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Introduction: Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. Materials and Methods: A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. Results: A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. Conclusions: EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation. [ABSTRACT FROM AUTHOR]

Lisda Amalia, Ryan Tantri Ardo Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Lisda Amalia, Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl. Eykman 38, Bandung, 40161, Indonesia, Email dr.lisda@gmail.comIntroduction: Cerebral venous sinus thrombosis (CVST) is a cerebral vascular disorder that currently occurs quite often and has very varied clinical symptoms. Headache is the main symptom most commonly found in patients with CVST and multiple sinus involvement often have a more severe prognosis and poor clinical outcome. This study aimed to learn the relationship between D-dimer level, numeric rating scale (NRS), and amount of sinus involvement in CVST patients.Methods: This study was a retrospective observational analytic study with a cross-sectional approach using medical records and supporting data (D-dimer level and imaging finding) on patients diagnosed with CVST at Dr Hasan Sadikin Hospital Bandung.Results: Sixty-five CVST patients met the study criteria with mean age of 47 years and mostly female (76.9%). Patients with single sinus involvement had a median initial NRS of 4 (range 2– 6) and multiple sinus involvement was higher at 8 (range 5– 9). Statistical test results showed a significant difference between D-dimer level, NRS and amount of sinus involvement (P< 0.001).Conclusion: D-dimer level, NRS, and amount of sinus involvement are associated with amount of sinus involvement in CVST patients. Involvement of multiple sinus will cause higher NRS with higher D-dimer level.Keywords: CVST, D-dimer, NRS, sinus involvement

This study aims to systematically review the current literature on pediatric cerebral venous sinus thrombosis (CVST) following closed head injury and to evaluate the clinical management of these patients. Systemic review of the literature was conducted using the following databases: PubMed, Google Scholar, Microsoft Academic, Clinical Trials, Cochrane Library, and Web of Science. All databases were searched from their date of inception to June 2022. Inclusion criteria were applied to identify articles reporting on pediatric patients with CVST following closed head injury. Out of the articles screened, 23 met the inclusion criteria, reporting on 23 pediatric patients with CVST. Falls were the most common cause of traumatic CVST (52.2%), followed by motor vehicle accidents (30.4%). Nausea and vomiting were the most common presenting symptoms (71.4%), and magnetic resonance venogram was the most common diagnostic method (43.5%). Multisinus involvement was noted in 52.2% of cases. Patients with falls from height were more likely to receive conservative management than those with nonfall mechanisms of injury (p < 0.05). Pediatric CVST following closed head injury is a rare condition, with only case reports available in the literature. Prompt diagnosis and early treatment can lead to good survival and neurological outcomes. In severe cases, neurosurgical intervention may be necessary to prevent mortality and severe morbidity. This review highlights the need for further research to establish evidence-based management guidelines for this rare but potentially serious condition in the pediatric population. [ABSTRACT FROM AUTHOR]

Introduction: Dural arteriovenous fistula (DAVF) is an uncommon malformation involving an abnormal connection between dural arteries, or the pachymeningeal branches of cerebral arteries, and dural veins. Its exact pathogenesis remains elusive. Known potential triggers for DAVF include cerebral venous sinus thrombosis (CVST), trauma, ear infections, and cranial surgeries. Due to its rarity and diverse clinical presentations, diagnosing DAVF can be a challenge. Case description: We present a case of DAVF associated with CVST, manifesting as rapidly advancing parkinsonism accompanied by dementia over a month. Brain magnetic resonance imaging (MRI) revealed bilateral symmetric T2 hyperintensities in the basal ganglia and brain stem. Cerebral angiography further confirmed a fistula between the torcular herophili and the transversesigmoid sinuses. Despite strong recommendations for transvenous embolization of the fistula, the patient declined the procedure. The anticoagulant therapy and symptomatic treatments administered did not yield any improvement in the patient's condition. Additionally, we reviewed 27 DAVF-derived parkinsonism and dementia cases. Conclusion: DAVF must be considered in the differential diagnosis of cases of rapidly progressive parkinsonism with concurrent dementia. Given its potential for treatment and reversibility, timely diagnosis and intervention for DAVF are paramount. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition characterized by the formation of blood clots in the cerebral venous sinuses, which are responsible for draining blood and cerebrospinal fluid from the brain. CVST represents a significant cause of stroke in young individuals, with a mortality rate ranging from 6% to 15%. Methods: Common clinical presentations include symptoms like headaches, seizures, altered mental state, and focal neurological deficits. In India, a noteworthy occurrence of CVST is observed among postpartum women, while alcoholism poses a significant risk factor for males. Results: This study identifies headaches as the most prevalent initial symptom of CVST, followed by seizures and focal neurological deficits. The superior sagittal sinus is the most frequently affected in these patients. Notably, 83.3% of patients in this study achieved a favorable outcome. However, a midline shift exceeding 10mm was identified as a predictive factor for an unfavorable outcome in this series. Conclusions: Contrary to previous perceptions, CVST is not uncommon in males. The early diagnosis and prompt intervention have a positive impact on overall patient outcomes. This research sheds light on the importance of recognizing CVST in a broader demographic, its common symptoms, and the critical role of timely intervention for improved patient prognosis.

Background: Cerebral venous sinus thrombosis (CVST) presents with a wide variety of neurological symptoms in various combinations and has a high mortality rate of up to 50%. Recent advances in neuroimaging and therapeutic interventions have brought it down to 10%–20%. The study aims to identify critical prognostic factors associated with poor outcomes in patients with CVST. Materials and Methods: All cases of CVST aged >18 years from July 2015 to July 2020 who were not terminally ill and bedridden before the illness were evaluated at the entry point for various risk factors and after 30 days for outcome assessment with the modified Rankin scale (mRS). The outcome was dichotomized, applying mRS

Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20–37) versus 47 (IQR 32–58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11–40]) than in HICs (44/102 [43%, 95% CI 34–53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs. [ABSTRACT FROM AUTHOR]

Background: To evaluate the role of non-enhanced computed tomography (NECT) brain in diagnosis of acute cerebral venous sinus thrombosis (CVST). Methods: This cross sectional study was done in the Department of Radiodiagnosis among 32 patients referred to Radiology Department with symptoms & signs of acute cerebral venous sinus thrombosis (ACVST). The attenuation values of different dural venous sinuses & major cerebral veins/ large cortical veins were recorded in the proforma. The sensitivity, specificity & accuracy of using attenuation value of 70 HU as predicted in previous article was calculated. Also the cut off attenuation value suggestive of thrombosis was calculated retrospectively in our study keeping sensitivity, specificity and accuracy to the maximum. Results: The majority of subjects are of 21-30 years age group (31.25%) and maximum were males(62.5%). 10(31.2%) subjects reported positive MR venography findings. Analysis of ROC curve of HU shows a zone under the curve of 0.966 with cut-off of 70 as well, sensitivity of 96%, specificity of 91% and accuracy of 98% was reported. And with cut-off of 68 as well, sensitivity of 92%, specificity of 84% and accuracy of 93% was reported. Conclusion: In case of acute neurologic symptoms, NECT is the most commonly requested modality. Plain CT is definite for the analysis of acute CVST in an acute context, however, the density of venous sinuses decreases as the age of the clot increases. According to our findings, the cut-off value for CVST diagnosis should be 70 HU (sensitivity 96 percent, specificity 91 percent), with no need for additional confirmatory procedures like as venography. [ABSTRACT FROM AUTHOR]

