Search

Background: The relationship between venous thromboembolism and both insulin resistance and metabolic syndrome is still a matter of debate. The objective of this work was to investigate the possible association between cerebral venous sinus thrombosis (CVST) and both insulin resistance and metabolic syndrome. We aimed also to assess micro-RNA-122 serum levels in patients with CVST in comparison to controls. Methods: This case-control study was conducted on patients having a clinical and neuroimaging diagnosis of acute CVST (within 1 week from the onset). Patients with inconclusive brain imaging, those with a history of malignancy, diabetic patients, and patients on drugs known to affect the insulin sensitivity or lipid profile were excluded from the study. Metabolic syndrome in the included cases and controls was evaluated by measuring waist circumference and blood pressure in addition to assessment of Triglycerides, HDL, and fasting blood sugar. The state of insulin resistance was established if the Homeostasis model assessment–insulin resistance (HOMA-IR) value > 2.5. Serum micro-RNA-122 serum level was measured for both patients and controls. Results: In the present study, 36 cases diagnosed as having CVST and 34 age & sex matched controls were included. There were statistically significant differences between patients with CVST and controls regarding BMI, waist circumference, TG, fasting glucose, fasting insulin & HOMA- IR (P-value = 0.002, 0.001, 0.004, 0.003, 0.021, 0.008 respectively). There was no statistically significant difference between patients with CVST and controls regarding micro-RNA-122 serum level (P-value = 0.376), whereas CVST patients with insulin resistance had a significantly higher micro-RNA-122 serum level in comparison to those without (P-value < 0.001). Patients with CVST had a significantly higher frequency of both metabolic syndrome and insulin resistance in comparison to controls (P-value = 0.008, 0.002 respectively). Conclusion: There is a significant association between CVST and both insulin resistance and metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST), a serious cerebrovascular and neurological emergency, is common in pregnant individuals and accounts for approximately 0.5–1.0% of all cerebrovascular diseases. However, CVST with cryptococcal meningoencephalitis in immunocompetent pregnant patients is rare. Case presentation: A 30-year-old woman who was 33 weeks pregnant presented with recurrent dizziness, headache, and vomiting as the main clinical manifestations, all of which were initially nonspecific. After assessment of the cerebrospinal fluid, skull computerized tomography, magnetic resonance imaging, and other laboratory and imaging examinations, the patient was diagnosed with secondary pregnancy-related CVST with cryptococcal meningoencephalitis. Despite receiving potent anticoagulant and antifungal treatment, the patient's condition deteriorated, and the patient's family opted to cease treatment. Conclusions: We present a rare case of CVST with cryptococcal meningoencephalitis in an immunocompetent pregnant patient. The difficulty of diagnosing and treating secondary pregnancy-related CVST caused by cryptococcal meningoencephalitis, as well as the great challenges faced at present are highlighted. One crucial lesson from the present case is that when clinical and imaging signs are unusual for CVST during pregnancy, it is essential to account for the possibility of other central nervous system (CNS) diseases, such as CNS infections with Cryptococcus, which may cause CVST. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis has not been reported in anti-N-methyl-d-aspartate receptor-antibody encephalitis in the absence of an underlying thrombotic state while rituximab induced cerebral venous sinus thrombosis is rarely reported. We report a patient with anti-N-methyl-d-aspartate receptor-antibody encephalitis without a prothrombotic state who developed cerebral venous sinus thrombosis following rituximab treatment. Case presentation: A 15-year-old Sri Lankan girl who had been in remission following an episode of anti-N-methyl-d-aspartate receptor-antibody encephalitis 2 years ago, presented with a relapse of anti-N-methyl-d-aspartate receptor-antibody encephalitis characterized by recurrent seizures, mutism, and cognitive abnormalities. Since response was inadequate to first-line immunotherapy, she was administered four doses of rituximab at weekly intervals. Two days after the fourth dose, she developed increasing headaches, and her cranial magnetic resonance venogram confirmed the development of cerebral venous sinus thrombosis. Screening for prothrombotic states were negative. She made an unremarkable recovery following anticoagulation. Conclusion: This case highlights the occurrence of the rare but serious complication of cerebral venous sinus thrombosis following rituximab in the context of anti-N-methyl-d-aspartate receptor-antibody encephalitis and informs the clinician to be wary of new onset headache in patients with anti-N-methyl-d-aspartate receptor-antibody encephalitis treated with immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening subtype of stroke. Prompt and appropriate anticoagulation is crucial for improving the prognosis of CVST and preventing its recurrence. Identifying the underlying cause of CVST is decisive for guiding anticoagulant selection and determining treatment duration. Case Presentation: A 50-year-old man presented with a 35-day history of headache, nausea, vomiting, and blurred vision. Digital subtraction angiography performed at another facility revealed CVST. A contrast-enhanced black-blood MRI at our center confirmed the diagnosis, which was supported by a high intracranial pressure of 330mmH2O. Laboratory tests showed elevated leukocytes and platelet counts, raising suspicion of an underlying myeloproliferative neoplasms (MPNs). A bone marrow biopsy demonstrated increased megakaryocytes and granulocytes, and genetic testing identified the presence of the Janus kinase 2 V617F (JAK2 V617F) mutation, leading to a diagnosis of pre-primary myelofibrosis (pre-PMF). During hospitalization, anticoagulation with nadroparin calcium and fibrinolytic therapy were initiated. Upon discharge, rivaroxaban and aspirin were prescribed to prevent CVST recurrence and arterial thrombosis. Conclusion: This case highlights the importance of recognizing dynamic changes in routine blood tests that may link CVST to underlying hematological disorders. The JAK2 mutation is not only associated with MPNs but also increases the risk of thrombosis, including CVST. Further investigation is warranted to better understand the mechanisms by which JAK2 mutations contribute to thrombosis and to explore the potential benefits of JAK2 inhibitors in reducing this risk. [ABSTRACT FROM AUTHOR]

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]

Objectives: We aimed to identify conditions mimicking nervous system involvement among patients with Behçet's syndrome (BS) and to determine clinical, laboratory and imaging findings that may help in the differential diagnosis. Methods: We screened the charts of 500 consecutive BS patients to identify those who were referred to neurology at any time during their follow-up. The final diagnoses, presenting signs and symptoms, laboratory and imaging results were retrieved from patient charts. Patients who did not have a follow-up visit during the last 3 months were invited to the clinic. Results: Among the 500 BS patients, 116 (23%) had been referred to neurology. Among these, 29 (5.8%) were diagnosed with typical central nervous system involvement of BS (NeuroBS). The type of NeuroBS was parenchymal involvement in 21 patients, cerebral venous sinus thrombosis in 7 patients, and both in 1 patient. 30 patients (6%) had other conditions related to the nervous system, 46 (9.2%) did not have a nervous system disorder, and their symptoms recovered spontaneously, and 11 (2.2%) were lost to follow-up without a definite diagnosis. Of the 30 BS patients who were diagnosed with another nervous system condition, 14 (46%) had primary headache syndromes, 6 (20%) had psychiatric disorders, 2 had entrapment neuropathy, and 1 each had epilepsy, glial tumor, multiple sclerosis, Meniere's disease, optic neuritis, neuroretinitis, steroid myopathy and polyneuropathy. Conclusion: Nervous system conditions other than NeuroBS are frequent among BS patients referred to neurology. Caution is required to avoid misdiagnosis of these patients as NeuroBS. [ABSTRACT FROM AUTHOR]

