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Sample records for cerebral venous sinus

  1. Cerebral sinus venous thrombosis

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Milena Castellar-Leones, Sandra; Alcala-Cerra, Gabriel; Rafael Moscote-Salazar, Luis

    2013-01-01

    Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment. PMID:24347950

  2. Cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy

    PubMed Central

    Nie, Quanmin; Guo, Pin; Ge, Jianwei; Qiu, Yongming

    2015-01-01

    Cerebral venous sinus thrombosis (CVST) rarely induces cerebral hemorrhage, and CVST with cerebral hemorrhage during early pregnancy is extremely rare. Upon literature review, we are able to find only one case of CVST with cerebral hemorrhage in early pregnancy. In this paper, we report another case of a 27-year-old patient who developed CVST with cerebral hemorrhage in her fifth week of pregnancy. Although the optimal treatment for this infrequent condition remains controversial, we adopted anticoagulation as the first choice of treatment and obtained favorable results. PMID:25630781

  3. Neurobrucellosis and cerebral venous sinus thrombosis: a case report.

    PubMed

    Ibrahimagić, Omer Ć; Smajlović, Dževdet; Dostović, Zikrija; Iljazović, Amra; Kojić, Biljana; Zonić, Lejla

    2017-10-01

    To present a case of co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis. Case report.  We presented 49-year-old Caucasian domicile female-farmer with a history of headache, weakness, and vomiting for a period of three months. Also, she had significant papilledema. We diagnosed rare co-morbidity of neurobrucellosis (confirmed after ELISA-test in serum samples and CSF analysis of pleocytosis/increase in protein/decrease in glucose level) in the setting of cerebral venous thrombosis developed in left sigmoid/left transverse sinus (confirmed after MRV of brain). Favorable outcome was achieved by applying protracted polymicrobial antibiotic therapy and heparin. It may be challenging to diagnose neurobrucellosis, especially in patients with atypical presentation and abortive clinical forms. The co-morbidity of neurobrucellosis and cerebral venous sinus thrombosis is uncommon. However, it provides a possibility of brucella-colonization in cerebral venous sinuses as a potential hidden link between them. Patients with severe and persistent headache, as well as other neurological symptoms/signs should be considered for neurobrucellosis in endemic, but also in brucella non-endemic regions due to migrations. According to literature survey, this co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis is third one reported from Europe.

  4. Cerebral venous sinus thrombosis presenting with auditory hallucinations and illusions.

    PubMed

    Wong, Victoria S S; Adamczyk, Peter; Dahlin, Brian; Richman, David P; Wheelock, Vicki

    2011-03-01

    Cerebral venous sinus thrombosis may present with seizures or neuropsychiatric symptoms, but does not typically present with hallucinations. We present a case of venous thrombosis of the right sigmoid and transverse sinuses that presented with auditory hallucinations and illusions. We describe a 45-year-old woman with a history of myasthenia gravis, stable on oral prednisone and monthly intravenous immunoglobulin infusions, who started on a progesterone/estrogen combination contraceptive pill for menorrhagia 3 weeks before admission and presented with symptoms of headache, fever, and auditory hallucinations and illusions. The patient's cerebrospinal fluid showed lymphocytic pleocytosis. Two electroencephalograms showed significant right temporal lobe slowing. Magnetic resonance venogram of the brain showed venous sinus thrombosis of the right sigmoid and transverse sinuses. Magnetic resonance imaging showed a cortical venous infarct in the right middle temporal gyrus. The patient's auditory hallucinations and illusions resolved spontaneously weeks after presentation. This case suggests that auditory hallucinations and illusions should be added to the already broad spectrum of presenting features of cerebral venous sinus thrombosis. The nondominant right middle temporal gyrus may play a role in such auditory hallucinations.

  5. Lower motor neuron facial palsy in cerebral venous sinus thrombosis

    PubMed Central

    Kulkarni, Girish Baburao; Ravi, Yadav; Nagaraja, Dindigur; Veerendrakumar, Mustare

    2013-01-01

    With advances in the neuro-imaging modalities, diverse manifestations of the cerebral venous sinus thrombosis (CVT) are being recognized. There are very few reports of isolated cranial nerve palsies in CVT. In this case report, we describe a patient of lower motor neuron facial palsy with CVT who was successfully treated with anticoagulation, highlighting the atypical manifestation of the disease. PMID:23914113

  6. A rare localization of cerebral venous sinus thrombosis. Case report

    PubMed Central

    CARANGELO, B.; LAVALLE, L.; TIEZZI, G.; BRANCO, D.; LIPPA, L.; MILEO, E.; COSTANTINO, G.; MARIOTTINI, A.; MUSCAS, G.; MATURO, A.

    2015-01-01

    In this work the Authors report their experience on the treatment of a case of cavernous venous sinus thrombosis. The diagnosis is clinical and neuroradiological, CT, MRN, cerebral angiography and orbital venography have aided in establishing the diagnosis during life. Very interesting is the therapeutic approach. PMID:26017108

  7. Local Intrasinus Thrombolysis for Cerebral Venous Sinus Thrombosis

    PubMed Central

    Karanam, Lakshmi sudha Prasanna; Baddam, Sridhar Reddy; Pamidimukkala, Vijaya; Vemuri, Ramatharaknath; Byrapaneni, Sravanthi; Polavarapu, Raghavasarma

    2016-01-01

    Background Cerebral venous strokes due to cerebral venous sinus thrombosis (CVST) have varied presentation and clinical outcome. Despite aggressive medical treatment with optimal anticoagulation, some patients develop progressive neurologic deterioration causing significant morbidity and mortality. The aim of the present series is to analyze the safety and efficacy of in situ thrombolysis in patients with cerebral venous sinus thrombosis in severe clinical grade and refractory to conventional medical management. Materials and methods Twenty-nine patients with cerebral venous thrombosis who received in situ thrombolysis during a 3-year period (April 2013 to April 2016) were included in the study. Tissue plasminogen activator (tpa) was used in all the patients. The lytic agent was infused into the sinus via the micro catheter. Data regarding demographic, clinical, and radiologic features were analyzed in all the patients. Results Recanalization of the affected sinuses was achieved in all the cases. Twenty-four patients had good outcome (mRs 0 or1) and three patients had mild deficits (mRs 2). One patient had moderate disability (mRs 3). One patient succumbed due to increased hematoma causing midline shift and transtentorial herniation. At 3 months follow–up, 26 patients were asymptomatic and two patients had minor symptoms. Conclusion Local intrasinus thrombolysis (LIST) is safe and effective method in patients with poor clinical grade and the present study highlights the benefit of thrombolysis, particularly in patients unresponsive to anticoagulation. The improved efficacy of this therapy depends on early recognition of worsening symptoms and timely intervention. PMID:27829970

  8. Homocystinuria with Cerebral Venous Sinus Thrombosis: Excellent Recovery with Intravenous Recombinant Tissue Plasminogen Activator.

    PubMed

    Gowda, Vykuntaraju K; Nanjundappa, Raghunath C; Pendharkar, Hima; Benakappa, Naveen

    2017-01-01

    Hyperhomocysteinemia can cause cerebral venous thrombosis. Recombinant tissue plasminogen activator is one of the treatment options for cerebral venous thrombosis in selected cases. We present here a 7-year-old boy with homocysteinuria with stroke. MRI of brain showed cerebral venous sinus thrombosis. We successfully treated with intravenous recombinant tissue plasminogen activator. He recovered completely without any complications. Recombinant tissue plasminogen activator can be considered one of the treatment options in cerebral venous thrombosis in homocystinura.

  9. Cerebral venous sinus thrombosis associated with a combined contraceptive ring.

    PubMed

    Fugate, Jennifer E; Robinson, Maisha T; Rabinstein, Alejandro A; Wijdicks, Eelco F M

    2011-03-01

    Combined contraceptive vaginal rings are used as an alternative to oral contraceptives with a purported advantage of allowing lower hormonal doses, and thus potentially confer a lower venous thromboembolism risk. Cerebral venous sinus thrombosis (CVST) has not been previously described in association with use of a combined contraceptive ring. A 32-year-old white woman presented with severe headache progressively worsening over days and subsequently developed acute left sided hemiplegia and sensory loss. Brain imaging revealed acute right parietal cortical infarction and extensive CVST. Evaluation for primary thrombophilia was unrevealing. The sole hypercoagulable risk factor identified was use of a vaginal contraceptive ring. The patient was anticoagulated and demonstrated marked clinical improvement. We report the first described case of CVST associated with use of a vaginal contraceptive ring. CVST should be recognized as a potentially fatal complication related to this therapy.

  10. Cerebral Venous Sinus Thrombosis during Everest Expedition: A Case Report and Review of the Literature

    PubMed Central

    Khanal, P.; Shrestha, A. M.; Bhattarai, S.; Sapkota, D.; Sharma, N.; Devkota, U. P.

    2016-01-01

    Cerebral venous sinus thrombosis (CVST) is a rare but serious disorder that is associated with a poor clinical outcome. We report a 35-year-old man who had a severe headache and diplopia while climbing Mount Everest. His MR venography showed right transverse and right sigmoid sinus thrombosis. He improved on anticoagulant and symptomatic measures. Cerebral venous sinus thrombosis at high altitude is discussed. PMID:27872776

  11. Cerebral Venous Sinus Thrombosis during Everest Expedition: A Case Report and Review of the Literature.

    PubMed

    Khanal, P; Thapa, L; Shrestha, A M; Bhattarai, S; Sapkota, D; Sharma, N; Devkota, U P

    2016-01-01

    Cerebral venous sinus thrombosis (CVST) is a rare but serious disorder that is associated with a poor clinical outcome. We report a 35-year-old man who had a severe headache and diplopia while climbing Mount Everest. His MR venography showed right transverse and right sigmoid sinus thrombosis. He improved on anticoagulant and symptomatic measures. Cerebral venous sinus thrombosis at high altitude is discussed.

  12. Diffuse Subarachnoid Hemorrhage Secondary to Cerebral Venous Sinus Thrombosis.

    PubMed

    Anderson, Brian; Sabat, Shyamsunder; Agarwal, Amit; Thamburaj, Krishnamoorthy

    2015-01-01

    Aneurysmal rupture accounts for the majority of nontraumatic subarachnoid hemorrhage (SAH). Increasingly recognized is the occurrence of nontraumatic convexity SAH unaccounted for by aneurysmal rupture. These presentations require consideration of rare but clinically significant sources of SAH. We report a patient presenting with prolonged mild headaches and acute onset of seizure like activity found to have diffuse subarachnoid hemorrhage and extensive dural venous sinus thrombosis involving the superior sagittal sinus and right transverse-sigmoid sinuses. There are few reported cases of SAH secondary to dural sinus thrombosis; however most of these are convexity hemorrhage. Sinus thrombosis presenting as diffuse SAH is extremely rare, as is showcased in this report.

  13. Longitudinal Volume Quantification of Deep Medullary Veins in Patients with Cerebral Venous Sinus Thrombosis : Venous Volume Assessment in Cerebral Venous Sinus Thrombosis Using SWI.

    PubMed

    Dempfle, A K; Harloff, A; Schuchardt, F; Bäuerle, J; Yang, S; Urbach, H; Egger, K

    2017-06-06

    Susceptibility-weighted imaging (SWI) visualizes small cerebral veins with high sensitivity and could, thus, enable quantification of hemodynamics of deep medullary veins. We aimed to evaluate volume changes of deep medullary veins in patients with acute cerebral venous sinus thrombosis (CVST) over time in comparison to healthy controls. All magnetic resonance imaging (MRI) experiments were executed at 3 T using a 32-channel head coil. Based on SWI and semiautomatic postprocessing (statistical parametric mapping [SPM8] and ANTs), the volume of deep medullary veins was quantified in 14 patients with acute CVST at baseline and the 6‑month follow-up, as well as in 13 healthy controls undergoing repeated MRI examination with an interscan interval of at least 1 month. Deep medullary venous volume change over time was significantly different between healthy controls and patient groups (p < 0.001). Patients with superior sagittal sinus thrombosis (SSST) showed a significant decline from baseline to follow-up measurements (9.8 ± 4.9 ml versus 7.5 ± 4.2 ml; p = 0.02), whereas in patients with transverse sinus thrombosis (TST) and healthy controls no significant volume changes were observable. Venous volume quantification was feasible and reproducible both in healthy volunteers and in patients. The decrease of venous volume in patients over time represents improvement of venous drainage, reduction of congestion, and normalization of microcirculation due to treatment. Thus, quantification of venous microcirculation could be valuable for estimation of prognosis and guidance of CVST therapy in the future.

  14. Antiphospholipid syndrome presenting as cerebral venous sinus thrombosis: a case series and a review.

    PubMed

    Shlebak, Abdul

    2016-04-01

    The cerebral venous sinus system is a rare site for venous thrombosis except in patients with antiphospholipid syndrome. We describe three patients presenting with cerebral venous thrombosis in association with other thrombotic sites in two patients and as an only site in one patient. Antiphospholipid syndrome has varied clinical manifestations but the defining feature is the persistent presence of antiphospholipid antibodies. In this report we will review the clinical and laboratory diagnostic criteria and the management of patients with antiphospholipid syndrome.

  15. Diffuse Subarachnoid Hemorrhage Secondary to Cerebral Venous Sinus Thrombosis

    PubMed Central

    Anderson, Brian; Sabat, Shyamsunder; Agarwal, Amit; Thamburaj, Krishnamoorthy

    2015-01-01

    Summary Background Aneurysmal rupture accounts for the majority of nontraumatic subarachnoid hemorrhage (SAH). Increasingly recognized is the occurrence of nontraumatic convexity SAH unaccounted for by aneurysmal rupture. Case Report These presentations require consideration of rare but clinically significant sources of SAH. We report a patient presenting with prolonged mild headaches and acute onset of seizure like activity found to have diffuse subarachnoid hemorrhage and extensive dural venous sinus thrombosis involving the superior sagittal sinus and right transverse-sigmoid sinuses. Conclusions There are few reported cases of SAH secondary to dural sinus thrombosis; however most of these are convexity hemorrhage. Sinus thrombosis presenting as diffuse SAH is extremely rare, as is showcased in this report. PMID:26097524

  16. Unusual venous sinuses.

    PubMed

    Srijit, D; Shipra, P

    2007-01-01

    The dural venous sinuses lie in between the two layers of the dura mater. The dural venous sinuses are important, because they receive blood from the brain and the cranial bones. All sinuses are related to the inner surface of the skull, except for the inferior sagittal and the straight sinus. The sinuses related to the inner surface of the skull produce impressions on it. During routine ostelogical teaching for undergraduate medical students, we observed an unusual oblique sinus, which connected the right and the left transverse sinuses. This unusual oblique sinus measured 2 cm and had a course from the right to the left side. The superior sagittal sinus turned onto the right but at a much higher level than the left transverse sinus. Although these sinuses communicated with each other, the normal position of the confleunce of the sinus (meeting point of superior sagittal sinus, right and left transverse sinus and the occipital sinus) was not seen. The impression meant for the posterior lobe of the left cerebral hemisphere was distinctly greater than that of the right side. The presence of such an anomaly suggests a possible developmental defect or handedness of the individual. The knowledge of the anatomical variations of the dural venous sinuses may have great clinical implications during venography, shunt surgeries and also helpful for neurologists and radiologists in addition to academic interest (Fig. 2, Ref 10) Full Text (Free, PDF) www.bmj.sk.

  17. An unusual cause of cerebral venous sinus thrombosis: prothrombin G20210A gene mutation.

    PubMed

    Porres-Aguilar, Mateo; Square, Jaime H; Storey, Raul; Rodriguez-Dunn, Simon; Mohamed-Aly, Mohamed S

    2007-09-01

    Cerebral venous sinus thrombosis represents less than 1% of all strokes, being an uncommon entity with a wide spectrum of clinical scenarios. We present a 45-year-old Hispanic female with a history of long-term oral contraceptive use who was diagnosed with cerebral venous sinus thrombosis due to a heterozygous carrier mutation in the prothrombin G20210A gene. The patient was successfully managed with intravenous heparin with favorable clinical results without adverse effects. The prevalence of inherited primary thrombophilia increases with additional risk factors such as the use of oral contraceptives that can trigger or prothrombotic events in any vascular bed. An increased prevalence in the prothrombin G20210 gene mutation has been demonstrated in the Mexican-Mestizo population. Controversy exists regarding therapy of cerebral venous sinus thrombosis; according to experts, heparin remains the cornerstone of therapy with acceptable outcomes. More clinical trials are required to evaluate long-term outcomes in this subgroup of patients.

  18. Assessment of cerebral venous sinus thrombosis using T2*-weighted gradient echo magnetic resonance imaging sequences

    PubMed Central

    Bidar, Fatemeh; Faeghi, Fariborz; Ghorbani, Askar

    2016-01-01

    Background: The purpose of this study is to demonstrate the advantages of gradient echo (GRE) sequences in the detection and characterization of cerebral venous sinus thrombosis compared to conventional magnetic resonance sequences. Methods: A total of 17 patients with cerebral venous thrombosis (CVT) were evaluated using different magnetic resonance imaging (MRI) sequences. The MRI sequences included T1-weighted spin echo (SE) imaging, T*2-weighted turbo SE (TSE), fluid attenuated inversion recovery (FLAIR), T*2-weighted conventional GRE, and diffusion weighted imaging (DWI). MR venography (MRV) images were obtained as the golden standard. Results: Venous sinus thrombosis was best detectable in T*2-weighted conventional GRE sequences in all patients except in one case. Venous thrombosis was undetectable in DWI. T*2-weighted GRE sequences were superior to T*2-weighted TSE, T1-weighted SE, and FLAIR. Enhanced MRV was successful in displaying the location of thrombosis. Conclusion: T*2-weighted conventional GRE sequences are probably the best method for the assessment of cerebral venous sinus thrombosis. The mentioned method is non-invasive; therefore, it can be employed in the clinical evaluation of cerebral venous sinus thrombosis. PMID:27326365

  19. Poor Prognostic Outcome in Cerebral Venous Sinus Thrombosis Associated with Dyskinesia and Elevated Platelet Volume.

    PubMed

    Wang, Shousen; Xu, Bingyang; Zhao, Qingshuang; Li, Jun; Hong, Jingfang; Wei, Liangfeng; Zhao, Lin

    2016-01-01

    Although about 80% of patients with cerebral venous sinus thrombosis have a good prognosis, some patients develop severe complications and a small proportion do not survive. The study included patients who had been diagnosed with cerebral venous sinus thrombosis in our hospital from May 2008 to February 2014. Based on the modified Rankin Scale (mRS) scores at 3 months for outcome, the patients were divided into two groups: good prognosis (mRS score ≤ 2) and poor prognosis (mRS score > 2). Univariate and multivariate regression analysis were performed to identify significant prognostic factors for poor outcome. A total of 86 patients with cerebral venous sinus thrombosis, 54 males and 32 females, average age 41.3 years (range, 3-83 years), were enrolled. Of these 86 patients, 64 (74.4%) had a good prognosis and 22 (25.6%) a poor prognosis. Univariate analysis revealed that dyskinesia was a significant risk factor (factor with odds ratio >1) for poor prognosis. In multivariate analysis, the risk of poor prognosis in patients with dyskinesia was 23 times higher than for those without dyskinesia (p < 0.001). Thrombosis of the sinus transervus was found to reduce the risk of poor prognosis in both univariate and multivariate analysis. Most patients with cerebral venous sinus thrombosis have a good prognosis but patients with dyskinesia have a poorer prognosis.

  20. Novel balloon-and-aspiration method for cerebral venous sinus thrombosis: dental-floss technique.

    PubMed

    Matsuda, Yoshikazu; Okada, Hideo; Chung, Joonho; Webster Crowley, R; Lopes, Demetrius K

    2017-04-01

    Cerebral venous sinus thrombosis is sometimes fatal. The standard treatment for sinus thrombosis is anticoagulation, but endovascular intervention must be considered when medical treatment fails. Mechanical thrombectomy is usually required when a large clot burden exits. Unfortunately, in sinus thrombosis attributable to a clot burden larger than that in an intracranial artery, the conventional technique used for intraarterial acute stroke intervention with a stent retriever and/or aspiration is not very effective. The authors describe here their endovascular approach to mechanical thrombectomy for sinus thrombosis using aspiration combined with angioplasty balloon support.

  1. Cerebral venous sinus thrombosis in homocystinuria: Dietary intervention in conjunction with anticoagulation

    PubMed Central

    Yap, Sufin; Annesley-Williams, Deborah; Hardiman, Orla

    2017-01-01

    The presentation of cerebral venous sinus thrombosis may be acute or chronic with a progressive clinical course. The diagnosis can be challenging, and there are several clinical syndromes associated with the disease. It is also an uncommon but recognised complication of homocystinuria. We describe a case where early anticoagulation, together with dietary intervention, was associated with a favourable clinical outcome. PMID:28835823

  2. Cerebral venous sinus thrombosis in homocystinuria: Dietary intervention in conjunction with anticoagulation.

    PubMed

    Yap, Sufin; Annesley-Williams, Deborah; Hardiman, Orla

    2017-01-01

    The presentation of cerebral venous sinus thrombosis may be acute or chronic with a progressive clinical course. The diagnosis can be challenging, and there are several clinical syndromes associated with the disease. It is also an uncommon but recognised complication of homocystinuria. We describe a case where early anticoagulation, together with dietary intervention, was associated with a favourable clinical outcome.

  3. Reversible changes in diffusion- and perfusion-based imaging in cerebral venous sinus thrombosis.

    PubMed

    Lin, Ning; Wong, Andrew K; Lipinski, Lindsay J; Mokin, Maxim; Siddiqui, Adnan H

    2016-02-01

    Diffusion- and perfusion-based imaging studies are regularly used in patients with ischemic stroke. Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and is primarily treated by systemic anticoagulation. Endovascular intervention can be considered in cases of failed medical therapy, yet the prognostic value of diffusion- and perfusion-based imaging for CVST has not been clearly established. We present a patient with CVST whose abnormal findings on MRI and CT perfusion images were largely reversed after endovascular treatment.

  4. Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosis

    PubMed Central

    Oblak, Janja Pretnar; Popovic, Katarina Surlan

    2016-01-01

    Abstract Background The aim of the study was to investigate the sensitivity and specificity of non-contrast computed tomography (NCCT) in the diagnosis of cerebral venous sinus thrombosis (CVST). Methods. Screening our neurological department database, we identified 53 patients who were admitted to neurological emergency department with clinical signs of CVST. Two independent observers assessed the NCCT scans for the presence of CVST. CT venography and/or MR venography were used as a reference standard. Interobserver agreement between the two readers was assessed using Kappa statistic. Attenuation inside the cerebral venous sinuses was measured and compared between the patient and the control group. Results CVST was confirmed in 13 patients. Sensitivity and specificity of NCCT for overall presence of CVST were 100% and 83%, respectively, with Kappa value of 0.72 (a good agreement between observers). The attenuation values between CVST patients and control group were significantly different (73.4 ± 14.12 HU vs. 58.1 ± 7.58 HU; p = 0.000). The ROC analysis showed an area under the curve (AUC) of 0.916 (95% CI, 0.827 – 1.00) and an optimal cutoff value of 64 HU, leading to a sensitivity of 85% and specificity of 87%. Conclusions NCCT as a first-line investigation has a high value for diagnosis of CVST in the emergency setting. The additional measurement of the sinus attenuation may improve the diagnostic value of the examination. PMID:27679541

  5. Whole-Brain Computed Tomographic Perfusion Imaging in Acute Cerebral Venous Sinus Thrombosis

    PubMed Central

    Mokin, Maxim; Ciambella, Chelsey C.; Masud, Muhammad W.; Levy, Elad I.; Snyder, Kenneth V.; Siddiqui, Adnan H.

    2016-01-01

    Background Acute cerebral venous sinus thrombosis (VST) can be difficult to diagnose because of its diverse clinical presentation. The utility of perfusion imaging for diagnosing VST is not well understood. Summary We retrospectively reviewed cases of acute VST in patients who underwent whole-brain (320-detector-row) computed tomographic (CT) perfusion imaging in combination with craniocervical CT venography. Perfusion maps that were analyzed included cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time, and time to peak. Among the 10 patients with acute VST included in this study, 9 had perfusion abnormalities. All perfusion abnormalities were localized in areas adjacent to the occluded sinus and did not match typical anterior or posterior circulation arterial territories. Bilateral perfusion deficits were seen in 4 cases. In 2 cases, parenchymal hemorrhage was diagnosed on noncontrast CT imaging; in those cases, focal CBV and CBF were reduced. Key Messages Whole-brain CT perfusion imaging with 320-detector-row scanners can further assist in establishing the diagnosis of VST by detecting perfusion abnormalities corresponding to venous and not arterial territories. CT perfusion could assist in the differentiation between focal reversible changes, such as those caused by vasogenic edema, and irreversible changes due to infarction. PMID:27051406

  6. A Case of Cerebral Sinus Venous Thrombosis Resulting in Mortality in Severe Preeclamptic Pregnant Woman

    PubMed Central

    Soydinc, Hatice Ender; Ozler, Ali; Evsen, Mehmet Sıddık; Sak, Muhammet Erdal; Basaranoglu, Serdar; Dusak, Abdurrahim; Cetincakmak, Mehmet Guli

    2013-01-01

    Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality. PMID:23509646

  7. Cerebral Venous Sinus Thrombosis in a Patient with Undiagnosed Factor VII Deficiency.

    PubMed

    Qadir, Hira; Rashid, Anila; Adil, Salman Naseem

    2017-09-01

    Factor VII (FVII) deficiency is one of the rare inherited bleeding disorders. Thrombosis has been occasionally described in inherited FVII deficiency. Here, we report a young female with undiagnosed FVII deficiency who presented with cerebral venous sinus thrombosis (CVST). Oral contraceptive pill was found to be prothrombotic risk factor. The CVSToccurred in spite of the congenital FVII deficiency indicating that no definitive antithrombotic protection is assured by this defect. Low molecular weight heparin and anti-Xa assay were found to be safe choice of anticoagulation and monitoring, respectively, in this patient.

  8. [Cerebral venous sinuses thrombosis in an infant with supramitral obstructive membrane associated with partial anomalous pulmonary venous return].

    PubMed

    Smilari, P; Romeo, M G; Sciacca, P; Scalzo, G; Gallo, C; Mattia, C; Manfrè, L; Distefano, G

    2005-04-01

    Cerebral venous thrombosis is quite rare in newborn infants, but probably its incidence is not well evaluated because clinical signs and cerebral echocardiography are not specific. We report the case of an newborn infant with massive cerebral venous thrombosis associated with heart malformation: supramitral ring and partial anomalous pulmonary venous connection in the superior vena cava.

  9. Cerebral venous sinus thrombosis secondary to typhoid fever: a case report and brief summary of the literature.

    PubMed

    Pineda, Maria Carissa; Lopinto-Khoury, Carla

    2012-07-01

    There have been few reports of typhoid fever (or salmonellosis) presenting with cerebral venous sinus thrombosis. We present such a case to highlight the importance of recognizing an etiology for cerebral sinus thrombosis and to discuss the role of salmonella in thrombogenesis. A 19-year-old man with a history of migraine presented with headache, nausea, vomiting, and fever, and was found to have a cerebral venous sinus thrombosis on magnetic resonance venography. He later developed profuse watery diarrhea and cultures grew salmonella species, consistent with typhoid fever. Treatment with antibiotics and oral anticoagulation led to resolution of his symptoms within 2 days and recanalization of the thrombosis was proven on magnetic resonance venography 6 months later. The development of profuse diarrhea after thrombosis suggests a direct thrombogenic effect of salmonella independent of dehydration. Systemic infections should be considered in all patients with thrombosis to identify treatable causes.

  10. Cerebral venous sinus thrombosis in pregnancy and puerperium: A pooled, systematic review.

    PubMed

    Kashkoush, Ahmed I; Ma, Henry; Agarwal, Nitin; Panczykowski, David; Tonetti, Daniel; Weiner, Gregory M; Ares, William; Kenmuir, Cynthia; Jadhav, Ashutosh; Jovin, Tudor; Jankowitz, Brian T; Gross, Bradley A

    2017-05-01

    Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST); however studies describing diagnosis and management in this population are limited. The objective of this study was to amalgamate published case reports and series regarding diagnosis and management of CVST in pregnancy and puerperium. Searches of PubMed and the Cochrane library were performed using search terms "pregnancy"/"puerperium" and "sinus occlusion"/"sinus thrombosis". Studies were included in our pooled analysis if they included individual patient symptoms, management approach and follow-up condition. Multivariate regression was utilized to assess the effect of non-modifiable factors on excellent outcome (mRS 0). Sixty-six patients were included. Mean duration of symptom onset to diagnosis was 5.9days (95% CI 4.2-7.6). Clot involvement of the superior sagittal sinus was seen in 67% of cases, the transverse/sigmoid in 64% and of the deep venous system in 15% of cases. Management approaches included anticoagulation (91% of patients), IA (intra-arterial) thrombolysis alone (26%), and IA thrombectomy with IA thrombolysis (8%). Fifty-nine percent of patients were mRS 0 at follow-up; 94% were mRS 0-2. Presentation with headache alone was associated with excellent outcome on multivariate analysis (p=0.04); coma/obtundation predicted against excellent outcome (p=0.03). As compared to IA thrombolysis alone, patients undergoing IA thrombolysis with IA thrombectomy demonstrated a trend toward better outcome (p=0.10). Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Concurrent Angioplasty Balloon Placement for Stent Delivery through Jugular Venous Bulb for Treating Cerebral Venous Sinus Stenosis. Technical Report.

    PubMed

    Qureshi, Adnan I; Khan, Asif A; Capistrant, Rachel; Qureshi, Mushtaq H; Xie, Kevin; Suri, M Fareed K

    2016-10-01

    To report upon technique of concurrent placement of angioplasty balloon at the internal jugular vein and sigmoid venous sinus junction to facilitate stent delivery in two patients in whom stent delivery past the jugular bulb was not possible. A 21-year-old woman and a 41-year-old woman with worsening headaches, visual obscuration or diplopia were treated for pseudotumor cerebri associated with transverse venous stenosis. Both patients had undergone primary angioplasty, which resulted in improvement in clinical symptoms followed by the recurrence of symptoms with restenosis at the site of angioplasty. After multiple attempts at stent delivery through jugular venous bulb were unsuccessful, a second guide catheter was placed in the ipsilateral internal jugular vein through contralateral femoral venous approach. A 6 mm × 20 mm (left) or 5 × 15 mm (right) angioplasty balloon was placed across the internal jugular vein and sigmoid sinus junction and partially inflated until the inflation and relative straightening of the junction was observed. In both patients, the internal jugular vein and sigmoid sinus junction was successfully traversed by the stent delivery system in a parallel alignment to inflated balloon. Balloon mounted stent was deployed at the site of restenosis with near complete resolution of lumen narrowing delivery and improvement in clinical symptoms. We report a technique for realignment and diameter change with concurrent placement and partial inflation of angioplasty balloon at the jugular venous bulb to facilitate stent delivery into the sigmoid and transverse venous sinuses in circumstances where multiple attempts at stent delivery are unsuccessful.

  12. Cerebral Venous Thrombosis in the Superior Sagittal Sinus as a Rare Cause of a Paroxysmal Kinetic Tremor

    PubMed Central

    Murao, Kei; Arakawa, Shuji; Furuta, Yoshihiko; Shijo, Masahiro; Ago, Tetsuro; Kitazono, Takanari

    2016-01-01

    Cerebral venous thrombosis (CVT) has a broad spectrum of clinical presentation compared to arterial etiology. Seizure is one of the common symptoms and is more frequent than in other stroke types. Hence, transient neurological symptoms in CVT patients are usually due to epileptic seizures, while transient repetitive movement disorder is extremely rare except as a complication of epilepsy. We report a case of CVT in the superior sagittal sinus with a 1-year history of paroxysmal kinetic tremor without evident epilepsy. PMID:28203183

  13. Cerebral venous and sinus thrombosis and thrombophilic mutations in Western Iran: association with factor V Leiden.

    PubMed

    Rahimi, Zohreh; Mozafari, Hadi; Bigvand, Amir Hossein Amiri; Doulabi, Reza Mohammad; Vaisi-Raygani, Asad; Afshari, Dariush; Razazian, Nazanin; Rezaei, Mansour

    2010-08-01

    The present study aimed at investigating the prevalence of factor V Leiden G1691A, prothrombin G20210A, and MTHFR C677T in cerebral venous and sinus thrombosis (CVST) patients and their possible association with CVST in Western Iran. A total of 24 CVST patients with the mean age of 37.1 +/- 11.7 years and 100 sex- and age-matched healthy individuals from Kermanshah Province of Iran with ethnic background of Kurd were studied for factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T by PCR-RFLP method using Mnl I, Hind III, and Hinf I restriction enzymes, respectively. Prevalence of factor V Leiden was 16.7% in patients and 2% in control group. A significant association was found between factor V Leiden mutation and CVST with odds ratio (OR) of 9.8 (95% confidence intervals [CI] 1.68-57.2, P = .01). No prothrombin G20210A was found among patients. In patients, MTHFR C677T tended to be higher (58.3%) compared to control (44%), OR of 1.8 (95% CI 0.73-4.5, P = .2). Our study for the first time has determined the prevalence of inherited thrombophilia in a homogenous ethnic group of CVST patients and suggests that factor V Leiden, and not the prothrombin gene mutation is a risk factor for CVST in Western Iran.

  14. Concurrent Angioplasty Balloon Placement for Stent Delivery through Jugular Venous Bulb for Treating Cerebral Venous Sinus Stenosis. Technical Report

    PubMed Central

    Qureshi, Adnan I.; Khan, Asif A.; Capistrant, Rachel; Qureshi, Mushtaq H.; Xie, Kevin; Suri, M. Fareed K.

    2016-01-01

    OBJECTIVE To report upon technique of concurrent placement of angioplasty balloon at the internal jugular vein and sigmoid venous sinus junction to facilitate stent delivery in two patients in whom stent delivery past the jugular bulb was not possible. CLINICAL PRESENTATION A 21-year-old woman and a 41-year-old woman with worsening headaches, visual obscuration or diplopia were treated for pseudotumor cerebri associated with transverse venous stenosis. Both patients had undergone primary angioplasty, which resulted in improvement in clinical symptoms followed by the recurrence of symptoms with restenosis at the site of angioplasty. INTERVENTION After multiple attempts at stent delivery through jugular venous bulb were unsuccessful, a second guide catheter was placed in the ipsilateral internal jugular vein through contralateral femoral venous approach. A 6 mm × 20 mm (left) or 5 × 15 mm (right) angioplasty balloon was placed across the internal jugular vein and sigmoid sinus junction and partially inflated until the inflation and relative straightening of the junction was observed. In both patients, the internal jugular vein and sigmoid sinus junction was successfully traversed by the stent delivery system in a parallel alignment to inflated balloon. Balloon mounted stent was deployed at the site of restenosis with near complete resolution of lumen narrowing delivery and improvement in clinical symptoms. CONCLUSION We report a technique for realignment and diameter change with concurrent placement and partial inflation of angioplasty balloon at the jugular venous bulb to facilitate stent delivery into the sigmoid and transverse venous sinuses in circumstances where multiple attempts at stent delivery are unsuccessful. PMID:27829971

  15. A Flare of Ulcerative Colitis Accompanied With Cerebral Sinus Venous Thrombosis And Bilateral Thalamic Infarctus: A Case Report

    PubMed Central

    Dulger, Ahmet Cumhur; Begenik, Huseyin; Demirtas, Levent; Esen, Ramazan; Emre, Habib

    2012-01-01

    Ulcerative colitis (UC) is a chronic inflammatory and recurrent disorder that is characterized by bowel inflammation. Some patients with Inflammatory Bowel Disease (IBD) have acute, severe, and sometimes devastating intracranial complications that require immediate medical intervention. Cerebral sinus vein thrombosis is a rare but serious extraintestinal complication associated with ulcerative colitis. Herein we report a 30-year-old man with UC who presented with a flare of gastrointestinal symptoms with mental obtundation and apathy. Total colonoscopy revealed active colitis and cranial MRI showed extensive cerebral sinus venous thrombosis with thalamic infarcts. Because the patient was clinically unstable metilprednisolon with low molecular weight heparin were administered. Two days after treatment the patient was died despite all medical efforts. PMID:27785183

  16. Acute venous sinus thrombosis after chickenpox infection.

    PubMed

    Sardana, Vijay; Mittal, Lal Chand; Meena, S R; Sharma, Deepti; Khandelwal, Girish

    2014-08-01

    Chickenpox is one of the classic childhood diseases. Recently chicken pox has been reported in adults with more severe systemic and neurological complications. Cerebral venous thrombosis (CVT) is a life threatening disorder if not treated in time. We report a patient with post varicella CVT as a rare complication of primary Varicella zoster virus. Vasculitic arterial infarction is known while venous stroke has rarely been reported with Varicella-zoster virus infection. Here, we report an immunocompetent 30 yr old male who developed chickenpox after contact with his daughter two month back. He presented with acute neurological deficit, one week after onset of skin lesion. MR venography revealed non-visualisation of left transverse sinus and left sigmoid sinus suggestive of venous sinus thrombosis. Varicella infection is rarely associated with venous sinus thrombosis. Possibly hypercoagulable state produced by the infection or direct invasion of virus in venous endothelial wall with subsequent damage to endothelium leading to thrombosis could be the cause.

  17. Cerebral Venous Thrombosis.

    PubMed

    Sassi, Samia Ben; Touati, Nahla; Baccouche, Hela; Drissi, Cyrine; Romdhane, Neila Ben; Hentati, Fayçal

    2016-01-01

    Data regarding cerebral venous thrombosis in North Africa are scarce. This study aims to identify the clinical features, risk factors, outcome, and prognosis of cerebral venous thrombosis in Tunisia. Data of 160 patients with radiologically confirmed cerebral venous thrombosis, hospitalized in Mongi Ben Hmida National Institute of Neurology (Tunis, Tunisia), were retrospectively collected and analyzed. The mean age was 37.3 years with a female predominance (83.1%). The mode of onset was subacute in most cases (56.2%). Headache was the most common symptom (71.3%), and focal neurologic symptoms were the main clinical presentation (41.8%). The most common sites of thrombosis were the superior sagittal sinus (65%) and the lateral sinus (60.6%). More than 1 sinus was involved in 114 (71.2%) patients. Parenchymal lesions observed in 85 (53.1%) patients did not correlate with cerebral venous thrombosis extent. Major risk factors were obstetric causes (pregnancy and puerperium) found in 46 (38.6% of women aged <50 years) patients, followed by anemia (28.1%) and congenital or acquired thrombophilia (16.2%). Mortality rate was of 6.6%. Good outcome at 6 months (modified Rankin Scale ≤2) was observed in 105 (87.5%)of 120 patients available for follow-up. Predictors of poor outcome were altered consciousness and elevated plasma C-reactive protein levels. Clinical and radiologic presentation of cerebral venous thrombosis in Tunisia was quite similar to other parts of the world with, however, a particularly high frequency of obstetric causes. Plasma C-reactive protein level should be considered as a prognostic factor in CVT.

  18. Plasmodium vivax cerebral malaria complicated with venous sinus thrombosis in Colombia.

    PubMed

    Pinzón, Miguel A; Pineda, Juan C; Rosso, Fernando; Shinchi, Masaru; Bonilla-Abadía, Fabio

    2013-05-13

    Complicated malaria is usually due to Plasmodium falciparum. Nevertheless, Plasmodium vivax is infrequently related with life-threatening complications. Few cases have been reported of severe Plasmodium vivax infection, and most of them from Southeast Asia and India. We report the first case of cerebral malaria due to Plasmodium vivax in Latin America, complicated with sagittal sinus thrombosis and confirmed by a molecular method. Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  19. Successful treatment of extensive cerebral venous sinus thrombosis using a combined approach with Penumbra aspiration system and Solitaire FR retrieval device

    PubMed Central

    Raychev, Radoslav; Tateshima, Satoshi; Rastogi, Sachin; Balgude, Amit; Yafeh, Banafsheh; Saver, Jeffrey L; Vespa, Paul M; Buitrago, Manuel; Duckwiler, Gary

    2013-01-01

    We present a young woman with rapidly progressive neurologic decline in the setting of malignant cerebral edema due to extensive superior sagittal sinus thrombosis and cortical venous thrombosis despite intravenous heparin administration. Complete revascularization of the occluded sinus was achieved using suction thrombectomy with the 5 max Penumbra catheter in combination with the Solitaire FR clot retrieval device. The successful endovascular treatment halted the progression of her cerebral edema, and the patient eventually had an excellent recovery after prolonged intensive medical therapy. To our knowledge, this is the first reported case describing such a combined mechanical approach for cerebral venous sinus thrombosis. The clot retrieval properties of the Solitaire device combined with direct aspiration via the newest generation Penumbra catheters may allow more rapid, safe and efficient revascularization than all previously reported endovascular treatments for this potentially devastating condition. PMID:24022899

  20. Clinical Characteristics of Cerebral Venous Sinus Thrombosis in Patients with Systemic Lupus Erythematosus: A Single-Centre Experience in China.

    PubMed

    Wang, Li; Chen, Hua; Zhang, Yao; Liu, Wanli; Zheng, Wenjie; Zhang, Xuan; Zhang, Fengchun

    2015-01-01

    Clinical characteristics of systemic lupus erythematosus (SLE) patients complicated with cerebral venous sinus thrombosis (CVST) between 2000 and 2013 were analyzed through this retrospective, single-centre study. Of 4747 hospitalized SLE patients, 17 (0.36%, 12 females, average age 30) had CVST. Headache (88.2%) was the most common neurological symptom followed by nausea or vomiting (47.1%), conscious disturbance (41.2%), edema of eyelids or conjunctiva (35.3%), blurred vision or diplopia (35.3%), and seizure (35.3%). Increased intracranial pressure (ICP) occurred in 13 cases (76.5%). Magnetic resonance venography (MRV) detected thrombosis in the transverse (82.4%), sigmoid (52.9%), and sagittal (35.3%) sinuses, with frequent (70.6%) multiple sinus occlusions. Compared to SLE patients without CVST, SLE patients with CVST had a higher prevalence of thrombocytopenia and positive antiphospholipid antibodies and a higher SLE disease activity index (SLEDAI) score. 13 patients achieved improvement following glucocorticoids and immunosuppressants treatment, as well as anticoagulants, while 3 patients died at the hospital. CVST is relatively rare in SLE and tends to occur in active lupus patients. Intracranial hypertension is common but nonspecific clinical feature, so MRV evaluation is necessary to establish a diagnosis. Aggressive treatment for the rapid control of SLE activity combined with anticoagulants can improve the prognosis.