Purpose: Accurate assessment of dural sinus, deep and cortical venous thrombosis on MR imaging is challenging. The aim of this study is to evaluate the accuracy of 3D-T1 turbo spin echo (T1S), sequences in detecting venous thrombosis and comparing it with susceptibility-weighted imaging (SWI), magnetic resonance venography (MRV) and post contrast T1 magnetization-prepared rapid acquisition gradient echo (T1C). Methods: A blinded retrospective observational analysis of 71 consecutive patients evaluated for cerebral venous thrombosis (CVT) and 30 control patients was performed. Multimodality reference standard adopted included T1C, SWI with MRV. Sub-analyses in superficial, deep and cortical venous segments were performed in addition to correlation of signal intensity of thrombus with the clinical stage. Results: A total of 2222 segments in 101 complete MRI examinations were evaluated. Sensitivity/specificity/positive predictive value/negative predictive value/accuracy and precision of T1S for detection of cortical vein thrombosis was 0.994/1/1/0.967/0.995/1, 1/0.874/0.949/1/0.963/0.950 for detection of superficial venous sinus thrombosis and 1/1/1/1/1/1 for deep venous thrombosis. The AUC yield for T1S was 0.997 for cortical, 1 for deep and 0.988 for superficial venous segments. Conclusion: T1S paralleled the accuracy of conventional sequences in the overall detection of CVT but showed superior accuracy in the detection of cortical venous thrombosis. It makes a fitting addition to the CVT MRI protocol in scenarios demanding negation of gadolinium administration. [ABSTRACT FROM AUTHOR]

Purpose: A prospective, observational study was done at the country leading tertiary care hospital to evaluate etiologies, clinical features, diagnosis, and prognosis of cerebral venous sinus thrombosis (CVST) in the Pakistani population. Methods: 34 patients with clinical and MRI features suggestive of CVST were evaluated. Modified Rankin Score (mRS) was assessed of all patients at presentation. Results: The mean age of presentation was 30.69 years with female predominance (n = 28). Headache was most common presenting symptoms (97%, n = 33) followed by seizure (59%, n = 20), hemiparesis (56%; n = 19), altered sensorium (47%; n = 16), vomiting (21%; n-7) and cranial nerve involvement (18%; n = 6). 72% of patients (n = 23) had thrombosis of superior sagittal sinus, 53% of patients (n = 17) had thrombosis of the transverse sinus, 25% patients (n = 8) of patients had sigmoid sinus thrombosis, 16 % patients (n = 8) had straight sinus thrombosis. The most common cause for provoked CVST was found to be pregnancy/puerperium in 53% (n = 18 patients), followed by previous CVST/DVT in 12% (n = 4), and then OCP and parainfectious causes which were 3% (n = 1) for each and elevated factor VIII and protein deficiency were found in 7 patients. MRS between 3 and 5 was assessed in most patients on presentation (n = 23). Conclusion: CVST is an under-recognized cause of stroke in the young population, especially in the puerperium period. Clinical presentation is highly variable, and correction with magnetic resonance imaging with venography is the current diagnostic modality of choice. Aggressive management with anticoagulants is safe with excellent clinical outcomes.

Background & Objectives: Cerebral vascular thrombosis can lead to devastating disability if not timely diagnosed and treated. Susceptibility-weighted imaging (SWI) is evolving as means of rapid investigation in the detection of intravascular clots in vascular thrombosis. The aim of this study is to detect the diagnostic accuracy of SWI and its role in cerebral vascular thrombosis. Materials & Methods: The study was done on 40 patients, who underwent MR imaging of the brain using GЕ Optima MR 360 1.5 Tеslа MRI machine at the Department of Radiodiagnosis of IMS & SUM Hospital, Bhubaneswar. The data collected were categorized as arterial or venous infarcts, which were further evaluated on the basis of the presence of intravascular clot, venous congestion, hemorrhagic areas, zone of penumbra, and risk of hemorrhagic transformation on SWI with conventional MR sequences and NC-MRA/MRV. Results: In this study, SWI showed a sensitivity of 88.24% in the detection of intravascular thrombus as compared to 60.00% on combined T1W and T2W images with a p-value of 0.004. SWI has a sensitivity of 85.71% as compared to 72% on NC-MRA/MRV for intravascular clot detection with a p-value of 0.001. It could also detect the presence of hemorrhagic areas and cortical venous congestion with 100% sensitivity as compared to other sequences. In cerebral ischemic stroke, it could additionally detect the zone of penumbra and risk of hemorrhagic transformation which could not be detected on other sequences. Conclusion: SWI is considered a useful sequence that detects the presence of intravascular thrombus due to an increased concentration of deoxyhemoglobin. It also provides useful additional information regarding the presence of hemorrhagic areas and their risk of occurrence following thrombolytic therapy. Hence, SWI should be included in routine imaging protocol of the brain.

Lisda Amalia Department of Neurology, Medical Faculty, Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung, West Java, IndonesiaCorrespondence: Lisda Amalia, Email dr.lisda@gmail.comAbstract: Cerebral sinus venous thrombosis (CVST) is a disease caused by occlusion of intracranial venous structures, including the cerebral sinuses, cortical veins, and the proximal jugular vein. Delay in diagnosis and therapy can lead to complications such as bleeding infarction and even death. Thrombosis that causes CVST is the process of forming a blood clot in a blood vessel. Thrombosis occurs when the balance between thrombogenic factors and the protective mechanisms of thrombogenesis is disturbed. Platelet function abnormalities in CVST cases can be in the form of impaired adhesion function, impaired release or secretion reactions, and impaired aggregation function. Dysfunction and disruption of endothelial structure due to inflammation causes platelet adhesion so that platelets stick together with collagen in endothelial cells. Platelet-selectin is a type 1 transmembrane protein in platelet granules and megakaryocytes and plays a role in mediating interactions between leukocytes and ligands that help the adhesion process of leukocytes and platelets so that they can be used as predictors of thrombosis in patients with CVST.Keywords: platelet-selectin, CVST, platelet aggregation, prothrombotic