Juvenile neurolupus presents primarily with neuropsychiatric manifestations which may also be the initial presentation. Such primary neuropsychiatric SLE (NPSLE) events are a consequence either of microvasculopathy and thrombosis, or of autoantibodies and inflammatory mediators. Diagnosis of NPSLE requires the exclusion of other causes, and clinical assessment directs the selection of appropriate investigations. These investigations include measurement of autoantibodies, analysis of cerebrospinal fluid, electrophysiological studies, neuropsychological assessment and neuroimaging to evaluate brain structure and function. In our patient, the disease presented with chronic headache initially diagnosed as migraine, followed by fever and paraparesis. Fundoscopy showed retinal haemorrhages. Investigations revealed anaemia, neutrophilic leucocytosis, thrombocytopenia and raised inflammatory markers (ESR 119 mm/h CRP 58 mg/L) and high globulin. MRI brain showed diffuse meningeal enhancement resembling meningitis but CSF analysis was normal. ANA and dsDNA were positive with low C3, C4. All diffuse meningeal enhancements may not be meningitis and one needs to corroborate all the clinical, biochemical and imaging analyses to come to a diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Post-traumatic cerebral venous sinus thrombosis (ptCVT) is a rare but serious complication of traumatic brain injury (TBI). Managing ptCVT is challenging due to the concurrent risk of traumatic intracranial hematoma (ICH) expansion. Limited data exists on the safety and efficacy of anticoagulation therapy (ACT) in these cases. Methods: This single-center observational cohort study included adult TBI patients with concurrent ICH and ptCVT. Low-molecular-weight heparin (LMWH) or heparin infusion was used to treat all ptCVTs based on institutional protocols. The outcomes of interest were hemorrhagic and thrombotic complications. Results: Out of 1,039 TBI-patients admitted between 2006 and 2020, 32 met the inclusion criteria. The median time from injury to ptCVT diagnosis was 24 h. ACT was initiated at a median of 9 h after ptCVT diagnosis. Patients were administered either heparin infusion (n = 8) or LMWH at dosages ranging from 28 to 72% of the therapeutic level (n = 24). There were no hemorrhagic complications, even in patients receiving LMWH at ≥ 50% of the therapeutic dose. Thrombotic complications occurred in 3 patients (9.4%) – two cases of thrombus progression and one venous infarct. The patients who developed thrombotic complications differed from those who did not by having a 17-h delay in ACT initiation after diagnosis or by receiving an initial LMWH dose at 28% of the therapeutic level. Conclusion: LMWH at approximately 50% of the therapeutic level was effective for managing ptCVT associated with TBI in our retrospective dataset, with no risk of hematoma expansion. Prospective trials are warranted to confirm these results. [ABSTRACT FROM AUTHOR]

Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalize obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy can be an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction. [ABSTRACT FROM AUTHOR]

Abstract Background The relationship between venous thromboembolism and both insulin resistance and metabolic syndrome is still a matter of debate. The objective of this work was to investigate the possible association between cerebral venous sinus thrombosis (CVST) and both insulin resistance and metabolic syndrome. We aimed also to assess micro-RNA-122 serum levels in patients with CVST in comparison to controls. Methods This case-control study was conducted on patients having a clinical and neuroimaging diagnosis of acute CVST (within 1 week from the onset). Patients with inconclusive brain imaging, those with a history of malignancy, diabetic patients, and patients on drugs known to affect the insulin sensitivity or lipid profile were excluded from the study. Metabolic syndrome in the included cases and controls was evaluated by measuring waist circumference and blood pressure in addition to assessment of Triglycerides, HDL, and fasting blood sugar. The state of insulin resistance was established if the Homeostasis model assessment–insulin resistance (HOMA-IR) value > 2.5. Serum micro-RNA-122 serum level was measured for both patients and controls. Results In the present study, 36 cases diagnosed as having CVST and 34 age & sex matched controls were included. There were statistically significant differences between patients with CVST and controls regarding BMI, waist circumference, TG, fasting glucose, fasting insulin & HOMA- IR (P-value = 0.002, 0.001, 0.004, 0.003, 0.021, 0.008 respectively). There was no statistically significant difference between patients with CVST and controls regarding micro-RNA-122 serum level (P-value = 0.376), whereas CVST patients with insulin resistance had a significantly higher micro-RNA-122 serum level in comparison to those without (P-value

Jiawei Zhao,1– 3,&ast; Kai Liu,1– 3,&ast; Qinqin Dai,2– 4 Mengmeng Zhang,2– 4 Shen Li,1– 3 Yuan Gao,1– 3 Hongbing Liu,1– 3 Xin Wang,1– 3 Yuming Xu,1– 3 Bo Song1– 3 1Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China; 2NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan Province, People’s Republic of China; 3Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan Province, People’s Republic of China; 4School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bo Song; Yuming Xu, Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China, Email fccsongb@zzu.edu.cn; xuyuming@zzu.edu.cnPurpose: The serum uric acid to lymphocyte ratio (ULR) is a systemic marker of inflammation, and it has been studied as an indicator of prognosis in cardiovascular disease. This study investigates the relationship between ULR and clinical outcomes in patients with cerebral venous sinus thrombosis (CVST).Patients and Methods: A total of 636 patients with CVST were included in the study and randomly divided into a training set (n = 445) and a testing set (n = 119) in a ratio of 7:3.Logistic regression analysis was employed to analyze the risk factors for poor outcomes. The nomogram was established using the training dataset, and its predictive performance was assessed with the testing dataset.Results: ULR accurately predicted poor outcomes in CVST and was linked to a higher likelihood of poor outcomes (OR=1.015, 95% CI: 1.003– 1.026, P = 0.013). Age, infection, intracranial hypertension, coma, and intracerebral hemorrhage were independent predictors of poor outcomes in CVST. Additionally, a new nomogram incorporating ULR was constructed to predict the risk of poor outcomes in CVST patients. The nomogram demonstrated good accuracy and reliability, as shown by the receiver operating characteristic curve, calibration curve, and decision curve analysis.Conclusion: ULR independently forecasted poor outcomes in patients with CVST. The novel nomogram incorporating ULR could provide CVST patients with personalized risk assessment and treatment plans, leading to improved patient prognosis.Keywords: serum uric acid to lymphocyte ratio, cerebral venous sinus thrombosis, outcomes, risk factors, nomogram