  1. Use of tissue-glue-coated collagen sponge (TachoSil) to repair minor cerebral dural venous sinus lacerations: technical note.

    PubMed

    Gazzeri, Roberto; Galarza, Marcelo; Fiore, Claudio; Callovini, Giorgio; Alfieri, Alex

    2015-03-01

    Significant hemorrhage may occur from the cerebral venous sinuses during the dural separation from the bone flap, particularly in elderly patients. It is important to achieve an urgent hemostatic control. To evaluate the efficacy and safety of a new fixed combination tissue sealant (TachoSil) in patients with bleeding from lacerations of cerebral venous sinuses. Between September 2012 and June 2014, 57 patients (39 female, 18 male) presenting with iatrogenic tears of the superior sagittal or transverse/sigmoid sinuses were treated with a topical fibrin sealant patch. Intraoperative source of bleeding, time to bleeding control, quantity of sealant sponge used, and postoperative complications were evaluated. Time to hemostasis was used as the primary end point. Effective hemostasis, defined as cessation of bleeding after application of topical hemostatic agent, was achieved no later than 4 minutes in all except 5 patients with persistent bleeding from the sinus. In these 5 cases, bleeding was finally stopped after application of a new larger layer of TachoSil Sponge (2 cases) or gelatin hemostatic matrix (2 cases) or fibrin glue (1 case) over the layer of TachoSil. We report our experience with a new hemostasis technique to manage bleeding from iatrogenic lacerations of cerebral venous sinuses.

  2. Wavelet-Based Angiographic Reconstruction of Computed Tomography Perfusion Data: Diagnostic Value in Cerebral Venous Sinus Thrombosis.

    PubMed

    Kunz, Wolfgang G; Schuler, Felix; Sommer, Wieland H; Fabritius, Matthias P; Havla, Lukas; Meinel, Felix G; Reiser, Maximilian F; Ertl-Wagner, Birgit; Thierfelder, Kolja M

    2017-05-01

    The aim of this study was to test the diagnostic value of wavelet-based angiographic reconstruction of CT perfusion data (waveletCTA) to detect cerebral venous sinus thrombosis (CVST) in patients who underwent whole-brain CT perfusion imaging (WB-CTP). Datasets were retrospectively selected from an initial cohort of 2863 consecutive patients who had undergone multiparametric CT including WB-CTP. WaveletCTA was reconstructed from WB-CTP: the angiographic signal was generated by voxel-based wavelet transform of time attenuation curves (TACs) from WB-CTP raw data. In a preliminary clinical evaluation, waveletCTA was analyzed by 2 readers with respect to presence and location of CVST. Venous CT and MR angiography (venCTA/venMRA) served as reference standard. Diagnostic confidence for CVST detection and the quality of depiction for venous sections were evaluated on 5-point Likert scales. Thrombus extent was assessed by length measurements. The mean CT attenuation and waveletCTA signal of the thrombus and of flowing blood were quantified. Sixteen patients were included: 10 patients with venCTA-/venMRA-confirmed CVST and 6 patients with arterial single-phase CT angiography (artCTA)-suspected but follow-up-excluded CVST. The reconstruction of waveletCTA was successful in all patients. Among the patients with confirmed CVST, waveletCTA correctly demonstrated presence, location, and extent of the thrombosis in 10/10 cases. In 6 patients with artCTA-suspected but follow-up-excluded CVST, waveletCTA correctly ruled out CVST in 5 patients. Reading waveletCTA in addition to artCTA significantly increased the diagnostic confidence concerning CVST compared with reading artCTA alone (4.4 vs 3.6, P = 0.044). The mean flowing blood-to-thrombus ratio was highest in waveletCTA, followed by venCTA and artCTA (146.2 vs 5.9 vs 2.6, each with P < 0.001). In waveletCTA, the venous sections were depicted better compared with artCTA (4.2 vs 2.6, P < 0.001), and equally well compared with ven

  3. Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology.

    PubMed

    Ranta, Susanna; Tuckuviene, Ruta; Mäkipernaa, Anne; Albertsen, Birgitte K; Frisk, Tony; Tedgård, Ulf; Jónsson, Ólafur G; Pruunsild, Kaie; Gretenkort Andersson, Nadine; Winther Gunnes, Maria; Saulyte Trakymiene, Sonata; Frandsen, Thomas; Heyman, Mats; Ruud, Ellen; Helgestad, Jon

    2015-02-01

    We present a prospective multicentre cohort of 20 children with acute lymphoblastic leukaemia (ALL) and cerebral sinus venous thrombosis (CSVT). The study covers a period of 5 years and comprises 1038 children treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL 2008 protocol. The cumulative incidence of CSVT was 2%. Sixteen of the thromboses were related to asparaginase and 16 to steroids. Most CSVTs occurred in the consolidation phase. Nearly all were treated with low molecular weight heparin without bleeding complications. Mortality related to CSVT directly or indirectly was 10%, emphasizing the importance of this complication.

  4. Case of Cerebral Venous Thrombosis with Unusual Venous Infarcts

    PubMed Central

    Kamaraju, Susheel Kumar; Pasupaleti, Bhimeswarao; Juluri, Naganarasimharaju

    2015-01-01

    Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed. PMID:26023623

  5. Frosted branch angiitis and cerebral venous sinus thrombosis as an initial onset of neuro-Behçet's disease: a case report and review of the literature.

    PubMed

    Ferreira, Bruno Fortaleza de Aquino; Rodriguez, Ever Ernesto Caso; Prado, Leandro Lara do; Gonçalves, Celio Roberto; Hirata, Carlos Eduardo; Yamamoto, Joyce Hisae

    2017-04-15

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

  6. Reversible cerebral vasoconstriction syndrome in the context of recent cerebral venous thrombosis: Report of a case.

    PubMed

    Bourvis, Nadège; Franc, Julie; Szatmary, Zoltan; Chabriat, Hugues; Crassard, Isabelle; Ducros, Anne

    2016-01-01

    Reversible cerebral constriction syndrome and cerebral venous thrombosis are two rare conditions. Reversible cerebral constriction syndrome affects the cerebral arteries and the pathology is still largely unknown. To date, no physiological link with cerebral venous thrombosis has been reported. We report here the case of a 24-year-old woman who presented a reversible cerebral constriction syndrome in the setting of a cerebral venous thrombosis. Cerebral venous thrombosis had developed in her left lateral venous sinus, within the stent placed one year before, in order to treat an idiopathic intracranial hypertension. The co-occurrence of cerebral venous thrombosis and reversible cerebral constriction syndrome in the same patient raises the issue of a potential link between them. We discuss the potential common trigger factors in this case: recent hormonal therapy; intracranial hypotension iatrogenically induced by lumbar puncture. © International Headache Society 2015.

  7. [Diagnostic and treatment standards for cerebral sinus venous thrombosis : Results of an online survey of German stroke units].

    PubMed

    Geisbüsch, C; Ringleb, P A; Busse, O; Hamann, G F; Nagel, S

    2017-07-10

    The aim of this survey was to characterize the current diagnostic and therapeutic strategies for thrombosis of the cerebral sinus and veins (CVT) performed in German stroke units (SU). Between September 2015 and January 2016 all clinical heads of certified SUs in Germany were invited to participate in a standardized online survey. The survey concentrated on the basic characteristics of SUs, diagnostic and therapeutic procedures and was made anonymous if so desired. Frequencies were expressed as percentages and differences between regional stroke units (RSU) and supraregional (i. e. comprehensive) SUs (SRSU) were compared with the χ(2)-test or Fisher's test RESULTS: A total of 107 SU heads participated (response rate 42.8%) and 55.1% of these were RSUs. In 77.2% the diagnosis is made by magnetic resonance imaging angiography (MR-A, RSU 81.1% vs. SRSU 72.3%; p = 0.29). Of the SUs 79.1% determined d‑dimer if CVT is suspected (79.3% vs. 78.7%; p = 0.94) and 88.5% carried out screening for thrombophilia (89.5% vs. 87.2%; p = 0.72). Intravenous unfractionated heparin (67.2% vs. 70.2%; p = 0.74) or subcutaneous low molecular weight heparin (32.8% vs. 29.8%; p = 0.74) are first line therapy in all SUs. Invasive procedures, such as hypothermia (3.7% vs. 10.6%; p = 0.25), hemicraniectomy (26% vs. 63.9%; p = 0.0001), endovascular techniques (11.1% vs. 40.4%; p = 0.0007) and systemic thrombolysis (5.5% vs. 10.6%; p = 0.47) are performed more frequently in SRSUs. Of the SUs 18.5% already use new oral anticoagulants (10.7% vs. 27.7%; p = 0.027). Most of the SUs organize a follow-up visit (70.9% vs. 76.6%; p = 0.52) with a MRI (94.2% vs. 91.1%; p = 0.7) within the first 6 months. The survey revealed substantial homogeneity between RSUs and SRSUs and standards are mostly in line with the guidelines. Non-established procedures, such as invasive therapeutic procedures and the administration of new oral anticoagulants were used significantly more often in SRSUs.

  8. Factor V Leiden, factor V Cambridge, factor II GA20210, and methylenetetrahydrofolate reductase in cerebral venous and sinus thrombosis: A case-control study

    PubMed Central

    Saadatnia, Mohammad; Salehi, Mansour; Movahedian, Ahmad; Shariat, Seyed Ziaeddin Samsam; Salari, Mehri; Tajmirriahi, Marzieh; Asadimobarakeh, Elham; Salehi, Rasoul; Amini, Gilda; Ebrahimi, Homa; Kheradmand, Ehsan

    2015-01-01

    Background: Factor V G1691A (FV Leiden), FII GA20210, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are the most common genetic risk factors for thromboembolism in the Western countries. However, there is rare data in Iran about cerebral venous and sinus thrombosis (CVST) patients. The aim of this study was to evaluate the frequency of common genetic thrombophilic factors in CVST patients. Materials and Methods: Forty consequently CVST patients from two University Hospital in Isfahan University of Medical Sciences aged more than 15 years from January 2009 to January 2011 were recruited. In parallel, 51 healthy subjects with the same age and race from similar population selected as controls. FV Leiden, FII GA20210, MTHFR C677T, and FV Cambridge gene mutations by polymerase chain reaction technique were evaluated in case and control groups. Results: FV Leiden, FII GA20210, and FV Cambridge gene mutations had very low prevalence in both case (5%, 2%, 0%) and control (2.5%, 0%, 0%) and were not found any significant difference between groups. MTHFR C677T mutations was in 22 (55%) of patients in case group and 18 (35.5%) of control group (P = 0.09). Conclusion: This study showed that the prevalence of FV Leiden, FII GA20210, and FV Cambridge were low. Laboratory investigations of these mutations as a routine test for all patients with CVST may not be cost benefit. PMID:26600830

  9. Factor V Leiden, factor V Cambridge, factor II GA20210, and methylenetetrahydrofolate reductase in cerebral venous and sinus thrombosis: A case-control study.

    PubMed

    Saadatnia, Mohammad; Salehi, Mansour; Movahedian, Ahmad; Shariat, Seyed Ziaeddin Samsam; Salari, Mehri; Tajmirriahi, Marzieh; Asadimobarakeh, Elham; Salehi, Rasoul; Amini, Gilda; Ebrahimi, Homa; Kheradmand, Ehsan

    2015-06-01

    Factor V G1691A (FV Leiden), FII GA20210, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are the most common genetic risk factors for thromboembolism in the Western countries. However, there is rare data in Iran about cerebral venous and sinus thrombosis (CVST) patients. The aim of this study was to evaluate the frequency of common genetic thrombophilic factors in CVST patients. Forty consequently CVST patients from two University Hospital in Isfahan University of Medical Sciences aged more than 15 years from January 2009 to January 2011 were recruited. In parallel, 51 healthy subjects with the same age and race from similar population selected as controls. FV Leiden, FII GA20210, MTHFR C677T, and FV Cambridge gene mutations by polymerase chain reaction technique were evaluated in case and control groups. FV Leiden, FII GA20210, and FV Cambridge gene mutations had very low prevalence in both case (5%, 2%, 0%) and control (2.5%, 0%, 0%) and were not found any significant difference between groups. MTHFR C677T mutations was in 22 (55%) of patients in case group and 18 (35.5%) of control group (P = 0.09). This study showed that the prevalence of FV Leiden, FII GA20210, and FV Cambridge were low. Laboratory investigations of these mutations as a routine test for all patients with CVST may not be cost benefit.

  10. Clinical tests of noninvasive optoacoustic cerebral venous oxygenation monitoring system

    NASA Astrophysics Data System (ADS)

    Petrov, Y. Y.; Petrova, I. Y.; Esenaliev, R. O.; Prough, D. S.

    2009-02-01

    Monitoring of cerebral venous oxygenation is critically important for management of patients with traumatic brain injury and cardiac surgery patients. At present, there is no technique for noninvasive, accurate monitoring of this important physiologic parameter. We built a compact optoacoustic system for noninvasive, accurate cerebral venous oxygenation monitoring using a novel optoacoustic probe and algorithm that allow for direct probing of sagittal sinus blood with minimal signal contamination from other tissues. We tested the system in large animal and clinical studies and identified wavelengths for accurate measurement of cerebral blood oxygenation. The studies demonstrated that the system may be used for noninvasive, continuous, and accurate monitoring of cerebral venous blood oxygenation.

  11. Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations

    PubMed Central

    MITSUHASHI, Yutaka; HAYASAKI, Koji; KAWAKAMI, Taichiro; NAGATA, Takashi; KANESHIRO, Yuta; UMABA, Ryoko; OHATA, Kenji

    2016-01-01

    The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage. PMID:27063146

  12. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review.

    PubMed

    Torres, Ronaldo Afonso; Torres, Bruna Ribeiro; de Castilho, Alessandra Soares Rocha; Honorato, Ronaldo

    2014-01-01

    Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms 'nephrotic syndrome' and 'cerebral sinovenous thrombosis'. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes.

  13. Cerebral venous sinus thrombosis as a recurrent thrombotic event in a patient with heterozygous prothrombin G20210A genotype after discontinuation of oral anticoagulation therapy: how long should we treat these patients with warfarin?

    PubMed

    Jukic, Ivana; Titlic, Marina; Tonkic, Ante; Rosenzweig, Daniel

    2007-08-01

    Cerebral venous sinus thrombosis is an uncommon condition with many clinical manifestations, and hereditary prothrombotic conditions such as factor Leiden V, deficiency of protein S, protein C and antithrombin III, as well as prothrombin gene mutation, may account for 10-15% of cases. To date, conflicting results have been reported for recurrent venous thrombosis in the patients with factor V Leiden and prothrombin G20210A mutation, since some studies have shown a higher risk for recurrent venous thrombosis in carriers of these two mutations than in non-carriers, and the last study showed higher risk only for carriers of double defect (homozygous or double heterozygous for this mutations). Case report is presented. We report a case of cerebral sinus thrombosis as a recurrent thrombotic event in a patient with heterozygous prothrombin G20210A genotype after discontinuation of oral anticoagulation therapy. Since many facts are controversial, the use of secondary prophylaxis for thrombosis in these patients is still a matter of debate without clear consensus recommendation. Data on the risk of recurrent thrombotic events in thrombophilic patient is insufficient. The main unclear question concerning these patients is: how long and whom should we treat with long-term anticoagulant therapy as secondary prophylaxis of DVT? The problem for practitioner is that we do not have guidelines and precise recommendations for secondary thromboprophylaxis in this or similar cases. This case is remarkable for its favorable and quick outcome and its rarity, because CSVT is an uncommon condition and heterozygous prothrombin G20210A genotype was only found predisposing factor for CSVT. Further studies of risk of recurrent venous thrombosis in patients with heterozygous prothrombin G20210A genotype with the larger sample size are required.

  14. A Rare Case of Transverse Sinus Venous Thrombosis Simulating Postdural Puncture Headache After Cervical Epidural Injection.

    PubMed

    Guirguis, Maged; Jusino, Eduardo; Tolba, Reda; Samuel, Samuel

    2016-08-01

    Postdural puncture headache (PDPH) is a feared complication related to epidural steroid injections. We report a unique case in which all subjective and objective findings indicated the diagnosis of PDPH. However, the patient failed appropriate conservative and interventional management. Therapeutic failure prompted further investigation to establish the correct diagnosis of cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare, difficult to diagnose, but potentially lethal disorder with nonspecific and variable clinical presentations, including headache and focal neurological deficits. Performing magnetic resonance imaging and magnetic resonance venogram should be considered early, especially in patients who fail to respond to standard interventions for PDPH.

  15. A rare cause of cerebral venous thrombosis: cryptococcal meningoencephalitis.

    PubMed

    Senadim, Songul; Alpaydin Baslo, Sezin; Tekin Güveli, Betül; Dedei Daryan, Metin; Kantaroglu, Elif; Ozturk, Oya; Atakli, Dilek

    2016-07-01

    Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a non-endemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis.

  16. A Series of Cerebral Venous Sinus Thromboses Treated with Intra-Arterial tPA infused over Ten Hours with a 0.027-inch Catheter and Literature Review

    PubMed Central

    Ziu, Endrit; Haley, O'Hara; Ibrahimi, Muhammad; Simon, Scott

    2016-01-01

    Cerebral venous sinus thrombosis (CVST) can have devastating results, with mortality reported in 44% of cases. No randomized trials exist in order to define what qualifies as failure of conservative therapy, and there is no specific intervention to date which is considered safe and effective. Case series suggest that thrombolysis infusion is safer than thrombectomy, but methods of administration, dose, and duration of therapy tend to vary widely. We present three consecutive CVST patients treated with heparin who suffered both clinical and radiographic deterioration, and went on to have endovascular therapy. Each patient was successfully recanalized by placing a 0.027-inch microcatheter at the proximal portion of the thrombus and infusing 20 mg of alteplase dissolved in 1 liter of normal saline infused at 100 ml per hour for an infusion of 2 mg of alteplase per hour for ten hours.  PMID:27462480

  17. Risk Factors for Cerebral Venous Thrombosis.

    PubMed

    Silvis, Suzanne M; Middeldorp, Saskia; Zuurbier, Susanna M; Cannegieter, Suzanne C; Coutinho, Jonathan M

    2016-09-01

    Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involving the cerebral veins and dural sinuses. In contrast to more common sites of venous thromboembolism (VTE), such as the legs and lungs, CVT mainly affects young adults and children, and women are affected three times more often than men. Although presenting symptoms are variable, headache is usually the first symptom, often in combination with focal neurologic deficits and epileptic seizures. The primary therapy for CVT consists of heparin followed by oral anticoagulation for at least 3 to 6 months. The mortality in the acute phase is 5 to 10% and a substantial proportion of survivors suffer from long-term disabilities. A large number of risk factors have been linked to CVT, although the scientific evidence for an association varies considerably between risk factors. Some risk factors, such as hereditary thrombophilia, correspond with risk factors for more common sites of VTE, whereas others, such as head trauma, are specific to CVT. In most patients, at least one risk factor can be identified. In this review, we provide an overview of the risk factors for CVT.

  18. [Cerebral venous thrombosis imagiologic features in a pregnant woman].

    PubMed

    Ferreira, Maria Madalena; Rios, Ana Cristina; Fragata, Isabel; Baptista, José Tiago; Manaças, Rui; Reis, João

    2011-01-01

    Cerebral venous thrombosis (CVT) is a relatively rare but serious condition potentially reversible upon accurate diagnosis and adequate therapy. The peri-partum state and pregnancy are predisposing factors and TVC accounts for about 6% of maternal deaths. Its clinical symptoms depend on the the thrombus site and extension, and also on the existing collateral vessels network. We present the case of a 33 year-old woman, 13 weeks pregnant, that complained of headaches and whose cranial magnetic resonance imaging revealed a subtotal oclusión of the superior sagittal sinus. We discuss the imaging features of dural venous thrombosis in the acute phase.

  19. Transarterial venous sinus occlusion of dural arteriovenous fistulas using ONYX.

    PubMed

    Torok, Collin M; Nogueira, Raul G; Yoo, Albert J; Leslie-Mazwi, Thabele M; Hirsch, Joshua A; Stapleton, Christopher J; Patel, Aman B; Rabinov, James D

    2016-12-01

    The purpose of this article is to present a case series of transarterial venous sinus occlusion for dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses. From 2006 to 2012, 11 patients with DAVF of the transverse and sigmoid sinuses were treated with transarterial closure of the affected venous sinus using ethylene vinyl alcohol copolymer (ONYX). The consecutive retrospective cohort included six female and five male patients with an age range of 30-79. Patients presented with stroke, intracranial hemorrhage, seizure, headache, focal neurologic deficit or cognitive change. Lesions were categorized as Cognard II a + b (n = 5) or Cognard II b (n = 6). Four of this latter group consisted of isolated sinus segments. Selection criteria for dural sinus occlusion included direct multi-hole fistulas involving a broad surface in length or circumference of the sinus wall. External carotid artery (ECA) branches were directly embolized when considered safe. High-risk arterial supply from ICA, PICA, AICA or ECA cranial nerve branches were closed via retrograde approach during sinus occlusion. DAVF closure was accomplished in all 11 patients with a total of 17 embolization procedures using ONYX. High-risk arterial collaterals were closed via artery-artery or artery-sinus-artery embolization. The vein of Labbe was spared in the four cases with initial antegrade flow. No neurologic complications occurred, and DAVF closures were durable on three-month angiography. Transarterial closure of the transverse and sigmoid sinuses. © The Author(s) 2016.

  20. Cerebral arterial occlusion and intracranial venous thrombosis in a woman taking oral contraceptives.

    PubMed Central

    Montón, F.; Rebollo, M.; Quintana, F.; Berciano, J.

    1984-01-01

    Occlusion of the middle cerebral artery and thrombosis of the superior sagittal sinus are reported in a 30-year-old woman taking oral contraceptives (OC). The coexistence of arterial and venous cerebral pathology as a complication of OC use has only been previously reported in one case. The pathogenesis of this rare association is briefly discussed. Images Fig. 1 Fig. 2 PMID:6462985

  1. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review

    PubMed Central

    Torres, Ronaldo Afonso; Torres, Bruna Ribeiro; de Castilho, Alessandra Soares Rocha; Honorato, Ronaldo

    2014-01-01

    Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes. PMID:25607275

  2. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

    PubMed Central

    Hosaka, Ai; Yamaguchi, Tetsuto; Yamamoto, Fumiko; Shibagaki, Yasuro

    2015-01-01

    Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures. PMID:26693366

  3. [Venous sinuses of the dura mater of the bird brain].

    PubMed

    Krasnikov, Iu A

    1988-04-01

    By means of corrosive, injection and tracheoscopy methods venous formations of the brain have been studied in 19 species of birds--endemical for Far East--from 12 orders. Four types of the venous sinuses structure have been distinguished in the dura mater: the first type of the structure is specific for birds that live an inactive and quiet life (blue rock pigeon, Ussuric pheasant, Tetrastes bonasia, domestic hen). The second type of the sinus structure occurs in birds, that sharply change the speed and height of their flight (Otus bakkamoena). The most manifested changes in the sinus structure are noted in waterfowl and diving birds, that spend much time in flight, in dendrocolaptidae and in day predaceous birds; in them the longitudinal sinus forms a rhombus.

  4. Cerebral Venous Thrombosis in Pregnancy-A Poignant Allegory of an Unusual Case

    PubMed Central

    Shailesh, Gaikwad Harsha; Gupta, Sumedha; Sharma, Manjula; Mittal, Pratima

    2016-01-01

    Cerebral Venous Thrombosis (CVT), also known as cortical venous, cerebral sinus, cerebral venous sinus, or dural sinus thrombosis, is an infrequent grave condition affecting pregnant females, resulting from clot formation in one of the many outflow tracts of the brain. Although pregnancy-associated stroke or CVT is uncommon, the risk of stroke is greatly increased above the low baseline rate in young patients during late pregnancy and, even more so, during the puerperium. Haemorrhagic infarction can occur in the acute stage of CVT. The article reports a case of CVT in puerperium in woman without any risk factors for thrombosis, highlighting the difficulties encountered in differentiating this rare cause from common diagnoses such as eclampsia. Also, clinical considerations and relevant literature review on prognostic factors affecting outcome have been addressed. CVT is an uncommon serious neurologic disorder in young gravidas requiring prudent assessment of the potential differential diagnoses and prompt management. PMID:28208950

  5. [Subarachnoid hemorrhage induced by cerebral venous thrombosis].

    PubMed

    El Otmani, H; Moutaouakil, F; Fadel, H; Slassi, I

    2012-12-01

    Nontraumatic subarachnoid hemorrhage is a relatively rare disease, typically secondary to a ruptured aneurysm. We report the case of a 23-year-old patient who developed a subarachnoid hemorrhage caused by extensive cerebral venous thrombosis due to a factor V Leiden mutation. Cerebral venous thrombosis is an uncommon etiology of subarachnoid hemorrhage. This raises diagnostic difficulties and a therapeutic dilemma regarding the use of anticoagulants. Copyright © 2012. Published by Elsevier Masson SAS.

  6. Cerebral Venous Congestion as Indication for Thrombolytic Treatment

    SciTech Connect

    Tsai, Fong Y. Kostanian, Varoujan; Rivera, Monica; Lee, Kwo-Whie; Chen, Clayton C.; Nguyen, Thong H.

    2007-07-15

    Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods

  7. Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience

    PubMed Central

    Mokin, Maxim; Lopes, Demetrius K; Binning, Mandy J; Veznedaroglu, Erol; Liebman, Kenneth M; Arthur, Adam S; Doss, Vinodh T; Levy, Elad I

    2015-01-01

    Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0–2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder. PMID:26055685

  8. Baloon angioplasty for venous sinus stenosis in a idiopathic intracranial hypertension case.

    PubMed

    Bajrami, Arsida; Senadim, Songul; Cabalar, Murat; Azman, Filiz; Bozkurt, Dilek; Kara, Batuhan; Selcuk, Hakan; Yayla, Vildan

    2015-05-01

    The Idiopathic Intracranial Hypertension (IIH) is a well characterised condition with intractable headaches, visual obscurations, and papilloedema as dominant features, mainly affecting obese women. With the advent of magnetic resonance (MR) venography and increased use of cerebral angiography, there has been recent emphasis on the significant number of patients with IIH found to have associated non-thrombotic dural venous sinus stenosis. This has led to a renewed interest in endovascular stenting and angioplasty as a treatment for IIH in patients non-responsive to medical treatment. We present a patient without known risk factors for IIH and non-responsive to treatment. The 19-year-old woman presented with headache and diplopia. She was diagnosed with IIH since she was five years of age and had been non-responsive to lumbar cerebrospinal fluid (CSF) drainage and acetazolamide treatment. MR venography revealed thin calibration of transverse sinus. Digital subtraction angiography (DSA) venous phase also revealed 50% stenosis of transverse sinus, 50% stenosis of left proximal sigmoid sinus and 90% stenosis of its distal part leading to obstruction of left transverse sinus outflow and forced directed drainage of left hemisphere to the anterior region.

  9. Extreme clinical presentations of venous stasis: coronary sinus thrombosis.

    PubMed

    Kachalia, Amit; Sideras, Panagiotis; Javaid, Mian; Muralidharan, Sethu; Stevens-Cohen, Pilar

    2013-11-01

    Sixty six year old male with history of heart failure was admitted for dysphagia, weight loss. CT scan chest revealed diffuse oesophageal wall thickening. Upper endoscopy, oesophagogram confirmed diagnosis of achalasia. TTE revealed severely reduced biventricular systolic function with LVEF 10%; PASP 75-80 mmHg. Parasternal long views showed dilated coronary sinus with a visible, mobile 2.0 cm thrombus. Pro-thrombotic workup was negative. Coronary sinus thrombosis has been identified as a rare complication to invasive cardiac procedures causing damage to coronary sinus endothelium and in hypercoagulable states.Typically acute thrombosis presents with chest pain, dynamic ECG changes, but chronic development does not present with ischaemic signs due to formation of efficient collateral circulation. We present a case report of stable primary coronary sinus thrombus incidentally diagnosed, secondary to chronic venous stasis in coronary circulation. Currently, there are no guidelines to assist physicians in long term management of such patients and thus warrants further investigations.

  10. Unusual Presentation of Dengue Fever-Cerebral Venous Thrombosis

    PubMed Central

    Vairamon, Pradhosh M; Gowtham, Thiruvengadam; Das, Ashok Kumar

    2015-01-01

    Dengue infection can present as febrile illness with thrombocytopenia, dengue shock syndrome and dengue haemorrhagic fever. Neurological manifestation of dengue infection is more predominant in endemic region. Here, we report a case with unusual neurological presentation of dengue infection. A 16-year-old boy presented with fever for two week duration, headache and double vision involving left eye for two days. He had multiple erythematous rashes all over the body on 3rd day and treated conservatively. On examination he had bilateral papilloedema, left eye restricted abduction. His investigation revealed thrombocytopenia and positive dengue serology. His MRI brain with venogram showed bilateral transverse sinus thrombosis. Hence he was diagnosed as cerebral venous thrombosis due to dehydration with underlying dengue infection. He was hydrated and managed conservatively. On 3rd day his double vision started improving. His repeat MR Venogram was done after two week duration, which revealed recanalisation of bilateral transverse sinus. PMID:26266153

  11. Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

    PubMed Central

    Rim, Hyun Taek; Jun, Hyo Sub; Ahn, Jun Hyong; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho; Cho, Byung Moon

    2016-01-01

    Objective Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers. Materials and Methods A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed. Results Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes. Conclusion Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident. PMID:27847760

  12. [Endovascular thrombolysis for massive cerebral venous thrombosis in a teenager with nephrotic syndrome].

    PubMed

    Costa, Paula; Biscoito, Luísa; Vieira, Marisa; Marçal, Mónica; Camilo, Cristina; Neto, Lia; Abecasis, Francisco; Almeida, Margarida; Correia, Manuela

    2010-01-01

    Cerebral venous thrombosis is a rare but potentially severe condition in children. We present the case of a teenager with corticodependent nephrotic syndrome diagnosed at five months of age and treated with cyclosporine A. In the context of recurrence of nephrotic syndrome he presented with headache, vomiting and severe intracranial hypertension. While the raised intracranial pressure and the status epilepticus were controlled, the brain imaging revealed venous thrombosis of all venous sinus, with absence of venous drainage. He was submitted to local thrombolysis with recombinant tissue plasminogen activator, with recanalization of the venous sinuses. The outcome was favourable, without neurological deficits. In this case, the early radiologic intervention was crucial, enabling a full neurological recovery, in a teenager whose initial prognosis was very poor.

  13. Cortical blindness as a rare presentation of cerebral venous thrombosis.

    PubMed

    Wang, Bonnie; Moon, Seong-Jin; Olivero, William C; Wang, Huan

    2013-05-09

    Cerebral venous thrombosis (CVT) remains a diagnostic and therapeutic challenge for clinicians. Manifesting in a remarkably wide spectrum of symptoms and signs, CVT often presents in a misleading fashion-if unrecognized or misdiagnosed, it carries potentially fatal consequences. Visual loss is quite rare as the initial presentation of CVT and is typically a finding more frequent in chronic cases with associated papilledema on funduscopy Ferro, Lopes, Rosas and Fontes (Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis. Cerebrovasc Dis 2005;19: :152-6). We report a rare case of acute cortical blindness as the initial presentation of CVT in an 18-year-old female patient and review the current literature. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

  14. Cortical blindness as a rare presentation of cerebral venous thrombosis

    PubMed Central

    Wang, Bonnie; Moon, Seong-Jin; Olivero, William C.; Wang, Huan

    2013-01-01

    Cerebral venous thrombosis (CVT) remains a diagnostic and therapeutic challenge for clinicians. Manifesting in a remarkably wide spectrum of symptoms and signs, CVT often presents in a misleading fashion—if unrecognized or misdiagnosed, it carries potentially fatal consequences. Visual loss is quite rare as the initial presentation of CVT and is typically a finding more frequent in chronic cases with associated papilledema on funduscopy Ferro, Lopes, Rosas and Fontes (Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis. Cerebrovasc Dis 2005;19:152–6). We report a rare case of acute cortical blindness as the initial presentation of CVT in an 18-year-old female patient and review the current literature. PMID:24964444

  15. [Thrombosis of the intracranial venous sinuses after ingestion of estroprogestative agents. 4 cases].

    PubMed

    Rousseaux, P; Bernard, M H; Scherpereel, B; Morel, M; Guyot, J F

    1977-06-04

    The authors report 4 cases of thrombosis of the superior longitudinal sinus (SLS) in women taking oestroprogestational agents. This complication is very rare, only 25 cases existing in the literature. The clinical picture consists of premonitory headaches associated with neurological signs suggesting lesions affecting both hemispheres in alternation. In the absence of treatment, sudden deterioration on about the tenth day is to be feared. This picture is similar to that of puerperal thrombosis of the SLS. The diagnosis should be confirmed by carotid arteriography, which demonstrates the presence of collateral varices and the thrombosed sinus giving a "negative" image on the AP view. Cerebral scintigraphy shows one or more areas of uptake in the form of adjacent rounded shapes, corresponding to cerebral infarctions of venous origin. As far as the responsibility of oestro-progenstational agents is concerned, the role is suggested by the analogy with puerperal thromboses and also by the absence of cases in men (with the exception of head injury, infections of the face and haematological malignancies). The prognosis is grave (19 deaths out of 29 cases), but surviving patients are completely cured. This prognosis would seem to be essentially dependent upon the possibilities of venous callateral circulation, which are variable in each individual patient. Anticoagulants and thrombolytic risk, in effective doses, to transform the venous thrombosis into a cerebral haemorrhage. Treatment consists rather of methods to reduce cerebral volume, aimed at maximal use of collateral varices and assisting the patient to overcome to acute phase of the first 2 weeks. Headache would seem to be the principal presenting symptom. In our opinion, no biological test gives a reliable indication as to those women most at risk and contraindictions are in fact of a clinical character.

  16. Sigmoid sinus cortical plate dehiscence induces pulsatile tinnitus through amplifying sigmoid sinus venous sound.

    PubMed

    Tian, Shan; Wang, Lizhen; Yang, Jiemeng; Mao, Rui; Liu, Zhaohui; Fan, Yubo

    2017-02-08

    Sigmoid sinus cortical plate dehiscence (SSCPD) is common in pulsatile tinnitus (PT) patients, and is treated through SSCPD resurfacing surgery in clinic, but the bio-mechanism is not clear as so far. This study aimed to clarify the bio-mechanism of PT sensation induced by SSCPD, and quantify the relationship of cortical plate (CP) thickness and PT sensation intensity. It was hypothesized that SSCPD would induce PT through significantly amplifying sigmoid sinus (SS) venous sound in this study. Finite element (FE) analysis based on radiology data of typical patient was used to verify this hypothesis, and was validated with clinical reports. In cases with different CP thickness, FE simulations of SS venous sound generation and propagation procedure were performed, involving SS venous flow field, vibration response of tissue overlying dehiscence area (including SS vessel wall and CP) and sound propagation in temporal bone air cells. It was shown in results that SS venous sound at tympanic membrane was 56.9dB in SSCPD case and -45.2dB in intact CP case, and was inaudible in all thin CP cases. It was concluded that SSCPD would directly induce PT through significantly amplifying SS venous sound, and thin CP would not be the only pathophysiology of PT. This conclusion would provide a theoretical basis for the design of SSCPD resurfacing surgery for PT patients with SSCPD or thin CP. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Dilated cerebral venous system observed in growth restricted fetuses.

    PubMed

    Baron, Joel; Mastrolia, Salvatore Andrea; Shelef, Ilan; Tirosh, Dan; Daniel-Spiegel, Etty; Hershkovitz, Reli

    2017-04-03

    The dilation of the fetal cerebral veins is a rare phenomena that may be associated to a bad obstetric outcome, and is usually connected to antenatal thrombosis of the posterior dural venous sinuses. There are several descriptions of cerebral vein distension on magnetic resonance imaging (MRI), but all of them are detected postnatally. We present herein two cases of fetal antenatal cerebral dilation of the venous system, without any association to any sign of vein thrombosis, and a systematic review of literature regarding pathogenesis, diagnosis and outcomes associated to the antenatal detection of this condition with the use of MRI. To identify potentially eligible studies, we searched PubMed, Scopus, Cochrane Library (all from inception to October 20(th), 2016) and applied no language restrictions. The electronic database search provided a total of 22843 results. After the exclusion of duplicates, manuscripts that resulted not relevant to the review based on title and abstract screening, and analysis of manuscripts eligible for full-text assessment, no papers were found related to the subject reported in the present manuscript.

  18. The use of autologous venous blood for maxillary sinus floor augmentation in conjunction with sinus membrane elevation: an experimental study.

    PubMed

    Kim, Ha-Rang; Choi, Byung-Ho; Xuan, Feng; Jeong, Seung-Mi

    2010-03-01

    There have been reports of successful bone formation with sinus floor elevation induced by simply elevating the maxillary sinus membrane and filling the sinus cavity with a blood clot. We investigated the feasibility of maxillary sinus floor augmentation using the patient's own venous blood in conjunction with a sinus membrane elevation procedure. An implant that protruded 8 mm into the maxillary sinus after sinus membrane elevation was placed in the maxillary sinus of six adult female mongrel dogs. The resulting space between the membrane and the sinus floor was filled with autologous venous blood retrieved from each dog. The implants were left in place for 6 months. During the experimental period, the created space collapsed and the sinus membrane fell down onto the implant. A small amount of new bone formation occurred in the space created by the collapsed membrane. The average height of newly formed bone around the implants in the sinus was 2.7+/-0.7 mm on the buccal side and 0.6+/-0.3 mm on the palatal side. The results of this pilot study indicate that blood clots do not have sufficient integrity to enable the sinus membrane to remain in an elevated position for therapeutically effective periods of time. Accordingly, it is recommended that this method be used only when a small amount of new bone formation is necessary around implants in the maxillary sinus cavity.

  19. Cerebral venous system and anatomical predisposition to high-altitude headache.

    PubMed

    Wilson, Mark H; Davagnanam, Indran; Holland, Graeme; Dattani, Raj S; Tamm, Alexander; Hirani, Shashivadan P; Kolfschoten, Nicky; Strycharczuk, Lisa; Green, Cathy; Thornton, John S; Wright, Alex; Edsell, Mark; Kitchen, Neil D; Sharp, David J; Ham, Timothy E; Murray, Andrew; Holloway, Cameron J; Clarke, Kieran; Grocott, Mike P W; Montgomery, Hugh; Imray, Chris

    2013-03-01

    As inspired oxygen availability falls with ascent to altitude, some individuals develop high-altitude headache (HAH). We postulated that HAH results when hypoxia-associated increases in cerebral blood flow occur in the context of restricted venous drainage, and is worsened when cerebral compliance is reduced. We explored this hypothesis in 3 studies. In high-altitude studies, retinal venous distension (RVD) was ophthalmoscopically assessed in 24 subjects (6 female) and sea-level cranial magnetic resonance imaging was performed in 12 subjects ascending to 5,300m. Correlation of headache burden (summed severity scores [0-4]≤24 hours from arrival at each altitude) with RVD, and with cerebral/cerebrospinal fluid (CSF)/venous compartment volumes, was sought. In a sea-level hypoxic study, 11 subjects underwent gadolinium-enhanced magnetic resonance venography before and during hypoxic challenge (fraction of inspired oxygen=0.11, 1 hour). In the high-altitude studies, headache burden correlated with both RVD (Spearman rho=0.55, p=0.005) and with the degree of narrowing of 1 or both transverse venous sinuses (r=-0.56, p=0.03). It also related inversely to both the lateral+third ventricle summed volumes (Spearman rho=-0.5, p=0.05) and pericerebellar CSF volume (r=-0.56, p=0.03). In the hypoxic study, cerebral and retinal vein engorgement were correlated, and rose as the combined conduit score fell (a measure of venous outflow restriction; r=-0.66, p<0.05 and r=-0.75, p<0.05, respectively). Arterial hypoxemia is associated with cerebral and retinal venous distension, whose magnitude correlates with HAH burden. Restriction in cerebral venous outflow is associated with retinal distension and HAH. Limitations in cerebral venous efferent flow may predispose to headache when hypoxia-related increases in cerebral arterial flow occur. Copyright © 2013 American Neurological Association.

  20. Cerebral Venous Thrombosis and Headache--A Case-Series.

    PubMed

    Sparaco, Marco; Feleppa, Michele; Bigal, Marcelo E

    2015-06-01

    Headache happens in the majority of patients with Cerebral Venous Thrombosis (CVT) being sometimes the sole manifestation of the disease. Herein we report a case-series of CVT, focusing on headache characteristics. Etiological, clinical, and radiological features of 25 consecutive adult patients with CVT were compiled from August 2005 to December 2013. Diagnosis of CVT was confirmed by brain magnetic resonance imaging and magnetic resonance venography. All patients underwent extensive systematic etiological and genetic work-up at admission. A structured questionnaire about the characteristics of headache was responded by all participants. Headache was reported by 23 out of 25 (92%) of participants, being by far the most frequent symptom. It was the sole manifestation in nearly one third of the patients (8/25, 32.0%). Headache was typically severe (19/23, 82.6%) and throbbing (16/23, 69.5%), with sudden onset (13/23, 56.5%) and non-remitting (20/23, 86.9%) characteristics. The sinus most frequently involved was the transverse sinus (24/25, 96.0%), either alone or in association with other sinuses. Headache is the most frequent symptom and sometimes the sole presentation of CVT. © 2015 American Headache Society.