Objectives: There is a higher prevalence of cerebral venous sinus thrombosis (CVST) in more recent times, owing to increased awareness, clinical diagnostic skills, and advancements in neuroimaging modalities. This study aimed to identify and characterize the geographical, clinical, and etiological profiles of patients with CVST that may be relevant to planning appropriate diagnostic and therapeutic strategies to improve functional recovery. Methods and Results: A retrospective observational study was carried out at a tertiary care hospital between March 2014 and October 2018. The demographics and clinical profile of the hospitalized patients were extracted from the Medical Record Division. Choropleth maps were created to present the geographic distribution of the patients with CVST admitted to our hospital. A total of 145 patients with CVST were included in the study. Etiological factors revealed striking abnormalities in red blood cells counts and serum homocysteine. Analyzing the geographical distribution of the patients with CVST showed most of the patients hailed from Central Karnataka Plateau 106 (73%). Polycythemia was most commonly seen in patients residing in the Central Karnataka Plateau 21 (62%). Conclusion: It is inferred that large scale community-based studies to identify a genetic abnormality like a mutant erythropoietin gene should be undertaken to plan effective diagnostic, therapeutic, and preventive measures.

The COVID-19 pandemic evolved rapidly, overwhelming health care systems around the world. The cost to life and socioeconomic burden prompted a search for new treatments and vaccines. Several collaborations developed and could deliver state-of-the-art vaccines with acceptable efficacy and safety in record time. Recently, vaccination with Oxford-AstraZeneca and Johnson and Johnson vaccines was halted due to the reported adverse effects of vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST). Although a detailed risk-benefit analysis led to their reinstitution, physicians across the world are still trying to understand the pathophysiology and mechanisms of these neurological adverse effects in order to better identify, diagnose, and treat them. One of the mechanisms that have been implicated is related to the adenovirus-based vector of these vaccines. COVISHIELD, which is the most widely administered vaccine in India, also shares the same vector. As India enters the next phase of vaccine distribution for younger adults, there are chances that such adverse effects may emerge. In this review, we analyze the temporary suspension of the administration of the vaccines due to VITT/CVST, summarize the existing guidelines about diagnosis and treatment of these neurological disorders as well as the need for increasing pharmacovigilance and awareness among physicians. Screening for potential risk factors, avoiding aggravating factors like dehydration, and providing choices in vaccinating the high-risk populations could help in avoiding these rare but potentially fatal adverse outcome.

Background: Cerebral venous thrombosis (CVT) is a rare thrombotic condition which is traditionally treated with anti-coagulation therapy. Subsets of patients with severe CVT have been treated with endovascular thrombectomy (EVT). Despite the high estimated mortality associated with severe CVT, there has been only one randomized control trial done regarding safety and efficacy of EVT in severe CVT compared to standard medical management. Evidence in this area is lacking. Objective: The aim of this systematic review is to analyze all existing literature and generate robust information regarding the role of EVT in the management of patients with severe CVT. Methods: This systematic review and meta-analysis followed PRISMA guideline. PubMed, Embase, Google Scholar, and CNKI were searched for eligible studies from 2007 to 2021. Safety and efficacy of EVT were evaluated by meta-analyzing recanalization status, the good functional outcome at follow-up, recurrent CVT, new hematoma. A pooled proportion with a 95% confidence interval was derived from a meta-analysis of various outcomes (CI). Results: A total of 33 studies comprising 610 patients treated with EVT were included for analysis which comprised one randomized control trial, one prospective study and 31 retrospective studies. Based on pooled data, 85% of patients had good functional outcome, 62% had complete recanalization, 5% had all-cause mortality, and 3% had catheter related complications. The efficacy outcomes in this analysis had a significant heterogeneity and a subgroup analysis was also done to explain these findings. The minimum time of follow up was 3 months and varied EVT techniques were used across the studies. Conclusion: This meta-analysis suggests EVT may be safe and efficacious in treating patients with severe CVT. Registration: Our protocol was registered with PROSPERO: International prospective register of systematic reviews with the registration number CRD42021254760. [ABSTRACT FROM AUTHOR]

The SARS Covid-19 pneumonia became a pandemic in 2019 affecting millions worldwide and carried a significant high mortality rate. The common presentation of this novel virus is upper and lower respiratory tract infection. However, its popularity as neuropathogen has increased dramatically. Patient presents a wide range of symptoms. We report a case of Covid-19 encephalitis which was incidentally found to have cerebral venous sinus thrombosis, presented with acute delirium and then developed new onset seizures.

Objectives: There is a higher prevalence of cerebral venous sinus thrombosis (CVST) in more recent times, owing to increased awareness, clinical diagnostic skills, and advancements in neuroimaging modalities. This study aimed to identify and characterize the geographical, clinical, and etiological profiles of patients with CVST that may be relevant to planning appropriate diagnostic and therapeutic strategies to improve functional recovery. Methods and Results: A retrospective observational study was carried out at a tertiary care hospital between March 2014 and October 2018. The demographics and clinical profile of the hospitalized patients were extracted from the Medical Record Division. Choropleth maps were created to present the geographic distribution of the patients with CVST admitted to our hospital. A total of 145 patients with CVST were included in the study. Etiological factors revealed striking abnormalities in red blood cells counts and serum homocysteine. Analyzing the geographical distribution of the patients with CVST showed most of the patients hailed from Central Karnataka Plateau 106 (73%). Polycythemia was most commonly seen in patients residing in the Central Karnataka Plateau 21 (62%). Conclusion: It is inferred that large scale community-based studies to identify a genetic abnormality like a mutant erythropoietin gene should be undertaken to plan effective diagnostic, therapeutic, and preventive measures. [ABSTRACT FROM AUTHOR]

Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done. Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female‐to‐male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty‐nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board. [ABSTRACT FROM AUTHOR]

One of the most prevalent neurological impairments is cerebrovascular accident (CVA). Ischemic stroke and CVST have been linked to the AstraZeneca COVID‐19 vaccine. Three Sudanese patients developed these diseases after receiving the AstraZeneca COVID‐19 vaccine, indicating a relationship between the AstraZeneca COVID‐19 vaccine and these conditions. Ischemic stroke and CVST have been linked to the AstraZeneca vaccine. It is critical to anticipate such scenarios and educate patients about the potential adverse effects of vaccination in order to encourage them to seek medical treatment early if any symptoms appear after they have been vaccinated to avoid consequences. [ABSTRACT FROM AUTHOR]

Abstract Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done. Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female‐to‐male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty‐nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board.