Abstract Background Cerebral venous sinus thrombosis (CVST), a serious cerebrovascular and neurological emergency, is common in pregnant individuals and accounts for approximately 0.5–1.0% of all cerebrovascular diseases. However, CVST with cryptococcal meningoencephalitis in immunocompetent pregnant patients is rare. Case presentation A 30-year-old woman who was 33 weeks pregnant presented with recurrent dizziness, headache, and vomiting as the main clinical manifestations, all of which were initially nonspecific. After assessment of the cerebrospinal fluid, skull computerized tomography, magnetic resonance imaging, and other laboratory and imaging examinations, the patient was diagnosed with secondary pregnancy-related CVST with cryptococcal meningoencephalitis. Despite receiving potent anticoagulant and antifungal treatment, the patient’s condition deteriorated, and the patient’s family opted to cease treatment. Conclusions We present a rare case of CVST with cryptococcal meningoencephalitis in an immunocompetent pregnant patient. The difficulty of diagnosing and treating secondary pregnancy-related CVST caused by cryptococcal meningoencephalitis, as well as the great challenges faced at present are highlighted. One crucial lesson from the present case is that when clinical and imaging signs are unusual for CVST during pregnancy, it is essential to account for the possibility of other central nervous system (CNS) diseases, such as CNS infections with Cryptococcus, which may cause CVST.

Abstract Background Cerebral venous sinus thrombosis has not been reported in anti-N-methyl-d-aspartate receptor-antibody encephalitis in the absence of an underlying thrombotic state while rituximab induced cerebral venous sinus thrombosis is rarely reported. We report a patient with anti-N-methyl-d-aspartate receptor-antibody encephalitis without a prothrombotic state who developed cerebral venous sinus thrombosis following rituximab treatment. Case presentation A 15-year-old Sri Lankan girl who had been in remission following an episode of anti-N-methyl-d-aspartate receptor-antibody encephalitis 2 years ago, presented with a relapse of anti-N-methyl-d-aspartate receptor-antibody encephalitis characterized by recurrent seizures, mutism, and cognitive abnormalities. Since response was inadequate to first-line immunotherapy, she was administered four doses of rituximab at weekly intervals. Two days after the fourth dose, she developed increasing headaches, and her cranial magnetic resonance venogram confirmed the development of cerebral venous sinus thrombosis. Screening for prothrombotic states were negative. She made an unremarkable recovery following anticoagulation. Conclusion This case highlights the occurrence of the rare but serious complication of cerebral venous sinus thrombosis following rituximab in the context of anti-N-methyl-d-aspartate receptor-antibody encephalitis and informs the clinician to be wary of new onset headache in patients with anti-N-methyl-d-aspartate receptor-antibody encephalitis treated with immunotherapy.

Abstract Background Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening subtype of stroke. Prompt and appropriate anticoagulation is crucial for improving the prognosis of CVST and preventing its recurrence. Identifying the underlying cause of CVST is decisive for guiding anticoagulant selection and determining treatment duration. Case Presentation A 50-year-old man presented with a 35-day history of headache, nausea, vomiting, and blurred vision. Digital subtraction angiography performed at another facility revealed CVST. A contrast-enhanced black-blood MRI at our center confirmed the diagnosis, which was supported by a high intracranial pressure of 330mmH2O. Laboratory tests showed elevated leukocytes and platelet counts, raising suspicion of an underlying myeloproliferative neoplasms (MPNs). A bone marrow biopsy demonstrated increased megakaryocytes and granulocytes, and genetic testing identified the presence of the Janus kinase 2 V617F (JAK2 V617F) mutation, leading to a diagnosis of pre-primary myelofibrosis (pre-PMF). During hospitalization, anticoagulation with nadroparin calcium and fibrinolytic therapy were initiated. Upon discharge, rivaroxaban and aspirin were prescribed to prevent CVST recurrence and arterial thrombosis. Conclusion This case highlights the importance of recognizing dynamic changes in routine blood tests that may link CVST to underlying hematological disorders. The JAK2 mutation is not only associated with MPNs but also increases the risk of thrombosis, including CVST. Further investigation is warranted to better understand the mechanisms by which JAK2 mutations contribute to thrombosis and to explore the potential benefits of JAK2 inhibitors in reducing this risk.

Cerebral venous sinus thrombosis (CVST) and hyperlipidemia are severe complications of L-Asparaginase (L-Asp) during the treatment of B-cell acute lymphoblastic leukemia (B-ALL). Herein, we reported a 9-year-old B-ALL boy who underwent abnormal hypertriglyceridemia and CVST presenting as seizures and disturbance of consciousness twice during the induction therapy. Fortunately, he survived treatment with anticoagulant and lipid-lowering therapy. No thrombophilia-related gene mutation was detected, but a heterozygous mutation in lipoprotein lipase (LPL) gene was identified. His neurological symptoms were managed with short-term anticoagulant therapy and long-term lipid-lowering therapy. This case illustrated the manifestation and potential pathogenesis of CVST and highlighted the essentiality of screening baseline lipid profile and dyslipidemia- and thrombophilia-related gene mutation.

Objectives: Cerebral venous sinus thrombosis (CVST) is a rare but serious manifestation of venous thrombosis in patients with antiphospholipid syndrome (APS). This study investigated the risk factors, clinical characteristics and prognosis of CVST in APS patients. Methods: This retrospective cohort study included all thrombotic APS (tAPS) patients from Peking Union Medical College Hospital (PUMCH) from April 2005 to August 2023. Demographic characteristics, laboratory data and thrombotic risk factors were compared between tAPS-CVST group and tAPS-non-CVST group. Kaplan–Meier survival analysis was utilized to compare the recanalization rate and the recurrence rate. Results: A total of 453 APS patients were enrolled, and 40 (8.8%) APS patients were with CVST. The median age of the APS-CVST patients was 27 (21.25, 32.75) years, and 72.5% were females. In 50% of these patients, CVST was the initial symptom of APS, with headache being the most prevalent clinical symptom (95%). Involvement of more than two venous sinuses were observed in 79.5% of patients, with the transverse sinus (79.5%) and sigmoid sinus (74.4%) being the most commonly affected sites. Oral contraceptives, intracranial infections and malignancy were identified as risk factors of APS-CVST. There were no statistically significant differences in baseline characteristics or the distribution of antiphospholipid antibodies profiles between the two groups. After a median follow-up of 24 (12, 52) months, 21 patients (52.5%) experienced recanalization, and 13 patients (32.5%) had a thrombotic recurrence. Survival analysis indicated that adequate anticoagulant therapy significantly contributed to recanalization (HR 6.27, 95% CI 2.616–15.02, P = 0.003), while continuous anticoagulant therapy was highly effective in reducing the recurrence of thrombotic events (HR 0.14, 95% CI 0.0447–0.4328, P = 0.0007). Conclusion: CVST should be considered in APS patients who experience sudden onset headaches, particularly those with thrombotic risk factors, such as the use of oral contraceptives, intracranial infections and malignancy. Continuous and adequate anticoagulant therapy is pivotal and beneficial for achieving recanalization and prevention of recurrence. Key Points • The prevalence of CVST in patients with APS may be underestimated. • APS-CVST is associated with special risk factors, including pregnancy, intracranial infection, oral contraceptives and tumors. • Long-term and adequate anticoagulation therapy can increase the vascular recanalization rate and reduce thrombosis recurrence. [ABSTRACT FROM AUTHOR]