  1. Novel optoacoustic system for noninvasive continuous monitoring of cerebral venous blood oxygenation

    NASA Astrophysics Data System (ADS)

    Petrov, Yuriy; Petrov, Irene Y.; Prough, Donald S.; Esenaliev, Rinat O.

    2012-02-01

    Traumatic brain injury (TBI) and spinal cord injury are a major cause of death for individuals under 50 years of age. In the USA alone, 150,000 patients per year suffer moderate or severe TBI. Moreover, TBI is a major cause of combatrelated death. Monitoring of cerebral venous blood oxygenation is critically important for management of TBI patients because cerebral venous blood oxygenation below 50% results in death or severe neurologic complications. At present, there is no technique for noninvasive, accurate monitoring of this clinically important variable. We proposed to use optoacoustic technique for noninvasive monitoring of cerebral venous blood oxygenation by probing cerebral veins such as the superior sagittal sinus (SSS) and validated it in animal studies. In this work, we developed a novel, medical grade optoacoustic system for continuous, real-time cerebral venous blood oxygenation monitoring and tested it in human subjects at normal conditions and during hyperventilation to simulate changes that may occur in patients with TBI. We designed and built a highly-sensitive optoacoustic probe for SSS signal detection. Continuous measurements were performed in the near infrared spectral range and the SSS oxygenation absolute values were automatically calculated in real time using a special algorithm developed by our group. Continuous measurements performed at normal conditions and during hyperventilation demonstrated that hyperventilation resulted in approximately 12% decrease of cerebral venous blood oxygenation.

  2. Cortical subarachnoid hemorrhage caused by cerebral venous thrombosis.

    PubMed

    Oda, Shinri; Shimoda, Masami; Hoshikawa, Kaori; Osada, Takahiro; Yoshiyama, Michitsura; Matsumae, Mitsunori

    2011-01-01

    Patients with non-traumatic, non-aneurysmal, and non-perimesencephalic subarachnoid hemorrhage (SAH) tend to have clots circumscribed along the cortical convexity, a condition referred to as acute cortical SAH. Cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. The study tried to establish the diagnosis and management of cortical SAH caused by CVT. Retrospective review of 145 patients with non-traumatic SAH identified 15 patients with no ruptured aneurysm. Clinical features were investigated with a specific focus on patients with SAH caused by CVT. Eight of the 15 patients had perimesencephalic SAH, and 7 had cortical SAH. SAH caused by CVT was diagnosed in 4 of the 7 patients with cortical SAH. The cortical SAH involved the unilateral convexity or sylvian cistern and spared the basal cistern on computed tomography in all 4 patients. CVT occurred in the transverse sinus and cortical vein (1 patient), insular vein (1 patient), and cortical vein (2 patients). Identification of thrombosed veins or sinuses was established directly by T(2)*-weighted and diffusion-weighted magnetic resonance (MR) imaging in the acute stage and diffusion-weighted and T(1)-weighted MR imaging in the subacute stage. All patients had cortical swelling without findings of venous hemorrhagic infarction on T(2)*-weighted MR imaging. None of the 4 patients received active treatment, and all had favorable outcomes. CVT in patients with non-traumatic cortical SAH should be first excluded as a potential hemorrhagic cause by MR imaging for thrombosed veins or sinuses before initiating antifibrinolytic therapy.

  3. The Ovine Cerebral Venous System: Comparative Anatomy, Visualization, and Implications for Translational Research

    PubMed Central

    Nitzsche, Björn; Lobsien, Donald; Seeger, Johannes; Schneider, Holm; Boltze, Johannes

    2014-01-01

    Cerebrovascular diseases are significant causes of death and disability in humans. Improvements in diagnostic and therapeutic approaches strongly rely on adequate gyrencephalic, large animal models being demanded for translational research. Ovine stroke models may represent a promising approach but are currently limited by insufficient knowledge regarding the venous system of the cerebral angioarchitecture. The present study was intended to provide a comprehensive anatomical analysis of the intracranial venous system in sheep as a reliable basis for the interpretation of experimental results in such ovine models. We used corrosion casts as well as contrast-enhanced magnetic resonance venography to scrutinize blood drainage from the brain. This combined approach yielded detailed and, to some extent, novel findings. In particular, we provide evidence for chordae Willisii and lateral venous lacunae, and report on connections between the dorsal and ventral sinuses in this species. For the first time, we also describe venous confluences in the deep cerebral venous system and an ‘anterior condylar confluent’ as seen in humans. This report provides a detailed reference for the interpretation of venous diagnostic imaging findings in sheep, including an assessment of structure detectability by in vivo (imaging) versus ex vivo (corrosion cast) visualization methods. Moreover, it features a comprehensive interspecies-comparison of the venous cerebral angioarchitecture in man, rodents, canines and sheep as a relevant large animal model species, and describes possible implications for translational cerebrovascular research. PMID:24736654

  4. The ovine cerebral venous system: comparative anatomy, visualization, and implications for translational research.

    PubMed

    Hoffmann, Anke; Stoffel, Michael H; Nitzsche, Björn; Lobsien, Donald; Seeger, Johannes; Schneider, Holm; Boltze, Johannes

    2014-01-01

    Cerebrovascular diseases are significant causes of death and disability in humans. Improvements in diagnostic and therapeutic approaches strongly rely on adequate gyrencephalic, large animal models being demanded for translational research. Ovine stroke models may represent a promising approach but are currently limited by insufficient knowledge regarding the venous system of the cerebral angioarchitecture. The present study was intended to provide a comprehensive anatomical analysis of the intracranial venous system in sheep as a reliable basis for the interpretation of experimental results in such ovine models. We used corrosion casts as well as contrast-enhanced magnetic resonance venography to scrutinize blood drainage from the brain. This combined approach yielded detailed and, to some extent, novel findings. In particular, we provide evidence for chordae Willisii and lateral venous lacunae, and report on connections between the dorsal and ventral sinuses in this species. For the first time, we also describe venous confluences in the deep cerebral venous system and an 'anterior condylar confluent' as seen in humans. This report provides a detailed reference for the interpretation of venous diagnostic imaging findings in sheep, including an assessment of structure detectability by in vivo (imaging) versus ex vivo (corrosion cast) visualization methods. Moreover, it features a comprehensive interspecies-comparison of the venous cerebral angioarchitecture in man, rodents, canines and sheep as a relevant large animal model species, and describes possible implications for translational cerebrovascular research.

  5. Dangerous Headache: A Case of Dural Venous Sinus Thrombosis with Protein S Deficiency.

    PubMed

    Kumar, M Hari; Deepthi, D Angeline; Singh, Deepak Ningombam; Virupakshappa, Banu; Rahul, R

    2017-01-01

    Dural Venous Sinus Thrombosis (DVST) is a sporadic cause of headache. DVST is a recherché complication of maxillary sinus infection. Maxillary sinusitis infection may spread directly to orbit via lamina papyracea and it is expedited by the presence veins of breschet. The authors present a clinical case of dural sinus thrombosis with protein S deficiency and also describe an effective management approach for DVST.

  6. Dangerous Headache: A Case of Dural Venous Sinus Thrombosis with Protein S Deficiency

    PubMed Central

    Deepthi, D Angeline; Singh, Deepak Ningombam; Virupakshappa, Banu; Rahul, R

    2017-01-01

    Dural Venous Sinus Thrombosis (DVST) is a sporadic cause of headache. DVST is a recherché complication of maxillary sinus infection. Maxillary sinusitis infection may spread directly to orbit via lamina papyracea and it is expedited by the presence veins of breschet. The authors present a clinical case of dural sinus thrombosis with protein S deficiency and also describe an effective management approach for DVST. PMID:28274079

  7. Investigation of cerebral venous outflow in microgravity.

    PubMed

    Taibi, Angelo; Gadda, Giacomo; Gambaccini, Mauro; Menegatti, Erica; Sisini, Francesco; Zamboni, Paolo

    2017-08-31

    The gravitational gradient is the major component to face when considering the physiology of venous return and there is a growing interest in understanding the mechanisms ensuring the heart filling in the absence of gravity for astronauts who perform long-term space missions. The purpose of the Drain Brain project was to monitor the cerebral venous outflow of the crew member during an experiment on the International Space Station, so as to study the compensatory mechanisms that facilitate this essential physiological action in subjects living in a microgravity environment. Such venous function has been characterized by means of a novel application of strain-gauge plethysmography which uses a capacitive sensor. In this contribution, preliminary results of our investigation have been presented. In particular, comparison of plethysmography data confirmed that long duration spaceflights lead to a redistribution of venous blood volume and showed interesting differences in the amplitude of cardiac oscillations measured at the level of the neck veins. The success of the experiment has also demonstrated that thanks to its easy portability, non-invasiveness, and non-operator dependence, the proposed device can be considered as a novel tool for use aboard the International Space Station. Further trials are now undergoing to complete the investigation on the drainage function of the neck veins in microgravity. © 2017 Institute of Physics and Engineering in Medicine.

  8. Multiple medullary venous malformations decreasing cerebral blood flow: Case report

    SciTech Connect

    Tomura, N.; Inugami, A.; Uemura, K.; Hadeishi, H.; Yasui, N. )

    1991-02-01

    A rare case of multiple medullary venous malformations in the right cerebral hemisphere is reported. The literature review yielded only one case of multiple medullary venous malformations. Computed tomography scan showed multiple calcified lesions with linear contrast enhancement representing abnormal dilated vessels and mild atrophic change of the right cerebral hemisphere. Single-photon emission computed tomography using N-isopropyl-p-({sup 123}I) iodoamphetamine demonstrated decreased cerebral blood flow in the right cerebral hemisphere.

  9. Mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis.

    PubMed

    Ma, Ji; Shui, Shaofeng; Han, XinWei; Guo, Dong; Li, Teng-Fei; Yan, Lei

    2016-12-01

    Background Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity with substantial diagnostic and therapeutic dilemmas. The appropriate management of CVST remains to be defined. Purpose To evaluate the efficiency and safety of mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Material and Methods Twenty-three consecutive patients with CVST who were treated with mechanical thrombectomy using Solitaire AB stents between January 2013 and October 2014 were retrospectively analyzed. The headache intensity was evaluated according to the visual analogue scale (VAS), and neurological function was assessed using the National Institute of Health Stroke Scale (NIHSS). Follow-up data were available for all patients for 6-14 months. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) were performed at 3 and 6 months after neurointervention, and telephone interviews were performed monthly thereafter. The Wilcoxon signed-rank test was used to compare the evaluation data (VAS and NIHSS) at admission and discharge. Results Twenty-six Solitaire AB stents were used. No neurointervention-related complications were noted. The symptoms were significantly improved after neurointervention in all patients. The comparisons between the VAS and NIHSS evaluations at admission and discharge were significantly different ( P < 0.05). No recurrence was observed during the follow-up period. Conclusion Mechanical thrombectomy with Solitaire AB stents is safe and effective for the treatment of CVST and can significantly improve clinical symptoms. The occurrence of complications is low, and the prognosis is favorable.

  10. Veno-venous bridges: the forerunners of the sinus venosus defect

    PubMed Central

    Butts, Ryan J.; Crean, Andrew M.; Hlavacek, Anthony M.; Spicer, Diane E.; Cook, Andrew C.; Oechslin, Erwin N.; Anderson, Robert H.

    2014-01-01

    Background Differentiation of the so-called sinus venosus defect from other defects permitting shunting between the atrial chambers remains problematic. The lesion is not a true septal defect, and current theories to explain the existence of the sinus venosus defect fall short. The presence of persistent systemic to pulmonary venous connections has been proposed to explain the existence of the sinus venosus defect. Methods Clinical histories and radiological findings of six patients are reviewed. Three patients have veno-venous bridges, two have partial anomalous pulmonary venous connections, and one patient has a sinus venosus defect. The clinical information is reviewed, along with current developmental and morphological considerations. Discussion We provide radiographic, developmental, and morphological evidence to support the theory that a so-called sinus venosus defect is the consequence of persistence of foetal systemic to pulmonary veno-venous bridges, rather than of deficiencies in atrial septation. PMID:21729517

  11. Veno-venous bridges: the forerunners of the sinus venosus defect.

    PubMed

    Butts, Ryan J; Crean, Andrew M; Hlavacek, Anthony M; Spicer, Diane E; Cook, Andrew C; Oechslin, Erwin N; Anderson, Robert H

    2011-12-01

    Differentiation of the so-called sinus venosus defect from other defects permitting shunting between the atrial chambers remains problematic. The lesion is not a true septal defect, and current theories to explain the existence of the sinus venosus defect fall short. The presence of persistent systemic to pulmonary venous connections has been proposed to explain the existence of the sinus venosus defect. Clinical histories and radiological findings of six patients are reviewed. Three patients have veno-venous bridges, two have partial anomalous pulmonary venous connections, and one patient has a sinus venosus defect. The clinical information is reviewed, along with current developmental and morphological considerations. We provide radiographic, developmental, and morphological evidence to support the theory that a so-called sinus venosus defect is the consequence of persistence of foetal systemic to pulmonary veno-venous bridges, rather than of deficiencies in atrial septation.

  12. New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns.

    PubMed

    Suh, Dae Chul; Lee, Jeong Hyun; Kim, Sang Joon; Chung, Sun Ju; Choi, Choong Gon; Kim, Hyun Jeong; Kim, Chang Jin; Kook, Michael; Ahn, Hyo-Sook; Kwon, Sun Uck; Kim, Jong Sung

    2005-06-01

    An extradurally located cavernous sinus dural arteriovenous fistula (CSDAVF) exhibits different clinical behavior from other dural arteriovenous fistulas (DAVFs) located between 2 dural leaves. The aim of this study is to define angiographic types of CSDAVF associated with presenting symptom (Sx) and venous drainage patterns. CSDAVFs during a mean of 23-month follow-up period of 58 patients (17 to 73 years, male:female ratio=8:50) were retrospectively analyzed. The 3 types of CSDAF, ie, proliferative (PT), restrictive (RT), and late restrictive (LRT) types, were categorized by the degrees and patterns of prominent arteriovenous shunt as well as venous flow. The status of the venous connection with CS and the presenting Sx patterns classified as orbital (OrbSxP), ocular (OcuSxP), cavernous (CavSxP), and cerebral (CerSxP) were associated with angiographic types as well as symptom onset, age, and gender. Correlations of discrete and categorical variables were statistically analyzed using the chi2 or Fisher exact test. PT (n=23) and RT (n=23) of CSDAVF were more common than LRT (n=12) (P=0.016) in patients with younger than 65 years and were related to OrbSxP (P=0.015) and CavSxP (P=0.038) in contrast to LRT to OcuSxP (P=0.004). Early onset of Sxs was related to the OrbSxP (P=0.08) and CavSxP (P<0.001). CerSxP (5%) was noted in RT or LRT. OrbSxP was related to the superior ophthalmic venous drainage (P=0.026) and CavSxP to the inferior petrosal sinus (P=0.046) and posterior fossa venous drainages (P=0.014). Seven patients revealed chronological progression of CSDAVF from PT to LRT and even to complete healing. CSDAVF presents as 3 distinctive angiographic types and is associated with presenting Sxs and venous drainage patterns.

  13. Influence of central venous pressure upon sinus node responses to arterial baroreflex stimulation in man

    NASA Technical Reports Server (NTRS)

    Mark, A. L.; Takeshita, A.; Eckberg, D. L.; Abboud, F. M.

    1978-01-01

    Measurements were made of sinus node responses to arterial baroreceptor stimulation with phenylephrine injection or neck suction, before and during changes of central venous pressure provoked by lower body negative pressure or leg and lower truck elevation. Variations of central venous pressure between 1.1 and 9.0 mm Hg did not influence arterial baroreflex mediated bradycardia. Baroreflex sinus node responses were augmented by intravenous propranolol, but the level of responses after propranolol was comparable during the control state, lower body negative pressure, and leg and trunk elevation. Sinus node responses to very brief baroreceptor stimuli applied during the transitions of central venous pressure also were comparable in the three states. The authors conclude that physiological variations of central venous pressure do not influence sinus node responses to arterial baroreceptor stimulation in man.

  14. Cerebral Venous Thrombosis in Paroxysmal Nocturnal Hemoglobinuria

    PubMed Central

    Meppiel, Elodie; Crassard, Isabelle; de Latour, Régis Peffault; de Guibert, Sophie; Terriou, Louis; Chabriat, Hugues; Socié, Gérard; Bousser, Marie-Germaine

    2015-01-01

    Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder of hematopoietic stem cells characterized by hemolytic anemia, marrow failure, and a high incidence of life-threatening venous thrombosis. Cerebral venous system is the second most frequent location of thrombosis after hepatic veins. However, data about PNH-related cerebral venous thrombosis (CVT) are very scarce because of the rarity of both the disorders. We report a French study about PNH patients with CVT. Patients were recruited retrospectively, from the Société Française d’Hématologie (SFH) registry of 465 patients with PNH; the Lariboisière registry of 399 patients with CVT; and a direct contact with 26 French Hematology Units. We review cases reported since 1938 in the English and French language literature. We then compared patients of our series with cases from the literature, with non-PNH-related CVT cases from Lariboisière registry, and with PNH patients without CVT from SFH registry. Fifteen patients were included between 1990 and 2012. Most patients were women (12/15) and half of them presented associated hormonal venous thrombosis risk factors. Three patients had concomitant hepatic vein thrombosis. CVT was the first manifestation of PNH in 4 patients. No major difference in CVT characteristics was found compared with non-PNH-related CVT cases, except for a younger age at diagnosis in PNH patients (P < 0.001). All patients were treated with anticoagulation therapy. One death occurred in acute stage. All surviving patients were independent 1 year after. Median survival time was 9 years. Recurrent thrombosis rate was 50% at 6 years, occurring in patients that did not have bone marrow transplantation or eculizumab therapy. Cases of death were mainly related to hepatic vein thrombosis. Prognosis of CVT was good in our series. However, these patients have a poor long-term prognosis due to PNH disease by itself. PNH treatment should be proposed as soon as possible to

  15. Venous sinus thrombosis after Proteus vulgaris meningitis and concomitant Clostridium abscess formation.

    PubMed

    Bodur, Hürrem; Colpan, Aylin; Gozukucuk, Ramazan; Akinci, Esragul; Cevik, Mustafa Aydin; Balaban, Neriman

    2002-01-01

    A 19-y-old woman presented with Proteus vulgaris meningitis as a complication of chronic otitis media. Despite treatment with ceftazidime and amikacin no clinical improvement was observed. Cranial MRI revealed right-sided mastoiditis/otitis media and venous sinus thrombosis. After mastoidectomy, repeat cranial MRI demonstrated abscess formation in the venous sinuses. The abscess was drained. Clostridium spp. was isolated from the abscess culture.

  16. Persistent valve of systemic venous sinus: a cause of neonatal cyanosis.

    PubMed

    Qureshi, Ahmad U; Latiff, Haifa A; Sivalingam, Sivakumar

    2014-08-01

    Incomplete involution of valve of systemic venous sinus can present across a spectrum of anatomical lesions ranging from eustachian valve to division of right atrium (cor triatriatum dexter) with overlapping features. We present the case of a neonate presenting with cyanosis, having persistent valve of systemic venous sinus with anatomical details of the redundant tissue in right atrium suggesting an intermediate form between Chiari network and division of right atrium.

  17. CEREBRAL VENOUS THROMBOSIS AND TURNER SYNDROME: A RARE REPORTED ASSOCIATION.

    PubMed

    Guler, A; Alpaydin, S; Bademkiran, F; Sirin, H; Celebisoy, N

    2015-01-01

    Turner Syndrome is the only known viable chromosomal monosomy, characterised by the complete or partial absence of an X chromosome. It's the most common chromosomal abnormality in females. Apart from the well known dysmorphic features of the syndrome, it has been associated with a number of vascular pathologies; mainly involving the cardiovascular, renovascular, peripheral vascular and cerebrovascular system. It seems striking that thromboembolism is not considered as a feature of the syndrome. Most of the thromboembolism cases are related to the arterial vascular system; except for some rare reported portal venous thrombosis cases, peripheral venous thrombosis cases and to the best of our knowledge a single case of cerebral venous thrombosis with Dandy Walker malformation and polymicrogyria. We herein report a cerebral venous thrombosis case with Turner Syndrome. With no other found underlying etiology, we want to highlight that Turner Syndrome, itself, may have a relationship not only with the cerebral arterial vascular system pathologies but also with the cerebral venous thrombosis.

  18. Resolution of Pulsatile Tinnitus after Venous Sinus Stenting in Patients with Idiopathic Intracranial Hypertension

    PubMed Central

    Dinkin, Marc; Suurna, Maria; Hannsgen, Kelly; Bui, Xem

    2016-01-01

    Objective Evaluate the role of venous sinus stenting in the treatment of pulsatile tinnitus among patients with Idiopathic Intracranial Hypertension (IIH) and significant venous sinus stenosis. Subjects and Methods A written informed consent approved by the Weill Cornell institutional review board was signed and obtained from the study participants. Thirty-seven consecutive patients with IIH and venous sinus stenosis who were treated with venous sinus stenting between Jan.2012-Jan.2016 were prospectively evaluated. Patients without pulsatile tinnitus were excluded. Tinnitus severity was categorized based on “Tinnitus Handicap Inventory” (THI) at pre-stent, day-0, 1-month, 3-month, 6-month, 12-month, 18-month and 2-year follow-up. Demographics, body-mass index (BMI), pre and post VSS trans-stenotic pressure gradient were documented. Statistical analysis performed using Pearson’s correlation, Chi-square analysis and Fischer’s exact test. Results 29 patients with a mean age of 29.5±8.5 years M:F = 1:28. Median (mean) THI pre and post stenting were: 4 (3.7) and 1 (1) respectively. Median time of tinnitus resolution post VSS was 0-days. There was significant improvement of THI (Δ Mean: 2.7 THI [95% CI: 2.3–3.1 THI], p<0.001) and transverse-distal sigmoid sinus gradient (Δ Mean: -15.3 mm Hg [95% CI: 12.7–18 mm Hg], p<0.001) post-stenting. Mean follow-up duration of 26.4±9.8 months (3–44 months). VSS was feasible in 100% patients with no procedural complications. Three-patients (10%) had recurrent sinus stenosis and tinnitus at mean follow-up of 12 months (6–30 months). Conclusion Venous sinus stenting is an effective treatment for pulsatile tinnitus in patients with IIH and venous sinus stenosis. PMID:27768690

  19. Hereditary thrombophilia in cerebral venous thrombosis: a study from India.

    PubMed

    Pai, Navin; Ghosh, Kanjaksha; Shetty, Shrimati

    2013-07-01

    A systematic study of thrombophilia markers in a large series of patients with cerebral venous thrombosis (CVT) from India is scarce. The present study was undertaken to know the prevalence of common hereditary thrombophilia in a large series of CVT patients from India. Six hundred and twelve (354 men, 219 women and 39 children) consecutive patients with CVT admitted to various hospitals in Mumbai between 2001 and 2010 were investigated for the common thrombophilia markers, that is, protein C (PC), protein S, antithrombin (AT), and factor V Leiden (FVL) mutation. The main presenting clinical manifestations included papilledema (62%), headache (62%), hemiparesis (48%), seizures (31%), and cranial nerve palsy (7%). All the patients were managed with heparin followed by warfarin during the succeeding 6 months. Superior sagittal sinus thrombosis was the commonest site (74%) followed by cortical venous thrombosis (15%). Associated clinical pathologies were dehydration, sepsis, pregnancy and puerperium, malaria, and tuberculosis; but in the majority of patients, there was no obvious cause. Eighteen percent of the patients had any of the thrombophilia markers studied; PC deficiency was the commonest thrombophilia marker followed by deficiency of protein S, FVL mutation and AT deficiency. The men below 45 years with PC deficiency (P=0.03) and women with protein S deficiency were significantly higher (P=0.04). In conclusion, CVT is not an uncommon cause of neurological deficit as was presented in earlier reports. Pregnancy and puerperium-related CVT was much less common. Thrombophilia markers accounted for approximately one-fifth of the patients. Death due to CVT has shown remarkable reduction (13%) because of early diagnosis and appropriate anticoagulation.

  20. Cerebral venous blood oxygenation monitoring during hyperventilation in healthy volunteers with a novel optoacoustic system

    NASA Astrophysics Data System (ADS)

    Petrov, Andrey; Prough, Donald S.; Petrov, Irene Y.; Petrov, Yuriy; Deyo, Donald J.; Henkel, Sheryl N.; Seeton, Roger; Esenaliev, Rinat O.

    2013-03-01

    Monitoring of cerebral venous oxygenation is useful to facilitate management of patients with severe or moderate traumatic brain injury (TBI). Prompt recognition of low cerebral venous oxygenation is a key to avoiding secondary brain injury associated with brain hypoxia. In specialized clinical research centers, jugular venous bulb catheters have been used for cerebral venous oxygenation monitoring and have demonstrated that oxygen saturation < 50% (normal range is 55-75%) correlates with poor clinical outcome. We developed an optoacoustic technique for noninvasive monitoring of cerebral venous oxygenation. Recently, we designed and built a novel, medical grade optoacoustic system operating in the near-infrared spectral range for continuous, real-time oxygenation monitoring in the superior sagittal sinus (SSS), a large central cerebral vein. In this work, we designed and built a novel SSS optoacoustic probe and developed a new algorithm for SSS oxygenation measurement. The SSS signals were measured in healthy volunteers during voluntary hyperventilation, which induced changes in SSS oxygenation. Simultaneously, we measured exhaled carbon dioxide concentration (EtCO2) using capnography. Good temporal correlation between decreases in optoacoustically measured SSS oxygenation and decreases in EtCO2 was obtained. Decreases in EtCO2 from normal values (35-45 mmHg) to 20-25 mmHg resulted in SSS oxygenation decreases by 3-10%. Intersubject variability of the responses may relate to nonspecific brain activation associated with voluntary hyperventilation. The obtained data demonstrate the capability of the optoacoustic system to detect in real time minor changes in the SSS blood oxygenation.

  1. Diagnostic Performance of Routine Brain MRI Sequences for Dural Venous Sinus Thrombosis.

    PubMed

    Patel, D; Machnowska, M; Symons, S; Yeung, R; Fox, A J; Aviv, R I; Jabehdar Maralani, P

    2016-06-16

    Signs suggestive of unexpected dural venous sinus thrombosis are detectable on routine MR imaging studies without MRV. We assessed performance characteristics and interrater reliability of routine MR imaging for the diagnosis of dural venous sinus thrombosis, focusing on the superior sagittal, transverse, and sigmoid sinuses. This case series included 350 patients with MRIs performed with contrast-enhanced MRV and 79 patients with routine MRIs performed within 48 hours of a CTV from 2008 to 2014 (total, n = 429). Routine MR images were separated from the contrast-enhanced MRVs and CTVs. Three neuroradiologists, blinded to clinical data, independently reviewed the MRIs for signs of dural venous sinus thrombosis, including high signal on sagittal T1, loss of flow void on axial T2, high signal on FLAIR, high signal on DWI, increased susceptibility effects on T2*-weighted gradient recalled-echo imaging, and filling defects on axial contrast-enhanced spin-echo T1WI and/or volumetric gradient-echo T1WI. Two neuroradiologists independently reviewed contrast-enhanced MRVs and CTVs to determine the consensus gold standard. Interrater reliability was calculated by using the κ coefficient. Contrast-enhanced MRV and CTV confirmed that dural venous sinus thrombosis was present in 72 of 429 cases (16.8%). The combination of routine MR sequences had an overall sensitivity of 79.2%, specificity of 89.9%, and moderate interrater reliability (κ = 0.50). The 3 readers did not have similar performance characteristics. 69.4% of positive cases had clinical suspicion of dural venous sinus thrombosis indicated on imaging requisition. Routine MR images can suggest dural venous sinus thrombosis with high specificity in high-risk patients, even in cases without clinical suspicion. © 2016 American Society of Neuroradiology.

  2. Partial aortic occlusion and cerebral venous steal: venous effects of arterial manipulation in acute stroke.

    PubMed

    Pranevicius, Osvaldas; Pranevicius, Mindaugas; Liebeskind, David S

    2011-05-01

    Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and "luxury perfusion" in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifested by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution analogous to positive end-expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs.

  3. Unroofed Coronary Sinus Presenting as Cerebral Abscess: A Case Report

    PubMed Central

    Murthy, Avinash; Jain, Ankit; El-Hajjar, Mohammad

    2013-01-01

    A sixty eight year-old woman with a long-standing history of hypertension, dizziness and a history of congenital heart disease presented with speech difficulties and disorientation. She was diagnosed with a brain abscess, confirmed by a stereotactic biopsy. Transthoracic echocardiographic evaluation revealed a persistent left superior vena cava (PLSVC) with an unroofed coronary sinus (URCS) along with a small secundum atrial septal defect. Her heart catheterization showed a partially unroofed coronary sinus along with a bidirectional shunt. She was referred for surgical closure of her unroofed coronary sinus and the secundum atrial septal defect. Her brain abscess responded well to antibiotic treatment. While waiting for open-heart surgery, she suffered from an acute myocardial infarction and underwent emergent percutaneous coronary intervention to the right coronary artery. Subsequently, she underwent elective surgical repair of the unroofed coronary sinus, along with closure of the atrial septal defect. When she was seen in follow-up she reported a complete resolution of her dizziness and felt more energetic. Unroofed coronary sinus syndrome (URCS) is a rare congenital cardiac anomaly in which there is a communication between the coronary sinus and the left atrium. While non-invasive imaging with echocardiography, MRI or CT is helpful in making the diagnosis, cardiac catheterization remains integral in the evaluation and management planning. Management is guided by the presence of clinical symptoms with consideration of repair when patients become symptomatic. Prognosis after surgery is excellent, recently transcatheter based treatment therapies are becoming more frequent. We present a rare case of URCS with PLSVC presenting as a cerebral abscess in late adulthood. She had bidirectional shunting manifesting as a cerebral abscess. She responded well to the corrective surgery and was doing well on follow up.

  4. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Ferro, José M; Bacelar-Nicolau, Helena; Rodrigues, Teresa; Bacelar-Nicolau, Leonor; Canhão, Patrícia; Crassard, Isabelle; Bousser, Marie-Germaine; Dutra, Aurélio Pimenta; Massaro, Ayrton; Mackowiack-Cordiolani, Marie-Anne; Leys, Didier; Fontes, João; Stam, Jan; Barinagarrementeria, Fernando

    2009-01-01

    Around 15% of patients die or become dependent after cerebral vein and dural sinus thrombosis (CVT). We used the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) sample (624 patients, with a median follow-up time of 478 days) to develop a Cox proportional hazards regression model to predict outcome, dichotomised by a modified Rankin Scale score >2. From the model hazard ratios, a risk score was derived and a cut-off point selected. The model and the score were tested in 2 validation samples: (1) the prospective Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT) sample with 91 patients; (2) a sample of 169 consecutive CVT patients admitted to 5 ISCVT centres after the end of the ISCVT recruitment period. Sensitivity, specificity, c statistics and overall efficiency to predict outcome at 6 months were calculated. The model (hazard ratios: malignancy 4.53; coma 4.19; thrombosis of the deep venous system 3.03; mental status disturbance 2.18; male gender 1.60; intracranial haemorrhage 1.42) had overall efficiencies of 85.1, 84.4 and 90.0%, in the derivation sample and validation samples 1 and 2, respectively. Using the risk score (range from 0 to 9) with a cut-off of >or=3 points, overall efficiency was 85.4, 84.4 and 90.1% in the derivation sample and validation samples 1 and 2, respectively. Sensitivity and specificity in the combined samples were 96.1 and 13.6%, respectively. The CVT risk score has a good estimated overall rate of correct classifications in both validation samples, but its specificity is low. It can be used to avoid unnecessary or dangerous interventions in low-risk patients, and may help to identify high-risk CVT patients. (c) 2009 S. Karger AG, Basel.

  5. Cerebral venous infarction during a high altitude expedition.

    PubMed

    Cheng, S; Chng, S M; Singh, R

    2009-08-01

    Bilateral venous infarction of the brain due to thrombosis of the deep cerebral venous system is relatively rare, accounting for approximately 3-8 percent of all cases of cerebral venous thrombosis (CVT). Known risk factors include the use of oral contraceptives, pregnancy, puerperium, malignancy and thrombophilic states. CVT, in the setting of acute mountain sickness (AMS), has rarely been reported. We present an unusual occurrence of bilateral deep subcortical venous infarction in a previously-well, 39-year-old woman, who developed AMS during a high altitude expedition in Nepal. The possible mechanisms responsible for this unfortunate event include dehydration with resultant relative polycythaemia and raised intracranial pressure at high altitudes. CVT should be considered in mountain climbers presenting with progressive neurological deterioration that is not solely attributable to AMS.

  6. [A case of total cavopulmonary connection by utilization of coronary sinus as a hepatic venous return].

    PubMed

    Koide, M; Sakai, A; Iwata, Y; Sanae, T; Kunii, Y; Moriki, N; Ayusawa, Y; Seguchi, M

    2000-10-01

    A 2-year-old boy with polysplenia, double outlet right ventricle after pulmonary banding and unilateral bidirectional shunt was operated on. A modified total cavopulmonary connection was done by utilization of coronary sinus as a retrograde route for the hepatic venous return. Left SVC was transected and its distal end was anastomosed to the left pulmonary artery after PA angioplasty. An equine pericardial patch was placed over the ostia of the hepatic vein and coronary sinus. Two ostia of the coronary veins were excluded from the created route. The proximal end of the left SVC was anastomosed to the inferior side of the left pulmonary artery. Postoperative course was uneventful. The postoperative angiogram showed smooth hepatic venous return through the coronary sinus and no pressure gradient was recorded between hepatic vein and pulmonary artery.

  7. Evidence for novel structures (primo vessels and primo nodes) floating in the venous sinuses of rat brains.

    PubMed

    Lee, Ho-Sung; Park, Won-Hee; Je, A-Reum; Kweon, Hee-Seok; Lee, Byung-Cheon

    2012-08-01

    We for the first time report evidence for existence of novel structures, primo vessels (PVs) and primo nodes (PNs) floating inside the venous sinuses of rat brains. For this purpose, we applied a chromium-hematoxylin (Cr-Hx) solution to stain the PVs and the PNs floating inside the venous sinuses (superior sagittal sinus, strait sinus, and transverse sinus) of seven rats' brains preferentially compared to the blood clots that easily form during surgery. Cr-Hx-stained PVs and PNs were examined by light and transmission electron microscopies: (1) we were consistently able to visualize the PVs and the PNs in the venous sinuses of all seven rats' brains. (2) The PVs and PNs consisted of rod-shaped and some round-shaped cells, respectively, as demonstrated by using 4',6-diamidino-2-phenylindole (DAPI). (3) Cross sections of the PVs showed that the sinuses contained loose fibrous materials and clusters of nano-sized granules enveloped by the cortex. The above data imply that thrombus of the venous sinuses may be related with these novel floating structures. However, the functions of the PVs and PNs floating in the venous sinuses remain to be investigated in terms of normal or thrombus-provoked diseases. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Noninvasive optoacoustic monitoring of cerebral venous blood oxygenation in newborns

    NASA Astrophysics Data System (ADS)

    Petrov, Irene Y.; Wynne, Karon E.; Petrov, Yuriy; Esenaliev, Rinat O.; Richardson, C. Joan; Prough, Donald S.

    2012-02-01

    Cerebral ischemia after birth and during labor is a major cause of death and severe complications such as cerebral palsy. In the USA alone, cerebral palsy results in permanent disability of 10,000 newborns per year and approximately 500,000 of the total population. Currently, no technology is capable of direct monitoring of cerebral oxygenation in newborns. This study proposes the use of an optoacoustic technique for noninvasive cerebral ischemia monitoring by probing the superior sagittal sinus (SSS), a large central cerebral vein. We developed and built a multi-wavelength, near-infrared optoacoustic system suitable for noninvasive monitoring of cerebral ischemia in newborns with normal weight (NBW), low birth-weight (LBW, 1500 - 2499 g) and very low birth-weight (VLBW, < 1500 g). The system was capable of detecting SSS signals through the open anterior and posterior fontanelles as well as through the skull. We tested the system in NBW, LBW, and VLBW newborns (weight range: from 675 g to 3,000 g) admitted to the neonatal intensive care unit. We performed single and continuous measurements of the SSS blood oxygenation. The data acquisition, processing and analysis software developed by our group provided real-time, absolute SSS blood oxygenation measurements. The SSS blood oxygenation ranged from 60% to 80%. Optoacoustic monitoring of the SSS blood oxygenation provides valuable information because adequate cerebral oxygenation would suggest that no therapy was necessary; conversely, evidence of cerebral ischemia would prompt therapy to increase cerebral blood flow.

  9. A Case of Unexplained Cerebral Sinus Thrombosis in a 22-Year-Old Obese Caucasian Woman

    PubMed Central

    Seheult, Jansen N.; Chibisov, Irina

    2016-01-01

    Herein, we present the case of a 22-year old obese Caucasian woman female with no acquired thrombophilic risk factors who was diagnosed with extensive cerebral sinus thrombosis. A detailed thrombophilia workup demonstrated persistently elevated plasminogen activator inhibitor 1 (PAI-1) activity levels, with an elevated PAI-1 antigen concentration and homozygosity for the PAI-1 4G allele (4G/4G genotype). The patient was treated with indefinite warfarin anticoagulation medication due to the unprovoked nature of her thrombotic event. Disturbances in the fibrinolytic system, in particular PAI-1, have been related to an increased risk of arterial and venous thrombosis. In this article, we discuss the pathophysiology of hypofibrinolysis associated with elevated PAI-1 levels and the PAI-1 4G/5G polymorphism. PMID:27287941

  10. Cerebral venous thrombosis after immune thrombocytopenic purpura and anti-D immune globulin therapy.

    PubMed

    Kayyali, Husam R; Abdelmoity, Ahmed T; Morriss, M Craig; Graf, William D

    2008-03-01

    Cerebral venous thrombosis has multiple etiologies and a wide variety of clinical manifestations. This article reports on a young girl who developed cerebral venous thrombosis after intravenous anti-D immune globulin therapy for immune thrombocytopenic purpura. In this case, venous infarction was manifested by an unusual pattern of restricted diffusion limited to the corpus callosum. The cause of cerebral venous thrombosis in this patient may be related to both immune thrombocytopenia and immunoglobulin therapy.

  11. Venous thrombosis in subclavian, axillary, brachial veins with extension to internal jugular vein, right sigmoid sinus and simultaneous pulmonary embolism

    PubMed Central

    Tamizifar, Babak; Beigi, Arash; Rismankarzadeh, Maryam

    2013-01-01

    We present a rare case of Venous Thrombosis in Subclavian, Axillary, Brachial Veins with extension to Internal Jugular vein, right sigmoid sinus and simultaneous Pulmonary embolism during the treatment with low molecular weight heparin. PMID:23901341

  12. Human cerebral venous outflow pathway depends on posture and central venous pressure

    PubMed Central

    Gisolf, J; van Lieshout, J J; van Heusden, K; Pott, F; Stok, W J; Karemaker, J M

    2004-01-01

    Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R2 = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins. PMID:15284348

  13. In utero magnetic resonance imaging for diagnosis of dural venous sinus ectasia with thrombosis in the fetus.

    PubMed

    Fanou, Evgenia Maria; Reeves, Mike J; Howe, David T; Joy, Harriet; Morris, Susan; Russell, Sarah; Griffiths, Paul D

    2013-12-01

    Dural venous sinus ectasia with thrombosis (DVSET) in the fetus is a rare condition that can be diagnosed prenatally with the use of fetal MR imaging, yet with limited indication of long-term clinical significance. To describe and evaluate the diagnostic value of fetal MR imaging in the prenatal diagnosis of dural venous sinus ectasia with thrombosis and its clinical significance. We report a series of nine fetuses with dural venous sinus ectasia with thrombosis. The mothers, located in four feto-maternal centres, were referred for fetal MR imaging due to space occupying lesions identified on second-trimester antenatal ultrasound. In all but one case the dural venous sinus ectasia with thrombosis was in the vicinity of the venous confluence (VC) with various extension in the posterior dural sinuses. Antenatal follow-up imaging was performed in seven cases and showed progression in one, stable appearances in one and regression in five cases. Three pregnancies were terminated. In the remaining six cases there was no reported neurological deficit at up to 44 months of clinical follow-up. This is among the largest series of postnatal clinical follow-up in cases of prenatal diagnosis of dural venous sinus ectasia with thrombosis in the literature. Clinical follow-up suggests a good prognosis when antenatal follow-up shows partial or complete thrombus resolution.

  14. Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension.

    PubMed

    Buell, Thomas J; Raper, Daniel M; Ding, Dale; Chen, Ching-Jen; Liu, Kenneth C

    2017-09-26

    We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Bilateral Vertebral Venous Sinus Thrombosis Causing Cervical Spinal Cord Compression in a Dog

    PubMed Central

    Rhue, Kathryn E.; Taylor, Amanda R.; Cole, Robert C.; Winter, Randolph L.