Abstract One of the most prevalent neurological impairments is cerebrovascular accident (CVA). Ischemic stroke and CVST have been linked to the AstraZeneca COVID‐19 vaccine. Three Sudanese patients developed these diseases after receiving the AstraZeneca COVID‐19 vaccine, indicating a relationship between the AstraZeneca COVID‐19 vaccine and these conditions.

• Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition, causing 0.5% of all strokes. • Due to the rarity of occurrence and nonspecific varieties of symptoms, such as headache, papilledema, or focal neurological deficits, the diagnosis of CVST might be often missed. • The majority of cases presented with loss of consciousness or decreased GCS (41%), followed by headache (26%), scalp abrasions/lacerations (21%), paralysis (18%), visual disturbance (18%), nystagmus (15%), and agitation (15%). • The current study showed that the non-surgical outcomes were better than the surgical outcomes. Cerebral venous sinus thrombosis (CSVT) is a rare condition, causing 0.5% of all strokes only, several mechanisms might be involved in forming the thrombosis, including closed head injury. Systematic review was done by using the following databases: PubMed, Google Scholar, Microsoft Academic, Clinical Trials, Cochrane Library, and Web of Science. 25 articles met our criteria out of 152 articles, average and standard deviation of the age was 38.2 ± 16.8 years with an age range of 18–82. The majority of cases presented with loss of consciousness or decreased GCS (41%), followed by headache (26%), scalp abrasions/lacerations (21%), paralysis (18%), visual disturbance (18%), nystagmus (15%), and agitation (15%). The most commonly used diagnostic method was angiography. Thrombosis was the most frequently reported radiological finding among all the cases (26/34, 76%). Comparisons of outcomes between patients who underwent surgical intervention and those who did not undergo surgery revealed a significant difference in outcome favoring non-surgical treatment (p < 0.005, odds ratio (OR) 0.04, (95% CI) 0.003 – 0.30). Non-surgical outcomes were better than the surgical outcomes. However, no significant difference was seen comparing anti-coagulation versus conservative management (supportive without anticoagulation), single versus multi-sinuses (≥2 sinuses) involvement, and between any of the sinuses involved. [ABSTRACT FROM AUTHOR]

Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, multiple but rare complications of this infection have been described, comprising cerebral venous sinus thrombosis (CVST) and immune thrombocytopenic purpura (ITP). Although these two complications have been reported as separate entities, to the best of our knowledge, their concurrent presentation has not been reported. In this case report, we present a middle-aged man with a history of COVID-19 infection who developed a sudden-onset severe occipital headache followed by right-sided blindness (right homonymous hemianopia). Upon his diagnostic workup, brain computed tomography scan with and without contrast was indicative of thrombosis of the left transverse venous sinus and hemorrhagic venous infarction. In addition, laboratory data revealed thrombocytopenia, which upon investigation confirmed a diagnosis of ITP. We postulate three pathophysiological mechanisms for this circumstance: either COVID-19 infection caused ITP and then ITP gave rise to CVST, or COVID-19 complications themselves resulted in ITP and CVST independently and simultaneously, or another plausible mechanism is immune-mediated thrombocytopenia caused by the anti-platelet 4-factor antibody, which is the proposed mechanism for CVST after the COVID-19 vaccine. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 vaccines became available after being carefully monitored in clinical trials with safety and efficacy on the human body. However, a few recipients developed unusual side effects, including cerebral venous sinus thrombosis (CVST). We aim to systematically review the baseline features, clinical characteristics, treatment, and outcomes in patients developing CVST post-COVID-19 vaccination. Methods: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) 2020 guideline. Investigators independently searched PubMed, Embase, and Google Scholar for English language articles published from inception up until September 10, 2021, reporting the incidence of CVST post-COVID-19 vaccines. We analyzed CVST patients' baseline data, type of vaccines, clinical findings, treatment, and outcomes. Our systematic review process yielded patient-level data. Result: The final analysis included 25 studies that identified 80 patients who developed CVST after the COVID-19 vaccination. Of the 80 CVST cases, 31 (39.24%) patients died. There was no significant relationship between mortality and age (P =.733), sex (P =.095), vaccine type (P =.798), platelet count (P =.93), and comorbidities such as hypertension (P =.734) and diabetes mellitus (P =.758). However, mortality was associated with the duration of onset of CVST symptoms after vaccination (P =.022). Patients with CVST post-COVID-19 vaccination were more likely to survive if treated with an anticoagulant (P =.039). Patients who developed intracranial hemorrhage (P =.012) or thrombosis in the cortical vein (P =.021) were more likely to die. Conclusion: COVID-19 vaccine-associated CVST is associated with high mortality rate. Timely diagnosis and management can be lifesaving for patients. [ABSTRACT FROM AUTHOR]

Cerebral venous thrombosis (CVT) is caused by partial or complete occlusion of the major cerebral venous sinuses or the smaller feeding cortical veins which predispose to the risk of venous infarction and hemorrhage. Current guidelines recommend treating CVT with either low‐molecular‐weight heparin (LMWH) or unfractionated heparin (UFH) followed by an oral vitamin K antagonist (VKA) for 3–12 months. Direct oral anticoagulants (DOACs) have already established benefit over warfarin as a long‐term treatment of symptomatic venous thromboembolic disorder like deep vein thrombosis (DVT), and pulmonary embolism (PE) given its equal efficacy and better safety profile. The benefit of DOACs over warfarin as a long‐term anticoagulation for CVT has likewise been extensively studied, yet it has not been approved as first‐line therapy in the current practice. We therefore performed a systematic review and meta‐analysis of relevant studies to generate robust evidence regarding the safety and efficacy of DOACs in CVT. This meta‐analysis demonstrates that the use of DOACs in CVT has similar efficacy and safety compared to VKAs with better recanalization rate. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic evolved rapidly, overwhelming health care systems around the world. The cost to life and socioeconomic burden prompted a search for new treatments and vaccines. Several collaborations developed and could deliver state-of-the-art vaccines with acceptable efficacy and safety in record time. Recently, vaccination with Oxford-AstraZeneca and Johnson and Johnson vaccines was halted due to the reported adverse effects of vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST). Although a detailed risk-benefit analysis led to their reinstitution, physicians across the world are still trying to understand the pathophysiology and mechanisms of these neurological adverse effects in order to better identify, diagnose, and treat them. One of the mechanisms that have been implicated is related to the adenovirus-based vector of these vaccines. COVISHIELD, which is the most widely administered vaccine in India, also shares the same vector. As India enters the next phase of vaccine distribution for younger adults, there are chances that such adverse effects may emerge. In this review, we analyze the temporary suspension of the administration of the vaccines due to VITT/CVST, summarize the existing guidelines about diagnosis and treatment of these neurological disorders as well as the need for increasing pharmacovigilance and awareness among physicians. Screening for potential risk factors, avoiding aggravating factors like dehydration, and providing choices in vaccinating the high-risk populations could help in avoiding these rare but potentially fatal adverse outcome. [ABSTRACT FROM AUTHOR]