Cerebral venous sinus thrombosis (CVST) illustrates multifactorial aetiology with varied clinical characteristics and is frequently linked to challenging diagnosis and inconstant prognosis, which necessitates for suitable medical skills and great suspicious index. The existing case report depicted the growth of dural arteriovenous fistula (DAF) due to CVST in young female patient with changed biochemical as well as radiological indicators. Twenty nine years old female patient was brought to hospital for dizziness and seizures. Glasgow Coma Scale was documented as E4 V5 M6 on first day of admission. Plain Computed Tomography outlined hypodensities in right basifrontal as well as periventricular areas close to frontal horn of right lateral ventricle. Cerebral Angio scan (DSA) showed elevated flow dural AV fistula of left transverse sigmoid junction. Serum urea (47 mg/dl) and serum creatinine (1.6 mg/dl) levels were found to be elevated. Patient was effectively operated through ‘endovascular embolization with Onyx’ as a part of emergency treatment protocol. She was supplemented with satisfactory postoperative care, followed up and discharged. Early clinical assessment, appropriate imaging technique and careful evaluation and treatment support can be key steps in managing patients of DAF following CVST. Onyx embolization may be practicable, active and lifesaving strategy in effective management of DAF accompanying with CVST in young patients. [ABSTRACT FROM AUTHOR]

A 21-year-old gentleman presented with low responsiveness and an unwitnessed tonic-clonic seizure. A 3-day history of fevers, headaches, and poor sleep was reported. He was initially treated for meningoencephalitis. Subsequently, he developed an erythematous rash over the face and chest. He had three generalised tonic-clonic seizures and his Glasgow Coma Score (GCS) deteriorated to 8 out of 15 requiring intubation and ventilation, and antiepileptics. Lumbar puncture (LP) results were unremarkable; however, the computed tomography (CT) head concluded bilateral haemorrhages and commented on the possibility of cerebral venous sinus thrombosis (CVST). Computed tomography venogram (CTV) confirmed CVST in the superior sagittal sinus, cortical vein and left transverse sinus. Repeat CT head revealed no new changes. Clinically, he exhibited residual left-sided weakness following stroke secondary to CVST. The patient was discharged with lifelong warfarin due to unprovoked CVST. He re-presented ten months later with persistent headaches. Clinical review noted bilateral papilloedema and he required LP to relieve raised intracranial pressure (ICP). In a 5-year follow-up, he continues to have raised ICP and associated headaches requiring further LPs. He continues to take warfarin, levetiracetam and topiramate, for headaches. This is an atypical case of CVST presenting initially with meningoencephalitis-like symptoms, demonstrating diverse clinical presentation. Ergo, this encourages an early multidisciplinary approach in presentations of headaches and seizures as clinical suspicion for CVST is high. Ultimately, this will appropriately identify patients for neuroimaging with computed tomography/magnetic resonance venogram. Furthermore, 5-year follow-up is presented in this case highlighting the importance of long-term follow-up in view of variable long-term complications that remain difficult to predict. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke. Acquired and inherited prothrombotic conditions are the most common risk factors for CVST. Sometimes, an etiology is not found. Wide utilization of next generation sequencing technologies in clinical practice may lead to identification of risk factors other than those classically associated with CVST. Method and Results: This retrospective clinical-laboratory observational study has a reference patient who presented with CVST as an adolescent. Work up for prothrombotic conditions showed high homocysteine level secondary to homozygosity for a common polymorphism, c.677 C > T in the methylenetetrahydrofolate reductase (MTHFR) gene. His older unaffected brother has a similar MTHFR genotype and high homocysteine. The whole exome sequencing revealed a likely pathogenic variant in the sodium voltage gated channel, alpha subunit 1(SCN1A) gene. Conclusion: CVST is a multifactorial disease. Prothrombotic conditions are the most common risk factors for CVST. High homocysteine due to the common MTHFR polymorphisms was previously attributed to various thrombotic conditions including CVST. Although high homocysteine due to MTHFR polymorphism may be a contributing factor, additional risk factors such as blood flow abnormalities during SCN1A related seizures may be needed for thrombosis. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but serious condition in both adults and children. Risk factors include thrombophilias, dehydration, and certain inherited conditions like sickle cell trait (SCT). We present a case of CVST in a pediatric patient with SCT to highlight key considerations in diagnosis and management. Case Presentation: A 14-year-old male with SCT presented with worsening headache and vomiting after prolonged sun exposure and dehydration during athletic camp. Imaging revealed right occipital hemorrhage, hydrocephalus, right CSVT, and bilateral cerebellar developmental venous anomalies. Hypercoagulability testing was normal. Diagnostic evaluation included computed tomography, magnetic resonance imaging, MR venography (MRV), and hypercoagulability testing. The patient was treated with an external ventricular drain, platelet transfusion, and anticoagulation. Management also involved hydration, platelet transfusion, supportive care, and multidisciplinary follow-up. Follow-up MRV showed recanalization. Conclusion: This case highlights SCT as a potential CVST risk factor. Timely recognition, evaluation of precipitants like dehydration, supportive care including anticoagulation, and multidisciplinary management are important. An individualized approach is needed to balance thrombosis recurrence and bleeding risks. Patients with SCT require education on risks and prompt evaluation of neurological symptoms to allow early diagnosis and care of CVST. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease that typically affects young females. Objectives: To describe the clinical, laboratory, and neuroimaging characteristics of CVST and evaluate the differences in characteristics of patients with unfavorable versus favorable outcomes. Methods: This retrospective study (2007 - 2018) reviewed all consecutive patients with CVST, assessing their demographic, clinical, laboratory, neuroimaging characteristics, and clinical outcomes. The modified Rankin Scale (mRS) was used to assess the functional outcomes of patients after a three-month follow-up. Factors affecting patients' outcomes (favorable [mRS ≤ 2] vs. unfavorable [mRS > 2]) were examined using the Independent t -test and chi-squared test. Results: A total of 141 patients (mean age: 38.15 ± 13.71; female-to-male ratio of 2.28) with CVST were included. Most of the admissions (42.6%) were in the summer. Most patients had a subacute disease onset (66.0%), with headaches being the most frequent manifestation (66.0%). Regular oral contraceptive pill use and fasting were the most frequent clinical risk factors (52.0% and 22.7%, respectively). Different types of inherited thrombophilia (deficiency in protein C, protein S, or antithrombin III) were recorded in nearly 13 to 16% of patients. The lateral transverse sinus (61.7%) and the superior sagittal sinus (45.4%) were the most frequently involved. The mortality rates at discharge and after three months were 4.3% and 8.0%, respectively. In the follow-up assessment, 81.3% of patients showed a favorable outcome [mRS ≤ 2], while 18.7% had an unfavorable outcome. Patients with unfavorable outcomes were significantly older compared to those with favorable outcomes (52 ± 5.81 vs. 35.95 ± 1.42, P = 0.017). Significant associations were observed between admission season (P = 0.020), chief complaint (P = 0.028), course of the disease (P = 0.021), previous thromboembolic events (P = 0.001), and antiphospholipid IgG (P = 0.032). Conclusions: The most prevalent risk factors among patients with CVST were being female, a history of using oral contraceptives, and fasting. Older patients with reduced consciousness, an acute disease course, a history of thromboembolic events, and positive antiphospholipid IgG are more likely to have an unfavorable outcome. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role. [ABSTRACT FROM AUTHOR]