    2017-01-01

    A 10-year-old male neutered mixed breed dog was evaluated for cervical hyperesthesia and tetraparesis. Magnetic resonance imaging of the brain and cervical spinal cord identified an extradural compressive lesion over the body of C2 caused by marked dilation of the vertebral venous sinuses. Following intravenous contrast administration both vertebral sinuses had heterogeneous contrast enhancement consistent with incomplete thrombi formation. An abdominal ultrasound also showed a distal aortic thrombus. A definitive cause for the thrombi formation was not identified, but the patient had several predisposing factors which may have contributed. The patient was treated with a combination of warfarin, clopidogrel, and enoxaparin as well as analgesics. Within 48 h of initiation of warfarin therapy, the tetraparesis and hyperesthesia were markedly improved. Repeat abdominal ultrasound 3 weeks after discharge showed reduction in size of aortic thrombus. Neurologic function remained normal for 6 weeks following initiation of treatment. Seventy-four days following initial diagnosis the patient rapidly declined and passed away at home. Necropsy was declined. This is the first report of vertebral venous sinus enlargement leading to spinal cord compression and tetraparesis in a dog. Additionally, warfarin in combination with clopidogrel and enoxaparin appeared to be a safe and effective treatment for the suspected thrombi reported in this case. Vertebral sinus enlargement secondary to thrombi should be considered as a differential diagnosis in patients presenting with tetraparesis and cervical hyperesthesia. PMID:28229071

  16. Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium

    PubMed Central

    Liang, Zhu-Wei; Gao, Wan-Li; Feng, Li-Min

    2017-01-01

    Due to the specific physiology associated with pregnancy and puerperium, cerebral venous sinus thrombosis (CVT) may manifest different characteristics. This study aimed to identify the clinical manifestations and prognosis of pregnancy-associated CVT. A total of 43 pregnancy-associated CVT patients were enrolled. We analysed the clinical presentations of the disease and performed a multivariate logistic regression analysis to determine which variables were associated with prognosis. Our descriptive results showed the following: 1) the incidence was 202 per 100,000 deliveries, and the mortality rate was 11.63%; 2) the most frequent symptom was headache; 3) the most frequent abnormal laboratory findings were increased levels of fibrinogen and several serum lipoproteins (including triglyceride, cholesterol, high-density lipoprotein, low-density lipoprotein, apolipoprotein A1, and apolipoprotein B); and 4) the superior sagittal sinus and transverse sinus were the most frequently affected locations. Moreover, an increased modified Rankin Scale score was positively associated with infection, seizure, intracerebral haemorrhage (ICH) and hypertensive disorders of pregnancy (HDP). Comparably, the occurrence of death was positively and significantly associated with infection, seizure and ICH. Consequently, timely diagnosis and treatment of pregnancy-associated CVT patients with infection, seizure, ICH or HDP are needed. Patients with infection, seizure or ICH have a greater risk of death. PMID:28262755

  17. Endovascular Treatment of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: Complications, Neurological Outcomes, and Radiographic Results

    PubMed Central

    Starke, Robert M.; Wang, Tony; Ding, Dale; Durst, Christopher R.; Crowley, R. Webster; Chalouhi, Nohra; Hasan, David M.; Dumont, Aaron S.; Jabbour, Pascal; Liu, Kenneth C.

    2015-01-01

    Introduction. Idiopathic intracranial hypertension (IIH) may result in a chronic debilitating disease. Dural venous sinus stenosis with a physiologic venous pressure gradient has been identified as a potential etiology in a number of IIH patients. Intracranial venous stenting has emerged as a potential treatment alternative. Methods. A systematic review was carried out to identify studies employing venous stenting for IIH. Results. From 2002 to 2014, 17 studies comprising 185 patients who underwent 221 stenting procedures were reported. Mean prestent pressure gradient was 20.1 mmHg (95% CI 19.4–20.7 mmHg) with a mean poststent gradient of 4.4 mmHg (95% CI 3.5–5.2 mmHg). Complications occurred in 10 patients (5.4%; 95% CI 4.7–5.4%) but were major in only 3 (1.6%). At a mean clinical follow-up of 22 months, clinical improvement was noted in 130 of 166 patients with headaches (78.3%; 95% CI 75.8–80.8%), 84 of 89 patients with papilledema (94.4%; 95% CI 92.1–96.6%), and 64 of 74 patients with visual symptoms (86.5%; 95% CI 83.0–89.9%). In-stent stenosis was noted in six patients (3.4%; 95% CI 2.5–4.3%) and stent-adjacent stenosis occurred in 19 patients (11.4%; 95% CI 10.4–12.4), resulting in restenting in 10 patients. Conclusion. In IIH patients with venous sinus stenosis and a physiologic pressure gradient, venous stenting appears to be a safe and effective therapeutic option. Further studies are necessary to determine the long-term outcomes and the optimal management of medically refractory IIH. PMID:26146651

  18. Sinusitis

    MedlinePlus

    ... my acute sinusitis is caused by viruses or bacteria? Acute viral sinusitis is likely if you have ... to tell if my sinusitis is caused by bacteria? Because sinusitis is treated differently based on cause. ...

  19. Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure?

    PubMed

    Bateman, Grant A; Lechner-Scott, Jeannette; Copping, Ross; Moeskops, Christopher; Yap, Swee Leong

    2017-07-06

    There is evidence that patients with multiple sclerosis (MS) and hydrocephalus share some common pathophysiological mechanisms. Alterations in CSF pressure are known to affect cerebral venous sinus geometry. To further explore these mechanisms, we measured the superior sagittal sinus (SSS) cross-sectional area 3 cm above the torcular using T2 images in 20 MS, 10 spontaneous intracranial hypotension (SIH), 21 hydrocephalus and 20 idiopathic intracranial hypertension (IIH) patients and compared with 20 matched controls. The SSS area was reduced by 25% in hydrocephalus (p = 0.0008), increased by 22% (p = 0.037) in SIH and unchanged in IIH compared to matched controls. In MS there was a 16% increase in SSS area (p = 0.01).The findings suggest that changes in SSS cross-sectional are common between MS and SIH patients, while in hydrocephalus and IIH these are different.

  20. Cerebral Venous Thromboembolism in Antiphospholipid Syndrome Successfully Treated with the Combined Use of an Anti-Xa Inhibitor and Corticosteroid.

    PubMed

    Sugie, Masayuki; Iizuka, Natsuko; Shimizu, Yuki; Ichikawa, Hiroo

    2015-01-01

    We herein report a case presenting with cerebral venous sinus thrombosis (CVST) associated with primary antiphospholipid syndrome (APS). The patient developed recurrent CVST followed by a hemorrhagic ischemic stroke despite the use of warfarin during the appropriate therapeutic window. Thus, we substituted warfarin to rivaroxaban with prednisolone and obtained a good clinical course. In addition to the effect of prednisolone of inhibiting elevated lupus anticoagulants and the recurrence of arterial thrombosis, rivaroxaban may prevent CVST and inhibit hypercoagulability induced by corticosteroids. The combination of an anti-Xa inhibitor and corticosteroid may be an alternative treatment for CVST and arterial thrombus with warfarin-resistant APS.

  1. [Long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of parasinus dural arteriovenous fistula].

    PubMed

    Chen, Liang; Huang, Xiang; Gu, Yu-xiang; Xu, Bin; Song, Dong-lei; Mao, Ying; Zhou, Liang-fu

    2013-03-05

    To retrospectively explore the long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of dural arteriovenous fistula interfering major dural sinus. Among 15 consecutively treated patients, the lesions were located in superior sagittal sinus (n = 7), medial segment of transverse sinus (n = 3) and lateral transverse and sigmoid sinus (n = 5). And 40% of them clinically presented with intracranial hypertension and 13.3% with hemorrhage. Preoperatively, Gamma knife therapy and transarterial occlusion were used in 1 case each. All underwent sinus skeletonization plus abnormal venous reflux interruption if any. Interfered sinus was preserved in 12 cases. In another 3 cases, completely occluded segment of sinus was resected after skeletonization. Surgical mortality was none. At discharge, the symptoms were relieved or disappeared in 12 cases. Follow-up study was available in 11 cases over a mean period of 6 years. A Karnofsky performance status (KPS) score of 90 or more was achieved in 8 cases and a KPS score of 80, 60 or 40 was found in 1 case each. Digital subtract angiography was performed in 9 cases and computed tomographic angiography in 1 case after operation. Cure was achieved in 7 cases and 3 cases had minimal residue without recurrence. Sinus skeletonization may stably block most blood supply to fistula so as to offer cure or long-term control of dural arteriovenous fistula.

  2. Differentiation of transverse sinus thrombosis from congenitally atretic cerebral transverse sinus with CT.

    PubMed

    Chik, Yolanda; Gottesman, Rebecca F; Zeiler, Steven R; Rosenberg, Jason; Llinas, Rafael H

    2012-07-01

    Transverse sinus thrombosis can have nonspecific clinical and radiographic signs. We hypothesized that the novel "sigmoid notch sign" (on head CT) can help differentiate transverse sinus thrombosis from a congenitally atretic sinus among individuals with absent signal in 1 transverse sinus by MR venography. We retrospectively evaluated 53 subjects with a unilaterally absent transverse sinus signal on MR venography. Eleven had true transverse sinus thrombosis and 42 had an atretic transverse sinus. Reviewers were trained in the sigmoid notch sign: "positive" if 1 of the sigmoid notches was asymmetrically smaller than the other, consistent with a congenitally absent transverse sinus on that side. This sign was scored on CT scans by 2 blinded reviewers to determine if signal dropout was clot or atretic sinus. A consensus rating was reached when the reviewers disagreed. Characteristics of the sigmoid notch sign as a diagnostic test were compared with a gold standard of full chart review by an independent reviewer. Each reviewer had a sensitivity of 91% (detecting 10 of 11 clots based on a negative sigmoid notch sign) and specificity of 71% to 81%; consensus specificity increased to 86% (36 of 42 individuals with an atretic sinus had a positive notch sign, detecting atretic sinuses based on presence of the sign). Asymmetries of the sigmoid notches on noncontrast brain CT is a very sensitive and specific measure of differentiating transverse sinus thrombosis from an atretic transverse sinus when absence of transverse sinus flow is visualized on MR venography.

  3. Regional quantification of cerebral venous oxygenation from MRI susceptibility during hypercapnia

    PubMed Central

    Fan, Audrey P; Evans, Karleyton C; Stout, Jeffrey N; Rosen, Bruce R; Adalsteinsson, Elfar

    2014-01-01

    There is an unmet medical need for noninvasive imaging of regional brain oxygenation to manage stroke, tumor, and neurodegenerative diseases. Oxygenation imaging from magnetic susceptibility in MRI is a promising new technique to measure local venous oxygen extraction fraction (OEF) along the cerebral venous vasculature. However, this approach has not been tested in vivo at different levels of oxygenation. The primary goal of this study was to test whether susceptibility imaging of oxygenation can detect OEF changes induced by hypercapnia, via CO2 inhalation, within selected a priori brain regions. Ten healthy subjects were scanned at 3 tesla with a 32-channel head coil. The end-tidal CO2 (ETCO2) was monitored continuously and inspired gases were adjusted to achieve steady-state conditions of eucapnia (41 ± 3 mmHg) and hypercapnia (50 ± 4 mmHg). Gradient echo phase images and pseudo-continuous arterial spin labeling (pcASL) images were acquired to measure regional OEF and CBF respectively during eucapnia and hypercapnia. By assuming constant cerebral oxygen consumption throughout both gas states, regional CBF values were computed to predict the local change in OEF in each brain region. Hypercapnia induced a relative decrease in OEF of -42.3% in the straight sinus, -39.9% in the internal cerebral veins, and approximately -50% in pial vessels draining each of the occipital, parietal, and frontal cortical areas. Across volunteers, regional changes in OEF correlated with changes in ETCO2. The reductions in regional OEF (via phase images) were significantly correlated (P < 0.05) with predicted reductions in OEF derived from CBF data (via pcASL images). These findings suggest that susceptibility imaging is a promising technique for OEF measurements, and may serve as a clinical biomarker for brain conditions with aberrant regional oxygenation. PMID:25300201

  4. Regional quantification of cerebral venous oxygenation from MRI susceptibility during hypercapnia.

    PubMed

    Fan, Audrey P; Evans, Karleyton C; Stout, Jeffrey N; Rosen, Bruce R; Adalsteinsson, Elfar

    2015-01-01

    There is an unmet medical need for noninvasive imaging of regional brain oxygenation to manage stroke, tumor, and neurodegenerative diseases. Oxygenation imaging from magnetic susceptibility in MRI is a promising new technique to measure local venous oxygen extraction fraction (OEF) along the cerebral venous vasculature. However, this approach has not been tested in vivo at different levels of oxygenation. The primary goal of this study was to test whether susceptibility imaging of oxygenation can detect OEF changes induced by hypercapnia, via CO2 inhalation, within selected a priori brain regions. Ten healthy subjects were scanned at 3T with a 32-channel head coil. The end-tidal CO2 (ETCO2) was monitored continuously and inspired gases were adjusted to achieve steady-state conditions of eucapnia (41±3mmHg) and hypercapnia (50±4mmHg). Gradient echo phase images and pseudo-continuous arterial spin labeling (pcASL) images were acquired to measure regional OEF and CBF respectively during eucapnia and hypercapnia. By assuming constant cerebral oxygen consumption throughout both gas states, regional CBF values were computed to predict the local change in OEF in each brain region. Hypercapnia induced a relative decrease in OEF of -42.3% in the straight sinus, -39.9% in the internal cerebral veins, and approximately -50% in pial vessels draining each of the occipital, parietal, and frontal cortical areas. Across volunteers, regional changes in OEF correlated with changes in ETCO2. The reductions in regional OEF (via phase images) were significantly correlated (P<0.05) with predicted reductions in OEF derived from CBF data (via pcASL images). These findings suggest that susceptibility imaging is a promising technique for OEF measurements, and may serve as a clinical biomarker for brain conditions with aberrant regional oxygenation. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Optimal Placement of Cerebral Oximeter Monitors to Avoid the Frontal Sinus as Determined by Computed Tomography.

    PubMed

    Gregory, Alexander J; Hatem, Muhammed A; Yee, Kevin; Grocott, Hilary P

    2016-01-01

    To determine the optimal location to place cerebral oximeter optodes to avoid the frontal sinus, using the orbit of the skull as a landmark. Retrospective observational study. Academic hospital. Fifty adult patients with previously acquired computed tomography angiography scans of the head. The distance between the superior orbit of the skull and the most superior edge of the frontal sinus was measured using imaging software. The mean (SD) frontal sinus height was 16.4 (7.2) mm. There was a nonsignificant trend toward larger frontal sinus height in men compared with women (p = 0.12). Age, height, and body surface area did not correlate with frontal sinus height. Head circumference was positively correlated (r = 0.32; p = 0.03) to frontal sinus height, with a low level of predictability based on linear regression (R(2) = 0.10; p = 0.02). Placing cerebral oximeter optodes>3 cm from the superior rim of the orbit will avoid the frontal sinus in>98% of patients. Predicting the frontal sinus height based on common patient variables is difficult. Additional studies are required to evaluate the recommended height in pediatric populations and patients of various ethnic backgrounds. The clinical relevance of avoiding the frontal sinus also needs to be further elucidated. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Focal stenosis of the sigmoid sinus causing intracranial venous hypertension: Case report, endovascular management, and review of the literature.

    PubMed

    Honarmand, Amir R; Hurley, Michael C; Ansari, Sameer A; Alden, Tord D; Kuhn, Ryan; Shaibani, Ali

    2016-04-01

    Regardless of the underlying pathology, elevated intracranial pressure is the endpoint of any impairment in either cerebrospinal fluid (CSF) absorption (including arachnoid villi) or intracranial venous drainage. In all age groups, the predominant final common pathway for CSF drainage is the dural venous sinus system. Intracranial venous hypertension (ICVH) is an important vascular cause of intracranial hypertension (and its subsequent sequelae), which has often been ignored due to excessive attention to the arterial system and, specifically, arteriovenous shunts. Various anatomical and pathological entities have been described to cause ICVH. For the second time, we present a unique case of severe focal stenosis in the distal sigmoid sinus associated with concurrent hypoplasia of the contralateral transverse sinus causing a significant pressure gradient and intracranial hypertension, which was treated with endovascular stent placement and angioplasty.

  7. Cerebral venous thrombosis following spinal surgery in a patient with Factor V Leiden mutation.

    PubMed

    Yılmaz, Baran; Ekşi, Murat Şakir; Akakın, Akın; Toktaş, Zafer Orkun; Demir, Mustafa Kemal; Konya, Deniz

    2016-08-01

    Cerebral venous thrombosis is a devastating event leading to high mortality and morbidity rates. We present a case of cerebral venous thrombosis that occurred following spinal surgery in a patient with Factor V Leiden mutation and G1691A heterozygosity. Possible prevention and treatment strategies have been discussed.

  8. Improvement in venous outflow following superior sagittal sinus decompression after a gunshot wound to the head: Case report

    PubMed Central

    Birk, Daniel M; Tobin, Matthew K; Moss, Heather E.; Feinstein, Eric; Charbel, Fady T; Alaraj, Ali

    2015-01-01

    The most commonly described indications for surgical management of closed depressed skull fractures are hematoma evacuation and repair of extensive cosmetic deformity. Venous sinus injury, which occurs in a subset of depressed skull fractures is not typically listed as an indication for surgical treatment due to the potential for major venous hemorrhage associated with operation near these structures. However, if patients exhibit signs and symptoms of intracranial hypertension and radiographic findings demonstrate sinus compromise, surgical elevation of the depressed skull fragments is indicated. The authors present the case of a 25-year-old woman with a depressed skull fracture secondary to a gunshot wound with symptomatic compromise in venous outflow of the posterior one-third of the superior sagittal sinus. The patient was treated with surgical decompression via bilateral craniectomy along with intracranial pressure lowering medical therapy and had almost full resolution of her presenting symptoms with documented improvement in flow through the superior sagittal sinus. While the use of surgical treatment for these types of injuries is highly debated we demonstrate here that safe, effective surgical management of these patients is possible and that surgical decompression should always be considered in the case of symptomatic venous sinus flow obstruction. PMID:25839927

  9. Differentiation of Transverse Sinus Thrombosis from Congenitally Atretic Cerebral Transverse Sinus with Computed Tomography

    PubMed Central

    Chik, Yolanda; Gottesman, Rebecca F.; Zeiler, Steven; Rosenberg, Jason; Llinas, Rafael H.

    2015-01-01

    Background Transverse sinus thrombosis can have nonspecific clinical and radiographic signs. We hypothesized that the novel “sigmoid notch sign” (on head CT) can help differentiate transverse sinus thrombosis from a congenitally atretic sinus among individuals with absent signal in one transverse sinus by magnetic resonance venography (MRV). Methods We retrospectively evaluated 53 subjects with a unilaterally absent transverse sinus signal on MRV. 11 had true transverse sinus thrombosis and 42 had an atretic transverse sinus. Reviewers were trained in the sigmoid notch sign: “positive” if one of the sigmoid notches was asymmetrically smaller than the other, consistent with a congenitally absent transverse sinus on that side. This sign was scored on CT scans by, two blinded reviewers to determine if signal dropout was clot or atretic sinus. A consensus rating was reached when the reviewers disagreed. Characteristics of the sigmoid notch sign as a diagnostic test were compared to a gold standard of full chart review by an independent reviewer. Results Each reviewer had a sensitivity of 91% (detecting 10/11 clots based on a negative sigmoid notch sign) and specificity of 71-81%; consensus specificity increased to 86% (36 of 42 individuals with an atretic sinus had a positive notch sign, detecting atretic sinuses based on presence of the sign). Conclusion Asymmetries of the sigmoid notches on non-contrast brain CT is a very sensitive and specific measure of differentiating transverse sinus thrombosis from an atretic transverse sinus when absence of transverse sinus flow is visualized on MRV. PMID:22588265

  10. Thrombus in Transit: A Potentially Life-threatening Complication of Cerebral Sinus Thrombosis.

    PubMed

    Petracca, Martina; Calandrelli, Rosalinda; Broccolini, Aldobrando; Caliandro, Pietro; Della Marca, Giacomo; Frisullo, Giovanni; Morosetti, Roberta; Profice, Paolo; Lamendola, Priscilla; Pennestrì, Faustino; Pilato, Fabio

    2017-01-01

    We report the case of a 41-year-old, 7-weeks-pregnant patient, presenting with headache and generalized seizure due to cerebral venous thrombosis complicated by jugular thrombosis and thrombus dislocation into right cardiac cavities. The patient was treated with intravenous heparin, and underwent embolectomy in extracorporeal circulation. This case illustrates the variability of cerebral venous thrombosis progression and a potentially life-threatening condition even during anticoagulant therapy.

  11. Cerebral venous thrombosis at high altitude: A systematic review.

    PubMed

    Zavanone, C; Panebianco, M; Yger, M; Borden, A; Restivo, D; Angelini, C; Pavone, A; Grimod, G; Rosso, C; Dupont, S

    2017-04-01

    High altitude may be a factor associated with cerebral venous thrombosis (CVT). As our knowledge of CVT at high altitude is limited, it was decided to pool such information from the available case studies to determine whether high altitude can predispose to CVT. A systematic review of the literature was performed for cases reporting CVT at high altitude. Searches of the PubMed database (up to July 2016) were performed for publications, using 'cerebral venous thrombosis' and 'high altitude' as keywords. Cross-referencing was also done to complete the search. Ultimately, 13 articles were included in our systematic review. The population consisted of 17 patients, predominately male (14/17), with a mean age of 32 (range: 19-47) years. Altitude range was 3000-8200m. Nine patients stayed at high altitude for>2 weeks; the duration of high altitude stay was unknown for the remainder. A hypercoagulable state was found in nine patients: secondary polycythemia in five; protein C deficiency in one; protein S deficiency in one; and factor V Leiden mutations in two. No comorbidities were found in any of these patients. Long-term stays at high altitude in association with a hypercoagulable state - in particular, congenital or acquired thrombophilia - appears to predispose to CVT. The association of CVT with a single exposure to high altitude seems low, but the risk cannot as yet be specifically estimated. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Thrombosis of the Cerebral Veins and Sinuses in Hamadan, West of Iran.

    PubMed

    Ghiasian, Masoud; Mansour, Maryam; Mazaheri, Shahir; Pirdehghan, Azar

    2016-06-01

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

  13. Cerebral Arteriovenous Malformation Flow Is Associated With Venous Intimal Hyperplasia.

    PubMed

    Shakur, Sophia F; Hussein, Ahmed E; Amin-Hanjani, Sepideh; Valyi-Nagy, Tibor; Charbel, Fady T; Alaraj, Ali

    2017-04-01

    The pathogenesis of venous intimal hyperplasia and venous outflow stenosis associated with cerebral arteriovenous malformation (AVM) draining veins is poorly understood. We sought to determine the relationship between maximum vein wall thickness and AVM flow. Patients who underwent AVM surgical resection and had flow measured before treatment using quantitative magnetic resonance angiography were retrospectively reviewed. Specimens were mounted on slides and stained with elastin special stain. Perinidal veins were identified, and maximum wall thickness was measured from digitized images. Relationship between maximum vein wall thickness and AVM flow was assessed. Twenty-eight patients were included. Spearman correlation revealed a statistically significant relationship between maximum vein wall thickness and total AVM flow (ρ=+0.51; P=0.006), AVM flow per draining vein (ρ=+0.41; P=0.03), and mean intranidal vessel diameter (ρ=+0.39; P=0.04). Maximum vein wall thickness increases with higher total AVM flow and AVM flow per draining vein. This finding implicates chronically high AVM inflow in venous intimal hyperplasia. © 2017 American Heart Association, Inc.

  14. Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus

    PubMed Central

    Guo, Ping

    2015-01-01

    Objectives To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography. Methods Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months. Results Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided. Conclusion Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus

  15. Sagittal sinus compression is associated with neonatal cerebral sinovenous thrombosis.

    PubMed

    Tan, Marilyn; Deveber, Gabrielle; Shroff, Manohar; Moharir, Mahendra; Pontigon, Anne-Marie; Widjaja, Elisa; Kirton, Adam

    2011-08-01

    Neonatal cerebral sinovenous thrombosis (CSVT) causes lifelong morbidity. Newborns frequently incur positional occipital bone compression of the superior sagittal sinus (SSS). We hypothesized that SSS compression is associated with neonatal CSVT. Our retrospective case-control study recruited neonates with CSVT (SickKids Children's Stroke Program, January 1992-December 2006). Controls were neonates without CSVT undergoing magnetic resonance or computed tomography venography (institutional imaging database, 2002-2005) who were matched 2 per each case patient. Blinded neuroimaging review by 2 experts quantified SSS compression and head position. Effect of SSS compression on the primary outcome of CSVT was determined (logistic regression). Secondary analyses included the relationship of head position to SSS compression (t test) and group comparisons (cases versus controls, cases with and without compression) for demographic, clinical, and CSVT factors (χ² and Wilcoxon Mann-Whitney tests). Case (n = 55) and control (n = 90) patients had similar ages and delivery modes. SSS compression was common (cases: 43%; controls: 41%). Controlling for gender and head position, SSS compression was associated with CSVT (odds ratio: 2.5 [95% confidence interval: 1.07-5.67]). Compression was associated with greater mean (SD) angle toward head flexion (101.2 [15.0] vs 111.5 [9.7]; P < .001). Among CSVT cases, neonates with and without compression had comparable gestational age, delivery mode, risk factors, anticoagulation treatment, thrombus location, propagation, infarction, recanalization, and outcome. Many idiopathic cases had SSS compression (79%). Interrater reliability of compression measurements was high (κ = 0.87). Neonatal SSS compression is common, quantifiable, and associated with CSVT. Optimizing head position and/or developing devices to alleviate mechanical SSS compression may represent a novel means to improve outcomes.

  16. Right Hand Weakness and Headache During Ascent to Mount Everest: A Case of Cerebral Venous Infarction.

    PubMed

    Kim, Jeong Hee; Kim, Soo Jeong; Kim, Hahn Young

    2017-05-01

    The increasing popularity of trekking in alpine regions has drawn attention to high altitude-associated health concerns. Here, we report a case of cerebral venous infarction as a consequence of a hypercoagulable state induced by secondary polycythemia as an adaptation to high altitude. When patients present focal neurological symptoms such as hemiparesis in addition to symptoms of acute mountain sickness or high-altitude cerebral edema such as headache, nausea, vomiting, and dizziness, cerebral venous infarction should be considered.

  17. Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model.

    PubMed

    Fracasso, Tony; Karger, Bernd; Schmidt, Peter F; Reinbold, Wolf D; Pfeiffer, Heidi

    2011-01-01

    There are few reported cases of death attributed to retrograde cerebral air embolism from central venous catheter. The pathophysiological mechanism and the necessary conditions are not fully understood, also because of missing experimental data. We performed experimental simulation while working on a possible case of retrograde cerebral air embolism. A hermetic system consisting of two containers connected to each other and to an electric pump by means of rubber hoses was built. In this system, a fluid (water and blood) could continuously flow under conditions similar to those of the common jugular vein. The part of the system representing the jugular vein could be freely positioned at angles between 0 and 90°. A central venous catheter was inserted into this part. After disconnection, the behavior of the air bubbles entering the hose through the tip of the catheter was evaluated at different positions. At angles between 0 and 45°, the air bubbles followed the fluid flow. At angles >45°, the air bubbles showed the tendency to flow upstream; this phenomenon was more evident the more vertically the hose was located. We were able to demonstrate that a retrograde air embolism can be caused by a disconnected catheter and is even more likely if the neck is in a vertical position. © 2010 American Academy of Forensic Sciences.

  18. Lessons from surgical outcome for intracranial meningioma involving major venous sinus

    PubMed Central

    Han, Moon-Soo; Kim, Yeong-Jin; Moon, Kyung-Sub; Lee, Kyung-Hwa; Yang, Jung-In; Kang, Woo Dae; Lim, Sa-Hoe; Jang, Woo-Youl; Jung, Tae-Young; Kim, In-Young; Jung, Shin

    2016-01-01

    Abstract Intracranial meningiomas involving the major venous sinus (MVS) pose several complication risks upon performing radical resection. Some surgeons consider MVS invasion a contraindication for a complete resection of meningioma, and others suggest total resection followed by venous reconstruction. The aim of the study was to analyze our surgical results and discuss management strategy for intracranial meningiomas involving the MVS. Between 1993 and 2011, 107 patients with intracranial meningiomas involving MVS underwent surgery in our institution. Clinicoradiological features including pathological features and operative findings were retrospectively analyzed. Median follow-up duration was 60.2 months (range, 6.2–218.2 months). Distributions of tumor cases according to the involved sinus were as follows: 86% parasagittal, 10.3% tentorial, and 3.7% peritorcular. Simpson Grade I/II removal was achieved in 93 of 107 patients (87%). Partially or totally occluded MVS by their meningiomas (Sindou classification IV and V) was found in 39 patients (36%). Progression rate was 12% (13/107) and progression-free survival rates were 89%, 86%, and 80% at 5, 7, and 10 years, respectively. Sindou classification (IV/V) and Karnofsky performance status (KPS) score 6 month after the surgery (KPS < 90) were predictive factors for progression in our study (P = 0.044 and P = 0.001, respectively). The resection degree did not reach statistical significance (P = 0.484). Interestingly, there was no progression in patients that underwent radiation therapy or gamma knife radiosurgery for residual tumor. There were no perioperative deaths. Complication rate was 21% with brain swelling being the most common complication. There was no predictive factor for occurrence of postoperative complication in this study. In conclusion, complete tumor resection with sinus reconstruction did not significantly prevent tumor recurrence in intracranial meningioma involving MVS

  19. Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography.

    PubMed

    Bulbul, Erdogan; Yanik, Bahar; Demirpolat, Gulen; Koksal, Vildan

    2015-12-01

    An extraordinary cerebral venous drainage pathway and dilated vein at the left posterior cervical region were detected with routine contrast-enhanced neck computed tomography exam. The left sigmoid sinus was drained by dilated mastoid emissary vein (MEV). The MEV continued as posterior auricular and posterior external jugular veins (PEJVs). The left PEJV directly drained into subclavian vein. Atretic right transverse sinus, left facial vein forming the external jugular vein, atresia and hypoplasia of upper internal jugular veins at the right and left sides, respectively, were the other uncommon findings in our case. Detecting venous variations may prevent complications during surgical and interventional procedures, so the radiologists should examine the superficial cervical veins closely.

  20. Spreading depression and focal venous cerebral ischemia enhance cortical neurogenesis

    PubMed Central

    Tamaki, Ryo; Orie, Samuel Ige; Alessandri, Beat; Kempski, Oliver; Heimann, Axel

    2017-01-01

    Endogenous neurogenesis can arise from a variety of physiological stimuli including exercise, learning, or “enriched environment” as well as pathological conditions such as ischemia, epilepsy or cortical spreading depression. Whether all these conditions use a common trigger to set off endogenous neurogenesis is yet unclear. We hypothesized that cortical spreading depression (CSD) induces neurogenesis in the cerebral cortex and dentate gyrus after cerebral venous ischemia. Forty-two Wistar rats alternatively underwent sham operation (Sham), induction of ten CSDs or venous ischemia provoked via occlusion of two adjacent superficial cortical vein followed by ten induced CSDs (CSD + 2-VO). As an additional control, 15 naïve rats received no intervention except 5-bromo-2′-deoxyuridine (BrdU) treatment for 7 days. Sagittal brain slices (40 μm thick) were co-stained for BrdU and doublecortin (DCX; new immature neuronal cells) on day 9 or NeuN (new mature neuronal cells) on day 28. On day 9 after sham operation, cell proliferation and neurogenesis occurred in the cortex in rats. The sole induction of CSD had no effect. But on days 9 and 28, more proliferating cells and newly formed neurons in the ipsilateral cortex were observed in rats subjected to CSD + 2VO than in rats subjected to sham operation. On days 9 and 28, cell proliferation and neurogenesis in the ipsilateral dentate gyrus was increased in sham-operated rats than in naïve rats. Our data supports the hypothesis that induced cortical neurogenesis after CSD + 2-VO is a direct effect of ischemia, rather than of CSD alone. PMID:28966642

  1. Anomalous PiB enhancement in the Superior Sagittal and Transverse Venous Sinuses

    PubMed Central

    Raymond, Scott B.; Cohen, Ann D.; Becker, Carl; Price, Julie; Klunk, William E.

    2012-01-01

    Pittsburgh compound-B (PiB), an amyloid-binding positron emission tomography (PET) tracer, is widely used for imaging amyloid-β in those with and at risk for Alzheimer disease. Here, we report on an otherwise normal 68-year-old female with abnormally high and very focal PiB retention. Coregistered T1-weighted magnetic resonance imaging and dynamic 2-fluoro-2-deoxy-D-glucose (FDG) images confirmed that the focal PiB enhancement was in the superior sagittal and transverse sinuses, outside of the adjacent cortex. Flow through the venous vasculature was normal as assessed by dynamic FDG PET imaging. These features supported the conclusion that PiB retention was not simply due to a hemodynamic abnormality, but may have represented PiB binding to fibrillar deposits of a β-sheet protein (ie, amyloid), whose nature is currently unclear. PMID:21909018

  2. Anomalous PiB enhancement in the superior sagittal and transverse venous sinuses.

    PubMed

    Raymond, Scott B; Cohen, Ann D; Becker, Carl; Price, Julie; Klunk, William E

    2012-01-01

    Pittsburgh compound-B (PiB), an amyloid-binding positron emission tomography (PET) tracer, is widely used for imaging amyloid-β in those with and at risk for Alzheimer disease. Here, we report on an otherwise normal 68-year-old female with abnormally high and very focal PiB retention. Coregistered T1-weighted magnetic resonance imaging and dynamic 2-fluoro-2-deoxy-D-glucose (FDG) images confirmed that the focal PiB enhancement was in the superior sagittal and transverse sinuses, outside of the adjacent cortex. Flow through the venous vasculature was normal as assessed by dynamic FDG PET imaging. These features supported the conclusion that PiB retention was not simply due to a hemodynamic abnormality, but may have represented PiB binding to fibrillar deposits of a β-sheet protein (ie, amyloid), whose nature is currently unclear.

  3. Quantifying cerebral hypoxia by near-infrared spectroscopy tissue oximetry: the role of arterial-to-venous blood volume ratio

    NASA Astrophysics Data System (ADS)

    Rasmussen, Martin B.; Eriksen, Vibeke R.; Andresen, Bjørn; Hyttel-Sørensen, Simon; Greisen, Gorm

    2017-02-01

    Tissue oxygenation estimated by near-infrared spectroscopy (NIRS) is a volume-weighted mean of the arterial and venous hemoglobin oxygenation. In vivo validation assumes a fixed arterial-to-venous volume-ratio (AV-ratio). Regulatory cerebro-vascular mechanisms may change the AV-ratio. We used hypotension to investigate the influence of blood volume distribution on cerebral NIRS in a newborn piglet model. Hypotension was induced gradually by inflating a balloon-catheter in the inferior vena cava and the regional tissue oxygenation from NIRS (rStO) was then compared to a reference (rStO) calculated from superior sagittal sinus and aortic blood sample co-oximetry with a fixed AV-ratio. Apparent changes in the AV-ratio and cerebral blood volume (CBV) were also calculated. The mean arterial blood pressure (MABP) range was 14 to 82 mmHg. PaCO2 and SaO2 were stable during measurements. rStO mirrored only 25% (95% Cl: 21% to 28%, p<0.001) of changes in rStO. Calculated AV-ratio increased with decreasing MABP (slope: -0.007·mmHg-1, p<0.001). NIRS estimates that CBV decreased with decreasing MABP (slope: 0.008 ml/100 g/mmHg, p<0.001). Thus, cerebral NIRS oximetry responded poorly to changes in tissue oxygenation during hypotension induced by decreased preload. An increase in the AV-ratio during hypotension due to arterial vasodilation and, possibly, cerebral venous collapse may be a part of the explanation.

  4. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension.

    PubMed

    Satti, Sudhakar R; Leishangthem, Lakshmi; Spiotta, Alejandro; Chaudry, M Imran

    2017-04-01

    Background Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial hypertension without radiographic evidence of a mass lesion in the brain. Dural venous sinus stenosis has been increasingly recognized as a treatable cause, and dural venous sinus stenting (DVSS) is increasingly performed. Methods A 5 year single-center retrospective analysis of consecutive patients undergoing DVSS for medically refractory IIH. Results There were 43 patients with a mean imaging follow-up of 6.5 months and a mean clinical follow-up period of 13.5 months. DVSS was performed as the first procedure for medically refractory IIH in 81.4% of patients, whereas 18.6% of patients included had previously had a surgical procedure (ventriculoperitoneal (VP) shunt or optic nerve sheath fenestration (ONSF)). Headache was present in all patients and after DVSS improved or remained stable in 69.2% and 30.8%, respectively. Visual acuity changes and visual field changes were present in 88.4% and 37.2% of patients, respectively. Visual field improved or remained unchanged in 92%, but worsened in 8% after stenting. There was a stent patency rate of 81.8%, with an 18.2% re-stenosis rate. Of the 43 procedures performed, there was a 100% technical success rate with zero major or minor complications. Conclusion Based on this single-center retrospective analysis, DVSS can be performed with high technical success and low complication rates. A majority of patients presented primarily with headache, and these patients had excellent symptom relief with DVSS alone. Patients presenting with visual symptoms had lower success rates, and this population, if stented, should be carefully followed for progression of symptoms.

  5. Cerebral venous thrombosis: a Moroccan retrospective study of 30 cases

    PubMed Central

    Souirti, Zouhayr; Messouak, Ouafae; Belahsen, Faouzi

    2014-01-01

    Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better than arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnosis. We studied 30 cases of CVT diagnosed in the department of neurology at the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%), consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behçet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes were observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated. PMID:25317229

  6. Sinusitis

    MedlinePlus

    ... to decrease swelling, especially if there are nasal polyps or allergies Surgery to enlarge the sinus opening and drain the ... each year. Most fungal sinus infections need surgery. Surgery to repair ... or nasal polyps may prevent the condition from returning.

  7. Sinusitis.

    PubMed

    Morcom, Samuel; Phillips, Nicholas; Pastuszek, Andrew; Timperley, Daniel

    2016-06-01

    Acute and chronic sinusitis are common primary care presentations. They are caused by mucosal inflammation, which inhibits mucociliary function of the nose and paranasal sinuses. This article provides an overview of acute and chronic sinusitis, and a guide to workup and management in a primary care setting. Complications and other indications for referral are discussed. Sinusitis involves a wide spectrum of presentations, both acute and chronic. It is primarily a medical condition, and surgical management is reserved for complicated or refractory cases.

  8. Cerebral Venous Thrombosis as an Extrahepatic Manifestation of Acute Anicteric Hepatitis A Infection

    PubMed Central

    Zis, Panagiotis; Kontogeorgi, Elli; Karakalos, Dimitrios; Pavlopoulou, Despoina; Sevastianos, Vassilios A.

    2012-01-01

    Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis has been regarded as a rare associated condition. We report the case of a 31-year-old woman presenting with CVT associated with hepatitis A virus (HAV) infection, outlining probable pathogenic mechanisms. We suggest that hepatitis A serological markers should be routinely included in the investigation of cerebral venous thrombosis of unknown etiology, in nonvaccinated patients with risk factors of a recent HAV exposure. PMID:22934203

  9. Cerebral venous thrombosis in a child with nephrotic syndrome: case report.

    PubMed

    Bhoobun, Shalinee; Jalloh, Alhaji Alusaine; Jacobsen, Kathryn H

    2012-01-01

    Cerebral venous thrombosis (CVT), a rare and life threatening complication of nephrotic syndrome, has a variable and non-specific presentation, posing diagnostic challenges. We describe a case of CVT in a Sierra Leonean child with nephrotic syndrome who was successfully treated for the condition despite the resource limitations of the hospital. This case highlights the importance of considering cerebral venous thrombosis as a complication of idiopathic nephrotic syndrome in children presenting with neurological symptoms.

  10. Immunocompetent young man with cerebral abscess and cortical venous infarction mimicking cerebritis caused by Gemella morbillorum

    PubMed Central

    Milnik, Annette; Gazis, Angelos; Tammer, Ina; Bartels, Claudius

    2013-01-01

    Gemella morbillorum is an anaerobic gram-positive diplococcus and in most cases a harmless commensal, which occasionally causes infections in the central nervous system. We report on an immunocompetent young man with focal neurological symptoms and cephalgia caused by a cerebral abscess. Although successful treatment was done with neurosurgical intervention and antibiotic therapy, he suffered from a venous infarction 5 weeks after first diagnosis, which mimicked cerebritis as an early stage of relapsing abscess. Imaging and investigation of cerebrospinal fluid was necessary for sufficient differential diagnosis and antibiotic therapy could be stopped after altogether 8 weeks of treatment. In summary, G morbillorum causes not only biphasic infections, but also can be accompanied by infarction in the central nervous system despite sufficient antibiotic therapy. PMID:23355562

  11. Immunocompetent young man with cerebral abscess and cortical venous infarction mimicking cerebritis caused by Gemella morbillorum.

    PubMed

    Milnik, Annette; Gazis, Angelos; Tammer, Ina; Bartels, Claudius

    2013-01-25

    Gemella morbillorum is an anaerobic gram-positive diplococcus and in most cases a harmless commensal, which occasionally causes infections in the central nervous system. We report on an immunocompetent young man with focal neurological symptoms and cephalgia caused by a cerebral abscess. Although successful treatment was done with neurosurgical intervention and antibiotic therapy, he suffered from a venous infarction 5 weeks after first diagnosis, which mimicked cerebritis as an early stage of relapsing abscess. Imaging and investigation of cerebrospinal fluid was necessary for sufficient differential diagnosis and antibiotic therapy could be stopped after altogether 8 weeks of treatment. In summary, G morbillorum causes not only biphasic infections, but also can be accompanied by infarction in the central nervous system despite sufficient antibiotic therapy.

  12. Hormonal Contraceptives and Cerebral Venous Thrombosis Risk: A Systematic Review and Meta-Analysis

    PubMed Central

    Amoozegar, Farnaz; Ronksley, Paul E.; Sauve, Reg; Menon, Bijoy K.

    2015-01-01

    Objectives: Use of oral contraceptive pills (OCP) increases the risk of cerebral venous sinus thrombosis (CVST). Whether this risk varies by type, duration, and other forms of hormonal contraceptives is largely unknown. This systematic review and meta-analysis update the current state of knowledge. Methods: We performed a search to identify all published studies on the association between hormonal contraceptive use and risk of CVST in women aged 15–50 years. Results: Of 861 studies reviewed, 11 were included. The pooled odds of developing CVST in women aged 15–50 years taking OCPs was 7.59 times higher compared to women not taking OCPs (OR = 7.59, 95% CI 3.82–15.09). Data are insufficient to make conclusions about duration of use and other forms of hormonal contraceptives. Conclusion: Oral contraceptive pills use increases the risk of developing CVST in women of reproductive age. Future studies are required to determine if duration and type of hormonal contraceptives modify this risk. PMID:25699010

  13. Clinical significance of factor V leiden and prothrombin G20210A-mutations in cerebral venous thrombosis - comparison with arterial ischemic stroke.