Latar Belakang dan Tujuan: Trombosis sinus venosus serebral (TSVS) merupakan penyakit akibat oklusi struktur vena intrakranial, termasuk sinus serebral, vena korteks, dan bagian proksimal vena jugularis. Keterlambatan diagnosis dan terapi dapat mengakibatkan terjadinya komplikasi seperti infark berdarah bahkan kematian.Tujuan penelitian ini adalah untuk mengetahui karakteristik klinis pasien TSVS yang diagnosisnya telah dikonfirmasi melalui pemeriksaan DSA. Metode: Penelitian ini bersifat deskriptif observasional retrospektif. Pada pasien yang telah didiagnosis TSVS di Bagian Neurologi Rumah Sakit Hasan Sadikin Bandung periode Juni 2015 sampai November 2017. Hasil: Terdapat 33 subjek dengan rentang usia 40-49 tahun (24,2%) dan mayoritas adalah perempuan sebanyak 22 orang (66,7%). Faktor resiko terbanyak adalah infeksi 8 orang (24,2%), dan kondisi protrombotik sebanyak 6 orang (18,2%). Gejala klinis terbanyak adalah nyeri kepala yaitu 27 orang (81,8%). Lokasi sinus yang tersering mengalami trombosis adalah sinus transversus pada 28 orang dengan gejala mayoritas nyeri kepala. Kadar D-Dimer ditemukan meningkat dengan rata-rata 1,21 mg/L. Simpulan: Pasien TSVS terjadi pada perempuan dengan rentang usia dekade pertengahan dan faktor resiko terbanyak adalah infeksi. Nyeri kepala merupakan gejala paling sering. Lokasi trombosis mayoritas terjadi pada sinus transversus dan ditemukan peningkatan D-Dimer. Clinical Characteristics of Cerebral Venous Sinus Thrombosis (CVST) Patients in Neurology Ward Hasan Sadikin General Hospital Bandung Abstract Background and Objective: CVST is an entity caused by intracranial vein, including cerebral sinuses, cortical vein and proximal part of the jugular vein. A delay in diagnosing and treating can result in brain infarct with hemorrhagic transformation, even death. The goal of this study is to learn the clinical characteristics of patients with CVST that had been confirmed by DSA. Method: This was a retrospective observational descriptive study and subjects were hospitalized patients which had been diagnosed CVST in Neurology ward Hasan Sadikin General Hospital from June 2015 to November 2017. Results: there was 33 subjects with most (22 patient/66.7%) being women between 40-49 years old. In this study the most frequently found risk factor was infection in 8 subjects (24.2%), prothrombotic conditions in 6 subjects (18.2%). The clinical manifestations were mainly headache in 27 subjects (81,8%). The sinus most often involved was the transverse sinus (28 subjects) with the clinical manifestation being headache. D-dimer levels were also increased with mean 1.21 mg/dl. Conclusion: CVST patients are mostly in women at the midle age of decade, with infection being the most frequent risk. Headache was the most frequent clinical manifestation. Location of thrombosis were more often found on the transverse sinus and D-Dimer level was increased.

Introduction: Cerebral venous sinus thrombosis (CVST) is rare; however, it has been observed in patients with vaccine-induced immune thrombotic thrombocytopaenia syndrome (VITT) following the use of adenovirus vector vaccines against COVID-19. Adverse vaccine effects have been heavily addressed in mainstream media, likely contributing to vaccination anxiety. This study aimed to assess how the vaccine rollout and media coverage has influenced the use of computed tomography venography (CTV) in an acute care setting of a tertiary hospital.Method: Single-centre retrospective cohort study from 30 March 2021 to 13 June 2021. Direct comparison to same calendar dates in the preceding 3 years.Results: In 2021, 57 patients received CTV with headache being the reason in 48 (84%) and 40 (70%) had received ChAdOx1 nCov-19 (AstraZeneca COVID-19 vaccination). Only 20 of these patients received CTV after platelets and D-Dimer had returned, and only three patients met existing guidelines for imaging. Zero cases were positive. The number of CTV studies was 5.2 times than in 2020 and 2.7 times the mean number for the 3 preceding years.Conclusion: The use of CTV in patients with headache has markedly increased at our centre since negatively biased vaccination influence of mainstream media. Headache is a common vaccine-related side effect and VITT is exceptionably rare. With the rates of vaccination increasing in the community, these results highlight the importance of strict adherence to established evidence-based guidelines. Otherwise, critical care capacity, and in particular imaging resources already under pressure will be strained further. [ABSTRACT FROM AUTHOR]

Background and purpose: Cerebral venous sinus thrombosis (CVST) has been described after vaccination against SARS‐CoV‐2. The clinical characteristics of 213 post‐vaccination CVST cases notified to the European Medicines Agency are reported. Methods: Data on adverse drug reactions after SARS‐CoV‐2 vaccination notified until 8 April 2021 under the Medical Dictionary for Regulatory Activities Term 'Central nervous system vascular disorders' were obtained from the EudraVigilance database. Post‐vaccination CVST was compared with 100 European patients with CVST from before the COVID‐19 pandemic derived from the International CVST Consortium. Results: In all, 213 CVST cases were identified: 187 after AstraZeneca/Oxford (ChAdOx1 nCov‐19) vaccination and 26 after a messenger RNA (mRNA) vaccination (25 with Pfizer/BioNTech, BNT162b2, and one with Moderna, mRNA‐1273). Thrombocytopenia was reported in 107/187 CVST cases (57%, 95% confidence interval [CI] 50%–64%) in the ChAdOx1 nCov‐19 group, in none in the mRNA vaccine group (0%, 95% CI 0%–13%) and in 7/100 (7%, 95% CI 3%–14%) in the pre‐COVID‐19 group. In the ChAdOx1 nCov‐19 group, 39 (21%) reported COVID‐19 polymerase chain reaction tests were performed within 30 days of CVST symptom onset, and all were negative. Of the 117 patients with a reported outcome in the ChAdOx1 nCov‐19 group, 44 (38%, 95% CI 29%–47%) had died, compared to 2/10 (20%, 95% CI 6%–51%) in the mRNA vaccine group and 3/100 (3%, 95% CI 1%–8%) in the pre‐COVID‐19 group. Mortality amongst patients with thrombocytopenia in the ChAdOx1 nCov‐19 group was 49% (95% CI 39%–60%). Conclusions: Cerebral venous sinus thrombosis occurring after ChAdOx1 nCov‐19 vaccination has a clinical profile distinct from CVST unrelated to vaccination. Only CVST after ChAdOx1 nCov‐19 vaccination was associated with thrombocytopenia. [ABSTRACT FROM AUTHOR]