Cerebrovascular disease encompasses a vast array of conditions. The imaging recommendations for stroke-related conditions involving noninflammatory steno-occlusive arterial and venous cerebrovascular disease including carotid stenosis, carotid dissection, intracranial large vessel occlusion, and cerebral venous sinus thrombosis are encompassed by this document. Additional imaging recommendations regarding complications of these conditions including intraparenchymal hemorrhage and completed ischemic strokes are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

BackgroundPatients with sub-acute cerebral venous sinus thrombosis experience (SA.CVST) severe symptoms compared to two other venous sinus-related diseases, including chronic cerebral venous sinus thrombosis (C.CVST) and idiopathic intracranial hypertension (IIH).ObjectiveThis study aimed to determine whether the different immune reactions in different venous sinuses are related.MethodsStagnant blood in the cerebral venous sinuses was extracted by passing a microcatheter and CD14-positive cells were sorted by magnetic beads and subjected to RNA-seq sequencing.ResultsCompared to patients with IIH, 128 genes were significantly down-regulated and 373 genes were significantly up-regulated in the sub-acute CVST samples. The functions of these genes were mainly focused on “immune response”, “T cell activation” and “plasma membrane”. Gene Set Enrichment Analysis (GSEA) showed T cell survival and activation-related function significantly unregulated in sub-acute CVST. On the other hand, there were 366 genes down-regulated in chronic CVST and 75 genes up-regulated in chronic CVST. In functional annotation, these differently expressed genes were enriched in the “extracellular region”, “chemokine-mediated signaling pathway” and “immune response”. GSEA analysis confirmed that chemokine-related functions were all up-regulated in sub-acute CVST and monocyte-macrophage adhesion functions were also significantly up-regulated.ConclusionThis study suggested the CD14-positive created an activated immune response in sub-acute CVST.

BackgroundThis study examined the etiology, treatment response, and prognosis of patients with cerebral venous sinus thrombosis (CVST) at a single institution.MethodsThis retrospective study included patients diagnosed with CVST between January 2016 and December 2020 at Baotou Central Hospital. The data were collected from patient charts, including sex, age, comorbidities, pregnancy, smoking, alcohol drinking, symptoms at onset, radiological location, examinations, Glasgow coma scale (GCS) at admission, National Institutes of Health stroke scale (NIHSS) at admission, modified Rankin scale (mRS) at admission, and treatments.ResultsThe study included 31 patients (13 males and 18 females) aged 39.0 (interquartile range, 30.0–53.0) years. Three (9.7%) patients had a history of hypertension, one (3.2%) had a history of stroke, four (12.9%) had thrombotic disorders, six (19.4%) were pregnant (including three who delivered), four (12.9%) were smoking, and four (12.9%) were drinking alcohol. The GCS at admission was 15.0 (IQR, 15.0–15.0), the NIHSS at admission was 0.0 (IQR, 0.0–2.0), and the mRS at admission was 0.0 (IQR, 0.0–0.0). The patients were grouped according to their mRS (>0 vs. 0); there were no significant differences between the two groups regarding the patient characteristics (all p > 0.05). Only an NIHSS of >0 at follow-up was associated with a 3-month mRS >0 (p 0 at follow-up was associated with a 3-month mRS >0.

BackgroundThe appearance of cerebral venous sinus thrombosis (CVST) in childhood acute lymphocytic leukemia (ALL) is a rare life-threatening disease that can cause significant morbidity, neurological sequelae, and potentially poor outcomes.Case presentationWe present the case of a 13-year-old boy with ALL who developed CVST and intrinsic hemorrhage approximately 30 days after receiving chemotherapy with vincristine, dexamethasone, daunorubicin, and pegylated-asparaginase (PEG-Asp). He complained of a severe headache and then developed a generalized seizure at night. T1- and T2-weighted magnetic resonance imaging (MRI) and cerebral magnetic resonance venography sequences revealed superior sagittal sinus thrombosis and intrinsic hemorrhagic changes in the bilateral frontoparietal lobes. He received nadroparin calcium as the anticoagulant treatment and was switched to Erwinia asparaginase (Erwinia Asp) rather than PEG-Asp. Oxcarbazepine and clonazepam were started with good seizure control. Intrathecal treatment was delayed until 1 month later. Anticoagulation treatment was stopped for 24 h before and 6 h after lumbar puncture. Platelet transfusion was administered to ensure the platelet count remained at >50 × 109/L. Oral acetazolamide (500–1,000 mg, daily) was administered to relieve headache and reduce intracranial pressure. Three months later, brain MRI showed a complete resolution of or significant improvement in the filling defect. Nadroparin calcium was administered for 1 week after switching to Erwinia Asp to prevent clot recurrence. He completed the 6-month chemotherapy and is doing well with no neurological sequelae and no recurrence of bleeding or thrombosis.ConclusionsNadroparin calcium therapy appears to be safe and effective for pediatric CVST with ALL. The reintroduction of Erwinia Asp should be accompanied by anticoagulant therapy with nadroparin calcium.