    PubMed

    Beye, Aida; Pindur, Gerhard

    2017-08-28

    Cerebrovascular diseases are considered in a different way concerning their etiology with regard to arterial and venous occlusion. The role of thrombophilia in this context remains undetermined. For this reason, a case-control study was conducted including a total of 202 patients (154 females, 48 males) aged from 18 to 76 years (mean: 39.8 years) suffering either from cerebral sinus venous thrombosis (n = 101) or from arterial ischemic stroke (n = 101). Study groups were evaluated on the basis of age- and gender-matched pairs. Gene mutations of factor V-1691 (factor V Leiden) and prothrombin-20210 being considered as the most common thrombophilia markers were analyzed in this study. Factor V Leiden-mutations were found in 16.8% of patients with cerebral sinus venous thrombosis (CVT) and in 17.8% of patients with arterial ischemic stroke (AIS), which was significantly more frequent than in controls at a rate of 4.95% (ORs: 3.89 and 4.16). Prothrombin-mutations were significantly more frequent in CVT at a rate of 14.9% versus 2.97% in controls (OR: 5.70). This does not apply for AIS showing a rate of 4.95% prothrombin-mutations. Rates of factor V Leiden-mutations are not different in CVT compared with AIS. In contrast, however, prothrombin-mutations were significantly more frequent in CVT than in AIS with a rate of 14.9% versus 4.95% (OR 3.35). Furthermore, 3 cases with combined heterozygosity of factor V Leiden- and prothrombin-mutation have been identified in CVT, but not in AIS or controls. All of the above mentioned mutations were exclusively heterozygous. We conclude from these data that thrombophilia in terms of factor V Leiden genotype is a risk factor for both CVT and AIS in equal measure. In contrast, prothrombin-20210-mutations were different playing a significant role in the pathogenesis of cerebral sinus vein- thrombosis, but not in arterial ischemic stroke. Also, the combined occurrence of heterozygous prothrombin- and factor V Leiden

  14. Cerebral venous thrombosis in a Mexican multicenter registry of acute cerebrovascular disease: the RENAMEVASC study.

    PubMed

    Ruiz-Sandoval, José L; Chiquete, Erwin; Bañuelos-Becerra, L Jacqueline; Torres-Anguiano, Carolina; González-Padilla, Christian; Arauz, Antonio; León-Jiménez, Carolina; Murillo-Bonilla, Luis M; Villarreal-Careaga, Jorge; Barinagarrementería, Fernando; Cantú-Brito, Carlos

    2012-07-01

    Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that is usually not mentioned in multicenter registries on all-type acute stroke. We aimed to describe the experience on hospitalized patients with CVT in a Mexican multicenter registry on acute cerebrovascular disease. CVT patients were selected from the RENAMEVASC registry, which was conducted between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging, and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed. Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%), contraceptive use (18%), and pregnancy (12%) were the main risk factors in women. In 67% of men, CVT was registered as idiopathic, but thrombophilia assessment was suboptimal. Longitudinal superior sinus was the most frequent thrombosis location (78%). Extensive (>5 cm) venous infarction occurred in 36% of patients. Only 81% of patients received anticoagulation since the acute phase, and 3% needed decompressive craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic thromboembolism (8.5%) were the main in-hospital complications. The 30-day case fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards model, only age <40 years was associated with a mRS score of 0 to 2 (functional independence; rate ratio, 3.46; 95% CI, 1.34-8.92). The relative frequency of CVT and the associated in-hospital complications were higher than in other registries. Thrombophilia assessment and acute treatment was suboptimal. Young age is the main determinant of a good short-term outcome. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. The manifestation of vortical and secondary flow in the cerebral venous outflow tract: An in vivo MR velocimetry study.

    PubMed

    Kefayati, Sarah; Amans, Matthew; Faraji, Farshid; Ballweber, Megan; Kao, Evan; Ahn, Sinyeob; Meisel, Karl; Halbach, Van; Saloner, David

    2017-01-04

    Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D flow magnetic resonance imaging (4D-flow MRI) has recently allowed researchers to evaluate blood flow patterns in the arterial structures with great success. We utilized similar imaging techniques and found several distinct flow characteristics in the CVOT of subjects with and without lumenal irregularities. We present the flow patterns of 8 out of 38 subjects who have varying heights of the internal jugular bulb and varying lumenal irregularities including stenosis and diverticulum. In the internal jugular vein (IJV) with an elevated jugular bulb (JB), 4Dflow MRI revealed a characteristic spiral flow that was dependent on the level of JB elevation. Vortical flow was also observed in the diverticula of the venous sinuses and IJV. The diversity of flow complexity in the CVOT illustrates the potential importance of hemodynamic investigations in elucidating venous pathologies.

  16. VENOUS SAMPLING FOR CUSHING DISEASE: COMPARISON OF INTERNAL JUGULAR VEIN AND INFERIOR PETROSAL SINUS SAMPLING.

    PubMed

    Radvany, Martin G; Quinones-Hinojosa, Alfredo; Gallia, Gary L; Wand, Gary S; Salvatori, Roberto

    2016-09-01

    Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams. Five sites were simultaneously sampled in each patient (right and left IPS, right and left IJV, and femoral vein) before and after the administration of corticotrophin-releasing hormone or desmopressin. The test was considered consistent with CD when the IPS to peripheral ratio was >2 at baseline or >3 after stimulus and the IJV to peripheral ratio was >1.7 at baseline or >2 after stimulus. In 27 of 30 patients, IPSS results were consistent with a central source of ACTH. Two of the other 3 patients had EAS (one lung carcinoid and one occult), and 1 patient had pathology-proven CD. The sensitivity of IPSS was 96.4%. Only 64.2% of these patients had results meeting criteria for a central source of ACTH by IJVS criteria. Twenty patients with centralizing IPPS have undergone pituitary surgery. Of these, the central origin of excessive ACTH was confirmed with certainty in 16 patients. Among these 16 patients, the IPSS sensitivity was 93.8%, whereas 5 patients had false-negative IJVS (68.7% sensitivity). These results do not support the routine use of IJVS in establishing if the pituitary is the source of excessive ACTH. ACTH = adrenocorticotropic hormone CD = Cushing disease CRH = corticotrophin-releasing hormone CS = Cushing syndrome DDAVP = desmopressin EAS = ectopic ACTH secretion IJVS = internal jugular vein sampling IPSS = inferior petrosal sinus sampling JVS = jugular venous sampling MRI = magnetic resonance imaging.

  17. [Takayasu arteritis and cerebral venous thrombosis: report of a case].

    PubMed

    Rodríguez de Mingo, E; Riofrío Cabeza, S; Villa Albuger, T; Velasco Blanco, M J

    2014-01-01

    Palpitations, paresthesias and anxiety are very common reasons of consultation in primary care. We report the case of a 40 year-old Caucasian woman who came to the clinic due to these symptoms, and was finally diagnosed with Takayasu arteritis. Later, she had an episode of headache, as the initial manifestation of cerebral venous thrombosis. Takayasu arteritis is a systemic vasculitis affecting medium and large arteries, mainly leacausing stenosis of the aorta and its branches. It most frequently affects Asian women, being much rarer in Europe. The primary care doctor plays a key role in the initial diagnosis and monitoring of patients with rare diseases, such as Takayasu arteritis, and must be a basic support for the patient and family, providing information and advice, and contributing with his work to reduce the vulnerability of this group. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  18. Magnetic Resonance Imaging in Ischemic Stroke and Cerebral Venous Thrombosis.

    PubMed

    Krieger, Daniel A; Dehkharghani, Seena

    2015-12-01

    Imaging is indispensable in the evaluation of patients presenting with central nervous system emergencies. Although computed tomography (CT) is the mainstay of initial assessment and triage, magnetic resonance imaging (MRI) has become vital in expanding diagnostic capabilities, refining management strategies, and developing our understanding of disease processes. Ischemic stroke and cerebral venous thrombosis are 2 areas wherein MRI is actively revolutionizing patient care. Familiarity with the imaging manifestations of these 2 disease processes is crucial for any radiologist reading brain MR studies. In this review, the fundamentals of image interpretation will be addressed in-depth. Furthermore, advanced imaging techniques which are redefining the role of emergency MRI will be outlined, with a focus on the pathophysiological mechanisms that underlie image interpretation. In particular, emerging data surrounding the use of MR perfusion imaging in acute stroke management portend dramatic shifts in neurointerventional management. To this end, a review of the recent stroke literature will hopefully enhance the radiologist's role in both meaningful reporting and multidisciplinary teamwork.

  19. Cerebral venous infarction: a potentially avoidable complication of deep brain stimulation surgery.

    PubMed

    Morishita, Takashi; Okun, Michael S; Burdick, Adam; Jacobson, Charles E; Foote, Kelly D

    2013-01-01

    Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery. The diagnosis of venous infarction was based on 1) delayed onset of new neurologic deficits on postoperative day 1 or 2; 2) significant edema surrounding the superficial aspect of the implanted lead, with or without subcortical hemorrhage on CT scan. Four cases (0.8% per lead, 1.3% per patient) of symptomatic cerebral venous infarction were identified out of 500 DBS lead implantation procedures between July 2002 and August 2009. All four patients had Parkinson's disease. Their DBS leads were implanted in the subthalamic nucleus (n = 2), and the globus pallidus internus (n = 2). Retrospective review of the targeting confirmed that the planned trajectory passed within 3 mm of a cortical vein in two cases for which contrast-enhanced preoperative magnetic resonance (MR) imaging was available. In the other two cases, contrasted targeting images were not obtained preoperatively. Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high-resolution, contrast-enhanced, T1-weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures. © 2013 International Neuromodulation Society.

  20. Effect of echo contrast media on the visualization of transverse sinus thrombosis with transcranial 3-D duplex sonography.

    PubMed

    Delcker, A; Häussermann, P; Weimar, C

    1999-09-01

    Transcranial duplex sonography has the capacity of detecting venous flow as in the transverse sinus. During a 6-month period, 28 consecutive patients (mean age 55 y) with a clinically suspected diagnosis of cerebral sinus thrombosis were included in the study. All patients were examined using 3-D ultrasound equipment within 24 h of having undergone either venous computerized tomography (CT), venous magnetic resonance imaging (MRI) or cerebral angiography. A total of 22 healthy patients had a normal venous CT, venous MRI or cerebral angiography of both transverse sinuses. Before echo contrast enhancement, the transverse sinus could be visualized in only 2 of these 44 sinuses (22 patients). A total of 6 patients with an unilaterally missed transverse sinus in 3-D ultrasound suffered from sinus thrombosis (n = 3), hypoplasia (n = 2) or aplasia (n = 1) of the unilateral transverse sinus in neuroradiological tests. In none of the patients with an thrombosis of the transverse sinus did ultrasound contrast media application improve the visualization of the affected sinus. Our study confirms that the normal transverse sinus, insonated through the contralateral temporal bone, often cannot be visualized without the use of contrast agents. With transcranial 3-D duplex sonography, a differentiation between thrombosis, hypoplasia and aplasia of the sinus was not possible.

  1. Noncontrast computed tomographic Hounsfield unit evaluation of cerebral venous thrombosis: a quantitative evaluation.

    PubMed

    Besachio, David A; Quigley, Edward P; Shah, Lubdha M; Salzman, Karen L

    2013-08-01

    Our objective is to determine the utility of noncontrast Hounsfield unit values, Hounsfield unit values corrected for the patient's hematocrit, and venoarterial Hounsfield unit difference measurements in the identification of intracranial venous thrombosis on noncontrast head computed tomography. We retrospectively reviewed noncontrast head computed tomography exams performed in both normal patients and those with cerebral venous thrombosis, acquiring Hounsfield unit values in normal and thrombosed cerebral venous structures. Also, we acquired Hounsfield unit values in the internal carotid artery for comparison to thrombosed and nonthrombosed venous structures and compared the venous Hounsfield unit values to the patient's hematocrit. A significant difference is identified between Hounsfield unit values in thrombosed and nonthrombosed venous structures. Applying Hounsfield unit threshold values of greater than 65, a Hounsfield unit to hematocrit ratio of greater than 1.7, and venoarterial difference values greater than 15 alone and in combination, the majority of cases of venous thrombosis are identifiable on noncontrast head computed tomography. Absolute Hounsfield unit values, Hounsfield unit to hematocrit ratios, and venoarterial Hounsfield unit value differences are a useful adjunct in noncontrast head computed tomographic evaluation of cerebral venous thrombosis.

  2. Spatial distribution of flow and oxygenation in the cerebral venous drainage system.

    PubMed

    De Vis, Jill B; Lu, Hanzhang; Ravi, Harshan; Hendrikse, Jeroen; Liu, Peiying

    2017-08-09

    To investigate the venous oxygenation and flow in the brain, and determine how they might change under challenged states. Eight healthy human subjects (24-37 years) were studied. T2 -relaxation under spin tagging (TRUST) magnetic resonance imaging (MRI) and phase-contrast MRI were performed to measure venous oxygenation and venous blood flow, respectively, in the superior sagittal sinus (SSS), the straight sinus (SS), and the internal jugular veins (IJVs). Venous oxygenation was assessed at room air (0.03%CO2 , 21%O2 ) and under hyperoxia (O%CO2 , 95%O2 , and 5%N2 ) conditions. Venous blood flow was assessed at room air and under hypercapnia (5%CO2 , 21%O2 , and 74%N2 ) conditions. Whole-brain blood flow was also measured at the four feeding arteries of the brain using phase-contrast MRI. The changes in venous oxygenation and blood flow from room air to hyperoxia or hypercapnia conditions were tested using paired t-tests. Venous oxygenation in the SSS, the SS, and the IJVs was 61 ± 4%, 64 ± 4%, and 62 ± 4%, respectively, at room air, and increased to 70 ± 3% (P < 0.01 compared to room air), 71 ± 5% (P = 0.59), and 68 ± 5% (P < 0.05) under hyperoxic condition. The SSS, SS, and IJV drained 46 ± 9%, 16 ± 4%, and 79 ± 1% of whole-brain blood flow, respectively, and this flow distribution did not change under hypercapnic condition (P > 0.5). The results found in this study provide insight into the venous oxygenation and venous flow distribution and its heterogeneity among different venous structures. 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017. © 2017 International Society for Magnetic Resonance in Medicine.

  3. A Prospective Study of the Clinical Profile, Outcome and Evaluation of D-dimer in Cerebral Venous Thrombosis

    PubMed Central

    Dharanipragada, Subrahmanyam; Basu, Debdatta; Ananthakrishnan, Ramesh; Surendiran, Deepanjali

    2016-01-01

    Introduction Cerebral Venous Thrombosis (CVT) is a well known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in diagnosis of CVT. Aim To study various aspects of CVT and role of D-dimer. Materials and Methods The study period was September 2012 to July 2014 and included 80 imaging proven patients of CVT. We also included 39 controls for assessing D-dimer. Data was collected according to a preformed format. D-dimer was assessed by a rapid semi-quantitative latex agglutination assay. Discharged patients were followed up to six months. Results Of the total 44 were women and 36 were men (F: M=1.2:1). The mean age of the patients was 29.5±9.68 years. Most common clinical features were headache 77 (96.25%), papilloedema (67.5%) and seizures 51 (63.75%). Pregnancy was the most common cause of CVT. Superior sagittal and transverse sinuses were the most common sinuses to be affected. The sensitivity and specificity of D-dimer for diagnosing CVT was 84.62% and 80% respectively. The risk factors for poor prognosis were altered sensorium, presence of sepsis, increased sinus involvement and deep sinus thrombosis. Conclusion CVT affects both sexes equally. Puerperium still contributes to majority of the cases. Iron deficiency anaemia needs to be evaluated as a contributing factor for incidence of CVT. D-dimer is not useful in puerperal female with CVT. Positive D-dimer will strengthen the suspicion of CVT in patients with acute headache followed by a neurological deficit. PMID:27504325

  4. Morphological Variations in the Transverse Venous Sinus Anatomy of Dogs and its Relationship to Skull Landmarks.

    PubMed

    Carreira, L Miguel; Ferreira, A

    2016-08-01

    We characterized the anatomical morphology of the transverse venous sinus (TVS) of 69 canine adult cadavers belonging to three groups: brachycephalic (B), dolichocephalic (D) and mesaticephalic (M). In addition, we outlined its path over the skull using five classic human craniometric points (CPs): the asterion (ast), the bregma (b), the glabella (g), the stephanion (st) and the pterion (pt). The study aimed to establish anatomical differences in the TVS between groups and in the relationship between the TVS and skull. We found that TVS anatomy and its relationships to skull landmarks vary markedly between the groups, with similar anatomical arrangements in B and M. The TVS length can be ranked as M < B < D (with D being the biggest), whereas the width can be ranked as M < D < B (with B being the widest) with the right side being smaller than the left. In the B and M groups, the TVS assumes a craniocaudal trajectory that is closer to the lateral skull wall than in D, where the TVS presents a caudocranial direction. By documenting the morphological characteristics of the TVS, we can create a set of anatomical references allowing construction of a basic framework to greatly decrease the probability of TVS injury during neuronavigation procedures when supported by a good knowledge of the skull, brain anatomies and their relationships.

  5. Improved cerebral time-of-flight magnetic resonance angiography at 7 Tesla--feasibility study and preliminary results using optimized venous saturation pulses.

    PubMed

    Wrede, Karsten H; Johst, Sören; Dammann, Philipp; Özkan, Neriman; Mönninghoff, Christoph; Kraemer, Markus; Maderwald, Stefan; Ladd, Mark E; Sure, Ulrich; Umutlu, Lale; Schlamann, Marc

    2014-01-01

    Conventional saturation pulses cannot be used for 7 Tesla ultra-high-resolution time-of-flight magnetic resonance angiography (TOF MRA) due to specific absorption rate (SAR) limitations. We overcome these limitations by utilizing low flip angle, variable rate selective excitation (VERSE) algorithm saturation pulses. Twenty-five neurosurgical patients (male n = 8, female n = 17; average age 49.64 years; range 26-70 years) with different intracranial vascular pathologies were enrolled in this trial. All patients were examined with a 7 Tesla (Magnetom 7 T, Siemens) whole body scanner system utilizing a dedicated 32-channel head coil. For venous saturation pulses a 35° flip angle was applied. Two neuroradiologists evaluated the delineation of arterial vessels in the Circle of Willis, delineation of vascular pathologies, presence of artifacts, vessel-tissue contrast and overall image quality of TOF MRA scans in consensus on a five-point scale. Normalized signal intensities in the confluence of venous sinuses, M1 segment of left middle cerebral artery and adjacent gray matter were measured and vessel-tissue contrasts were calculated. Ratings for the majority of patients ranged between good and excellent for most of the evaluated features. Venous saturation was sufficient for all cases with minor artifacts in arteriovenous malformations and arteriovenous fistulas. Quantitative signal intensity measurements showed high vessel-tissue contrast for confluence of venous sinuses, M1 segment of left middle cerebral artery and adjacent gray matter. The use of novel low flip angle VERSE algorithm pulses for saturation of venous vessels can overcome SAR limitations in 7 Tesla ultra-high-resolution TOF MRA. Our protocol is suitable for clinical application with excellent image quality for delineation of various intracranial vascular pathologies.

  6. Improved Cerebral Time-of-Flight Magnetic Resonance Angiography at 7 Tesla – Feasibility Study and Preliminary Results Using Optimized Venous Saturation Pulses

    PubMed Central

    Wrede, Karsten H.; Johst, Sören; Dammann, Philipp; Özkan, Neriman; Mönninghoff, Christoph; Kraemer, Markus; Maderwald, Stefan; Ladd, Mark E.; Sure, Ulrich; Umutlu, Lale; Schlamann, Marc

    2014-01-01

    Purpose Conventional saturation pulses cannot be used for 7 Tesla ultra-high-resolution time-of-flight magnetic resonance angiography (TOF MRA) due to specific absorption rate (SAR) limitations. We overcome these limitations by utilizing low flip angle, variable rate selective excitation (VERSE) algorithm saturation pulses. Material and Methods Twenty-five neurosurgical patients (male n = 8, female n = 17; average age 49.64 years; range 26–70 years) with different intracranial vascular pathologies were enrolled in this trial. All patients were examined with a 7 Tesla (Magnetom 7 T, Siemens) whole body scanner system utilizing a dedicated 32-channel head coil. For venous saturation pulses a 35° flip angle was applied. Two neuroradiologists evaluated the delineation of arterial vessels in the Circle of Willis, delineation of vascular pathologies, presence of artifacts, vessel-tissue contrast and overall image quality of TOF MRA scans in consensus on a five-point scale. Normalized signal intensities in the confluence of venous sinuses, M1 segment of left middle cerebral artery and adjacent gray matter were measured and vessel-tissue contrasts were calculated. Results Ratings for the majority of patients ranged between good and excellent for most of the evaluated features. Venous saturation was sufficient for all cases with minor artifacts in arteriovenous malformations and arteriovenous fistulas. Quantitative signal intensity measurements showed high vessel-tissue contrast for confluence of venous sinuses, M1 segment of left middle cerebral artery and adjacent gray matter. Conclusion The use of novel low flip angle VERSE algorithm pulses for saturation of venous vessels can overcome SAR limitations in 7 Tesla ultra-high-resolution TOF MRA. Our protocol is suitable for clinical application with excellent image quality for delineation of various intracranial vascular pathologies. PMID:25232868

  7. Cerebral Venous Thrombosis Complicated by Hemorrhagic Infarction Secondary to Ventriculoperitoneal Shunting

    PubMed Central

    Son, Won-Soo

    2010-01-01

    While a delayed intracerebral hemorrhage at the site of a ventricular catheter has occasionally been reported in literature, a delayed hemorrhage caused by venous infarction secondary to ventriculoperitoneal shunting has not been previously reported. In the present case, a 68-year-old woman underwent ventriculoperitoneal shunting through a frontal burr hole, and developed a hemorrhagic transformation of venous infarction on the second postoperative day. This massive venous infarction was caused by bipolar coagulation and occlusion of a large paramedian cortical vein in association with atresia of the rostral superior sagittal sinus. Thus, to eliminate the risk of postoperative venous infarction, technical precautions to avoid damaging surface vessels in a burr hole are required under loupe magnification in ventriculoperitoneal shunting. PMID:21113365

  8. Clinical features, risk factors, and outcome of cerebral venous thrombosis in Tehran, Iran

    PubMed Central

    Yadegari, Samira; Ghorbani, Askar; Miri, S. Roohollah; Abdollahi, Mohammad; Rostami, Mohsen

    2016-01-01

    Introduction: Despite increasing the use of magnetic resonance imaging (MRI), cerebral venous sinus thrombosis (CVST) has remained an under-diagnosed condition. In this study, characteristics and frequency of various risk factors of CVST patients in a tertiary referral hospital were closely assessed. Methods: Patients with an unequivocal diagnosis of CVST confirmed by MRI and magnetic resonance venography during 6 years of the study were included. All data from the onset of symptoms regarding clinical signs and symptoms, hospital admission, seasonal distribution, medical and drug history, thrombophilic profile, D-dimer, neuroimaging, cerebrospinal fluid findings, mortality, and outcome were collected and closely analyzed. Result: A total of 53 patients with female to male ratio of 3.07 and mean age of 33.7 years were included in the study. Headache and papilledema were the most frequent clinical features (44 and 36 patients, respectively). An underlying disease (diagnosed previously or after admission) was the most common identified risk factor for CVST in both females and males (21 patients). A total of 15 women used the oral contraceptive pill (OCP) where 12 of them had simultaneously other predisposing factors. Overall, 19 patients (36%) had more than one contributing factor. D-dimer had a sensitivity of 71.4% in CVST patients. The mortality of patients in this study was 3.7% (n = 2). Focal neurologic deficit and multicranial nerve palsy were associated with poor outcome which defined as death, recurrence, and massive intracranial hemorrhage due to anticoagulation (P = 0.050 and 0.004, respectively). Conclusion: Unlike most of the CVST studies in which OCP was the main factor; in this study, an underlying disease was the most identified cause. Considering the high probability of multiple risk factors in CVST that was shown by this study, appropriate work up should be noted to uncover them. PMID:27695236

  9. Sex differences in cerebral venous thrombosis: A systematic analysis of a shift over time.

    PubMed

    Zuurbier, Susanna M; Middeldorp, Saskia; Stam, Jan; Coutinho, Jonathan M

    2016-02-01

    In contemporary studies, cerebral venous thrombosis is three times more common in adult women than in men. To study the change in sex ratio over time in cerebral venous thrombosis. We systematically reviewed the literature. Any type of study with at least 40 patients with cerebral venous thrombosis that reported sex ratio was eligible. We ranked studies according to the year halfway the period of patient recruitment. Pediatric studies were analyzed separately. Out of 6068 publications identified by our search, 112 studies (23,638 patients), published between 1966 and 2014, were included. The proportion of women among patients with cerebral venous thrombosis significantly increased over time from a median of 54.8% in studies prior to 1981 to 69.8% after 2001 (p = 0.002). There was a significant correlation between time of the study and proportion of women (Pearson's correlation coefficient 0.25, p = 0.01). Oral contraceptive use among women with cerebral venous thrombosis also increased over time (Pearson's correlation coefficient 0.29, p = 0.01). In contrast, the percentage of pregnancy-related cases remained stable (Pearson's correlation coefficient 0.04, p = 0.77). Among 1702 patients from pediatric studies, 39% were female and there was no correlation between sex ratio and time of the study (Pearson's correlation coefficient -0.42, p = 0.14). In adult patients with cerebral venous thrombosis, there is a shift in sex ratio over time with an increase in the proportion of women, whereas this is not observed in pediatric populations. A possible explanation for this phenomenon is an increase over time in the use of oral contraceptives by adult women. © 2016 World Stroke Organization.

  10. Angioarchitectural Changes in Subacute Cerebral Venous Thrombosis. A Synchrotron-based Micro- and Nano-CT Study

    SciTech Connect

    E Stolz; M Yeniguen; M Kreisel; M Kampschulte; S Doenges; D Sedding; E Ritman; T Gerriets; A Langheinrich

    2011-12-31

    It is well known that recanalization of thrombosed cerebral sinuses occurs early but without marked influence on the long-term outcome and on final venous infarct volume on magnetic resonance imaging. To better understand the possible microvascular mechanisms behind these clinical observations, we evaluated the sequels of subacute superior sagittal sinus (SSS) thrombosis in rats using micro- and nano-CT imaging of the same specimen to provide large volume and high resolution CT image data respectively. SSS thrombosis was induced in 11 animals which were euthanized after 6 h (n = 4) or 6 weeks (n = 7). Eight sham-operated rats served as controls. After infusion of contrast into the vasculature of the brains, these were isolated and scanned using micro-, nano-, and synchrotron-based micro-CT ((8 {mu}m{sup 3}), (900 nm){sup 3}, and (1.9 {mu}m{sup 3}) voxel sizes). The cross-sectional area of the superior sagittal sinus, microvessels and cortical veins were quantified. Tissue sections were stained against VEGF antigen. Immunohistochemistry was confirmed using quantitative rtPCR. SSS thrombosis led to a congestion of the bridging veins after 6 h. After 6 weeks, a network of small vessels surrounding the occluded SSS was present with concurrent return towards the diameter of the draining bridging veins of controls. This microvascular network connected to cortical veins as demonstrated by nano- and synchrotron-based micro-CT. Also the volume fraction and number of cortical veins increased significantly. Immunohistochemistry in the region of the microsvascular network demonstrated a strong immunoreactivity against VEGF, confirmed by rtPCR. The sequel of subacute SSS thrombosis induced a network of microvessels ('venogenesis') draining the bridging veins. Also the volume fraction of cortical veins increased significantly.

  11. Comparison of the lateral tail vein and the retro-orbital venous sinus as routes of intravenous drug delivery in a transgenic mouse model.

    PubMed

    Steel, Christina D; Stephens, Amber L; Hahto, Suzanne M; Singletary, Sylvia J; Ciavarra, Richard P

    2008-01-01

    In mice, intravenous injections are commonly administered in the lateral tail vein. This technique is sometimes difficult to carry out and may cause stress to mice. Though injection through the retro-orbital venous sinus can provide certain advantages over lateral tail vein injection, this method is poorly defined and infrequently used. To compare the efficacy of these two routes of drug delivery, the authors injected MAFIA transgenic mice with the depletion agent AP20187, which selectively induces apoptosis in macrophages. Each mouse received five consecutive daily injections through either the lateral tail vein or the retro-orbital venous sinus. The authors then compared macrophage depletion in different tissues (lung, spleen, bone marrow and peritoneal exudate cells). Both routes of injection were similarly effective. A separate experiment using BALB/c mice indicated that retro-orbital venous sinus injection was the less stressful of the two methods.

  12. Cerebral venous thrombosis and secondary polycythemia in a case of nephrotic syndrome.

    PubMed

    Nagaraju, Shankar Prasad; Bairy, Manohar; Attur, Ravindra Prabhu; Sambhaji, Charudutt Jayant

    2016-03-01

    Cerebral venous thrombosis (CVT) and polycythemia are considered as rare and life threatening complications of nephrotic syndrome. We report an unusual combination of both these complications in a case of nephrotic syndrome due to minimal change disease that was treated successfully. There was prompt and complete remission of nephrotic syndrome with steroid therapy, concurrent with complete resolution of polycythemia and CVT.

  13. Comparison of brain tissue and local cerebral venous gas tensions and pH.

    PubMed

    Edelman, G J; Hoffman, W E; Rico, C; Ripper, R

    2000-09-01

    Neurosurgical monitoring devices have recently become available which are capable of measuring cerebral tissue gas tensions and pH. Brain tissue sensors have not been conclusively demonstrated to correlate with other measurements of regional cerebral gas tensions or pH. The present study was undertaken to correlate sensor values for pO2, pCO2 and pH with blood samples taken concurrently from local cerebral veins. Adult mongrel dogs were anesthetized and a craniotomy was performed. A small gyral vein was isolated and cannulated. Adjacent to the venous catheter tip, a Neurotrend brain tissue probe was inserted in an intracortical location. Each subject received a sequence of manipulations in inspired oxygen and end tidal carbon dioxide conditions. Under each experimental condition, samples of arterial and gyral venous blood were obtained and blood gas analysis performed. Concurrent brain probe measurements of tissue pO2, pCO2 and pH were recorded. Statistical analysis determined that local tissue and cerebral venous blood values for pO2, pCO2 and pH were highly correlated (R(s) = 0.62-0.82; p < 0.001). This indicates that there exists a confirmable monotonic relationship between tissue values and conditions in the post-capillary venous bed. Tissue sensors such as the Neurotrend probe can offer reliable trend indications in brain tissue gas tensions and pH.

  14. The post-occipital spinal venous sinus of the Nile crocodile Crocodylus niloticus: its anatomy and use for blood sample collection and intravenous infusions.

    PubMed

    Myburgh, Jan G; Kirberger, Robert M; Steyl, Johan C A; Soley, John T; Booyse, Dirk G; Huchzermeyer, Fritz W; Lowers, Russel H; Guillette, Louis J

    2014-05-05

    The post-occipital sinus of the spinal vein is often used for the collection of blood samples from crocodilians. Although this sampling method has been reported for several crocodilian species, the technique and associated anatomy has not been described in detail in any crocodilian, including the Nile crocodile (Crocodylus niloticus). The anatomy of the cranial neck region was investigated macroscopically, microscopically, radiographically and by means of computed tomography. Latex was injected into the spinal vein and spinal venous sinus of crocodiles to visualise the regional vasculature. The spinal vein ran within the vertebral canal, dorsal to and closely associated with the spinal cord and changed into a venous sinus cranially in the post-occipital region. For blood collection, the spinal venous sinus was accessed through the interarcuate space between the atlas and axis (C1 and C2) by inserting a needle angled just off the perpendicular in the midline through the craniodorsal cervical skin, just cranial to the cranial borders of the first cervical osteoderms. The most convenient method of blood collection was with a syringe and hypodermic needle. In addition, the suitability of the spinal venous sinus for intravenous injections and infusions in live crocodiles was evaluated. The internal diameter of the commercial human epidural catheters used during these investigations was relatively small, resulting in very slow infusion rates. Care should be taken not to puncture the spinal cord or to lacerate the blood vessel wall using this route for blood collection or intravenous infusions.

  15. From presentation to follow-up: diagnosis and treatment of cerebral venous thrombosis.

    PubMed

    Bentley, J Nicole; Figueroa, Ramón E; Vender, John R

    2009-11-01

    Cerebral venous thrombosis is an uncommon cause of stroke but remains a challenge for physicians faced with this diagnosis largely due to the variability in presentation. Anticoagulation, typically with intravenous heparin, remains the mainstay of treatment for stable patients and is sufficient in the majority of cases. However, a significant mortality rate exists for cerebral venous thrombosis due to patients who deteriorate or do not adequately respond to initial treatments. It is in these patients that more aggressive interventions must be undertaken. The neurosurgeon is often called on, either acutely for initial evaluation of the stroke or venous hemorrhage or after the failure of initial therapy for clot evacuation, hemicraniectomy, or thrombectomy. A proper workup must include a search for an underlying, correctable cause as well as thorough follow-up with correction of identified risk factors to decrease the risk of recurrent disease.

  16. Numerical simulation of blood flow in an anatomically-accurate cerebral venous tree.

    PubMed

    Ho, Harvey; Mithraratne, Kumar; Hunter, Peter

    2013-01-01

    Although many blood flow models have been constructed for cerebral arterial trees, few models have been reported for their venous counterparts. In this paper, we present a computational model for an anatomically accurate cerebral venous tree which was created from a computed tomography angiography (CTA) image. The topology of the tree containing 42 veins was constructed with 1-D cubic-Hermite finite element mesh. The model was formulated using the reduced Navier-Stokes equations together with an empirical constitutive equation for the vessel wall which takes both distended and compressed states of the wall into account. A robust bifurcation model was also incorporated into the model to evaluate flow across branches. Furthermore, a set of hierarchal inflow pressure boundary conditions were prescribed to close the system of equations. Some assumptions were made to simplify the numerical treatment, e.g., the external pressure was considered as uniform across the venous tree, and a vein was either distended or partially collapsed but not both. Using such a scheme we were able to evaluate the blood flow over several cardiac cycles for the large venous tree. The predicted results from the model were compared with ultrasonic measurements acquired at several sites of the venous tree and agreements have been reached either qualitatively (flow waveform shape) or quantitatively (flow velocity magnitude). We then discuss the significance of this venous model, its potential applications, and also present numerical experiments pertinent to limitations of the proposed model.

  17. Superior Sagittal Sinus Dural Arteriovenous Fistulas Treated by Stent Placement for an Occluded Sinus and Transarterial Embolization

    PubMed Central

    Ohara, N.; Toyota, S.; Kobayashi, M.; Wakayama, A.

    2012-01-01

    Summary We describe a case of dural arteriovenous fistulas (DAVFs) involving the superior sagittal sinus (SSS) successfully treated with stent placement for an occluded sinus and transarterial embolization. A 61-year-old man who had been treated with anticoagulation for a known SSS thrombosis presented with a sudden onset of headache. CT scan revealed an intraventricular hemorrhage and cerebral angiography revealed DAVFs involving the SSS which had severe venous congestion and sinus occlusion. We treated this case with a staged endovascular approach which consisted of stent placement for the occluded sinus and transarterial intravenous embolization resulting in complete eradication of DAVFs. Recanalization of an occluded sinus by stent placement can reduce venous congestion and transarterial intravenous embolization can obliterate dural arteriovenous shunts. This staged strategy is feasible and should be considered a first option of treatment, especially for DAVFs which presented with intracranial hemorrhage and aggressive venous hypertension. PMID:22958774

  18. Association study of methylenetetrahydrofolate reductase C677T mutation with cerebral venous thrombosis in an Iranian population.

    PubMed

    Ghaznavi, Habib; Soheili, Zahra; Samiei, Shahram; Soltanpour, Mohammad S

    2015-12-01

    There are limited data on the role of methylenetetrahydrofolate reductase C677T polymorphism and hyperhomocysteinemia as risk factors for cerebral venous thrombosis in Iranian population. We examined a possible association between fasting plasma homocysteine levels, methylenetetrahydrofolate reductase C677T polymorphism, and cerebral venous thrombosis in 50 patients with a diagnosis of cerebral venous thrombosis (20-63 years old) and 75 healthy controls (18-65 years old). Genotyping of the methylenetetrahydrofolate reductase C677T gene polymorphism was performed by PCR-restriction fragment length polymorphism analysis, and homocysteine levels were measured by enzyme immunoassay. Fasting plasma homocysteine levels were significantly higher in cerebral venous thrombosis patients than in controls (P = 0.015). Moreover, plasma homocysteine levels were significantly higher in methylenetetrahydrofolate reductase 677TT genotype compared to 677CT and 677CC genotypes in both cerebral venous thrombosis patients (P = 0.01) and controls (P = 0.03). Neither 677CT heterozygote genotype [odds ratio (OR) 1.35, 95% confidence interval (CI) 0.64-2.84, P = 0.556] nor 677TT homozygote genotype (OR 1.73, 95% CI 0.32-9.21, P = 0.833) was significantly associated with cerebral venous thrombosis. Additionally, no significant differences in the frequency of 677T allele between cerebral venous thrombosis patients and controls were identified (OR 1.31, 95% CI 0.69-2.50, P = 0.512). In conclusion, our study demonstrated that elevated plasma homocysteine levels are significant risk factors for cerebral venous thrombosis. Also, methylenetetrahydrofolate reductase 677TT genotype is not linked with cerebral venous thrombosis, but is a determinant of elevated plasma homocysteine levels.

  19. Blood flow in the cerebral venous system: modeling and simulation.

    PubMed

    Miraucourt, Olivia; Salmon, Stéphanie; Szopos, Marcela; Thiriet, Marc

    2017-04-01

    The development of a software platform incorporating all aspects, from medical imaging data, through three-dimensional reconstruction and suitable meshing, up to simulation of blood flow in patient-specific geometries, is a crucial challenge in biomedical engineering. In the present study, a fully three-dimensional blood flow simulation is carried out through a complete rigid macrovascular circuit, namely the intracranial venous network, instead of a reduced order simulation and partial vascular network. The biomechanical modeling step is carefully analyzed and leads to the description of the flow governed by the dimensionless Navier-Stokes equations for an incompressible viscous fluid. The equations are then numerically solved with a free finite element software using five meshes of a realistic geometry obtained from medical images to prove the feasibility of the pipeline. Some features of the intracranial venous circuit in the supine position such as asymmetric behavior in merging regions are discussed.

  20. Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

    PubMed Central

    2016-01-01

    Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders. PMID:27006525

  1. Ultrasonographic Evaluation of Cerebral Arterial and Venous Haemodynamics in Multiple Sclerosis: A Case-Control Study

    PubMed Central

    Marchione, Pasquale; Morreale, Manuela; Giacomini, Patrizia; Izzo, Chiara; Pontecorvo, Simona; Altieri, Marta; Bernardi, Silvia; Frontoni, Marco; Francia, Ada

    2014-01-01

    Objective Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS), controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR), Primary Progressive (PP) Multiple Sclerosis and age and sex-matched controls subjects. Material and Methods All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV) of middle cerebral arteries (MCA), differences between cerebral venous outflow (CVF) in clinostatism and in the seated position (ΔCVF) and non-invasive cerebral perfusion pressure (CPP) were evaluated. Results 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS≥5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3±2 cm/s vs. 54.6±3 cm/s, p = 0.01). No significant differences in CPP were observed within and between groups. Conclusions The quantitative evaluation of cerebral blood flow (CBF) and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an

  2. Cerebral venous thrombosis as the first presentation of classical homocystinuria in an adult patient.

    PubMed

    Woods, Emily; Dawson, Charlotte; Senthil, Latha; Geberhiwot, Tarekegn

    2017-01-30

    A 30-year-old woman presented with severe headache, dysarthria and right hemiparesis. She was treated for suspected viral encephalopathy and recovered over the following weeks although the headaches persisted. Two months later she was treated in-hospital for pulmonary embolism. The following year she was readmitted for increased frequency of headaches and was given a diagnosis of migraine. A subsequent MRI head scan was suggestive of longstanding venous sinus infarcts and neuroradiology review concluded that encephalitis had been the incorrect initial diagnosis. Subsequent investigations for an underlying cause of the two episodes of venous thrombosis revealed a total homocysteine level of >350 μmol/L (<15 μmol/L). An underlying diagnosis of homocystinuria secondary to cystathionine β-synthase deficiency was made although this metabolic condition is normally recognised in childhood. Treatment with pyridoxine and betaine normalised her homocysteine levels and she has had no further thrombotic event since. 2017 BMJ Publishing Group Ltd.

  3. Quantitative separation of arterial and venous cerebral blood volume increases during voluntary locomotion

    PubMed Central

    Huo, Bing-Xing; Gao, Yu-Rong; Drew, Patrick J.

    2014-01-01

    Voluntary locomotion is accompanied by large increases in cortical activity and localized increases in cerebral blood volume (CBV). We sought to quantitatively determine the spatial and temporal dynamics of voluntary locomotion-evoked cerebral hemodynamic changes. We measured single vessel dilations using two-photon microscopy and cortex-wide changes in CBV-related signal using intrinsic optical signal (IOS) imaging in head-fixed mice freely locomoting on a spherical treadmill. During bouts of locomotion, arteries dilated rapidly, while veins distended slightly and recovered slowly. The dynamics of diameter changes of both vessel types could be captured using a simple linear convolution model. Using these single vessel measurements, we developed a novel analysis approach to separate out spatially and temporally distinct arterial and venous components of the location-specific hemodynamic response functions (HRF) for IOS. The HRF of each pixel of was well fit by a sum of a fast arterial and a slow venous component. The HRFs of pixels in the limb representations of somatosensory cortex had a large arterial contribution, while in the frontal cortex the arterial contribution to the HRF was negligible. The venous contribution was much less localized, and was substantial in the frontal cortex. The spatial pattern and amplitude of these HRFs in response to locomotion in the cortex was robust across imaging sessions. Separating the more localized, arterial component from the diffuse venous signals will be useful for dealing with the dynamic signals generated by naturalistic stimuli. PMID:25467301

  4. Angioplasty and stenting for intractable pulsatile tinnitus caused by dural venous sinus stenosis: a case series report.