Objectives: Several cases of unusual thrombotic events with thrombocytopenia were reported in several countries, in association with AstraZeneca's COVID-19 vaccine. The European medicines agency conducted a detailed review and concluded that there was no evidence to suggest an association of thrombotic events with the use of COVID-19 vaccine AstraZeneca. Methods: King Abdulaziz Medical City is a 1500 bed tertiary care hospital in Riyadh, Saudi Arabia; this study describes spontaneously reported vaccine adverse effects received through the hospital's internal electronic safety reporting system from December 2020 to 13 April 2021. We assessed each report for causality association utilizing the world health organization's (WHO) causality assessment of an adverse event following immunization (AEFI) classification 2nd Edition 2019. Results: The majority of the reported events were mild to moderate, there were five serious events, one reported cardiac arrest, two cerebral venous sinus thrombosis, and two pulmonary embolism. Clinical and laboratory summary of the five patients are presented in detail. Conclusions: Efforts of pharmacovigilance in mediating the rare risk of thrombosis associated with COVID-19 vaccine are crucial in providing awareness on the possible risk factors and signs/symptoms that should raise red flags. [ABSTRACT FROM AUTHOR]

Objectives. Optic nerve sheath fenestration (ONSF) is commonly used in idiopathic intracranial hypertension (IIH). Here we will present our experiences of ONSF in 26 patients with special attention to indications, surgical techniques and results Methods. The recorded data of patient management (with the result) who underwent ONSF were reviewed and studied retrospectively. Results. The total number of patients who underwent ONSF was 26. The male-female ratio was 1:12. Indications of ONSF were: 1. Idiopathic Intracranial Hypertension (IIH)-23 cases; 2. Cerebral Venous Sinus Thrombosis (CVST)-02 cases; 3. CNS Tuberculosis-01case. All patient underwent bilateral ONSF with post-operative continues lumbar CSF drain for 04 days. After fenestration gush of CSF came out with force in all-first operated eyes whereas 13-second operated eyes showed very little CSF flow after fenestration. Vision improved in different grades in all cases at discharge except in three cases. Preoperatively, visual acuity was either PL&PR or hand movement in 40 eyes where 04 eyes were preoperatively total blind (no PL&PR). Visual acuity improved in 48 eyes (92.3% eyes) where the patient can do his/her daily life activities including self-care. Improvement in IIH is 100% (23 cases i.e-46 eyes) whereas 01 case out of 02 cases in CVST. Though vision was improved dramatically fundal appearances changes very slowly and very less frequently returned to normal appearance. Conclusion. Due to the delicate and technically demanding nature of the surgery, safety is a major concern of the ONSF. Our experience showed ONSF is a technically safe operation with very good results where indicated.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. Although the patient received immediate anticoagulant and intravenous immune globulin treatment, he died within 24 h after hospital admission. VITT and CVST are rare conditions; however, the course may be fatal. Therefore, clinicians should be familiarized with the clinical and laboratory features of VITT.

Cerebral venous sinus thrombosis (CVST) adalah suatu sindrom seperti stroke, angka kejadiannya sangat jarang, sehingga dapat menjadi dilema bagi dokter di instalasi gawat darurat dalam menegakkan diagnosis. Seorang lelaki 25 tahun, 50 kg, tinggi badan 165 cm, mengeluh lemah anggota badan sebelah kanan sejak 12 jam sebelum masuk rumah sakit. Keluhan disertai dengan sukar berbicara. Satu hari sebelum masuk rumah sakit, pasien mabuk-mabukan dan mengalami muntah-muntah ± 3–5 x/hari. Riwayat kejang, konsumsi obat-obatan dan trauma sebelumnya disangkal. Tidak ada riwayat demam, hipertensi, diabetes mellitus dan penyakit penyerta lainnya. Dilakukan dekompresi evakuasi perdarahan sebagai tindakan penyelamatan jiwa setelah pasien terehidrasi, operasi dilakukan dalam anestesi umum. Lama operasi selama 2 jam dan lama pasien teranestesi 2 jam 15 menit. Pasien dirawat di ICU selama 2 hari, lalu dipindahkan ke ruang HCU. Pada hari ke-5 pascabedah mulai diberikan enoxaparin sodium 50 mg subcutan selama 6 hari. Lalu pasien dipindahkan ke ruang rawat inap dan pulang ke rumah pada hari ke-15 perawatan. Target pencapaian utama pada pasien CVST adalah untuk rekanalisasi penyumbatan, menjaga venous return, mengurangi risiko hipertensi vena, infark serebral dan emboli paru. Algoritma tatalaksana pasien CVST terkadang harus disesuaikan dengan kondisi klinis pasien saat tiba di rumah sakit. Pemberian low-weightmoleculer heparin (LWMH) tetap diberikan selama tidak terjadi peningkatan tekanan darah yang bermakna Cerebral Venous Sinus Thrombosis Management with Alkoholic and Intracerebral Hemorrhage Cerebral venous sinus thrombosis (CVST) is a syndrome similar a stroke, the incidence is very rare, so it can be a dilemma for doctors at emergency departments to make the diagnosis. A 25 year old male weighing 50 kg and height 165 cm. Patients complained of right limb wekness since 12 hours before admission. Complaints are accompanied by difficulty speaking. One day before entering the hospital, the patient got drunk and experienced vomiting ± 3–5 times a day. History of seizures, previous consumption of drugs and trauma was denied. No history of fever, hypertension, diabetes mellitus and other comorbidities. Decompression by hematoma evacuation was performed as a life-saving action after the patient was hydrated, surgery was performed under general anesthesia. Operation duration was 2 hours and anesthesia duration was 2 hours 15 minutes. The patient was admitted to the ICU for 2 days, then transferred to the HCU room. On the 5th day post-surgery patient got 50 mg subcutaneous enoxaparin for 6 days. Then the patient was transferred to the ward and returned home on the 15th day of treatment. The main achievement targets in CVST patients were for clotting recanalization, maintaining venous return, reducing the risk of venous hypertension, cerebral infarction and pulmonary embolism. The CVST patient management algorithm sometimes has to be adjusted to the patient's clinical condition upon arrival at the hospital. Provision of LWMH is still given as long as the blood pressure does not increase significantly.