PurposeComparison of the performance of high-resolution susceptibility weighted imaging with standard MR sequences and MR venography to identify cortical vein clots.MethodsA retrospective review of 51 consecutive cases of cerebral venous thrombosis and 27 controls was performed with independent analysis of all MR sequences. Reference standard was obtained with consensus in a separate session by reviewing all MR sequences together.ResultsCortical vein clots were observed in 30 cases including 9 males and 21 females in the age range of 1 month to 70 years (Mean 34.9 ± 20.2 years). Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of susceptibility weighted imaging for the identification of cortical vein clots were 0.93, 1.0, 1.0, 0.96 and 0.97 respectively. For all other sequences, sensitivity ranged from 0.06 to 0.39 and accuracy from 0.60 to 0.73. Combination of all sequences yielded a value of 1.0 for sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of cortical vein clots. Significant result for area under the receiver operating curve was observed only for SWI with a value of 0.91 (p - .000).ConclusionSusceptibility weighted imaging demonstrates the best sensitivity and accuracy among standard MR sequences including MR venography for the detection of early stage cortical vein clots. However, it needs to be interpreted in combination with other MR sequences for the most accurate evaluation of cortical vein clots.

Introduction: We report a case of cerebral venous sinus thrombosis (CVST) that presented with bilateral optic disc swelling and diplopia in the absence of headaches. Case Presentation: A 54-year-old woman with no relevant medical history presented with a 2-week history of diplopia and no loss of visual acuity in each eye. Eye movements revealed bilateral abduction deficits, and fundoscopic examination revealed bilateral optic disc swelling. Non-contrast computed tomography of the head showed no abnormalities. Magnetic resonance venography revealed the absence of flow in the superior sagittal and left transverse sinuses as a consequence of thrombosis. The patient was diagnosed with intracranial hypertension associated with abducens nerve palsies secondary to CVST and was initiated on anticoagulant therapy. CVST can lead to stroke even in younger individuals. Conclusion: CVST should be considered in differential diagnosis when bilateral papilledema and abducens nerve palsies are present, even in the absence of headache or other neurological findings.

Abstract Background Idiopathic nephrotic syndrome (NS) presents as a hypercoagulable state, of which thromboembolism (TE) is a well-known life-threatening complication. Although TE is more likely to occur in venous vessels than arterial vessels, arterial TE is important because it may cause after-effects, including tissue necrosis and cerebral infarction (CI); therefore, prompt diagnosis and appropriate treatment are required. We report a pediatric NS case with multiple CIs. Case presentation A 14-year-7-month-old Japanese girl was diagnosed with frequent relapsing NS, accompanied by headache and disturbance of consciousness during the second relapse. Brain magnetic resonance imaging (MRI) and four-dimensional computed tomography revealed multiple CIs, vasogenic edema, and cerebral venous sinus thrombosis (CVST). The patient had no underlying thrombophilia other than hypercoagulability due to NS and prednisolone (PSL), and no cardiac arrhythmia; however, a right-to-left shunt through the patent foramen ovale (PFO) was observed with the Valsalva maneuver by echocardiography. Therefore, we assumed that a potential cause of multiple CIs might be an embolic stroke, caused by thrombosis formed from a hypercoagulable state due to NS and PSL treatment and reached through PFO. Antiplatelet and anticoagulant therapies were administered for TE. She was treated with PSL and mycophenolate mofetil (MMF) for NS. Rituximab (RTX) was administered to prevent NS relapse after complete remission (CR). She underwent transcatheter PFO closure at age 14 years and 9 months because we considered that the right-to-left shunt through the PFO would be one of the risks for recurrent cerebral embolism when NS relapses. One year after the onset of CIs, an MRI indicated that the CVST had resolved, leaving no neurological sequelae due to CI; therefore, anticoagulant therapy was discontinued. And then she has been in CR for NS with only MMF therapy. Conclusions CI is a serious complication in patients with NS. The pathogenesis of multiple CIs is various, including right-to-left shunt through PFO, in addition to the hypercoagulability due to NS. It is important to investigate and manage underlying risks such as PFO, besides preventing the relapses of NS by aggressive treatments using MMF and RTX, in patients with NS.

Yassir Balla,1 Abdullahi Said Hashi,2 Ahmed Adam Osman,3,4 Mohamed Sheikh Hassan,5 Eren Mutlu3 1Department of Internal Medicine, Somali-Sudanese Specialized hospital, Mogadishu, Somalia; 2Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 3Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 4Faculty of Medicine and Surgery, University of Somalia, Mogadishu, Somalia; 5Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Adam Osman, Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Email fahadyare41@gmail.comAbstract: Cerebral sinovenous thrombosis (CSVT) encompasses a spectrum of disorders involving thrombosis of the cerebral venous system. As shown by previous epidemiological studies, the prevalence of cerebral sinovenous thrombosis is 4– 7 cases per million people. Nephrotic syndrome was very rarely associated with thrombosis cerebral veins or sinuses. Hypercoagulability and thrombotic complications in nephrotic syndrome are most commonly seen in deep veins of the lower extremities and renal veins. Our case highlights a unique scenario in which cerebral sinovenous thrombosis was the initial presentation of nephrotic syndrome in a patient that was not an important past medical or surgical problem. The patient was brought to the emergency department with severe headache, vomiting, altered mental status, and generalized body swelling. Laboratory results showed proteinuria, hypoalbuminemia and hyperlipidemia. Non-contrast brain CT demonstrated hemorrhagic venous infarct associated with vasogenic edema. A subsequent brain MR venogram demonstrated occlusion of superior sagittal and right transverse sinuses. She was managed with low molecular weight heparin and intervenous corticosteroids then shifted to rivaroxaban and oral steroids, respectively, which resulted in massive clinical improvement and resolution of thrombus.Keywords: nephrotic syndrome, cerebral venous sinus thrombosis, MR venography

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.