    PubMed

    Baomin, Li; Yongbing, Shi; Xiangyu, Cao

    2014-02-01

    Pulsatile tinnitus caused by dural venous sinus (DVS) stenosis is a newly identified form of tinnitus. Its persistent nature can severely affect patients' sleep and quality of life, leading to depression in severe cases. The aim of this report is to investigate the efficacy and safety of angioplasty and stenting in treating this form of tinnitus. Retrospective review. Chinese PLA General Hospital. Clinical data of 46 cases of pulsatile tinnitus caused by DVS stenosis treated between December 2009 and October 2012 using angioplasty and stenting were reviewed. Diagnosis of DVS abnormality was confirmed in all cases using digital subtraction angiography (DSA). Among these cases, stenosis was located in the transverse-sigmoid sinuses junction area ipsilateral to tinnitus in 44 cases and on both sides in the remaining 2 cases. Stenosis was treated with angioplasty and stenting in all cases. Pulsatile tinnitus disappeared immediately after the procedure in all 46 cases. There was no procedure-related complication. During the 2 to 36 months' follow-up, there was no recurrence. These results indicate that DVS stenosis is the cause of pulsatile tinnitus in these cases and that angioplasty and stenting are an effective and safe treatment for intractable pulsatile tinnitus caused by DVS stenosis.

  5. Transient global amnesia: cerebral venous outflow impairment-insight from the abnormal flow patterns of the internal jugular vein.

    PubMed

    Chung, Chih-Ping; Hsu, Hung-Yi; Chao, A-Ching; Sheng, Wen-Yung; Soong, Bing-Wen; Hu, Han-Hwa

    2007-11-01

    Cerebral venous reflux is found frequently in transient global amnesia (TGA) patients. The cerebral venous reflux mostly results from left brachiocephalic venous obstruction, and the level of reflux depends on different respiratory status. For further understanding of the role of venous outflow impairment in the pathogenesis of TGA, we used color duplex sonography to reveal the flow patterns in the internal jugular vein (IJV) and its branches (JB) under different respiratory conditions. We compared the frequency of abnormal venous flow of IJV and/or JB on color duplex sonography between 17 TGA patients and 17 age- and gender-matched normal individuals both at rest (regular breathing) and at deep inspiration. Further, these venous-flow abnormalities in IJV and JB were well described. Cranial 3-D time-of-flight magnetic resonance arteriography (MRA) were performed in all patients three to seven days after their TGA attacks and in all normal individuals to analyze the abnormal flow signals in the intracranial venous structures. In the result, abnormal flow-patterns in the left IJV and/or left JB during regular breathing were found more frequently in TGA patients than normal individuals (65% vs. 6%; p < 0.001). These abnormalities in TGA patients were (1) isolated reversed flow in the left JB, (2) segmental reversed flow in the left distal IJV and (3) continuous reversed flow in the left IJV and JB. The MRA study revealed that only the most severe reflux in the IJV causes intracranial venous reflux; six were in the group of continuous reversed flow in left IJV and one was in the group of segmental reversed flow in left distal IJV. These findings suggest that TGA might be one of the clinical manifestations of the "cerebral-type intermittent venous claudication," which stems from cerebral venous outflow impairment, insufficient venous collaterals and specific precipitating factors.

  6. Cerebral venous circulatory disturbance as an informative prognostic marker for neonatal hemorrhagic stroke

    NASA Astrophysics Data System (ADS)

    Semyachkina-Glushkovskaya, Oxana; Pavlov, Alexey; Navolokin, Nikita; Lychagov, Vladislav; Abdurashitov, Arkady; Zinchenko, Ekaterina; Gekaluk, Artemiy; Zhu, Dan; Shi, Rui; Luo, Qingming; Tuchin, Valery

    2016-04-01

    Neonatal hemorrhagic stroke (NHS) is a major problem of future generation's health due to the high rate of death and cognitive disability of newborns after NHS. The incidence of NHS in neonates cannot be predicted by standard diagnostic methods. Therefore, the identification of prognostic markers of NHS is crucial. There is evidence that stress-related alterations of cerebral blood flow (CBF) may contribute to NHS. Here, we assessed the stroke-associated CBF abnormalities for high prognosis of NHS using a new model of NHS induced by sound stress in the pre- and post-stroke state. With this aim, we used interdisciplinary methods such as a histological assay of brain tissues, laser speckle contrast imaging and Doppler coherent tomography to monitor cerebral circulation. Our results suggest that the venous stasis with such symptoms as progressive relaxation of cerebral veins, decrease the velocity of blood flow in them are prognostic markers for a risk of NHS and are an informative platform for a future study of corrections of cerebral venous circulatory disturbance related to NHS.

  7. The post-occipital spinal venous sinus of the Nile crocodile (Crocodylus niloticus): Its anatomy and use for blood sample collection and intravenous infusions.

    PubMed

    Myburgh, Jan G; Kirberger, Robert M; Steyl, Johan C A; Soley, John T; Booyse, Dirk G; Huchzermeyer, Fritz W; Lowers, Russel H; Guillette, Louis J

    2014-05-05

    The post-occipital sinus of the spinal vein is often used for the collection of blood samples from crocodilians. Although this sampling method has been reported for several crocodilian species, the technique and associated anatomy has not been described in detail in any crocodilian, including the Nile crocodile (Crocodylus niloticus). The anatomy of the cranial neck region was investigated macroscopically, microscopically, radiographically and by means of computed tomography. Latex was injected into the spinal vein and spinal venous sinus of crocodiles to visualise the regional vasculature. The spinal vein ran within the vertebral canal, dorsal to and closely associated with the spinal cord and changed into a venous sinus cranially in the post-occipital region. For blood collection, the spinal venous sinus was accessed through the interarcuate space between the atlas and axis (C1 and C2) by inserting a needle angled just off the perpendicular in the midline through the craniodorsal cervical skin, just cranial to the cranial borders of the first cervical osteoderms. The most convenient method of blood collection was with a syringe and hypodermic needle. In addition, the suitability of the spinal venous sinus for intravenous injections and infusions in live crocodiles was evaluated. The internal diameter of the commercial human epidural catheters used during these investigations was relatively small, resulting in very slow infusion rates. Care should be taken not to puncture the spinal cord or to lacerate the blood vessel wall using this route for blood collection or intravenous infusions.

  8. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    PubMed Central

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2013-01-01

    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  9. Computed tomographic angiography of the superficial cerebral venous anastomosis based on volume rendering, multi-planar reconstruction, and integral imaging display.

    PubMed

    Fang, Qiong; Chen, Feng; Jiang, Anhong; Huang, Yanping; Deng, Xuefei

    2015-12-01

    As damage to the superficial cerebral venous anastomosis may create catastrophic complications even after successful surgery, it is important to visualize and determine the normal features of the venous anastomosis with computed tomographic angiography. A total of 90 patients underwent a 64-detector row helical CT scan of head. The superficial cerebral venous anastomosis was reconstructed by volume rendering, multi-planar reconstruction, and integral display algorithm. In particular, we examined the vein of Trolard, the vein of Labbe, and the vein of Sylvian, in order to analyze the venous anastomosis. The superficial cerebral venous anastomosis varied across different individuals, and in this study, six types of anastomosis were found. In 28 % of patients, no venous anastomosis was found in the unilateral cerebral hemisphere. The display rate of the vein of Trolard, the vein of Labbe, and the vein of Sylvian in contributing to venous anastomosis was 70, 80, and 91 %, respectively. The number of vein of Trolard and vein of Labbe on the left side was greater than that of those on the right side. We implemented the 64-detector row helical CT as a rapid and noninvasive method to investigate the superficial cerebral venous anastomosis in our group of patients. We performed substantial image processing for the visualization of the superficial cerebral venous anastomosis; this would not only enable the early diagnosis of cerebral venous disease, but also protect the cerebral vein during neurosurgical intervention.

  10. Cardiac MRI and pulmonary MR angiography of sinus venosus defect and partial anomalous pulmonary venous connection in cause of right undiagnosed ventricular enlargement.

    PubMed

    Kafka, Henryk; Mohiaddin, Raad H

    2009-01-01

    Patients may be referred for cardiology assessment because of an enlarged right ventricle (RV) with no cause apparent on echocardiography. Cardiac MRI can contribute to the management of these patients by detecting sinus venosus defect or partial anomalous pulmonary venous connection (PAPVC). We sought to show how often sinus venosus defect or PAPVC was detected on MRI in patients with an enlarged RV without a previously established definite diagnosis. First cardiac MRI scans obtained over a 4-year period in adults with an undiagnosed cause of RV enlargement were searched for the MRI diagnosis of sinus venosus defect or PAPVC. Thirty-seven patients (25 female, 12 male) met the study criteria. Nineteen patients had a cardiac MRI diagnosis of sinus venosus defect, with PAPVC being present in 95% of those patients. All PAPVCs associated with sinus venosus defect were from the right side. Eleven of the 19 patients with sinus venosus defect underwent surgery at our institution. Sinus venosus defect was confirmed in all 11 cases. Of the 37 patients, 36 had PAPVC, which was right-sided in 27 patients (75%), left-sided in seven patients (19.4%), and bilateral in two patients (5.6%). Three patients had scimitar veins. The common defects associated with PAPVC were sinus venosus defect in 18 patients (50%) and secundum atrial septal defect in six patients (17%). This article about cardiac MRI in adults with sinus venosus defect and PAPVC shows that cardiac MRI can reliably detect and quantify these lesions when other methods have not provided a complete diagnosis for the cause of right heart enlargement.

  11. Borderline Intracranial Hypertension Manifesting as Chronic Fatigue Syndrome Treated by Venous Sinus Stenting.

    PubMed

    Higgins, Nicholas; Pickard, John; Lever, Andrew

    2015-11-01

    Chronic fatigue syndrome and cases of idiopathic intracranial hypertension without signs of raised intracranial pressure can be impossible to distinguish without direct measurement of intracranial pressure. Moreover, lumbar puncture, the usual method of measuring intracranial pressure, can produce a similar respite from symptoms in patients with chronic fatigue as it does in idiopathic intracranial hypertension. This suggests a connection between them, with chronic fatigue syndrome representing a forme fruste variant of idiopathic intracranial hypertension. If this were the case, then treatments available for idiopathic intracranial hypertension might be appropriate for chronic fatigue. We describe a 49-year-old woman with a long and debilitating history of chronic fatigue syndrome who was targeted for investigation of intracranial pressure because of headache, then diagnosed with borderline idiopathic intracranial hypertension after lumbar puncture and cerebrospinal fluid drainage. Further investigation showed narrowings at the anterior ends of the transverse sinuses, typical of those seen in idiopathic intracranial hypertension and associated with pressure gradients. Stenting of both transverse sinuses brought about a life-changing remission of symptoms with no regression in 2 years of follow-up. This result invites study of an alternative approach to the investigation and management of chronic fatigue.

  12. Cerebral venous etiology of intracranial hypertension and differentiation from idiopathic intracranial hypertension.

    PubMed

    Iencean, Stefan Mircea; Poeata, Ion; Iencean, Andrei Stefan; Tascu, Alexandru

    2015-03-01

    This study presents the characteristics that distinguish between idiopathic intracranial hypertension (ICH) and ICH caused by intracranial vascular damage. Twenty-one patients with ICH were included in this study. The analysis of the symptomatology correlated with the values of intracranial pressure, and the imaging findings revealed significant differences between these two types of ICH. ICH caused by intracranial venous vascular damage is named vascular ICH. Vascular ICH has a known etiology, such as cerebral vascular illness, and a relatively rapid increase in intracranial pressure of approximately 21 cmH2O and imaging findings show characteristic images of thrombosis or stenosis of the intracranial venous system, while all brain images (computed tomography, magnetic resonance imaging, angio-magnetic resonance imaging) are normal in idiopathic ICH. The treatment of vascular ICH is etiologic, pathogenic, and symptomatic, but that of idiopathic ICH is only symptomatic. Copyright © 2015. Published by Elsevier Taiwan.

  13. Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

    PubMed

    Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

    2008-12-01

    Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

  14. Comparison of jugular and transverse facial venous sinus blood analytes in healthy and critically ill adult horses.

    PubMed

    Lascola, Kara M; Vander Werf, Karie; Freese, Stephanie; Morgera, Alison; Schaeffer, David J; Wilkins, Pamela

    2017-03-01

    To compare blood gas, electrolyte, and metabolic analysis results between blood obtained by jugular and transverse facial venous sinus (TFVS) venipuncture in healthy adult horses and sick adult horses presented for emergency evaluation. Prospective, experimental study, from June 2012 to October 2013. Large animal university teaching hospital. Ten healthy adult University-owned horses and 48 client-owned adult horses (≥2 years old) presenting to the large animal hospital emergency service for medical or surgical evaluation of systemic illness. Venipunctures (jugular vein [JV] and TFVS) were performed using preheparinized syringes and obtained prior to institution of medical therapy. Samples were analyzed in random order within a 10-minute interval using a point-of-care blood gas analyzer (NOVA Critical Care Xpress) that also reports electrolyte and metabolite results. Comparisons between venipuncture sites were analyzed using the Student's paired t-test for normally distributed data and the Wilcoxon paired test for nonnormally distributed data. Bland-Altman analysis was used to assess agreement between venipuncture sites. There were no statistically significant differences found between variables for JV and TFVS in healthy horses. In sick horses, JV measurements were greater than TFVS for ionized calcium (P = 0.002) and glucose (P = 0.001), and less than TFVS for hematocrit (P = 0.015). Bland-Altman plots demonstrated small biases but overall agreement between sites. The TFVS can be used interchangeably with JV for venous blood gas analysis in healthy horses. In sick horses, identified differences were small and likely not clinically important. The reliability of this point-of-care blood gas analyzer for measurement of hematocrit remains to be determined. © Veterinary Emergency and Critical Care Society 2017.

  15. A microcontroller-based simulation of dural venous sinus injury for neurosurgical training.

    PubMed

    Cleary, Daniel R; Siler, Dominic A; Whitney, Nathaniel; Selden, Nathan R

    2017-06-02

    OBJECTIVE Surgical simulation has the potential to supplement and enhance traditional resident training. However, the high cost of equipment and limited number of available scenarios have inhibited wider integration of simulation in neurosurgical education. In this study the authors provide initial validation of a novel, low-cost simulation platform that recreates the stress of surgery using a combination of hands-on, model-based, and computer elements. Trainee skill was quantified using multiple time and performance measures. The simulation was initially validated using trainees at the start of their intern year. METHODS The simulation recreates intraoperative superior sagittal sinus injury complicated by air embolism. The simulator model consists of 2 components: a reusable base and a disposable craniotomy pack. The simulator software is flexible and modular to allow adjustments in difficulty or the creation of entirely new clinical scenarios. The reusable simulator base incorporates a powerful microcomputer and multiple sensors and actuators to provide continuous feedback to the software controller, which in turn adjusts both the screen output and physical elements of the model. The disposable craniotomy pack incorporates 3D-printed sections of model skull and brain, as well as artificial dura that incorporates a model sagittal sinus. RESULTS Twelve participants at the 2015 Western Region Society of Neurological Surgeons postgraduate year 1 resident course ("boot camp") provided informed consent and enrolled in a study testing the prototype device. Each trainee was required to successfully create a bilateral parasagittal craniotomy, repair a dural sinus tear, and recognize and correct an air embolus. Participant stress was measured using a heart rate wrist monitor. After participation, each resident completed a 13-question categorical survey. CONCLUSIONS All trainee participants experienced tachycardia during the simulation, although the point in the simulation

  16. Cerebral Venous Thrombosis Revealing Primary Sjögren Syndrome: Report of 2 Cases

    PubMed Central

    Mercurio, A.; Altieri, M.; Saraceni, V. M.; Paolucci, T.; Lenzi, G. L.

    2013-01-01

    Sjögren syndrome (SS) is an autoimmune disease of the exocrine glands, characterized by focal lymphocytic infiltration and destruction of these glands. Neurologic complications are quite common, mainly involving the peripheral nervous system (PNS). The most common central nervous system (CNS) manifestations are myelopathy and microcirculation vasculitis. However, specific diagnostic criteria for CNS SS are still lacking. We report two cases of primary SS in which the revealing symptom was cerebral venous thrombosis (CVT) in the absence of genetic or acquired thrombophilias. PMID:23424596

  17. Simultaneous appearance of cerebral venous thrombosis and subdural hematomas as rare cause of headache in puerperium following epidural analgesia: a case report

    PubMed Central

    Župan, Željko; Sotošek Tokmadžić, Vlatka; Matanić-Manestar, Marinka; Šustić, Alan; Antončić, Igor; Dunatov, Siniša; Pavlović, Ivan; Antulov, Ronald

    2012-01-01

    The aim of this study is to report the first case of simultaneous appearance of cerebral venous thrombosis (CVT) and bilateral subdural hematomas (SDHs) following epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum headache. A 26-year old primigravida with a history of epilepsy received epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the headache. Patient responded very well to the pain medication and oral hydration, and the headache was relieved. Ten days after the delivery, the headache reoccurred, and an epidural blood patch was performed that successfully relieved her symptom. Stronger progressive headache with nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with low molecular weight heparin and antiaggregation therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate therapy could be life-threatening. PMID:22911532

  18. [Morphometric characteristics of the asterion and the posterolateral surface of the skull: its relationship with dural venous sinuses and its neurosurgical importance].

    PubMed

    Galindo-de León, Salvador; Hernández-Rodríguez, Alejandra Nohemí; Morales-Ávalos, Rodolfo; Theriot-Girón, María Del Carmen; Elizondo-Omaña, Rodrigo Enrique; Guzmán-López, Santos

    2013-01-01

    The knowledge of the location and morphometric of the lateral venous sinus (transverse and sigmoid), and their relationship with the asterion and other surface anatomical landmarks, it is imperative for posterolateral approaches to the posterior cranial fossa to avoid vascular structures injury and surgical complications. Determine an anatomical area security for a drill that allows entry into the posterior cranial fossa without damaging adjacent structures, and study the morphometric characteristics asterion, the lateral sinus and bony landmarks of the posterolateral surface of the skull. With a 1.3 mm drill drilled both sides of 88 dry skulls (176 hemicranias). The anatomical landmarks studied were the asterion, the apex of the mastoid process, spina suprameatal, the Frankfurt horizontal plane, the posterior root of the zygomatic arch, the external occipital protuberance and its relationship with the sinus transversus. The asterion type I prevails in 74.4% of the pieces. In 82.4% of the skulls asterion level is, sinus transversus in less than 12.5% and above this at 5.1%. With the data obtained from this and other research, the initial trephine should be placed below the 15 mm and 15 mm asterion post this to reduce the risk of injury from sinus transversus.

  19. Cerebral venous thrombosis due to cryptogenic organising pneumopathy with antiphospholipid syndrome worsened by heparin-induced thrombocytopenia.

    PubMed

    Hsieh, J; Kuzmanovic, I; Vargas, M I; Momjian-Mayor, I

    2013-07-09

    Cerebral venous thrombosis (CVT) has usually been ascribed to prothrombotic conditions, oral contraceptives, pregnancy, malignancy, infection, head injury or mechanical precipitants. The case reported here illustrates two rare causes of CVT observed in the same patient: the presence of antiphospholipid antibodies associated with an asymptomatic cryptogenic organising pneumopathy (COP) which were considered the origin of the venous cerebral thrombosis and heparin-induced thrombocytopenia (HIT) which was responsible for the worsening of the thrombosis observed a few days after the introduction of treatment. Moreover, we provide here additional positive experience in the treatment of both, CVT and HIT, by fondaparinux with bridging to warfarin given their successful evolution under this anticoagulant option.

  20. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm

    PubMed Central

    Onu, David O; Hunn, Andrew W; Harle, Robin A

    2013-01-01

    The association of cerebral dural arteriovenous fistula (DAVF) and ipsilateral flow related aneurysm has infrequently been reported. We describe a male patient who presented with an acute haemorrhagic stroke and was found to have a large right fronto-parietal intra-parenchymal haemorrhage from the ruptured Borden type II DAVF in addition to a large venous aneurysm and a flow related intraosseous aneurysm of the contralateral middle meningeal artery (MMA) all clearly delineated by CT and DSA. He underwent emergency stereotactic evacuation of the intraparenchymal haemorrhage and successful surgical treatment of all the vascular lesions at the same time with residual neurological deficit. To our knowledge, this is the first such reported case. We discuss the challenging surgical treatment, emphasising the role of CT/DSA in management, and provide a literature review. PMID:24051149

  1. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm.

    PubMed

    Onu, David O; Hunn, Andrew W; Harle, Robin A

    2013-09-19

    The association of cerebral dural arteriovenous fistula (DAVF) and ipsilateral flow related aneurysm has infrequently been reported. We describe a male patient who presented with an acute haemorrhagic stroke and was found to have a large right fronto-parietal intra-parenchymal haemorrhage from the ruptured Borden type II DAVF in addition to a large venous aneurysm and a flow related intraosseous aneurysm of the contralateral middle meningeal artery (MMA) all clearly delineated by CT and DSA. He underwent emergency stereotactic evacuation of the intraparenchymal haemorrhage and successful surgical treatment of all the vascular lesions at the same time with residual neurological deficit. To our knowledge, this is the first such reported case. We discuss the challenging surgical treatment, emphasising the role of CT/DSA in management, and provide a literature review.

  2. Cerebral venous thrombosis and myeloproliferative neoplasms: results from two large databases.

    PubMed

    Dentali, Francesco; Ageno, Walter; Rumi, Elisa; Casetti, Ilaria; Poli, Daniela; Scoditti, Umberto; Maffioli, Margherita; di Minno, Matteo Nicola Dario; Caramazza, Domenica; Pietra, Daniela; De Stefano, Valerio; Passamonti, Francesco

    2014-07-01

    Myeloproliferative neoplasms (MPNs) include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Patients with MPNs are prone to develop arterial and venous thrombosis either at diagnosis or during follow-up; in particular splancnic vein is strongly associated with MPN. Conversely, presence of MPN is uncommon in patients with deep vein thrombosis of the lower extremities and with pulmonary embolism. Only few studies with conflicting results have evaluated the prevalence of an underlying MPN in patients with cerebral venous thrombosis (CVT), and limited evidence exists on the incidence of CVT in patients with established MPN. We assessed the frequency of MPNs in a series of 706 patients with cerebral vein thrombosis (CVT) and the frequency of CVT in a cohort of 2,143 MPNs patients. Twenty-seven CVT patients (3.8%) were diagnosed with MPN: 9 before CVT (1.3%), 4 concomitantly (0.6%), and 14 after CVT (2.0%). Nine CVT cases (0.4%) were diagnosed in the MPN cohort, with a slightly higher frequency in PV (five of 735, 0.7%) than in ET (three of 964, 0.3%) and in PMF (one of 444, 0.2%). Considering the analyses of these databases jointly, the results obtained suggest a weak association between CVT and MPNs and ultimately suggest that a thorough investigation looking for an underlying MPN may not be warranted in all the patients with CVT without overt myeloproliferative features. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis

    PubMed Central

    Tanabe, Natsumi; Hiraoka, Eiji; Hoshino, Masataka; Deshpande, Gautam A.; Sawada, Kana; Norisue, Yasuhiro; Tsukuda, Jumpei; Suzuki, Toshihiko

    2017-01-01

    Patient: Female, 49 Final Diagnosis: Cerebral venous thrombosis Symptoms: Altered mental state • weakness in limbs Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare co-existance of disease or pathology Background: Cerebral venous thrombosis (CVT) is a rare but fatal complication of hyperthyroidism that is induced by the hypercoagulable state of thyrotoxicosis. Although it is frequently difficult to diagnose CVT promptly, it is important to consider it in the differential diagnosis when a hyperthyroid patient presents with atypical neurologic symptoms. Care Report: A 49-year-old Japanese female with unremarkable medical history came in with thyroid storm and multiple progressive ischemic stroke identified at another hospital. Treatment for thyroid storm with beta-blocker, glucocorticoid, and potassium iodide-iodine was started and MR venography was performed on hospital day 3 for further evaluation of her progressive ischemic stroke. The MRI showed CVT, and anticoagulation therapy, in addition to the anti-thyroid agents, was initiated. The patient’s thyroid function was successfully stabilized by hospital day 10 and further progression of CVT was prevented. Conclusions: Physicians should consider CVT when a patient presents with atypical course of stroke or with atypical MRI findings such as high intensity area in apparent diffusion coefficient (ADC) mapping. Not only is an early diagnosis and initiation of anticoagulation important, but identifying and treating the underlying disease is essential to avoid the progression of CVT. PMID:28228636

  4. Cutaneous Venous Malformations in Familial Cerebral Cavernomatosis Caused by KRIT1 Gene Mutations

    PubMed Central

    Toll, Agustí; Parera, Elisabet; Giménez-Arnau, Ana M.; Pou, Alejandro; Lloreta, Josep; Limaye, Nisha; Vikkula, Miikka; Pujol, Ramon M.

    2009-01-01

    Background Cerebral cavernous malformations (CCMs) are vascular lesions characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. Although often asymptomatic, seizures, cerebral haemorrhages and focal neurological deficits are well-documented complications. Mutations in the CCM1 (7q21–22), CCM2 (7p13–15) and CCM3 (3q25.2–27) genes have been identified in familial CCM. In rare instances, the association of congenital hyperkeratotic cutaneous capillary-venous malformations (HCCVMs) with CCM1 has been reported. Observations: We studied 6 members of a family with CCMs. Four members of the family developed late-onset multiple, tiny, bluish, soft, cutaneous papules, mainly located on the face, arm and abdominal area, corresponding histologically to venous malformations. A splice donor site mutation in intron 4 (c. 1146 + 1 G→A) in the CCM1 gene was identified. Conclusions Our findings suggest that mutations in the KRIT1 gene may cause phenotypically heterogeneous cutaneous vascular lesions other than those previously described as HCCVMs. PMID:19182478

  5. Venous cerebral blood volume increase during voluntary locomotion reflects cardiovascular changes.

    PubMed

    Huo, Bing-Xing; Greene, Stephanie E; Drew, Patrick J

    2015-09-01

    Understanding how changes in the cardiovascular system contribute to cerebral blood flow (CBF) and volume (CBV) increases is critical for interpreting hemodynamic signals. Here we investigated how systemic cardiovascular changes affect the cortical hemodynamic response during voluntary locomotion. In the mouse, voluntary locomotion drives an increase in cortical CBF and arterial CBV that is localized to the forelimb/hindlimb representation in the somatosensory cortex, as well as a diffuse venous CBV increase. To determine if the heart rate increases that accompany locomotion contribute to locomotion-induced CBV and CBF increases, we occluded heart rate increases with the muscarinic cholinergic receptor antagonist glycopyrrolate, and reduced heart rate with the β1-adrenergic receptor antagonist atenolol. We quantified the effects of these cardiovascular manipulations on CBV and CBF dynamics by comparing the hemodynamic response functions (HRF) to locomotion across these conditions. Neither the CBF HRF nor the arterial component of the CBV HRF was significantly affected by pharmacological disruption of the heart rate. In contrast, the amplitude and spatial extent of the venous component of the CBV HRF were decreased by atenolol. These results suggest that the increase in venous CBV during locomotion was partially driven by peripheral cardiovascular changes, whereas CBF and arterial CBV increases associated with locomotion reflect central processes. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Davoudi, Vahid; Keyhanian, Kiandokht; Saadatnia, Mohammad

    2014-02-01

    We aimed to define the possible risk factors for acute and remote seizures in patients with cerebral vein and sinus thrombosis (CVST). Ninety-four patients were recruited prospectively at Al-Zahra Hospital, Isfahan, Iran, between April 2007 and April 2012. To identify seizure predictors, we compared demographic, clinical and imaging factors between patients with or without acute and remote seizures. Of the 94 patients, 32 (34%) experienced at least one seizure after CVST development. Bivariate analysis showed a significant association of remote seizure with loss of consciousness at presentation (P=0.05, OR: 5.11, 95%CI: 1.07-24.30), supratentorial lesions (P=0.02, OR: 9.04, 95%CI: 1.04-78.55), lesions in the occipital lobe (P=0.00, OR: 12.75, 95%CI: 2.28-71.16), lesions in the temporal and parietal lobes, thrombophilia (P=0.03, OR: 5.87, 95%CI: 1.21-28.39), seizure in the acute phase (P=0.00, OR: 13.14, 95%CI: 2.54-201.2) and sigmoid sinus thrombosis (P=0.00, OR: 12.5, 95%CI: 2.23-69.79). Seizures in the acute phase were also more common in patients with paresis (P=0.00, OR: 4.88, 95%CI: 1.91-12.46), hemorrhagic lesions indicated by imaging (P=0.02, OR: 2.77, 95%CI: 1.08-7.10), supratentorial lesions, lesions in the frontal (P=0.01, OR: 3.81, 95%CI: 1.28-11.31) and parietal lobes (P=0.00, OR: 5.16, 95%CI: 2-13.29), thrombophilia and history of miscarriage (P=0.03, OR: 2.91, 95%CI: 1.07-7.91). No factor predicted acute or remote seizure in a multiple logistic regression analysis. Our results demonstrate that seizure development in the acute phase is the most significant factor for development of remote seizure. Parenchymal lesions in the supratentorial area were also found to be associated with both acute and remote seizures. However, no factor was predictive of acute or remote seizures in a multivariate analysis. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  7. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis

    PubMed Central

    Fu, Fang-Wang; Rao, Jie; Zheng, Yuan-Yuan; Song, Liang; Chen, Wei; Zhou, Qi-Hui; Yang, Jian-Guang; Ke, Jiang-Qiong; Zheng, Guo-Qing

    2017-01-01

    Abstract Rationale: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is characterized by a pattern of extravasated blood restricted to the perimesencephalic cisterns, normal angiographic findings, and an excellent prognosis with an uneventful course and low risks of complication. The precise etiology of bleeding in patients with PNSAH has not yet been established. The most common hypothesis is that PNSAH is venous in origin. Intracranial venous hypertension has been considered as the pivotal factor in the pathogenesis of PNSAH. The underlying venous pathology such as straight sinus stenosis, jugular vein occlusion may contribute to PNSAH. We describe a patient in whom transverse sinus thrombosis preceded intracranial venous hypertension and PNSAH. These findings supported that the source of the subarachnoid hemorrhage is venous in origin. Patient concerns and diagnoses: A 45-year-old right-handed man was admitted to the hospital with a sudden onset of severe headache associated with nausea, vomiting, and mild photophobia for 6 hours. The patient was fully conscious and totally alert. An emergency brain computed tomography (CT) revealed an acute subarachnoid hemorrhage restricted to the perimesencephalic cisterns. CT angiography revealed no evidence of an intracranial aneurysm or underlying vascular malformation. Digital subtraction angiography of arterial and capillary phases confirmed the CT angiographic findings. Assessment of the venous phase demonstrated right transverse sinus thrombosis. Magnetic resonance imaging confirmed the diagnosis of cerebral venous sinus thrombosis (CVST). Lumbar puncture revealed an opening pressure of 360 mmH2O, suggestive of intracranial venous hypertension. Grave disease was diagnosed by endocrinological investigation. Interventions: Low-molecular-weight heparin, followed by oral warfarin, was initiated immediately as the treatment for cerebral venous sinus thrombosis and PNSAH. Outcomes: The patient discharged

  8. Autoantibodies against the Fibrinolytic Receptor, Annexin A2, in Cerebral Venous Thrombosis

    PubMed Central

    Cesarman-Maus, Gabriela; Cantú-Brito, Carlos; Barinagarrementeria, Fernando; Villa, Rosario; Reyes, Elba; Sanchez-Guerrero, Jorge; Hajjar, Katherine A; Latorre, Ethel Garcia

    2010-01-01

    Background and Purpose Cerebral venous thrombosis (CVT) may be a manifestation of underlying autoimmune disease. Antibodies against annexin A2 (anti-A2Ab) coincide with the antiphospholipid syndrome (APS), in which antiphospholipid antibodies (aPLA) are associated with thrombosis in any vascular bed. Annexin A2, a profibrinolytic receptor and binding site for β2-glycoprotein-I (β2-GPI), the main target for aPLA, is highly expressed on cerebral endothelium. Here we evaluate the prevalence of anti-A2Ab in CVT. Methods Forty individuals with objectively documented CVT (33 women and 7 men) and 145 healthy controls were prospectively studied for hereditary and acquired prothrombotic risk factors, classical aPLA, and anti-A2Ab. Results One or more prothrombotic risk factors were found in 85% of CVT subjects, (pregnancy/puerperium in 57.5%, classical aPLA in 22.5%, and hereditary procoagulant risk factors in 17.5%). Anti-A2Ab (titer >3SD) were significantly more prevalent in patients with CVT (12.5%) than in healthy individuals (2.1%, p<0.01, OR:5.9). Conclusions Anti-A2Ab are significantly associated with CVT, and may define a subset of individuals with immune-mediated cerebral thrombosis. PMID:21193750

  9. The Addition of Endovascular Intervention for Dural Venous Sinus Thrombosis: Single-Center Experience and Review of Literature.

    PubMed

    Nyberg, Eric M; Case, David; Nagae, Lidia M; Honce, Justin M; Reyenga, William; Seinfeld, Joshua; Poisson, Sharon; Leppert, Michelle H

    2017-10-01

    Dural venous sinus thrombosis (DVST) is a cause of infarction and intracranial hemorrhage (ICH) that can lead to significant morbidity. Endovascular therapy has emerged as an adjunctive therapy in select cases but has been associated with increased hemorrhagic complications. We present our experience with a large single-center cohort of DVST cases treated with current-generation thrombectomy devices. In this retrospective cohort study, a chart review was performed to compare presentations and outcomes of patients treated with anticoagulation alone with those treated with additional interventional therapy, using the modified Rankin Scale (mRS) score at discharge and at 90 days' follow-up. A total of 66 patients were included; 37 were treated with anticoagulation alone, and 29 underwent additional interventional therapy. Patients presenting with ICH or infarction had a significantly greater likelihood of disability at the time of discharge (odds ratio [OR] of 64.5 and 45.8, respectively; P < .0001) and at 90 days (OR of 28.4 and 22.8, respectively; P < .0001). Patients presenting with ICH or infarction were more likely to be selected for endovascular therapy (P < .05). Endovascular therapy was typically performed within 24 hours of admission; 9 patients (31%) had post-treatment hemorrhage, with 2 being (6.9%) symptomatic. There were fewer patients with slight disability (mRS score ≤1) in the endovascular group compared with the anticoagulation group at discharge (P = .05), but outcomes were not significantly different at 90 days (P = .19). Despite a higher rate of ICH or infarction at presentation in the endovascular group and an increased risk of postprocedural ICH, both treatment groups had similarly good functional outcomes at 90 days. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Central venous sinus thrombosis in a young woman taking norethindrone acetate for dysfunctional uterine bleeding: case report and review of literature.

    PubMed

    Rajput, Rajesh; Dhuan, Joginder; Agarwal, Shalini; Gahlaut, P S

    2008-08-01

    The association between the progestin-only pill used for treatment of menstrual disorders and central venous sinus thrombosis (CVST) has rarely been reported in the literature. This report describes a case of central venous sinus thrombosis following intake of norethindrone acetate for dysfunctional uterine bleeding secondary to polycystic ovary syndrome in a young woman with undiagnosed underlying hyperhomocysteinemia. A 23-year-old woman presented with severe headache, followed by hemiparesis, seizures, and altered sensorium. She had been prescribed norethindrone acetate for the management of dysfunctional uterine bleeding secondary to polycystic ovary syndrome. Investigations revealed acquired hyperhomocysteinemia, presumably due to nutritional deficiencies, and evidence of CVST on MRI and magnetic resonance venography. Investigations showed no evidence of inherited thrombophilia. The patient was treated with low molecular weight heparin, followed by warfarin, vitamin B12, vitamin B6, and folic acid, and recovered successfully. Although venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen-only pills for gynaecological disorders may develop thrombosis, especially if they have predisposing metabolic disorders.

  11. Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study.

    PubMed

    Ferro, J M; Lopes, M G; Rosas, M J; Ferro, M A; Fontes, J

    2002-01-01

    The purpose of this study was to analyze the long-term mortality, functional recovery and long-term complications of cerebral vein and dural sinus thrombosis (CVDST) admitted to Portuguese hospitals. A follow-up of symptomatic CVDST admitted to Portuguese hospitals since 1980 was performed. Fifty-one patients (retrospective cases) were re-evaluated during 1996; 91 consecutively admitted patients from 6/1995 to 6/1998 were followed up to 1999. In 1996, 4 (8%) of the retrospective cases had died (3 patients died in the acute phase), 4 (8%) could not be reached, 33 (64%) had recovered completely (Rankin 0 or 1) and 3 (6%) were dependent. The prospective cases had a mean follow-up of 1 year: 6 (7%) patients died in the acute phase, one (1%) died during follow-up, 75 (82%) recovered completely, and only 1 (1%) was dependent. For the prospective cases, worsening after admission (OR = 18.2; 95% CI = 2.9-112.4) and encephalopathy as the presenting syndrome (OR = 7.1; 95% CI = 1.2-40.9) predicted death or dependency, while absence of aphasia (OR 6.7, 95% CI = 1.6-33) and no worsening after admission (OR = 5.9; 95% CI = 1.6-20) predicted total recovery. During follow-up of the prospective cases, 4 (5%) patients had thrombotic events, 8 (10%) patients experienced seizures, 9 (11%) complained of severe headaches and 1 patient suffered severe visual loss. The long-term functional prognosis of patients with CVDST was fairly good with complete recovery in the majority of cases. However, these patients had a moderate risk of further thrombotic events and seizures. Copyright 2002 S. Karger AG, Basel

  12. Early pregnancy cerebral venous thrombosis and status epilepticus treated with levetiracetam and lacosamide throughout pregnancy.

    PubMed

    Ylikotila, Pauli; Ketola, Raimo A; Timonen, Susanna; Malm, Heli; Ruuskanen, Jori O

    2015-11-01

    Cerebral venous thrombosis (CVT) is an uncommon cause of stroke, accounting to less than 1% of all strokes. We describe a pregnant woman with a massive CVT in early pregnancy, complicated by status epilepticus. The mother was treated with levetiracetam, lacosamide, and enoxaparin throughout pregnancy. A male infant was born on pregnancy week 36, weighing 2.2kg. Both levetiracetam and and lacosamide were present in cord blood in levels similar to those in maternal blood. The infant was partially breast-fed and experienced poor feeding and sleepiness, starting to resolve after two first weeks. Milk samples were drawn 5 days after the delivery and a blood sample from the infant 3 days later. Lacosamide level in milk was low, resulting in an estimated relative infant dose of 1.8% of the maternal weight-adjusted daily dose in a fully breast-fed infant. This is the first case describing lacosamide use during pregnancy and lactation.

  13. Coupling between arterial and venous cerebral blood flow during postural change.

    PubMed

    Ogoh, Shigehiko; Washio, Takuro; Sasaki, Hiroyuki; Petersen, Lonnie G; Secher, Niels H; Sato, Kohei

    2016-12-01

    In supine humans the main drainage from the brain is through the internal jugular vein (IJV), but the vertebral veins (VV) become important during orthostatic stress because the IJV is partially collapsed. To identify the effect of this shift in venous drainage from the brain on the cerebral circulation, this study addressed both arterial and venous flow responses in the "anterior" and "posterior" parts of the brain when nine healthy subjects (5 men) were seated and flow was manipulated by hyperventilation and inhalation of 6% carbon dioxide (CO2). From a supine to a seated position, both internal carotid artery (ICA) and IJV blood flow decreased (P = 0.004 and P = 0.002), while vertebral artery (VA) flow did not change (P = 0.348) and VV flow increased (P = 0.024). In both supine and seated positions the ICA response to manipulation of end-tidal CO2 tension was reflected in IJV (r = 0.645 and r = 0.790, P < 0.001) and VV blood flow (r = 0.771 and r = 0.828, P < 0.001). When seated, the decrease in ICA blood flow did not affect venous outflow, but the decrease in IJV blood flow was associated with the increase in VV blood flow (r = 0.479, P = 0.044). In addition, the increase in VV blood flow when seated was reflected in VA blood flow (r = 0.649, P = 0.004), and the two flows were coupled during manipulation of the end-tidal CO2 tension (supine, r = 0.551, P = 0.004; seated, r = 0.612, P < 0001). These results support that VV compensates for the reduction in IJV blood flow when seated and that VV may influence VA blood flow.

  14. Cerebral venous thrombosis and thrombophilia: a systematic review and meta-analysis.

    PubMed

    Lauw, Mandy N; Barco, Stefano; Coutinho, Jonathan M; Middeldorp, Saskia

    2013-11-01

    Cerebral venous thrombosis (CVT) is a rare manifestation of venous thromboembolism (VTE) and stroke. The aim of our systematic review was to provide an updated summary of the strength of association between CVT and thrombophilia and to explore the relevance of thrombophilia for recurrence of CVT or other VTE, or other outcome variables. MEDLINE (via PubMed), EMBASE (via Ovid), and CENTRAL were systematically searched, including references of retrieved articles. Cohort studies of ≥ 40 patients and case-control studies comparing the prevalence of thrombophilia in patients with CVT and unrelated controls were eligible. Two reviewers independently selected studies, assessed quality, and extracted data. A meta-analysis was performed for high quality case-control studies with unselected cases and healthy controls. Odds ratios with 95% confidence intervals were calculated and pooled. We included 23 cohort studies and 33 case-control studies. A significant association was demonstrated between CVT and all inherited thrombophilic factors, as well as increased levels of homocysteine. Inconclusive results were found on the relevance of thrombophilia for recurrent CVT or other VTE. Although there is a strong association between CVT and thrombophilia, the clinical relevance of thrombophilia testing in patients with CVT seems limited, similarly to other forms of VTE.