Bacterial meningitis is a life-threatening condition and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous and sinus thrombosis (CVST) is an uncommon type of these complications, especially in meningococcal meningitis. The initiation of anticoagulant in septic thrombosis is controversial. A 35-year-old man was admitted to a hospital with fever and confusion. The diagnosis of N. meningitidis meningitis was established. Antimicrobial regimen (ceftriaxone) was continued. On the 3rd day, the patient's consciousness was improved; however, according to the patient's headache on day 7, brain imaging was performed which revealed a cerebral thrombosis in transverse and sigmoid sinuses. Although initiation of anticoagulant is controversial in septic thrombosis, the anticoagulant treatment also was started. Control brain magnetic resonance venogram done revealed complete resolution of cerebral CVST after 2 weeks. CVST as a complication of meningococcal meningitis should be considered. Anticoagulant treatment may be considered in the management of septic cerebral thrombosis if there are no contraindications. The use of anticoagulant needs further studies.

Background: To our knowledge, this is the first report of patient with BHD syndrome caused by a novel mutation in the FLCN gene who developed a cerebral venous sinus thrombosis(CVST). Case presentation: A 62-year-old male patient with a history of hypertension and two case of spontaneous pneumothorax. He had a 1-month history of headache and was admitted to the hospital one day after the headache aggravated. The patient had a family history of BHD syndrome which was confirmed by FLCN gene sequencing. Sequencing analysis revealed a novel nonsense mutation (NM_144997; c.607A > T; p.Lys203Ter) in the FLCN gene exon 6 of the patient, which was proved to be a pathogenetic mutation by pedigree verification. BHD syndrome was finally definitive diagnosis. Low molecular weight heparin (21 days) was given for anticoagulant therapy before and after resection of renal tumor which is confirmed to be clear cell carcinoma in the kidney. After discharge, warfarin was given for anticoagulant therapy (6 months). Conclusions: There was no recurrence of CVST. And no recurrence of tumor and new renal tumor were found in renal MRI examination after 6 months. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) in children is rare in a clinical setting. The aim of this study was to summarize the etiological, clinical, and imaging characteristics of CVST in children.Methods: We retrospectively analyzed the data of 30 patients with a diagnosis of CVST who were admitted to Children's Hospital of Fudan University from 2008 to 2018. The medical records, including clinical manifestations, laboratory data, neurological findings, treatment, and short-term prognosis were analyzed.Results: Etiologically, the causes of CVST were infection (7/30), tumor (3/30), nephritis or nephrotic syndrome (8/30), traumatic brain injury (1/30), and undefined disease (11/30). All 30 cases were diagnosed with CVST after a neuroimaging examination using brain magnetic resonance imaging (MRI) combined with magnetic angiography venography (MRV). With regard to short-term prognosis, all the patients were treated with anticoagulants, after which 26 cases improved.Conclusions: CVST patients do not typically present with specific clinical manifestations, which leads to a high rate of misdiagnosis and delayed therapy. Increased consideration and prompt MRV checkup plays a key role in achieving an accurate diagnosis. Overall, anticoagulation is a safe and effective treatment for CVST.

Background: Cerebral venous sinus thrombosis (CVST) presents with a wide variety of neurological symptoms in various combinations and has a high mortality rate of up to 50%. Recent advances in neuroimaging and therapeutic interventions have brought it down to 10%-20%. The study aims to identify critical prognostic factors associated with poor outcomes in patients with CVST., Materials and Methods: All cases of CVST aged >18 years from July 2015 to July 2020 who were not terminally ill and bedridden before the illness were evaluated at the entry point for various risk factors and after 30 days for outcome assessment with the modified Rankin scale (mRS). The outcome was dichotomized, applying mRS <3 as a good outcome, and analyzed with the Chi-square test or the Fischer's exact test in a bivariate analysis to identify associated variables., Results: A total of 149 subjects were studied. Glasgow Comma Scale (GCS) <9 ( P <0.001), focal neurological deficits ( P = 0.05), the presence of a mass effect ( P <0.001), and the need for decompressive hemicraniectomy ( P <0.001) were associated with poor outcomes. Age, gender, diagnostic delay, seizures at onset, papilledema, parenchymal lesions, deep sinus involvement, and multiple sinus thrombosis were not associated with a poor outcome., Conclusion: In our study, early diagnosis and treatment of CVST is associated with an overall favorable outcome even in the presence of traditional poor prognostic factors such as age, seizures at onset, deep sinus involvement, and multiple sinus involvement in the face of conventional risk factors. A large country-wide prospective study might help in elucidating the poor prognostic factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Annals of Indian Academy of Neurology.)

There are many uncontrollable factors in the pathogenesis of cerebral venous sinus thrombosis (CVST). In order to further explore the pathophysiology and morphology of CVST, it is necessary to establish a highly compatible CVST animal model that can standardize the site and stage of venous thrombosis. The present study employed the insertion of a self-made thread embolism into the superior sagittal sinus (SSS) to establish a rat model of SSS occlusion that emulates CVST. The thread embolism was removed after 6 h of SSS occlusion in order to achieve recanalization. After successful preparation of the model, the cerebral blood flow (CBF) status and ultrastructural changes of the blood–brain barrier (BBB) were monitored. This CVST model was able to achieve continuously high occlusion of SSS. The parasagittal venous-collateral circulation underwent extensive compensation and recombination, which alleviated blood flow stasis and brain tissue hypoxia caused by restricted reflux. Removing SSS occlusion significantly improved cerebral circulation, reduced brain edema, and accelerated the receding of brain edema. This study established a new model of acute occlusion and recanalization of SSS in rats via a thread-embolism method, which standardized the ischemic site and stage of venous thrombosis. In addition, our study suggests that promoting collateral circulation may be a potential treatment for promoting brain protection. • A model of acute occlusion and recanalization of the SSS has been established. • Brain edema after SSS occlusion is slightly reversible. • Compensatory effect of venous collateral circulation can improve brain edema. • Early removal of the SSS occlusion can improve cerebral blood circulation. [ABSTRACT FROM AUTHOR]