Aims: This study aimed to unravel the dehydration status of patients with cerebral venous sinus thrombosis (CVST) to facilitate the understanding of dehydration in CVST. Methods: This was a multicenter retrospective study and three populations were recruited, namely, patients with CVST, CVST mimics, and healthy subjects. Blood samples were obtained 1–2 days after admission to assess dehydration status. Stata 15.1 was performed for statistical analysis. Results: A total of 208 patients were diagnosed with CVST, 237 with CVST mimics, and 200 healthy individuals were enrolled. The urine specific gravity (USG, 1.020 [1.014, 1.029] vs. 1.017 [1.011, 1.021]) was higher in patients with CVST than in those with mimics (all p < 0.001). The percentage of USG >1.03 was also higher in CVST (22.6%) than in its mimics (6.3%, p < 0.001). With the development of CVST, USG (acute vs. sub‐acute vs. chronic, 1.022 [1.015, 1.033] vs. 1.021 [1.015, 1.031] vs. 1.019 [1.014, 1.025]) decreased. All dehydration‐related markers could not differentiate CVST from its mimics and healthy populations, and they were not associated with CVST severity and prognosis (p > 0.05). Conclusion: High levels of USG, especially USG >1.013, were more common in patients with CVST. Dehydration‐related indices could not characterize CVST and were not associated with CVST severity and prognosis. [ABSTRACT FROM AUTHOR]

Background: Idiopathic nephrotic syndrome (NS) presents as a hypercoagulable state, of which thromboembolism (TE) is a well-known life-threatening complication. Although TE is more likely to occur in venous vessels than arterial vessels, arterial TE is important because it may cause after-effects, including tissue necrosis and cerebral infarction (CI); therefore, prompt diagnosis and appropriate treatment are required. We report a pediatric NS case with multiple CIs. Case presentation: A 14-year-7-month-old Japanese girl was diagnosed with frequent relapsing NS, accompanied by headache and disturbance of consciousness during the second relapse. Brain magnetic resonance imaging (MRI) and four-dimensional computed tomography revealed multiple CIs, vasogenic edema, and cerebral venous sinus thrombosis (CVST). The patient had no underlying thrombophilia other than hypercoagulability due to NS and prednisolone (PSL), and no cardiac arrhythmia; however, a right-to-left shunt through the patent foramen ovale (PFO) was observed with the Valsalva maneuver by echocardiography. Therefore, we assumed that a potential cause of multiple CIs might be an embolic stroke, caused by thrombosis formed from a hypercoagulable state due to NS and PSL treatment and reached through PFO. Antiplatelet and anticoagulant therapies were administered for TE. She was treated with PSL and mycophenolate mofetil (MMF) for NS. Rituximab (RTX) was administered to prevent NS relapse after complete remission (CR). She underwent transcatheter PFO closure at age 14 years and 9 months because we considered that the right-to-left shunt through the PFO would be one of the risks for recurrent cerebral embolism when NS relapses. One year after the onset of CIs, an MRI indicated that the CVST had resolved, leaving no neurological sequelae due to CI; therefore, anticoagulant therapy was discontinued. And then she has been in CR for NS with only MMF therapy. Conclusions: CI is a serious complication in patients with NS. The pathogenesis of multiple CIs is various, including right-to-left shunt through PFO, in addition to the hypercoagulability due to NS. It is important to investigate and manage underlying risks such as PFO, besides preventing the relapses of NS by aggressive treatments using MMF and RTX, in patients with NS. [ABSTRACT FROM AUTHOR]

Background: Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome. Methods: This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS. Results: Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043). Conclusions: Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients. [ABSTRACT FROM AUTHOR]

Aim: As the main type of stroke, the incidence of cerebral venous thrombosis (CVT) has been rising. However, the comprehensive mechanisms behind it remain unclear. Thus, the multi‐omics study is required to investigate the mechanism after CVT and elucidate the characteristic pathology of venous stroke and arterial stroke. Methods: Adult rats were subjected to CVT and MCAO models. Whole‐transcriptome sequencing (RNA‐seq) and untargeted metabolomics analysis were performed to construct the transcriptome and metabolism profiles of rat brains after CVT and also MCAO. The difference analysis, functional annotation, and enrichment analysis were also performed. Results: Through RNA‐seq analysis, differentially expressed genes (DEGs) were screened. 174 CVT specific genes including Il1a, Ccl9, Cxxl6, Tnfrsf14, etc., were detected. The hemoglobin genes, including both Hba and Hbb, were significantly downregulated after CVT, compared both to the MCAO and Sham groups. Metabolism analysis showed that CVT had higher heterogeneity of metabolism compared to MCAO. Metabolites including N‐stearoyltyrosine, 5‐methoxy‐3‐indoleaceate, Afegostat, pipecolic acid, etc. were specially regulated in CVT. Through the immune infiltration analysis, it was found that CVT had a higher immune response, with the abundance of certain types of immune cells increased, especially T helper cells. It was important to find the prevalence of the activation of inflammatory chemokine, cytokine, NOD‐like pathway, and neutrophil extracellular trap. Conclusion: We explored and analyzed the gene expression and metabolomic characteristics of CVT, revealed the specific inflammatory reaction mechanism of CVT and found the markers in transcriptome and metabolism levels. It points out the direction for CVT early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Cerebral Venous Sinus Thrombosis (CVST) is a subtype of venous thromboembolism, which occurs in the dural venous sinuses. Blockage of the venous drainage of the brain leads to the development of hemorrhages. Strokes can hence develop in any individual, irrespective of age or sex. CVST is a very serious condition requiring immediate thrombolysis to prevent residual neurological deficits. We report the case of a lady aged 25 years, who presented to the emergency department with a severe diffuse headache for 4 days, associated with vomiting. This was followed by multiple episodes of seizures and altered sensorium the previous day. She had been taking desogestrel for the past 2 months. On examination, the patient was unconscious and febrile (102.8 F). On admission, Glasgow Coma Scale score of E2V2M3 and bilateral extensor plantar response were noted. Signs of meningeal irritation were absent. Her pupils were mid‐dilated, sluggishly reactive to light, and papilledema was present bilaterally. Based on imaging studies, she was diagnosed with a case of CVST. Her homocysteine levels were elevated. She recovered on appropriate treatment and was discharged on Ryle's feeding tube after 26 days of hospital stay with a Glasgow Coma Scale score of E4V5M6 and a flexor plantar response. The case emphasizes the need to rule out CVST in young adult females on oral contraceptive pills (OCP) presenting with severe neurological dysfunction. Vigilant screening, clinical suspicion and timely management can help cut down the associated mortality and morbidity in such cases. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) vaccines have been introduced to the masses for just over two years. Majority reported adverse events post vaccination are minor side effect such as pain or inflammation at local injection site. Serious side effects such as thrombotic events or myocarditis are rarely reported. Cerebral venous sinus thrombosis (CVST) is a thrombotic complication that may occur within one to two weeks from vaccine administration. We illustrated a case from our centre involving a healthy young lady who presented with headache and an episode of seizure following by vaccination. She was concurrently diagnosed with CVST and COVID-19 infection later with the aid of neuroimaging. The patient's normal platelet count made the diagnosis of vaccine induced immune related thrombotic thrombocytopenia unlikely. While serious adverse events are reported, such as our case, this should not support the growing vaccine hesitancy among the public as its benefits still greatly outweigh its risk at this juncture. [ABSTRACT FROM AUTHOR]