  15. Coagulation factor VII R353Q polymorphism and the risk of puerperal cerebral venous thrombosis.

    PubMed

    Kruthika-Vinod, T P; Nagaraja, Dindagur; Christopher, Rita

    2012-01-01

    Puerperal cerebral venous thrombosis (CVT) is a relatively common form of stroke in young women in India. The blood coagulation factor VII (FVII) R353Q polymorphism increases the risk for venous thrombosis. Our aim was to investigate the association of FVII R353Q polymorphism with the risk of puerperal CVT. A total of 100 women with puerperal CVT and 102 age-matched women without postpartum complications were investigated. FVII R353Q genotypes were identified using restriction fragment length polymorphism analysis. Our results showed that the homozygous FVII 353QQ genotype was present in 9% and 8% of patients and controls, respectively; and 42% of patients and 31.4% of controls had the heterozygous 353RQ genotype (odds ratio = 1.55, 95% confidence interval = 0.89-2.70; p = 0.243). Our findings suggest that the FVII R353Q polymorphism is not associated with increased risk for CVT occurring during the puerperal period in Indian women.

  16. High flow rates during modified ultrafiltration decrease cerebral blood flow velocity and venous oxygen saturation in infants.

    PubMed

    Rodriguez, Rosendo A; Ruel, Marc; Broecker, Lothar; Cornel, Garry

    2005-07-01

    The intracranial hemodynamic effects of modified ultrafiltration in children are unknown. We investigated the effects of different blood flow rates during modified ultrafiltration on the cerebral hemodynamics of children with weights above and below 10 kg. Thirty-one children (weights: < or = 10 kg, n = 21; > 10 kg, n = 10) undergoing cardiopulmonary bypass were studied. Middle-cerebral artery blood flow velocities and cerebral mixed venous oxygen saturations were measured before, five minutes from the beginning, and at the end of ultrafiltration. Patients were classified according to their blood flow rates during ultrafiltration in three groups: high (> or = 20 mL/kg/min), moderate (10-19 mL/kg/min), and low flow rates (< 10 mL/kg/min). During modified ultrafiltration, blood pressures and hematocrit increased (p < 0.001), but cerebral blood flow velocities and mixed venous oxygen saturations decreased (p < 0.001). A significant correlation was found between blood flow rates of ultrafiltration and the decline in mean cerebral blood flow velocity (r = - 0.48; p = 0.005) and cerebral oxygen saturation (r = - 0.49; p = 0.005) or hematocrit increase (r = 0.59; p = 0.001). Infants exposed to high flow rates had greater reduction of cerebral blood flow velocity and regional mixed venous saturation and higher hematocrit at the end of ultrafiltration compared with those subjected to moderate and low flow rates (p < 0.04). No significant difference was found between moderate and low flow groups. The flow rate of ultrafiltration was the only independent predictor of the changes in cerebral mixed venous oxygen saturation (p = 0.033). High blood flow rates through the ultrafilter during modified ultrafiltration transiently decrease the cerebral circulation in young infants compared with lower blood flow rates. These effects may be related to an increased diastolic runoff from the aorta into the ultrafiltration circuit that leads to a "stealing" effect from the intracranial

  17. A case of homocystinuria due to CBS gene mutations revealed by cerebral venous thrombosis.

    PubMed

    Sarov, Mariana; Not, Adeline; de Baulny, Hélène Ogier; Masnou, Pascal; Vahedi, Katayoun; Bousser, Marie-Germaine; Denier, Christian

    2014-01-15

    Homocystinuria caused by cystathionine beta synthase (CBS) deficiency is most often diagnosed in childhood and has a variable expressivity. The most frequent abnormalities include intellectual disability, ectopia lentis, myopia, skeletal abnormalities or thromboembolism. To report a case of homocystinuria unraveled by cerebral venous thrombosis (CVT). A 17 year old female was admitted in our department of neurology for subacute headache and presented seizures in the emergency room. Cerebral imaging revealed CVT. Severe hyperhomocysteinemia was found and led to the diagnosis of homocystinuria due to composite heterozygous mutations in the CBS gene. Further investigations disclosed lens subluxation in association with myopia, mild scoliosis and osteopenia. The patient was treated by heparin followed by warfarin, vitamin therapy and dietary methionine restriction. Total homocysteine and methionine levels became normal in a few weeks and the patient had a complete recovery. In patients with CVT, plasma total homocysteine measurement as part of the etiologic work up may reveal severe hyperhomocysteinemia due to CBS or remethylation defects that require specific treatment and management including perhaps protein-restricted diet and/or vitamin therapy for life. © 2013.

  18. Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Ferro, José M; Lopes, M G; Rosas, M J; Fontes, J

    2005-01-01

    Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome

  19. Ectatic and Occlusive Diseases of the Venous Drainage System of Cerebral Arteriovenous Malformations (AVMs) - with Emphasis on Spectacular Shrinking Neurological Deficits after Embolization.

    PubMed

    Goto, K

    2005-10-05

    During reviewing cases with AVM, the author noticed that stenotic and occlusive changes of the draining veins are commonly seen in high flow cerebral AVMs. However, little attention has been paid to these venous diseases until ectatic veins, generated in the upstream of the venous system, cause mass effect to the surrounding structures, or redistribution and shunting toward regional veins became insufficient after they are markedly overloaded or occluded. Cases with such venous abnormality are clinically important because of the possibility of dramatic improvement of neurological deficits after embolization of AVMs. Following presenting treatment results of 177 AVM case, the author is going to present five cases with abnormality in the Galenic venous system and two cases with abnormality in cortical veins associating with high flow cerebral AVMs. Consideration will be made on symptomatology and pathophysiologic mechanism of venous abnormalities associating with high flow cerebral AVMs.

  20. Post-coital intra-cerebral venous hemorrhage in a 78-year-old man with jugular valve incompetence: a case report

    PubMed Central

    2010-01-01

    Introduction Spontaneous intra-cerebral hemorrhage can occur in patients with venous disease due to obstructed venous outflow. Case presentation We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage. Conclusions To the best of our knowledge, this is the first case of intra-cerebral hemorrhage due to jugular valve incompetence in association with the physical exertion associated with sexual intercourse. PMID:20659320

  1. Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage.

    PubMed

    Ciccone, M M; Scicchitano, P; Gesualdo, M; Cortese, F; Zito, A; Manca, F; Boninfante, B; Recchia, P; Leogrande, D; Viola, D; Damiani, M; Gambacorta, V; Piccolo, A; De Ceglie, V; Quaranta, N

    2017-07-26

    To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD). Observational, prospective, cohort study. ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy). We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD. All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed. No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage. Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases. © 2017 John Wiley & Sons Ltd.

  2. Countercurrent transfer of dopamine from venous blood in the cavernous sinus to the arterial blood supplying the brain - the perfused rabbit head as an experimental model.

    PubMed

    Muszak, J; Krzymowski, T; Gilun, P; Stefanczyk-Krzymowska, S

    2014-10-01

    The objective of the current study was to check whether countercurrent transfer of dopamine occurs in the cavernous sinus of the rabbit and whether the rabbit can be used as an animal model to study cavernous sinus function. After exsanguination of the animal, oxygenated and warmed (37°C) Hanseneleit-Krebs buffer with autologous or homologous blood (in a 3:1 or 1:1 ratio) was pumped through both common carotid arteries into the head (60 ml/min; 80-100 mm Hg) and radiolabeled dopamine (3(H)-DA, 10 μCi) was infused into the cavernous sinus through the angular oculi vein. Cerebral blood from the basilar artery was collected from the cannulated vertebral artery during 3(H)-DA infusion and for 10 minutes after completion of infusion. Selected brain tissue samples were collected after completion of the head perfusion. It was demonstrated that dopamine can penetrate from the rabbit's cavernous sinus to the internal carotid artery supplying the brain. Dopamine permeation was greater when the rabbit head was perfused with buffer and blood in a 3:1 ratio than with 1:1 (P<0.01). When the head was perfused with buffer and blood in a 3:1 ratio, significant radioactivity was found in samples collected from the brain basilar artery during and after 3(H)-DA infusion (P<0.001). The radioactivity was identified as 34.13 ± 2.7% unmetabolized 3(H)-DA and 65.9 ± 2.7% its metabolites. Significant radioactivity was also found in some brain tissue samples in both groups (P<0.05). The concentration of free radiolabeled dopamine particles in the dialysate of blood plasma and plasma diluted with buffer did not differ significantly. Because the structures of the cavernous sinus and cavernous fragment of the internal carotid artery of the rabbit are similar to those in humans, it suggests that rabbits can serve as a model for experimental physiological studies of cavernous sinus function and retrograde dopamine transfer in the cavernous sinus should be considered as an important link in

  3. Comparative study of alveolar bone height and implant survival rate between autogenous bone mixed with platelet rich plasma versus venous blood for maxillary sinus lift augmentation procedure.

    PubMed

    Kumar, Namineni Kiran; Shaik, Mahaboob; Nadella, Koteswara Rao; Chintapalli, Balakrishna Manohar

    2015-06-01

    The aim of this study was to evaluate changes in alveolar bone height by means of radiographic examination and Straumann implant survival rate following maxillary sinus lift augmentation using autogenous bone in combination with platelet rich plasma (PRP) versus venous blood (VB). Fifty patients requiring sinus lift augmentation procedure included in the study were divided into two groups (n = 25). During the procedure the sub antral sinus cavity was augmented using autogenous bone taken from mandibular ramus area and mixed with PRP in one group and autogenous bone mixed with VB in the other group. Orthopantomograms were taken preoperatively, immediate, at 6 months and 1 year postoperatively. Height of alveolar bone at the site of sinus augmentation was measured on the radiographs. One hundred and twenty-one Straumann dental implants were placed after healing period. Age of the patients in the study groups ranged from 36 to 69 years. Differences in mean values of bone height measurements recorded in the PRP series revealed significant differences among the three subgroups (P = 0.001). Significant differences were noted between immediate postop and 6 month (P < 0.01), immediate postop and year (P < 0.01). In the VB series also significant differences were revealed among the three subgroups (P = 0.0280). Significant differences were noted between immediate postop and 6 month (P < 0.05). Comparison of results of subgroups of the two series at the three intervals revealed significant differences at 'immediate postop' values (P = 0.0002) and 'sixmon' values (P = 0.0435). Differences between 'year' values were not significant. Two implants were lost in PRP group. The results of this limited study reveals that both groups recorded a good increase in the alveolar bone height after sinus augmentation and showed no significant differences between these groups when compared to each other at 1 year postoperatively. When both sub groups compared with

  4. Endovascular correction of an infantile intracranial venous outflow obstruction.

    PubMed

    Soltanolkotabi, Maryam; Rahimi, Shahram; Hurley, Michael C; Bowman, Robin M; Russell, Eric J; Ansari, Sameer A; Shaibani, Ali

    2013-12-01

    The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization.

  5. Raised intracranial pressure and cerebral blood flow

    PubMed Central

    Johnston, I. H.; Rowan, J. O.

    1974-01-01

    Pressure changes within the venous outflow tract from the brain were studied in anaesthetized baboons. Segmental vascular resistance changes were also calculated and the results correlated with the changes in cerebral blood flow, measured by the 133Xenon clearance method. Three different methods were used to raise intracranial pressure: cisterna magna infusion, a supratentorial subdural balloon, and an infratentorial subdural balloon. A close correlation was found between the cortical vein pressure and intracranial pressure with all methods of raising intracranial pressure: the overall correlation coefficient was 0·98. In the majority of animals sagittal sinus pressure showed little change through a wide range of intracranial pressure. In three of the six animals in the cisterna magna infusion group, however, sagittal sinus pressure increased to levels approaching the intracranial pressure during the later stages of intracranial hypertension. Jugular venous pressure showed little change with increasing intracranial pressure. The relationship between cerebral prefusion pressure and cerebral blood flow differed according to the method of increasing intracranial pressure. This was due to differing patterns of change in prevenous vascular resistance as venous resistance increased progressively with increasing pressure in all three groups. The present results confirm, therefore, the validity of the current definition of cerebral perfusion pressure—that is, cerebral perfusion pressure is equal to mean arterial pressure minus mean intracranial pressure—by demonstrating that intracranial pressure does represent the effective cerebral venous outflow pressure. Images PMID:4209160

  6. Surgical planning for microsurgical excision of cerebral arterio-venous malformations using virtual reality technology.

    PubMed

    Ng, Ivan; Hwang, Peter Y K; Kumar, Dinesh; Lee, Cheng Kiang; Kockro, Ralf A; Sitoh, Y Y

    2009-05-01

    To evaluate the feasibility of surgical planning using a virtual reality platform workstation in the treatment of cerebral arterio-venous malformations (AVMs) Patient-specific data of multiple imaging modalities were co-registered, fused and displayed as a 3D stereoscopic object on the Dextroscope, a virtual reality surgical planning platform. This system allows for manipulation of 3D data and for the user to evaluate and appreciate the angio-architecture of the nidus with regards to position and spatial relationships of critical feeders and draining veins. We evaluated the ability of the Dextroscope to influence surgical planning by providing a better understanding of the angio-architecture as well as its impact on the surgeon's pre- and intra-operative confidence and ability to tackle these lesions. Twenty four patients were studied. The mean age was 29.65 years. Following pre-surgical planning on the Dextroscope, 23 patients underwent microsurgical resection after pre-surgical virtual reality planning, during which all had documented complete resection of the AVM. Planning on the virtual reality platform allowed for identification of critical feeders and draining vessels in all patients. The appreciation of the complex patient specific angio-architecture to establish a surgical plan was found to be invaluable in the conduct of the procedure and was found to enhance the surgeon's confidence significantly. Surgical planning of resection of an AVM with a virtual reality system allowed detailed and comprehensive analysis of 3D multi-modality imaging data and, in our experience, proved very helpful in establishing a good surgical strategy, enhancing intra-operative spatial orientation and increasing surgeon's confidence.

  7. Towards the genetic basis of cerebral venous thrombosis—the BEAST Consortium: a study protocol

    PubMed Central

    Cotlarciuc, Ioana; Marjot, Thomas; Khan, Muhammad S; Hiltunen, Sini; Haapaniemi, Elena; Metso, Tiina M; Putaala, Jukka; Zuurbier, Susanna M; Brouwer, Matthijs C; Passamonti, Serena M; Bucciarelli, Paolo; Pappalardo, Emanuela; Patel, Tasmin; Costa, Paolo; Colombi, Marina; Canhão, Patrícia; Tkach, Aleksander; Santacroce, Rosa; Margaglione, Maurizio; Favuzzi, Giovanni; Grandone, Elvira; Colaizzo, Donatella; Spengos, Kostas; Arauz, Antonio; Hodge, Amanda; Ditta, Reina; Debette, Stephanie; Zedde, Marialuisa; Pare, Guillaume; Ferro, José M; Thijs, Vincent; Pezzini, Alessandro; Majersik, Jennifer J; Martinelli, Ida; Coutinho, Jonathan M; Tatlisumak, Turgut; Sharma, Pankaj

    2016-01-01

    Introduction Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition accounting for <1% of all stroke cases and mainly affects young adults. Its genetic aetiology is not clearly elucidated. Methods and analysis To better understand the genetic basis of CVT, we have established an international biobank of CVT cases, Biorepository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) which aims to recruit highly phenotyped cases initially of European descent and later from other populations. To date we have recruited 745 CVT cases from 12 research centres. As an initial step, the consortium plans to undertake a genome-wide association analysis of CVT using the Illumina Infinium HumanCoreExome BeadChip to assess the association and impact of common and low-frequency genetic variants on CVT risk by using a case–control study design. Replication will be performed to confirm putative findings. Furthermore, we aim to identify interactions of genetic variants with several environmental and comorbidity factors which will likely contribute to improve the understanding of the biological mechanisms underlying this complex disease. Ethics and dissemination BEAST meets all ethical standards set by local institutional review boards for each of the participating sites. The research outcomes will be published in international peer-reviewed open-access journals with high impact and visibility. The results will be presented at national and international meetings to highlight the contributions into improving the understanding of the mechanisms underlying this uncommon but important disease. This international DNA repository will become an important resource for investigators in the field of haematological and vascular disorders. PMID:27881526

  8. Prevalence of cerebral cavernous malformations associated with developmental venous anomalies increases with age.

    PubMed

    Brinjikji, Waleed; El-Masri, Ali El-Rida; Wald, John T; Flemming, Kelly D; Lanzino, Giuseppe

    2017-06-22

    To test the hypothesis that the prevalence of cerebral cavernous malformation (CCM) associated with developmental venous anomalies (DVAs) increases with age, we studied the age-related prevalence of DVA-associated CCM among patients with DVAs. Patients with DVAs on contrast-enhanced MRI exams performed over a 2-year period were included in this study. A single neuroradiologist reviewed all imaging exams for the presence of CCMs. Baseline demographic data collected included age, gender, presence of CNS neoplasm, history of cranial radiation, and history of seizure. Patients were divided into age groups based on decade of life. Cochran-Armitage trend tests were performed to determine if increasing age was associated with CCM prevalence. A total of 1689 patients with DVAs identified on contrast-enhanced MRI were included. Of these patients, 116 (6.9%) had a cavernous malformation associated with the DVA. There was a significant positive association between age and the prevalence of DVA-associated CCM (P = 0.002). The prevalence of DVA-associated CCM was 0.8% for the 0-10 age group, 1.6% for the 11-20 age group, 7.5% for the 21-30 age group, 9.5% for the 31-40 age group, 6.1% for the 41-50 age group, 6.3% for the 51-60 age group, 7.4% for the 61-70 age group, and 11.6% for the >70 age group (P < .0001). Our study demonstrated an age-related increase in prevalence of DVA-associated cavernous malformations among patients with DVAs. These findings suggest that DVA-associated cavernous malformations are acquired lesions.

  9. Towards the genetic basis of cerebral venous thrombosis-the BEAST Consortium: a study protocol.

    PubMed

    Cotlarciuc, Ioana; Marjot, Thomas; Khan, Muhammad S; Hiltunen, Sini; Haapaniemi, Elena; Metso, Tiina M; Putaala, Jukka; Zuurbier, Susanna M; Brouwer, Matthijs C; Passamonti, Serena M; Bucciarelli, Paolo; Pappalardo, Emanuela; Patel, Tasmin; Costa, Paolo; Colombi, Marina; Canhão, Patrícia; Tkach, Aleksander; Santacroce, Rosa; Margaglione, Maurizio; Favuzzi, Giovanni; Grandone, Elvira; Colaizzo, Donatella; Spengos, Kostas; Arauz, Antonio; Hodge, Amanda; Ditta, Reina; Debette, Stephanie; Zedde, Marialuisa; Pare, Guillaume; Ferro, José M; Thijs, Vincent; Pezzini, Alessandro; Majersik, Jennifer J; Martinelli, Ida; Coutinho, Jonathan M; Tatlisumak, Turgut; Sharma, Pankaj

    2016-11-22

    Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition accounting for <1% of all stroke cases and mainly affects young adults. Its genetic aetiology is not clearly elucidated. To better understand the genetic basis of CVT, we have established an international biobank of CVT cases, Biorepository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) which aims to recruit highly phenotyped cases initially of European descent and later from other populations. To date we have recruited 745 CVT cases from 12 research centres. As an initial step, the consortium plans to undertake a genome-wide association analysis of CVT using the Illumina Infinium HumanCoreExome BeadChip to assess the association and impact of common and low-frequency genetic variants on CVT risk by using a case-control study design. Replication will be performed to confirm putative findings. Furthermore, we aim to identify interactions of genetic variants with several environmental and comorbidity factors which will likely contribute to improve the understanding of the biological mechanisms underlying this complex disease. BEAST meets all ethical standards set by local institutional review boards for each of the participating sites. The research outcomes will be published in international peer-reviewed open-access journals with high impact and visibility. The results will be presented at national and international meetings to highlight the contributions into improving the understanding of the mechanisms underlying this uncommon but important disease. This international DNA repository will become an important resource for investigators in the field of haematological and vascular disorders. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow

    PubMed Central

    Cognard, C.; Casasco, A.; Toevi, M.; Houdart, E.; Chiras, J.; Merland, J.

    1998-01-01

    OBJECTIVES—A retrospective study was carried out on 13 patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with isolated or associated signs of intracranial hypertension.
METHODS—Nine patients presented with symptoms of intracranial hypertension at the time of diagnosis. Ocular fundoscopy available in 12 patients showed bilateral papilloedema in eight and optic disk atrophy in four. Clinical evolution was particularly noticeable in five patients because of chronic (two patients) or acute (after lumbar shunting or puncture: three patients, one death) tonsillar herniation.
RESULTS—Two patients had a type I fistula (drainage into a sinus, with a normal antegrade flow direction). The remaining 11 had type II fistulas (drainage into a sinus, with abnormal retrograde venous drainage into sinuses or cortical veins). Stenosis or thrombosis of the sinus(es) distal to the fistula was present in five patients. The cerebral venous drainage was abnormal in all patients.
CONCLUSION—Type II (and some type I) DAVFs may present as isolated intracranial hypertension mimicking benign intracranial hypertension. Normal cerebral angiography should be added as a fifth criterion of benign intracranial hypertension. The cerebral venous drainage pattern must be carefully studied by contralateral carotid and vertebral artery injections to correctly evaluate the impairment of the cerebral venous outflow. Lumbar CSF diversion (puncture or shunting) may induce acute tonsillar herniation and should be avoided absolutely. DAVF may induce intracranial hypertension, which has a poor long term prognosis and may lead to an important loss of visual acuity and chronic tonsillar herniation. Consequently, patients with intracranial hypertension must be treated, even agressively, to obliterate the fistula or at least to reduce the arterial flow and to restore a normal cerebral venous drainage. The endovascular treatment may associate arterial or transvenous

  11. Sinus pericranii, petrosquamosal sinus and extracranial sigmoid sinus: Anatomical variations to consider during a retroauricular approach.

    PubMed

    Cisneros, Juan Carlos; Lopes, Paula Tardim; Bento, Ricardo Ferreira; Tsuji, Robinson Koji

    2017-06-01

    Lateral and sigmoid sinus malformations are uncommon and dangerous anatomical variations that surgeons may encounter when performing a retroauricular approach. We report three cases of rare temporal bone venous sinus anomalies seen in patients who underwent cochlear implant surgery. The first patient had a diagnosis of CHARGE syndrome and presented a bilateral persistent petrosquamosal sinus with sigmoid sinus agenesis, which made mastoidectomy for cochlear implantation difficult. The second patient presented an anomalous venous lake in the occipital region, which communicated the left dural venous sinuses with a conglomerate of pericranial vessels in the left nuchal region, also consistent with left sinus pericranii. The third patient presented with an extracranial sigmoid sinus that produced a troublesome bleeding immediately after the muscular-periosteal flap incision was performed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. [Evolution of angiographic signs of venous hypertension and clinical signs of intracranial hypertension in intracranial dural arteriovenous fistulas].

    PubMed

    Biondi, A; Casasco, A; Houdart, E; Gioino, C; Sourour, N; Vivas, E; Dormont, D; Marsault, C

    1999-03-01

    Dural arteriovenous fistulas (dAVFs) can cause cerebral venous hypertension (VHT). The most common mechanism is due to the fact that some dAVFs can drain retrogradelly in cortical (better defined as leptomeningeal) veins (directly or after drainage in a dural sinus) causing venous engorgement and consequently an impairment of the cerebral venous drainage. However, more rarely, dAVFs without a cortical venous drainage can also be responsible for VHT probably due to dAVF shunts causing insufficient antegrade cerebral venous drainage. In addition, dAVFs are often associated with stenosis and/or thrombosis of dural sinus(es) which can worsen the VHT. Raised pressure within the superior sagittal sinus causes impeded cerebrospinal reabsorption in the arachnoid villi allowing increased intracranial pressure. The venous engorgement in the cortical veins can cause a venous congestive encephalopathy analogous to the venous congestive myelopathy of the spinal dural AVFs. Clinically VHT can cause not only symptoms related to increased intracranial pressure but also seizures, neurological deficits, impairment of the cognitive functions and dementia. An important aspect is the risk of hemorrhage in dAVFs with a leptomeningeal venous drainage leading to VHT. Although the term VHT sensu strictu should be used if venous pressure measurements are performed, angiographic criteria for VHT such as delayed circulation time, venous engorgement and abnormal visualization of the cerebral veins are well established. The purpose of our study was to evaluate the angiographic signs of VHT in patients with dAVF and to study the course of the VHT and of the clinical signs of increased intracranial pressure before and after dAVF endovascular treatment. A retrospective chart analysis of 22 patients (13 males, 9 females) ranging in age from 20 to 87 years (mean: 53 ys.) with a dAVF associated with angiographic signs of VHT was performed. Ten dAVFs were located on the transverse/sigmoid sinus(es), 6

  13. [Possibilites to improve the cerebral venous tonus in patients suffering of accelerated ageing in blood circulation system by the nonmedicamentousal sympathocorrection method].

    PubMed

    Iakimova, M E; Latfullin, I A; Azin, A L; Kublanov, V S; Smirnov, A V

    2004-01-01

    The aim of the study was to evaluate the effectiveness of the transdermal electro impulses directed on ganglions stellatum in order to prevent the accelerated ageing and improve the cerebral venous flow. Using by the angioscanning method it was been found the phenomenon of ectasia in venae jugularis int. in patients suffering of accelerated ageing in 100% cases. The normalization of venous diameter after the treatment by electrical impulses has been found in 31-55% of cases.

  14. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis

    PubMed Central

    2013-01-01

    Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular. CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation. Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius. CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917

  15. Abducens nerve palsy due to inferior petrosal sinus thrombosis.

    PubMed

    Mittal, Shivam Om; Siddiqui, Junaid; Katirji, Bashar

    2017-02-24

    Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello's canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber's ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello's canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello's canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.

  16. New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

    PubMed Central

    Konakondla, Sanjay; Schirmer, Clemens M.; Li, Fengwu; Geng, Xiaogun; Ding, Yuchuan

    2017-01-01

    Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large

  17. Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension.

    PubMed

    Ogungbo, B; Roy, D; Gholkar, A; Mendelow, A D

    2003-12-01

    The authors present a 37-year-old lady with symptoms and signs suggestive of benign intracranial hypertension (BIH). Routine CT and MRI scans were normal. Further investigations were performed with magnetic resonance venography (MRV) and cerebral venography. These revealed obstruction of the right transverse sinus with high pressure (40 mmHg) proximal to the obstruction and low pressure (15 mmHg) distally. She was treated by transvenous stent deployment with resolution of her symptoms and the bilateral papilloedema. Evaluation of the cerebral venous system with MRV and or with formal cerebral venography should be included in routine investigations of patients with suspected BIH.

  18. Extra-abdominal venous thromboses at unusual sites.

    PubMed

    Martinelli, Ida; De Stefano, Valerio

    2012-09-01

    Venous thrombosis typically involves the lower extremities. Rarely, it can occur in cerebral, splanchnic, or renal veins, with a frightening clinical impact. Other rare manifestations are upper-extremity deep vein thrombosis, that can complicate with pulmonary embolism and post-thrombotic syndrome, and retinal vein occlusion, significantly affecting the quality of life. This review is focused on venous thromboses at unusual extra-abdominal sites. Local infections or cancer are frequent in cerebral sinus-venous thrombosis. Upper-extremity deep vein thrombosis is mostly due to catheters or effort-related factors. Common risk factors are inherited thrombophilia and oral contraceptive use. Acute treatment is based on heparin; in cerebral sinus-venous thrombosis, local or systemic fibrinolysis should be considered in case of clinical deterioration. Vitamin-K antagonists are recommended for 3-6 months; indefinite anticoagulation is suggested for recurrent thrombosis or unprovoked thrombosis and permanent risk factors. However, such recommendations mainly derive from observational studies; there are no data about long-term treatment of retinal vein occlusion.

  19. Embolism of cerebral tissue to lungs following gunshot wound to head.

    PubMed

    Hatfield, S; Challa, V R

    1980-04-01

    The case history of a 28-year-old man who sustained a gunshot wound to the head and developed multiple pulmonary emboli composed of cerebral tissue is presented. The brain tissue fragments probably entered the severed end of a bridging vein, traveled along the superior sagittal sinus, and gained access to the internal jugular vein and systemic venous return.

  20. Sinus thrombosis-do animal models really cover the clinical syndrome?

    PubMed

    Yenigün, Mesut; Jünemann, Martin; Gerriets, Tibo; Stolz, Erwin

    2015-06-01

    Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young patients. CVST represents with 0.5-3% of stroke cases a relatively rare disease. CVST affects 3-4 cases per 1 million overall and 7 cases per 1 million children and neonates. Typical clinical symptoms include headache, visual deficits and seizures. Beside the main condition associated with CVST in women in pregnancy and puerperium, the most frequently identified risk factors are oral hormonal contraceptives in combination with coagulation disorders. The initial treatment contains heparin and its efficacy is based on two randomized placebo-controlled trials including 79 patients together. A lack of understanding of the pathophysiology of CSVT makes animal models of this disease indispensable. Previously developed animal models of sinus sagittalis superior contributes to further clarify the pathophysiologic mechanisms and surrounding circumstances in the topic of cerebral venous thrombosis.

  1. Ten years of cerebral venous thrombosis: male gender and myeloproliferative neoplasm is associated with thrombotic recurrence in unprovoked events.

    PubMed

    Lim, H Y; Ng, C; Donnan, G; Nandurkar, H; Ho, Prahlad

    2016-10-01

    Cerebral venous thrombosis (CVT) is a rare venous thrombotic event. We review our local experience in the management of CVT in comparison to other venous thromboembolism (VTE) with specific focus on risk factors for thrombotic recurrence. Retrospective evaluation of consecutive CVT presentations from January 2005 to June 2015, at two major tertiary hospitals in Northeast Melbourne, Australia. This population was compared to a separate audit of 1003 consecutive patients with DVT and PE. Fifty-two patients (30 female, 22 male) with a median age of 40 (18-83) years, presented with 53 episodes of CVT. Twenty-nine episodes (55 %) were associated with an underlying risk factor, with hormonal risk factors in females being most common. The median duration of anticoagulation was 6 months with 11 receiving life-long anticoagulation. Eighty-one percent had residual thrombosis on repeat imaging, which was not associated with recurrence at the same or distant site. Nine (17 %) had CVT-related haemorrhagic transformation with two resultant CVT-related deaths (RR 22.5; p = 0.04). All three VTE recurrences occured in males with unprovoked events (RR 18.2; p = 0.05) who were subsequently diagnosed with myeloproliferative neoplasm (MPN). Compared to the non-cancer VTE population, non-cancer CVT patients were younger, had similar rate of provoked events and VTE recurrence, although with significantly higher rate of MPN diagnosis (RR 9.30 (2.29-37.76); p = 0.002) CVT is a rare thrombotic disorder. All recurrences in this audit occurred in male patients with unprovoked events and subsequent diagnosis of MPN, suggesting further evaluation for MPN may be warranted in patients with unprovoked CVT.

  2. Cerebral hemodynamic disturbance in dural arteriovenous fistula with retrograde leptomeningeal venous drainage: a prospective study using (123)I-iodoamphetamine single photon emission computed tomography.

    PubMed

    Kanemaru, Kazuya; Kinouchi, Hiroyuki; Yoshioka, Hideyuki; Yagi, Takashi; Wakai, Takuma; Hashimoto, Koji; Fukumoto, Yuichiro; Umeda, Takako; Onishi, Hiroshi; Nishiyama, Yoshihisa; Horikoshi, Toru

    2015-07-01

    The severity of cerebral hemodynamic disturbance caused by retrograde leptomeningeal venous drainage (RLVD) of a dural arteriovenous fistula (dAVF) is related to neurological morbidity and unfavorable outcome. However, the cerebral hemodynamics of this disorder have not been elucidated well. The aim of this study was to assess the relationship between the cerebral venous congestive encephalopathy represented as a high-intensity area (HIA) on T2-weighted MR images and the cerebral hemodynamics examined by (123)I-iodoamphetamine (IMP) single photon emission computed tomography (SPECT), as well as the predictive value of (123)I-IMP SPECT for the development and reversibility of venous congestion encephalopathy. Based on the pre- and posttreatment T2 HIAs associated with venous congestion encephalopathy, patients were divided into 3 groups: a normal group, an edema group, and an infarction group. The regional cerebral blood flow (rCBF) at the region with RLVD was analyzed by (123)I-IMP SPECT, and the results were compared among the groups. There were 11, 6, and 3 patients in the normal, edema, and infarction groups, respectively. No patients in the normal group showed any symptoms related to venous congestion. In contrast, all patients in the edema and infarction groups developed neurological symptoms. The rCBF in the edema group was significantly lower than that in the normal group, and significantly higher than that in the infarction group. The cerebral vascular reactivity (CVR) of the infarction group was significantly lower than that of the normal and edema groups. After treatment, the neurological signs disappeared in the edema group, but only partial improvement was seen in the infarction group. The rCBF also significantly increased in the normal and edema groups, but not in the infarction group. Quantitative rCBF measurement is useful for evaluating hemodynamic disturbance in dAVF with RLVD. The reduction of rCBF was strongly correlated with the severity of

  3. Innervation of the cerebral veins as compared with the cerebral arteries: a histochemical and electron microscopic study.

    PubMed

    Nakakita, K; Imai, H; Kamei, I; Naka, Y; Nakai, K; Itakura, T; Komai, N

    1983-03-01

    The distribution of nerve fibers in the cerebral veins was studied by catecholamine fluorescence simultaneously with acetylcholinesterase (AChE) histochemistry. A comparison of nerve fibers in the cerebral arteries was made. The ultrastructure of terminal boutons in the veins fixed with potassium permanganate was also studied. In the adventitia of the cerebral artery, green fluorescent aminergic fibers and brownish AChE-reactive (probably cholinergic) fibers were observed. In contrast, the cerebral venous system showed no AChE-positive fibers. Catecholamine fluorescent varicose fibers were detected in the dural sinus, the internal cerebral vein, and the superficial vein of Labbé. The highest density of aminergic fibers was found in the dural sinus and the second highest in the internal cerebral vein. Most of the terminal boutons in the adventitia of the cerebral veins were found adjacent to a muscle-like cell and showed only cored vesicles under electron microscopy. Results of our study suggest that the cerebral venous system has a neurogenic innervation, mainly from aminergic fibers, which is different from the neurogenic supply to the cerebral arterial system.

  4. Modeling modulation of intracranial pressure by variation of cerebral venous resistance induced by ventilation.

    PubMed

    Pasley, Richard L; Leffler, Charles W; Daley, Michael L

    2003-11-01

    To test, theoretically, the hypothesis that: (1) cyclic extravascular compressional modulation of the terminal venous bed occurs with positive pressure inhalation; and (2) the degree of modulation is diminished with increasing vascular dilation induced by increasing the level of the partial pressure of arterial blood carbon dioxide (PCO2), two modifications of Ursino's model of cerebrospinal fluid dynamics were made: (1) terminal venous bed resistance was synchronously modulated with the ventilation cycle; and (2) both the depth of modulation and cerebrovascular resistance were progressively reduced with increasing levels of PCO2. Recordings of intracranial pressure (ICP) and arterial blood pressure of piglets were obtained and correlated at different levels of hypercapnia. Simulated and experimental correlation values progressively increased monotonically as the level of PCO2 increased. Group (n = 4) mean values of correlation (+/- standard deviation) were 0.54 (+/- 0.17), 0.61 (+/- 0.08), 0.79 (+/- 0.06), 0.86 (+/- 0.04), 0.87 (+/- 0.05) for respective mean PCO2 levels (+/- standard deviation) of 32.9 (+/- 1.75), 41.4 (+/- 2.5), 55.9 (+/- 4.0), 72.5 (+/- 6.45), and 87.4 (+/- 7.25) mmHg. These results support the stated premise that dilation of the cerebrovasculature reduces the influence of positive pressure ventilation on the ICP recording by increasing the venous pressure and thus diminishing the likelihood of vascular compression.

  5. [Progressive Intracranial Hypertension due to Superior Sagittal Sinus Thrombosis Following Mild Head Trauma: A Case Report].

    PubMed

    Suto, Yuta; Maruya, Jun; Watanabe, Jun; Nishimaki, Keiichi

    2015-07-01

    Cerebral venous sinus thrombosis after mild head trauma without skull fracture or intracranial hematoma is exceptionally rare. We describe an unusual case of progressive intracranial hypertension due to superior sagittal sinus thrombosis following mild head trauma. A 17-year-old boy presented with nape pain a day after a head blow during a gymnastics competition (backward double somersault). On admission, he showed no neurological deficit. CT scans revealed no skull fractures, and there were no abnormalities in the brain parenchyma. However, his headache worsened day-by-day and he had begun to vomit. Lumbar puncture was performed on Day 6, and the opening pressure was 40 cm of water. After tapping 20 mL, he felt better and the headache diminished for a few hours. MR venography performed on Day 8 revealed severe flow disturbance in the posterior third of the superior sagittal sinus with multiple venous collaterals. Because of the beneficial effects of lumbar puncture, we decided to manage his symptoms of intracranial hypertension conservatively with repeated lumbar puncture and administration of glycerol. After 7 days of conservative treatment, his symptoms resolved completely, and he was discharged from the hospital. Follow-up MR venography performed on Day 55 showed complete recanalization of the superior sagittal sinus. The exact mechanism of sinus thrombosis in this case is not clear, but we speculate that endothelial damage caused by shearing stress because of strong rotational acceleration or direct impact to the superior sagittal sinus wall may have initiated thrombus formation.

  6. [Neonatal cerebral thrombosis and deficit of factor V leiden].

    PubMed

    Moliner Calderón, E; López Bernal, E; Ginovart Galiana, G; Nadal Amat, J; Cubells Riero, J

    2000-01-01

    Background Cerebral venous thrombosis is an inusual disease in neonatal age. Increasing reports of this disorder had described since magnetic resonance angiography is used. Case report Newborn of apropriate seze for gestational age was delivered at 35 weeks of gestation. Refered a severe hipoxic-isquemic disease with multisistemic afectation. The second day of life presented disseminated intravascular coagulation with pulmonary bleeding. The third day, the infant developed seizures that required treatment with diazepam in continuous perfussion. MR angiography visualized superior sagital and transvers sinus thrombosis. Coagulation study detected factor V Leiden. Comments Frecuently venous cerebral thrombosis is presenting with lethargy and seizures. The most common vessels involved are sagital and transvers sinus. It is described in association with exogenous risk factors that increasing blood hyperviscosity and additional inhered coagulation dissorders such as defects on antihrombina III, protein C and S and activate protein C resistance. The last defect has a hight prevalence in subjects with trombosis events.

  7. Cortical venous thrombosis following exogenous androgen use for bodybuilding.

    PubMed

    Sveinsson, Olafur; Herrman, Lars

    2013-02-05

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic-clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully.

  8. Cortical venous thrombosis following exogenous androgen use for bodybuilding

    PubMed Central

    Sveinsson, Olafur; Herrman, Lars

    2013-01-01

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic–clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully. PMID:23389726

  9. A case-series study of cerebral venous thrombosis in women using short course oral contraceptive

    PubMed Central

    Khomand, Payam; Hassanzadeh, Kambiz

    2016-01-01

    Background: We report a case series of cerebral vein thrombosis (CVT) in women who used oral contraceptive pill (OCP) in the Muslims Ramadan and fasting month. Methods: This study was a retrospective case series of 9 patients with diagnosis of CVT, who admitted in the neurology ward of Tohid Hospital of Sanandaj, Iran, in July-August 2014-2015. Results: Patients had no history of thrombosis before. They were treated with oral contraceptive more than 1 month to be able to fast during Ramadan. They did not have other possible risk factors for CVT. A headache was the most common in 9/9 patients (100%) followed by vomiting and vertigo. Conclusion: We found that high rate of CVT in female population during Ramadan indicates that it needs be considered as a specific risk factor and should be considered by healthcare system. PMID:27326364

  10. The Management of Symptomatic Cerebral Developmental Venous Anomalies: A Clinical Experience of 43 Cases

    PubMed Central

    Yu, Xin-guang; Wu, Chen; Zhang, Hui; Sun, Zheng-hui; Cui, Zhi-qiang

    2016-01-01

    Background Developmental venous anomalies (DVAs) are rare vascular diseases becoming more frequently diagnosed. Most patients with DVAs have no clinical symptoms with the exception of a few patients with epilepsy, intracranial hemorrhage, or neuro-function deficit. There is still controversy with respect to treatment strategies for symptomatic DVAs. Material/Methods Forty-three cases of symptomatic DVAs from January 2006 to October 2015 were retrospectively reviewed and the imaging characteristics of DVAs by CT, MRI, and DSA and the treatment modalities for DVAs were studied. Results Typical imaging characteristics of symptomatic DVAs were wedge or umbrella-shaped collections of dilated medullary veins converging in an enlarged subependymal or transcortical collecting vein, draining to the superficial or deep vein system. Based on location and draining vein features, symptomatic DVAs were tentatively classified into six different subtypes. Of the 43 cases, 19 were treated by surgical methods and 24 were treated conservatively. Conclusions We concluded that the rate of accompanying abnormalities in cases of symptomatic DVAs was high. Intracerebral hemorrhage was usually attributed to associated CMs or AVMs. The associated lesions and the branches responsible for bleeding could be resected while preserving the collecting vein as far as possible. PMID:27815963

  11. The effects of arterial carbon dioxide partial pressure and sevoflurane on capillary venous cerebral blood flow and oxygen saturation during craniotomy.

