue was collected from infarcted portion for further analysis using real time polymerase chain reaction and western blot technique for ER stress markers. Augmented expression of ER stress markers and up regulation of apoptotic genes were found in infarcted tissue. These markers improved on day 7. It is concluded that ER markers are up regulated at an early stage of CVST and may be important in pathophysiology., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Dural arteriovenous fistula (DAVF) may present with a variety of neurological symptoms, ranging from tinnitus to fatal hemorrhage. We report a case of rapidly progressive cognitive impairment due to cerebral venous engorgement that reversed after endovascular treatment in a patient with DAVF, cerebral sinus thrombosis and protein S deficiency. DAVF may be a cause of vascular cognitive impairment and should be considered particularly in cases with a rapidly progressive course because they are potentially treatable., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Thrombosis of the cerebral sinuses most often affects younger adults. Headache is a common complaint and can be accompanied by vomiting and papilloedema. The diagnosis rests on magnetic resonance imaging and the treatment consists of heparin or low-molecular weight heparin followed by vitamin K antagonists for three months or more. In fulminant cases local thrombolysis is administered, while symptomatic treatment for increased intracranial pressure is given. In retrospective analyses this approach has been associated with a good outcome - even in cases treated by decompressive craniectomy.

Objective: Cerebral venous sinus thrombosis (CVST) is a rare cerebral vascular disease. Early diagnosis and treatments are crucial for a better prognosis. This study investigated the clinical characteristics and risk factors associated with the prognosis of patients with CyST., Methods: From Jan 2009 to Jan 2013, patients who were admitted to the Department of Neurology of West China Hospital with confirmed CVST (according to the 2006 guideline of European neurology with neuroimaging when necessary) were consecutively recruited. Their medical records including demographic information and detailed clinical data were analyzed. The functional outcome of CVST was assessed 12 months after discharge using the modified Rankin Scale (mRS)., Results: A total of 73 patients were enrolled in this study. Acute and chronic onset of illness accounted for 13.7% and 35.6% of all patients, respectively. The earliest common symptom was headache (90.4%). Other initial symptoms included decreased visual acuity or blurred vision (2.7%), unilateral limb weakness (2.7%), diplopia (1. 4 9/o) and seizure (1.4%). CT scan was conducted in 46 patients (63.3%), which revealed 8 (17.4%) cases of cerebial hemorrhagic infarction. Delta sign and cord sign was shown in 34.8% and 30.4% CT imaging, respectively. The MRI scan confirmed that 27. 5% of those patients had encephaledema, 55% had delta sign and 45% had cord sign. The commonly involved location of CVST was right lateral sinus (68.5%), left lateral sinus (57.5%), ongitudinal sinus (53. 4%), left sigmoid sinus (50.7%), right sigmoid sinus (47.8%), confluence sinuum (32.9%), nferior sagittal sinus (21.900), sinus rectus (20.5%), jugular vein (12. 3%) and cerebral vein (9.6%). During the 12-month follow-up, 6.8% patients died, 72.6% had good mRS outcome (<2) and 27.4% had poor mRS outcome (> OR =2). The regression analysis identified epilepsy and papilledma as independent predictors of poor prognosis of CyST., Conclusion: It is difficult to recognize CVST at an early stage due to its diverse clinical presentations. Neuroimaging may be helpful for the diagnosis. Epilepsy and papilledema are potentially independent predictors for the 12-month functional outcome of patients with CVST.