Cerebral venous sinus thrombosis (CVST) has no identified cause in 15% of cases. Elevated factors (F) VIII and FXI have been associated with thromboembolism, but data on CVST are limited. We hypothesized that elevated plasma FVIII and FXI predispose to first and recurrent CVST. In 50 CVST survivors aged < 60 years, following anticoagulant cessation and in 50 controls, we determined plasma FVIII and FXI, along with fibrin clot properties: lysis time, permeability, maximum D-dimer (D-Dmax), and maximum rate of D-dimer increase (D-Drate). We recorded CVST recurrence during a follow-up of 58.5 (55.0–60.0) months. Plasma FVIII was 22.7% higher in CVST than in controls, with elevated FVIII > 150% in 13 (26%) vs. 4 (8%) patients, respectively (p = 0.02). Median FXI tended to be higher in CVST vs. controls (110.5 [99.0-117-0]% vs. 104.5 [97.0-116.0]%, p = 0.07), while FXI > 120% was observed more commonly in the former group (12 [24%] vs. 4 [8%], respectively, p = 0.03). Patients with FVIII > 150% were less likely to achieve complete recanalization compared with the remainder (2 [15.4%] vs. 28 [75.7%], respectively; p < 0.001). Eight patients (16%) experienced CVST recurrence. They had higher baseline FXI, but not FVIII, as compared with the remainder (125.5 [114.5–140.0]% vs. 107.5 [102.0-117.0]%, respectively, p = 0.01). Patients with FXI > 120% were four times more likely to have recurrent CVST (5 [62.5%] vs. 7 [16.7%], respectively; p = 0.01). Plasma FXI > 120% could represent a novel risk factor for first and recurrent CVST. Given advances in anti-FXI agents, CVST might be another indication for this emerging treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role.

Introduction: The high incidence of wasp stings have been causing a variety of injuries in China, but systemic complications are rarely reported. Case presentation: A 59-year-old man was severely attacked by wasps. He developed an acute onset of right hemiplegia and chest distress and was admitted to our emergency department 13 hours after being attacked. Various abnormal signals were found by biochemical tests. Magnetic resonance venography of head demonstrated that the superior sagittal sinus was not visible, indicating cerebral venous sinus thrombosis. Magnetic resonance imaging showed abnormal signals in the left frontal lobe, parietal lobe, and thalamus, indicating venous cerebral infarction and hemorrhage, coupled with subarachnoid hemorrhage. The patient was diagnosed with a rare combination of cerebral venous sinus thrombosis, cerebral venous infarction, and multi-organ dysfunction following hornet stings. After undergoing systematic treatment including blood perfusion, blood dialysis, anti-inflammatory hormone therapy, antiallergic medication, antibiotic use, and anticoagulation treatment, the patient showed significant improvement in limb muscle strength and dizziness symptoms. However, the patient developed irreversible kidney damage and is currently dependent on renal replacement therapy. Conclusions: This case highlights the serious systemic consequences that can occur following multiple wasp stings, including rare complications such as venous sinus thrombosis leading to cerebral infarction and renal failure. Early intervention with blood perfusion, hemodialysis, and plasmapheresis, in addition to general treatment, may help prevent permanent organ damage in patients with a large number of wasp stings.

甲状腺功能亢进作为一种可能影响血液凝固的内分泌疾病，与颅内静脉窦血栓形成的关联在临床上并不常见。本文报道1例21岁男性甲状腺功能亢进并发颅内静脉窦血栓形成患者的诊治过程。患者在接受包括甲巯咪唑、抗凝治疗在内的综合治疗后头痛等症状得到明显缓解，特别是经历了血管内介入取栓这一关键性治疗步骤。本病例强调了对甲状腺功能亢进患者进行全面评估的重要性，同时也提示了在特定情况下介入性治疗的潜在价值。未来更广泛的研究将有助于制定这些并发症的管理和预防措施。 Abstract: Hyperthyroidism, as an endocrine disease that may affect blood coagulation, is not commonly associated with cerebral venous sinus thrombosis in clinical practice. This paper reports the diagnosis and treatment process of a 21-year-old male patient with hyperthyroidism complicated by cerebral venous sinus thrombosis. Following comprehensive treatment, including thiamazole and anticoagulation therapy, the patient experienced significant relief from symptoms such as headaches, particularly after undergoing the crucial treatment step of endovascular interventional thrombectomy. This case emphasizes the importance of a thorough assessment of patients with hyperthyroidism and also suggests the potential value of interventional treatment in specific circumstances. Future broader research will contribute to clarifying the management and preventive measures for such complications.

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

Abstract Background Cerebral venous sinus thrombosis (CVST) is a rare form of stroke that is mainly seen in young women. It is frequently associated with hemorrhagic venous infarction and subarachnoid hemorrhage. There are few reports of CVST associated with chronic non-traumatic subdural hematoma (SDH). The diagnosis of CVST with spontaneous SDH is difficult because of the variability of its clinical features. The management of SDH associated with CVST is controversial and not well-established. Case presentation We report a 26-year-old woman with positive COVID-19 serology who presented with superior longitudinal sinus thrombosis associated with chronic spontaneous SDH. She was managed conservatively and treated with anticoagulation and corticosteroids. A follow-up angioscan 1 month after treatment showed regression of the SDH volume with partial repermeabilisation of the thrombosed sinus. Three months later, the follow-up angioscan showed complete resolution of the chronic SDH and superior longitudinal sinus thrombosis with restoration of venous flow. Conclusions CVST can also present with spontaneous chronic SDH. The management of SDH concomitant with CVST remains controversial due to the rarity of its presentation and the risks associated with the use of anticoagulation.

Cerebral venous sinus thrombosis (CVST) is an important cause of stroke, which accounts for 0.5%-1% of all strokes. CVST is principally manifested as headaches, papilledema, psychiatric symptoms, impaired consciousness and seizure disorders, with or without neurological defects.We encountered a case of CVST after subacute phase, revealing a hypodense thrombus in the superior sagittal sinus (SSS) on unenhanced CT. Retrospective observation of the serial unenhanced CT images taken at another hospital showed that the SSS thrombus changed from high to low attenuation for 10 days.RBCs dominant CVST at acute phase shows high attenuation on unenhanced CT and is effective for heparin therapy, whereas CVST after subacute phase shows low attenuation on unenhanced CT by the thrombus contents of fibrin, hemosiderin and collagen, and may be ineffective to heparin therapy. Therefore, it is important to accurately identify high attenuation of the CVST at acute phase on unenhanced CT and treat with heparin as early as possible.