The term "spot sign" was coined by Wada et al in 2007 and thought to be due to ongoing arterial bleeding in primary intraparenchymal haemorrhage (IPH). 1 Spot sign has also been described in the context of intraventricular haemorrhage (IVH). 2 Over the years arterial spot signs have been found to correlate with intraparenchymal hematoma expansion, worse clinical outcomes and increased risk of surgical intervention. 3 We are describing a unique instance of a spot sign in venous sinus thrombosis that initially misled the clinical diagnosis. An 83-year-old woman on dual antiplatelet therapy, with a history of minor stroke, presented with sudden right-sided weakness and dysarthria. Serial CT brain imaging revealed rapidly enlarging intraparenchymal haemorrhage (IPH). Contrast enhanced CT displayed multiple spot signs typically associated with arterial bleeding pattern. Initially possibility of antithrombotic related IPH was kept, however venogram confirmed venous pathology with focal superior sagittal sinus thrombosis (SSS). Unfortunately, the patient deteriorated and eventually succumbed to the illness before the diagnosis could be made. The case exemplifies the potential of venous sinus thrombosis to manifest as a spot sign, thereby emphasizing the need for a broader differential diagnosis. The rarity of venous spot signs may be attributed to patient-specific venous anatomy and poor collateralization in the occluded sinus territory. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men., Patients and Methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men., Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x10 9 /L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ., Discussion and Conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.S. has received a grant from Swiss Heart Foundation; C.C. has received speaker honoraria from Boehringer Ingelheim, personal fees for advisory board participation from AstraZeneca and Biogen, and personal fees for steering committee participation from Biogen and Bristol Myers Squibb; T.J.K. has received educational meeting cost assistance from Boehringer Ingelheim; T.S.F. receives in-kind study medication from Bayer Canada and advisory board honoraria from HLS Therapeutics; S.P. received research support from BMS/Pfizer, Boehringer-Ingelheim, Daiichi Sankyo, European Union, German Federal Joint Committee Innovation Fund, and German Federal Ministry of Education and Research, Helena Laboratories and Werfen as well as speakers’ honoraria/consulting fees from Alexion, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichi Sankyo, Portola, and Werfen (all outside the submitted work); R.L. reports fees paid to his institution for consultancy by Boehringer Ingelheim, Genentech, Ischemaview, Medtronic and Medpass; E.L. has received academic grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG 942851), Swedish Neurologic Society, Elsa and Gustav Lindh’s Foundation, Wennerströms’ Foundation, P-O Ahl’s Foundation and Rune and Ulla Amlöv’s Foundation for research on CVT; A.C. received speaker grants from Alexion Pharma, Italfarmaco, and Daiichi-Sankyo; M.W. has received consulting fees from Portola/Alexion; C.J. has received speaker honoraria from Alexion, CSL Behring, TEVA and Sanofi Genzyme, personal fees for advisory board participation from Alexion, Roche, Novartis and Merck Serono; H.K. has received personal fees for consulting and data safety monitoring board activities for Octapharma, Grifols, CSL Behring, UCB, Argenx, Takaeda, Alexion and his institution has received clinical trial support from Takaeda; S.N. has received consulting fees from Brainomix and lecture fees from Boehringer Ingelheim and BMS Pfizer; T.G. has received travel grants and speaker honoraria from Boehringer Ingelheim, Bayer, Novartis, BMS / Pfizer and Alexion; A.G. has received personal fees from Bayer Vital, Bristol Myers Squibb, and Daiichi Sankyo; K.J. has received academic grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG 965417) for research on CVT; T.T. has received personal fees from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Inventiva, and Portola Pharma; D.A.S. reports travel support from Boehringer Ingelheim, speaker fees from Bayer, and Advisory Board participation for AstraZeneca; J.M.F. has received personal fees from Boehringer Ingelheim, Bayer, and Daiichi Sankyo as well as grants from Bayer; J.M.C. has received grants paid to his institution from Boehringer Ingelheim and Bayer, and payments paid to his institution for data safety monitoring board participation by Bayer; M.A. reports personal fees from AstraZeneca, Bayer, Bristol Myers Squibb, Covidien, Daiichi Sankyo, Medtronic, Novartis, Pfizer, and Amgen; M.R.H. reports grants from the Swiss Heart Foundation and from the Bangerter Foundation, and Advisory Board participation for Amgen. All other authors have nothing to disclose.

Background: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication of adenoviral vector-based vaccines against SARS-CoV-2. This syndrome is caused by antibodies against platelet factor 4 (PF4; CXCL4) that lead to platelet activation and is characterized by thrombocytopenia and thrombosis in unusual locations, including cerebral venous sinus thrombosis (CVST). VITT can be classified based on anti-PF4 antibodies properties in vitro: those that require PF4 to activate platelets (PF4-dependent) and those that can activate platelets without additional PF4 (PF4-independent) in the serotonin release assay., Objectives: We aim to characterize the relationship of VITT platelet-activating profiles with CVST., Methods: We conducted a retrospective cohort study involving patients with confirmed VITT who were tested between March and June 2021. Data were collected with an anonymized form and cases were identified as VITT with high clinical suspicion according to platelet activation assays. Anti-PF4 antibody binding regions on PF4 were further characterized with alanine scanning mutagenesis., Results: Of the patients with confirmed VITT (n = 39), 17 (43.6%) had PF4-dependent antibodies and 22 (56.4%) had PF4-independent antibodies. CVST occurred almost exclusively in PF4-independent patients (11 of 22 vs 1 of 17; P < .05). Additionally, PF4-independent antibodies bound to 2 distinct epitopes on PF4, the heparin-binding region and a site typical for heparin-induced thrombocytopenia antibodies, whereas PF4-dependent antibodies bound to only the heparin-binding region., Conclusion: These findings suggest that VITT antibodies that cause PF4-independent platelet activation represent a unique subset of patients more likely to be associated with CVST, possibly due to the 2 different types of anti-PF4 antibodies., Competing Interests: Declaration Of Competing Interests There are no competing interests to disclose., (Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Most patients with cerebral venous sinus thrombosis (CVST) treated with anticoagulation have good outcomes. We examined which factors were associated with poor outcomes after treatment. We retrospectively reviewed patients ≥18 years old who were diagnosed with CVST between 1997 and 2015. Good (modified Rankin score [mRS] ≤2) and poor outcomes were dichotomized. Demographic, historical, clinical, imaging, and treatment characteristics were compared. Eighty-nine patients received treatment for CVST (52.8% males, 74.2% Caucasian). Sixty-eight (76.4%) had good outcomes and 21 (23.6%) had poor outcomes. Poor outcome was associated with systemic or central nervous system (CNS) infection (p = 0.002), lower use of heparin-only therapy than interventional-only treatments (p = 0.003), and increased use of craniectomy (p = 0.002). Good outcomes were associated with migrainous headache on presentation (p = 0.01) and involvement of superficial cortical vessels only (p = 0.02). No prothrombotic or imaging findings correlated with poor outcome. Multivariable analysis showed that any clinical risk factor (p = 0.02) and headache (p = 0.02) predicted improved outcome whereas systemic or CNS infection (p = 0.02) and craniectomy (p = 0.02) predicted poor outcome. A published risk score showed a moderate ability to predict good outcome but not poor outcome. Overall sensitivity (23.8%), specificity (75.0%), and positive (24.0%) and negative (77.0%) predictive value suggested moderate prediction of good outcome and limited prediction of poor outcome. Rates of poor outcomes in CVST were comparable with previous investigations (23.6%), but prediction of poor outcome remains challenging in patients with CVST. Our results suggested that systemic infection and craniectomy were the most robust predictors of poor outcome. [ABSTRACT FROM AUTHOR]