    PubMed

    Klein, Klaus Ulrich; Glaser, Martin; Reisch, Robert; Tresch, Achim; Werner, Christian; Engelhard, Kristin

    2009-07-01

    Intraoperative routine monitoring of cerebral blood flow and oxygenation remains a technological challenge. Using the physiological principle of carbon dioxide reactivity of cerebral vasculature, we investigated a recently developed neuromonitoring device (oxygen-to-see, O2C device) for simultaneous measurements of regional cerebral blood flow (rvCBF), blood flow velocity (rvVelo), oxygen saturation (srvO2), and hemoglobin amount (rvHb) at the capillary venous level in patients subjected to craniotomy. Twenty-six neurosurgical patients were randomly assigned to anesthesia with 1.4% or 2.0% sevoflurane end-tidal concentration. After craniotomy, a fiberoptic probe was applied on a macroscopically healthy surface of cerebral tissue next to the site of surgery. Simultaneous measurements in 2 and 8 mm cerebral depth were performed in each patient during lower (35 mm Hg) and higher (45 mm Hg) levels (random order) of arterial carbon dioxide partial pressure (PaCO2). The principle of these measurements relies on the combination of laser-Doppler flowmetry (rvCBF, rvVelo) and photo-spectrometry (srvO2, rvHb). Linear models were fitted to test changes of end points (rvCBF, rvVelo, srvO2, rvHb) in response to lower and higher levels of PaCO2, 1.4% and 2.0% sevoflurane end-tidal concentration, and 2 and 8 mm cerebral depth. RvCBF and rvVelo were elevated by PaCO2 independent of sevoflurane concentration in 2 and 8 mm depth of cerebral tissue (P < 0.001). Higher PaCO2 induced an increase in mean srvO2 from 50% to 68% (P < 0.001). RvVelo (P < 0.001) and srvO2 (P = 0.007) were higher in 8 compared with 2 mm cerebral depth. RvHb was not influenced by alterations in PaCO2 but positively correlated to sevoflurane concentration (P = 0.005). Increases in rvCBF and rvVelo by PaCO2 suggest preserved hypercapnic vasodilation under anesthesia with sevoflurane 1.4% and 2.0% end-tidal concentration. A consecutive increase in srvO2 implies that cerebral arteriovenous difference in oxygen was

  12. [Clinical and therapeutic heterogeneity of cerebral venous thrombosis: a description of a series of 20 cases].

    PubMed

    Flores-Barragán, J M; Hernández-González, A; Gallardo-Alcañiz, M J; del Real-Francia, M A; Vaamonde-Gamo, J

    Current neuro-radiological techniques have led to a more frequent diagnosis of cerebral vein thrombosis (CVT), and revealed its greater clinical heterogeneity. To analize the characteristics of the cases with the diagnosis of CVT in our unit between 1996 and 2008. We describe 20 cases of CVT (14 women and 6 men), with ages of 22 to 75 years. Headache was the most frequent symptom, followed by intracranial hypertension, disorders of consciousness and focal deficits. Unusual presentations included transitory ischemia and progressive optical neuropathy. Subacute and chronic courses were more frequent than acute. The etiology was diverse including puerperium, contraception, hyperthyroidism, meningitis, Leiden V factor mutation, multiple myeloma, Crohn, ulcerative colitis, meningioma and epidural anesthesia. No cause was found in 8 cases. Magnetic resonance imaging was always diagnostic. Patients were anticoagulated during the acute phase. In subacute or chronic presentations, a more conservative treatment was considered on individual basis. Only 6 patients had mild sequelae. We report a great variety of etiologies and patterns of presentation of CVT. CVT should be suspected in patients with subacute headache, even in outpatients. Nonacute presentation with isolated headache or intracranial hypertension could have better prognosis, requiring a less aggressive therapy.

  13. An experimental study on laser-induced suturing of venous grafts in cerebral revascularization surgery

    NASA Astrophysics Data System (ADS)

    Puca, Alfredo; Albanese, Alessio; Esposito, Giuseppe; Maira, Giulio; Rossi, Giacomo; Pini, Roberto

    2005-04-01

    To test laser-assisted high flow bypass in cerebral revascularization procedures, we set up an experimental model on rabbits which included harvesting a jugular vein graft and its implantation on the common carotid artery through a double end-to-side anastomosis. The study was carried out on 25 New Zealand rabbits by performing on each animal the proximal anastomosis using conventional suturing, while the distal one was obtained by means of low-power diode laser welding in association with the topical application of Indocyanine Green (ICG) solution to enhance local absorption of the laser light. After the procedure, the animals were subjected to a follow-up from 2 to 9 days. Bypass patency was evaluated by means of Doppler study. The vascular segments were excised and evaluated by histological and immunohistochemical examinations. Utilization of the diode laser was associated with a substantial shortening of the operative time, as well as with a more active endothelial regeneration process at the anastomotic site.

  14. Sinus Surgery

    MedlinePlus

    ... use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an ...

  15. Effect of ethanol on cerebral blood flow (CBF) and metabolism (CMRO2) in conscious sheep

    SciTech Connect

    Krasney, J.A.; Zubkov, B.; Iwamoto, J. )

    1991-03-11

    A moderate dose of ethanol severely depresses CBF and CMRO2 in the awake sheep fetus. However, the effects of ethanol on CBF and CMRO2 in the adult are unclear. The same dose of ethanol was infused for 2 hr in 5 ewes instrumented with aortic, left ventricular and sagittal sinus catheters. Ethanol caused ataxia accompanied by early modest and variable increases of total and regional CBF and CMRO2, followed by later modest and variable decreases of total and regional CBF (cerebellum) and CMRO2. Ethanol caused a cerebral transcapillary fluid shift as indicated by significant increases of the arterial-cerebral venous differences for hematocrit and hemoglobin. Brain wet-dry ratios increased by 10% above control levels. However, cerebral venous pressures were unchanged. The authors conclude that the adult cerebral response to ethanol differs quantitatively from that of the fetus. The functional significance of the cerebral fluid shift is unclear.

  16. The association between cerebral developmental venous anomaly and concomitant cavernous malformation: an observational study using magnetic resonance imaging.

    PubMed

    Meng, Guolu; Bai, Chuanfeng; Yu, Tengfei; Wu, Zhen; Liu, Xing; Zhang, Junting; zhao, Jizong

    2014-03-15

    Some studies reported that cerebral developmental venous anomaly (DVA) is often concurrent with cavernous malformation (CM). But there is lack of statistical evidence and study of bulk cases. The factors associated with concurrency are still unknown. The purpose of this study was to determine the prevalence of concomitant DVA and CM using observational data on Chinese patients and analyze the factors associated with the concurrency. The records of all cranial magnetic resonance imaging (MRI) performed between January 2001 and December 2012 in Beijing Tiantan Hospital were reviewed retrospectively. The DVA and CM cases were selected according to imaging reports that met diagnostic criteria. Statistical analysis was performed using the Pearson chi-square statistic for binary variables and multivariable logistic regression analysis for predictors associated with the concurrent CM. We reviewed a total of 165,230 cranial MR images performed during the previous 12 year period, and identified 1,839 cases that met DVA radiographic criteria. There were 205 patients who presented concomitant CM among the 1,839 DVAs. The CM prevalence in DVA cases (11.1%) was significantly higher than that in the non-DVA cases (2.3%) (P<0.01). In the multivariate analysis, we found that DVAs with three or more medullary veins in the same MRI section (adjusted OR = 2.37, 95% CI: 1.73-3.24), infratentorial DVAs (adjusted OR = 1.71, 95% CI: 1.26-2.33) and multiple DVAs (adjusted OR = 2.08, 95% CI: 1.04-4.16) have a higher likelihood of being concomitant with CM. CM are prone to coexisting with DVA. There is a higher chance of concurrent CM with DVA when the DVA has three or more medullary veins in the same MRI scanning section, when the DVA is infratentorial, and when there are multiple DVAs. When diagnosing DVA cases, physicians should be alerted to the possibility of concurrent CM.

  17. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology.

    PubMed

    Ferro, J M; Bousser, M-G; Canhão, P; Coutinho, J M; Crassard, I; Dentali, F; di Minno, M; Maino, A; Martinelli, I; Masuhr, F; Aguiar de Sousa, D; Stam, J

    2017-10-01

    Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence-based methodology. We followed the Grading of Recommendations, Assessment, Development and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews and writing recommendations based on the quality of available scientific evidence. We suggest using magnetic resonance or computed tomographic angiography for confirming the diagnosis of CVT and not routinely screening patients with CVT for thrombophilia or cancer. We recommend parenteral anticoagulation in acute CVT and decompressive surgery to prevent death due to brain herniation. We suggest preferentially using low-molecular-weight heparin in the acute phase and not direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that, in women who have suffered a previous CVT, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular-weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT. © 2017 EAN.

  18. Fatal cerebral air embolism following endoscopic evaluation of rectal stump

    PubMed Central

    Baban, Chwanrow Karim; Murphy, Michael; Hennessy, Tony; O'Hanlon, Deirdre

    2013-01-01

    A 63-year-old man underwent endoscopic evaluation of the rectal stump for rectal bleeding and suffered a massive cerebral air embolism with severe neurological impairment and subsequent death. The patient underwent a Hartmann's procedure 9 month previously for ischaemic bowel and was noted to have portal hypertension at laparotomy. We hypothesise that air entered the venous plexus around rectum and entered the azygos vein via a porto-systemic shunt and travelled retrogradely via the superior vena cava to the venous sinuses of the brain. PMID:23704447

  19. COMMUNITY ACQUIRED METHICILLIN SENSITIVE STAPHYLOCCUS AUREUS CEREBRAL ABSCESS IN A PREVIOUSLY HEALTH GENTLEMAN MIMICKING SIGNS OF CAVERNOUS SINUS THROMBOSIS-A UNIQUE PRESENTATION.

    PubMed

    Aijazi, Ishma; Abdulla, Fadhil M; Ibrahim, Ahmad Elbagir

    2015-01-01

    Central Nervous System (CNS) infections like meningitis and cerebral abscess caused by Staphylococcus aureus are usually seen in patients with neurosurgical interventions or immune compromised patients or patients with cardiac vegetation's. They are extremely rare in healthy patients. We report a case of a 44 year old Indian gentleman who was perfectly healthy with no known co morbidities, which presented with fever, neck stiffness and altered mental status. He had fulminant staph bacteraemia (as evidenced by persistently positive blood cultures) with meningitis and cerebral abscess. Extensive search was made to find the source of infection, but it was inconclusive. Isolated CNS Methicillin Sensitive Staphylococcus aureus (MSSA) infection in an apparently healthy patient is very rare. This gentleman presented with altered mental status, asymmetrical exophthalmos and multiple cranial nerve palsies. This case highlights the challenge of making early diagnoses of a brain abscess; since it has symptomology mimicking cavernous sinus thrombosis .This is due to the involvement of the cerebellopontine angle and extensive brain oedema and oedema of the retro bulbar tissues.

  20. Neuroimaging patterns of cerebral hyperperfusion

    NASA Astrophysics Data System (ADS)

    Semenov, S.; Portnov, Yu; Semenov, A.; Korotkevich, A.; Kokov, A.

    2017-08-01

    Cerebral hyperperfusion syndrome (CHS) after revascularization is a rare phenomenon associated with post-ischemic (reactive) hyperemia and acute pathological hyperperfusion. First described on perfusion CT as a very often moderate CBF increase, MTT/TTP decrease within 30% like a temporary effect, according to a short-time deterioration of neurological symptoms (vestibular ataxia - 58%, vegetative dysfunction - 100%, asthenic syndrome - 100%) in early postoperative period in patients with cardiac ischemia who had undergone coronary artery bypass surgery. The acute pathological hyperperfusion carotid revascularization is a casuistic phenomenon with two- or three-fold CBV and MTT/TTP increase and high hemorrhage risk. Besides, we detected similar exchanges via perfusion CT called benign hyperemia, which marks extension of MTT/TTP and an increase of CBV from 27% to 48% (average 30%), but with normal CBF-parameters, indicating that venous stasis in acute venous ischemic stroke due cerebral venous sinus-trombosis (68%), only 6% in cardioembolic stroke and appears never in arterial stroke. Territorial coincidence registered for perifocal of necrosis zones of benign hyperemia and vasogenic edema accompanied on MRI (DWI, ADC). Secondary hemorrhagic transformation registered for primary non-hemorrhagic venous stroke in 27%, only in 9% for arterial stroke and in 60% for cardioembolic stroke. Probably, congestion is an increasingly predisposing factor secondary hemorrhaging than necrosis.

  1. Disturbance in venous outflow from the cerebral circulation intensifies the release of blood-brain barrier injury biomarkers in patients undergoing cardiac surgery.

    PubMed

    Kotlinska-Hasiec, Edyta; Czajkowski, Marek; Rzecki, Ziemowit; Stadnik, Adam; Olszewski, Krysztof; Rybojad, Beata; Dabrowski, Wojciech

    2014-04-01

    Disturbances in venous outflow from the cerebral circulation may result in brain injury. Severe increases in brain venous pressure lead to brain ischemia and, subsequently, brain edema and intracranial hemorrhages. The purpose of this study was to determine the effect of changes in jugular venous bulb pressure (JVBP) on plasma blood brain-barrier biomarkers concentration and disturbances in arteriovenous total and ionized magnesium (a-vtMg and a-viMg) in brain circulation in patients undergoing coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB). Prospective observational study. Department of Cardiac Surgery at a Medical University Hospital. Ninety-two adult patients undergoing elective CABG with CPB under general anaesthesia were studied. Central venous pressure (CVP) was measured using a pulmonary artery catheter. The right jugular vein was cannulized retrogradely for jugular venous bulb pressure (JVBP) measurement. Concentrations of plasma S100β protein, matrix metalloproteinase 9 (MMP-9), creatine kinase isoenzyme BB (CK-BB) a-vtMg and a-viMg were measured as the markers of blood-brain barrier dysfunction. All of them were analyzed in comparison with JVBP during surgery and the early postoperative period. Elevated JVBP was noted after CPB and after surgery. Its increase above 12 mmHg intensified release of S100β, MMP-9 and CK-BB as well as disorders in a-vtMg and a-viMg. CVP correlated with JVBP, S100β, and MMP-9. Moreover, JVBP correlated with S100β and MMP-9. Cardiac surgery increased JVBP, and JVBP elevated above 12 mmHg intensified an increase in biomarkers of plasma blood-brain barrier disruption. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Effects of Hypothermic Cardiopulmonary Bypass on Internal Jugular Bulb Venous Oxygen Saturation, Cerebral Oxygen Saturation, and Bispectral Index in Pediatric Patients Undergoing Cardiac Surgery: A Prospective Study.

    PubMed

    Hu, Zhiyong; Xu, Lili; Zhu, Zhirui; Seal, Robert; McQuillan, Patrick M

    2016-01-01

    The objective of this study was to evaluate the effect of hypothermic cardiopulmonary bypass (CPB) on cerebral oxygen saturation (rSO2), internal jugular bulb venous oxygen saturation (SjvO2), mixed venous oxygen saturation (SvO2), and bispectral index (BIS) used to monitor cerebral oxygen balance in pediatric patients.Sixty American Society of Anesthesiologists Class II-III patients aged 1 to 4 years old with congenital heart disease scheduled for elective cardiac surgery were included in this study. Temperature, BIS, rSO2, mean arterial pressure, central venous pressure, cerebral perfusion pressure (CPP), and hematocrit were recorded. Internal jugular bulb venous oxygen saturation and SvO2 were obtained from blood gas analysis at the time points: after induction of anesthesia (T0), beginning of CPB (T1), ascending aortic occlusion (T2), 20 minutes after initiating CPB (T3), coronary reperfusion (T4), separation from CPB (T5), and at the end of operation (T6). The effect of hypothermia or changes in CPP on rSO2, SjvO2, SvO2, and BIS were analyzed.Compared with postinduction baseline values, rSO2 significantly decreased at all-time points: onset of extracorporeal circulation, ascending aortic occlusion, 20 minutes after CPB initiation, coronary reperfusion, and separation from CPB (P < 0.05). Compared with measurements made following induction of anesthesia, SjvO2 significantly increased with initiation of CPB, ascending aortic occlusion, 20 minutes after initiating CPB, coronary reperfusion, and separation from CPB (P < 0.05). Compared with induction of anesthesia, BIS significantly decreased with the onset of CPB, aortic cross clamping, 20 minutes after initiating CPB, and coronary reperfusion (P < 0.05). Bispectral index increased following separation from CPB. There was no significant change in SvO2 during cardiopulmonary bypass (P > 0.05). Correlation analysis demonstrated that rSO2 was positively related to CPP (r = 0.687, P = 0

  3. How Relevant Is Occlusion of Associated Developmental Venous Anomaly in Cerebral Cavernoma Surgery? A Clinical and Radiographic Comparison Study.

    PubMed

    Tantongtip, Dilok; Spetzger, Uwe; Arnold, Sebastian; von Schilling, Andrej; Kiriyanthan, George

    2016-03-01

    A developmental venous anomaly (DVA) associated with cerebral cavernous malformation (CCM) is the most common combined vascular malformation. Microsurgical resection of the CCM and avoidance of damage to the adjacent DVA is an overall accepted treatment regimen. Several publications have demonstrated serious consequences that possibly occur after damage of the associated DVA. Conversely, some authors have reported cases of injured DVAs without any relevant postoperative complications. This study compared the clinical and radiologic outcome in patients with and without occlusion of an associated DVA, following microsurgical removal of intracerebral cavernomas. In this single-center evaluation, all consecutive CCM surgical patients from January 1, 2006, to December 31, 2011, were reviewed in a retrospective cohort study. Follow-up was from 12 months to 7 years. The patients were divided into three groups: group I, CCM without associated DVA; group II, damage and occlusion of the associated DVA during CCM removal; and group III, preservation of the associated DVA following CCM removal. Preservation and damage, respectively, of the DVA were defined by evaluation of the corresponding pre- and postoperative magnetic resonance (MR) image sequences. The clinical and radiographic findings in all three groups were evaluated and compared. A total of 38 patients underwent microsurgical resection of a CCM. Overall, 24 patients (63%) had no associated DVA (group I), in 10 patients (26%) the associated DVA was impaired and occluded (group II), and in 4 patients (11%) the associated DVA was surgically not impaired and confirmed as preserved (group III). The rate of postoperative neurologic deficits was 37.5% in group I, 10% in group II, and 75% in group III (p = 0.05). Subgroup analysis in patients with preserved DVA (group III) showed a higher incidence of new postoperative neurologic deficits than in patients with impaired DVA (group II) (p = 0.041). However, no

  4. Sinus Venosus Atrial Septal Defect

    DTIC Science & Technology

    2010-04-01

    chest CT was performed to evaluate for pulmonary embolism (figure 2). The chest radiograph (figure 1) demonstrates increased central pulmonary ...Fig. 5 Sinus venosus defect at birth . The shaded area in purple represents the sinus venosum. The anomalous right pulmonary venous anatomy...department (ED) with chest pain and an ankle fracture after being hit by a car while riding a horse. Chest imaging noted enlarged central pulmonary

  5. The association between cerebral developmental venous anomaly and concomitant cavernous malformation: an observational study using magnetic resonance imaging

    PubMed Central

    2014-01-01

    Background Some studies reported that cerebral developmental venous anomaly (DVA) is often concurrent with cavernous malformation (CM). But there is lack of statistical evidence and study of bulk cases. The factors associated with concurrency are still unknown. The purpose of this study was to determine the prevalence of concomitant DVA and CM using observational data on Chinese patients and analyze the factors associated with the concurrency. Methods The records of all cranial magnetic resonance imaging (MRI) performed between January 2001 and December 2012 in Beijing Tiantan Hospital were reviewed retrospectively. The DVA and CM cases were selected according to imaging reports that met diagnostic criteria. Statistical analysis was performed using the Pearson chi-square statistic for binary variables and multivariable logistic regression analysis for predictors associated with the concurrent CM. Results We reviewed a total of 165,230 cranial MR images performed during the previous 12 year period, and identified 1,839 cases that met DVA radiographic criteria. There were 205 patients who presented concomitant CM among the 1,839 DVAs. The CM prevalence in DVA cases (11.1%) was significantly higher than that in the non-DVA cases (2.3%) (P<0.01). In the multivariate analysis, we found that DVAs with three or more medullary veins in the same MRI section (adjusted OR = 2.37, 95% CI: 1.73-3.24), infratentorial DVAs (adjusted OR = 1.71, 95% CI: 1.26-2.33) and multiple DVAs (adjusted OR = 2.08, 95% CI: 1.04-4.16) have a higher likelihood of being concomitant with CM. Conclusions CM are prone to coexisting with DVA. There is a higher chance of concurrent CM with DVA when the DVA has three or more medullary veins in the same MRI scanning section, when the DVA is infratentorial, and when there are multiple DVAs. When diagnosing DVA cases, physicians should be alerted to the possibility of concurrent CM. PMID:24628866

  6. Cerebral infarction and femoral venous thrombosis detected in a patient with diabetic ketoacidosis and heterozygous factor V Leiden G1691A and PAI-1 4G/5G mutations.

    PubMed

    Yaroglu Kazanci, Selcen; Yesilbas, Osman; Ersoy, Melike; Kihtir, Hasan Serdar; Yildirim, Hamdi Murat; Sevketoglu, Esra

    2015-09-01

    Cerebral infarction is one of the serious neurological complications of diabetic ketoacidosis (DKA). Especially in patients who are genetically prone to thrombosis, cerebral infarction may develop due to inflammation, dehydration, and hyperviscocity secondary to DKA. A 6-year-old child with DKA is diagnosed with cerebral infarction after respiratory insufficiency, convulsion, and altered level of consciousness. Femoral and external iliac venous thrombosis also developed in a few hours after central femoral catheter had been inserted. Heterozygous type of factor V Leiden and PAI-14G/5G mutation were detected. In patients with DKA, cerebral infarction may be suspected other than cerebral edema when altered level of consciousness, convulsion, and respiratory insufficiency develop and once cerebral infarction occurs the patients should also be evaluated for factor V Leiden and PAI-14G/5G mutation analysis in addition to the other prothrombotic risk factors.

  7. Surgical management of dural arteriovenous fistulas of the transverse-sigmoid sinus in 42 patients.

    PubMed

    Eftekhar, Behzad; Morgan, Michael Kerin

    2013-04-01

    A retrospective study was performed to analyse a prospectively collected database from a single surgeon (M.K.M.) of transverse-sigmoid sinus dural arteriovenous fistulas (DAVF) between 1991 and August 2011. During the study period, 144 patients with 160 DAVF were managed. Sixty-five of the DAVF were located in the transverse-sigmoid sinus and 42 were treated with surgery, or embolisation and surgery. All patients who underwent surgery were symptomatic with retrograde cortical venous drainage. The average follow-up period was 18months (range, 2-82months). Total elimination of the DAVF was achieved in all instances, including two patients (5%) who required further surgery after postoperative cerebral angiography showed that some venous drainage had persisted after the first operation. There was no new permanent neurological deficit or mortality attributable to surgery. Our institutional experience shows that in selected patients with transverse-sigmoid sinus DAVF, the involved sinus can be surgically resected with a high success rate and it is as safe as many alternative options. We suggest that this definitive treatment option should be offered to patients, and the outcome should be compared to other treatment modalities.

  8. Cortical Venous Filling on Dynamic Computed Tomographic Angiography: A Novel Predictor of Clinical Outcome in Patients With Acute Middle Cerebral Artery Stroke.

    PubMed

    van den Wijngaard, Ido R; Wermer, Marieke J H; Boiten, Jelis; Algra, Ale; Holswilder, Ghislaine; Meijer, Frederick J A; Dippel, Diederik W J; Velthuis, Birgitta K; Majoie, Charles B L M; van Walderveen, Marianne A A

    2016-03-01

    Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome. Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT and whole-brain CT perfusion/dynamic CT angiography within 9 hours after stroke-onset. We defined poor outcome as a modified Rankin Scale score of ≥3. Association between the extent and velocity of CVF and poor outcome at 3 months was analyzed with Poisson-regression. Prognostic value of optimal CVF (maximum opacification of cortical veins) in addition to age, stroke severity, treatment, Alberta Stroke Program Early CT score, cerebral blood flow, and collateral status was assessed with logistic regression and summarized with the area under the curve. Eighty-eight patients were included, with a mean age of 67 years. By combining the extent and velocity of optimal CVF, we observed a decreased risk of poor outcome in patients with good and fast optimal CVF, risk ratio of 0.5 (95% confidence interval, 0.3-0.7). Extent and velocity of optimal CVF had additional prognostic value (area under the curve, 0.88; 95% confidence interval, 0.77-0.98; P<0.02) compared with a model without CVF information. The combination of extent and velocity of optimal CVF, as assessed with dynamic CT angiography, is useful to identify patients with acute middle cerebral artery stroke at higher risk of poor clinical outcome at 3-month follow-up. URL: http://www.trialregister.nl/trialreg and http://www.clinicaltrials.gov. Unique identifier: NTR1804 and NCT00880113, respectively. © 2016 American Heart Association, Inc.

  9. Correlation of brain tissue oxygen tension with cerebral near-infrared spectroscopy and mixed venous oxygen saturation during extracorporeal membrane oxygenation.

    PubMed

    Tyree, Kreangkai; Tyree, Melissa; DiGeronimo, Robert

    2009-09-01

    The aim of this prospective, animal study was to compare brain tissue oxygen tension (PbtO(2)) with cerebral near infrared spectroscopy (NIRS) and mixed venous oxygen saturation (SVO(2)) during venoarterial extracorporeal membrane oxygenation (VA ECMO) in a porcine model. This was accomplished using twelve immature piglets with surgically implanted catheters placed in the superficial cerebral cortex to measure brain PbtO(2) and microdialysis metabolites. The NIRS sensor was placed overlying the forehead to measure cerebral regional saturation index (rSO(2)i) while SVO(2) was measured directly from the ECMO circuit. Animals were placed on VA ECMO followed by an initial period of stabilization, after which they were subjected to graded hypoxia and recovery. Our results revealed that rSO(2)i and SVO(2) correlated only marginally with PbtO(2) (R(2)=0.32 and R(2)=0.26, respectively) while the correlation between rSO(2)i and SVO( 2) was significantly stronger (R(2)=0.59). Cerebral metabolites and rSO(2)i were significantly altered during attenuation of PbtO( 2), p<0.05). A subset of animals, following exposure to hypoxia, experienced markedly delayed recovery of both rSO(2)i and PbtO( 2) despite rapid normalization of SVO(2). Upon further analysis, these animals had significantly lower blood pressure (p=0.001), lower serum pH (p=0.01), and higher serum lactate (p=0.02). Additionally, in this subgroup, rSO(2)i correlated better with PbtO(2) (R(2)=0.76). These findings suggest that, in our ECMO model, rSO(2)i and SVO( 2) correlate reasonably well with each other, but not necessarily with brain PbtO(2) and that NIRS-derived rSO(2)i may more accurately reflect cerebral tissue hypoxia in sicker animals.

  10. Sinusitis: Overview

    MedlinePlus

    ... pressuregrowths called polyps. These can block your sinus passages.When bacteria or a virus causes sinusitis, it’s ... nasal spray. This will clean out your nasal passages and help clear congestion. Your doctor may suggest ...

  11. Acute Sinusitis

    MedlinePlus

    ... headache. Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve ... Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, ...

  12. Pediatric Sinusitis

    MedlinePlus

    ... requests or policy questions to our media and public relations staff at newsroom@entnet.org . Your child’s sinuses ... viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is ...

  13. Isolated lateral sinus thrombosis presenting as cerebellar infarction in a patient with iron deficiency anemia.

    PubMed

    Lee, Ji-Hye; Park, Kyung-Jae; Chung, Yong-Gu; Kang, Shin-Hyuk

    2013-07-01

    As a rare cerebrovascular disease, cerebral venous thrombosis (CVT) is caused by various conditions including trauma, infection, oral contraceptive, cancer and hematologic disorders. However, iron deficiency anemia is not a common cause for CVT in adult. Posterior fossa infarction following CVT is not well demonstrated because posterior fossa has abundant collateral vessels. Here, we report a case of a 55-year-old man who was admitted with complaints of headache, nausea, and mild dizziness. The patient was diagnosed with isolated lateral sinus thrombosis presenting as cerebellar infarction. Laboratory findings revealed normocytic normochromic anemia due to iron deficiency, and the patient's symptoms were improved after iron supplementation.

  14. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-03-06

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome.

  15. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed Central

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-01-01

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome. PMID:25750219

  16. Diagnosis of Transverse Sinus Hypoplasia in Magnetic Resonance Venography: New Insights Based on Magnetic Resonance Imaging in Combined Dataset of Venous Outflow Impairment Case-Control Studies: Post Hoc Case-Control Study.

    PubMed

    Han, Ke; Chao, A-Ching; Chang, Feng-Chi; Hsu, Hung-Yi; Chung, Chih-Ping; Sheng, Wen-Yung; Chan, Lung; Wu, Jiang; Hu, Han-Hwa

    2016-03-01

    In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measured by magnetic resonance venography (MRV) and contrast T1-weighted magnetic resonance (contrast T1) were observed. To investigate these discrepancies, and considering that TS hypoplasia is associated with neurological disorders, we performed a post hoc analysis of prospectively collected data from 3 case-control studies on transient global amnesia (TGA), transient monocular blindness (TMB), and panic disorders while retaining the original inclusion and exclusion criteria. Magnetic resonance (MR) imaging of 131 subjects was reviewed to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction.MRV without contrast revealed that TS hypoplasia was observed in 69 subjects, whom we classified into 2 subgroups according to the concordance with contrast T1 observations: concordance indicated anatomically small TS (30 subjects), and discrepancy indicated that the MRV diagnosis is in fact flow-related and that TS is not anatomically small (39 subjects). The latter subgroup was associated with at least 1 site of venous compression/stenosis in the internal jugular vein (IJV) or the left brachiocephalic vein (BCV) (P < 0.001), which was significantly larger in patients than controls. Compensatory dilatation of contralateral TS diameter was only observed with MRV, not with contrast T1 imaging.The clinical implication of these results is that using MRV only, IJV/BCV compression/stenosis may be misdiagnosed as TS hypoplasia. And contralateral TS have no compensatory dilatation in its diameter in contrast T1 imaging, just compensatory increased flow volume.

  17. Recurrent cerebral venous thrombosis associated with heterozygote methylenetetrahydrofolate reductase C677T mutation and sickle cell trait without homocysteinemia: an autopsy case report and review of literature.

    PubMed

    Ali, Z; Troncoso, J C; Fowler, D R

    2014-09-01

    Elevated blood homocysteine concentration and certain genetic mutations have been associated with increased risk for developing arterial and venous thrombosis. A common mutation of methylenetetrahydrofolate reductase, MTHFR C677T, has been associated with elevated homocysteine concentration and increased risk for developing thrombosis in homozygote carriers. Heterozygote carriers for this gene mutation, if associated with other major or minor risk factors for thrombophilia, appear to be prone to develop thrombosis. A postmortem genetic testing for common mutations resulting in thrombophilia should be performed in all individuals who die as a result of thrombosis, regardless of predisposing risk factors, to determine the true prevalence of mutations in these individuals, and to assess the true role of a certain mutation, such as heterozygote MTHFR C677T, in the pathogenesis of thrombosis. Postmortem genetic testing for common mutations associated with thrombophilia in selected cases has potentially life-saving importance to surviving family members. We report a case of recurrent cerebral venous thrombosis in a 19 year old male with history of sickle cell trait, obesity, and high normal blood homocysteine, who was heterozygote for MTHFR C677T mutation.

  18. An analysis of the use of hyperoxia for measuring venous cerebral blood volume: comparison of the existing method with a new analysis approach.

    PubMed

    Blockley, Nicholas P; Griffeth, Valerie E M; Germuska, Michael A; Bulte, Daniel P; Buxton, Richard B

    2013-05-15

    Hyperoxia is known to cause an increase in the blood oxygenation level dependent (BOLD) signal that is primarily localised to the venous vasculature. This contrast mechanism has been proposed as a way to measure venous cerebral blood volume (CBVv) without the need for more invasive contrast media. In the existing method the analysis modelled the data as a dynamic contrast agent experiment, with the assumption that the BOLD signal of tissue was dominated by intravascular signal. The effects on the accuracy of the method due to extravascular BOLD signal changes, as well as signal modulation by intersubject differences in baseline physiology, such as haematocrit and oxygen extraction fraction, have so far been unexplored. In this study the effect of extravascular signal and intersubject physiological variability was investigated by simulating the hyperoxia CBVv experiment using a detailed BOLD signal model. This analysis revealed substantial uncertainty in the measurement of CBVv using the existing analysis based on dynamic contrast agent experiments. Instead, the modelling showed a simple and direct relationship between the BOLD signal change and CBVv, and an alternative analysis method with much reduced uncertainty was proposed based on this finding. Both methods were tested experimentally, with the new method producing results that are consistent with the limited literature in this area.

  19. Lateral sinus thrombosis associated with zoster sine herpete.

    PubMed

    Chan, James; Bergstrom, Richard T; Lanza, Donald C; Oas, John G

    2004-01-01

    Herpes zoster results from reactivation of the varicella zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. A 55-year-old woman presented with a 3-day history of left temporal and postauricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A computed tomography scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. Magnetic resonance imaging and magnetic resonance angiogram confirmed these findings. Laboratory studies revealed elevated neurotrophic immunoglobulin G levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anticoagulation. Her symptoms improved, and she was discharged 3 days later. LST is generally a complication of middle ear infection. Nonseptic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary in such cases so that a different treatment course can be identified and antiviral medication initiated promptly.

  20. Sagittal sinus thrombosis due to L-asparaginase

    PubMed Central

    Wani, Nisar A.; Kosar, Tasleem; Pala, Nazir A.; Qureshi, Umar A.

    2010-01-01

    Cerebral Sinovenous Thrombosis (CSVT) is a serious complication of L-asparaginase chemotherapy for leukemia in children. Clinical features of headache, altered consciousness, focal neurological deficit, and seizures developing during or immediately after treatment with L-asparaginase should alert the treating physician to the possibility of CSVT. Immediate imaging of the brain should be done using CT and MRI and the veins should be visualized noninvasively by CT and MR venography. We report two children on induction therapy for acute leukemia who presented with seizures, headache, and altered consciousness. Venous infarcts with and without hemorrhage were seen on CT in one patient and the empty delta sign was seen after contrast injection; however, the early changes were missed by CT. MRI detected dural sinus thrombosis relatively earlier in another patient, while the CT findings were equivocal; in this patient, contrast-enhanced MRI showed the empty delta sign and MR venography confirmed absent flow in the superior sagittal sinus, which was diagnostic of sinus thrombosis. Rapid anticoagulation was started with heparin and maintained with warfarin. The child with a unilateral small nonhemorrhagic infarct made a complete recovery while the other, with bilateral hemorrhagic infarcts, did not survive. We stress the importance of early diagnosis of CSVT using CT and MRI in children with leukemia being treated with L-asparaginase; this will permit timely treatment. PMID:21042505

  1. Using magnetic resonance imaging as a means to study chronic cerebral spinal venous insufficiency in multiple sclerosis patients.

    PubMed

    Utriainen, David; Feng, Wei; Elias, Saba; Latif, Zahid; Hubbard, David; Haacke, Ewart Mark

    2012-06-01

    The goal of this work is to present a broad magnetic resonance imaging (MRI) protocol for use in the study of chronic cerebrospinal venous insufficiency (CCSVI). The CCSVI MRI protocol includes the following sequences: time-resolved contrast-enhanced 3D MR angiography, 2D time-of-flight MR venography, and 3D volumetric interpolated breath-hold examination to assess venous structural abnormalities; phase-contrast MR imaging at different levels in the neck and thoracic cavity to quantify flow through the veins, arteries, and cerebrospinal fluid; T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and pre- and post-contrast T1-weighted imaging of the brain for examinations of parenchymal lesions; and finally, susceptibility-weighted imaging for quantification of iron deposition in the brain. Data from 111 clinically definite multiple sclerosis patients were assessed for potential structural and flow CCSVI risk criteria, including stenosis, atresia, aplasia, dominant to subdominant venous flow ratio (D:sD), and the sum of their flow rates. Of the 111 patients, 50 (45%) were determined to be nonstenotic (NST) with no stenosis or atresia in their internal jugular veins (IJV), and the rest 61 (55%) were stenotic (ST) having at least one internal jugular vein stenosis or atresia. No occurrence of aplasia was observed. A D:sD of greater than 3:1 was observed in 15 (24.6%) patients of the ST group and 2 (4.0%) patients of the NST group. A sum of dominant and subdominant venous flow rate of <8 mL/s was observed in 22 (36.1%) patients of the ST group and 6 (12.0%) patients of the NST group. MRI provides valuable information in the observation of potential CCSVI risk factors. Low total flow in the 2 dominant veins seemed to be the strongest indicator for risk of having stenoses in the multiple sclerosis population.

  2. Fungal Sinusitis.

    PubMed

    Raz, Eytan; Win, William; Hagiwara, Mari; Lui, Yvonne W; Cohen, Benjamin; Fatterpekar, Girish M

    2015-11-01

    Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome. Published by Elsevier Inc.

  3. Thai venous stroke prognostic score: TV-SPSS.

    PubMed

    Poungvarin, Niphon; Prayoonwiwat, Naraporn; Ratanakorn, Disya; Towanabut, Somchai; Tantirittisak, Tassanee; Suwanwela, Nijasri; Phanthumchinda, Kamman; Tiamkoa, Somsak; Chankrachang, Siwaporn; Nidhinandana, Samart; Laptikultham, Somsak; Limsoontarakul, Sansern; Udomphanthuruk, Suthipol

    2009-11-01

    Prognosis of cerebral venous sinus thrombosis (CVST) has never been studied in Thailand. A simple prognostic score to predict poor prognosis of CVST has also never been reported. The authors are aiming to establish a simple and reliable prognostic score for this condition. The medical records of CVST patients from eight neurological training centers in Thailand who received between April 1993 and September 2005 were reviewed as part of this retrospective study. Clinical features included headache, seizure, stroke risk factors, Glasgow coma scale (GCS), blood pressure on arrival, papilledema, hemiparesis, meningeal irritation sign, location of occluded venous sinuses, hemorrhagic infarction, cerebrospinal fluid opening pressure, treatment options, length of stay, and other complications were analyzed to determine the outcome using modified Rankin scale (mRS). Poor prognosis (defined as mRS of 3-6) was determined on the discharge date. One hundred ninety four patients' records, 127 females (65.5%) and mean age of 36.6 +/- 14.4 years, were analyzed Fifty-one patients (26.3%) were in the poor outcome group (mRS 3-6). Overall mortality was 8.4%. Univariate analysis and then multivariate analysis using SPSS version 11.5 revealed only four statistically significant predictors influencing outcome of CVST They were underlying malignancy, low GCS, presence of hemorrhagic infarction (for poor outcome), and involvement of lateral sinus (for good outcome). Thai venous stroke prognostic score (TV-SPSS) was derived from these four factors using a multiple logistic model. A simple and pragmatic prognostic score for CVST outcome has been developed with high sensitivity (93%), yet low specificity (33%). The next study should focus on the validation of this score in other prospective populations.

  4. [An advantage of T2*-weighted MRI for early detection of straight sinus thrombosis: a case report].

    PubMed

    Saito, Satoshi; Takahashi, Makio; Nonoguchi, Naosuke; Ohta, Tsuyoshi; Takahashi, Jun A; Matsumoto, Sadayuki

    2009-10-01

    A 44-year-old man presented with a 12-day history of severe non-throbbing headache. He showed no physical abnormality but obesity. On day 12, ring-shaped low intensity lesions inside straight sinus were revealed on T2*-weighted MRI image (T2*WI). On the following day (day 13), he was found unresponsive at home, and ambulated with disturbed consciousness. FLAIR and diffusion-weighted MRI image disclosed high intensity signals in bilateral thalamus which were postulated as vasogenic edema. MR venography and conventional cerebral angiography showed an absence of flow in inferior sagittal sinus, vein of Galen, and straight sinus. These findings confirmed the diagnosis of cerebral venous thrombosis (CVT). Anticoagulant treatment was introduced and his consciousness level was gradually improved. On day 43, he was discharged with no neurological sequelae. A delay of correct diagnosis and treatment with CVT can lead to devastating disability or even to death. An early diagnosis of CVT is often dismissed owing to the nonspecific symptoms such as headache and nausea. Recent reports described high sensitivity of T2*WI for detecting CVT. Alterations in blood flow and oxyhemoglobin reduced products, deoxyhemoglobin, in thrombosed veins often produce the magnetic susceptibility on T2*WI. A detection of ring-shaped low intensity lesions within venous sinus on T2*WI were quite rare, and the signal changes of these sinus lesions were successfully visualized by chronological T2*WI. Taken together, our case implies that T2*WI is the powerful tool for the early detection of CVT, even before the critical symptoms might happen.

  5. Comparison of haematopoietic stem cell engraftment through the retro-orbital venous sinus and the lateral vein: alternative routes for bone marrow transplantation in mice.

    PubMed

    Leon-Rico, D; Fernández-García, M; Aldea, M; Sánchez, R; Peces-Barba, M; Martinez-Palacio, J; Yáñez, R M; Almarza, E

    2015-04-01

    Bone marrow transplantation in mice is performed by intravenous administration of haematopoietic repopulating cells, usually via the lateral tail vein. This technique can be technically challenging to carry out and may cause distress to the mice. The retro-orbital sinus is a large area where there is a confluence of several vessels that provides an alternative route for intravenous access. Retro-orbital injection, although aesthetically unpleasant, can be performed rapidly without requiring mechanical restriction or heat-induced vasodilation. In addition, this technique can be easily learned by novice manipulators. This route of administration has been reported for use in bone marrow transplantation but there is no comparison of retro-orbital and tail vein injections reported for this specific purpose, although both routes have been compared for many other applications. Here, we provide for the first time a comprehensive comparison between tail vein and retro-orbital injections for two different bone marrow transplant scenarios in P3B and B6D2F1 mice. In both cases, no significant differences regarding donor engraftment were observed between mice transplanted using each of the techniques. Haematological counts and leukocyte subpopulation distribution were practically identical between both animal groups. Moreover, donor engraftment levels were less homogenous when cells were transplanted by tail vein injection, probably due to a higher risk of failure associated with this technique. All these data suggest that retro-orbital injection is a compelling alternative to conventional tail vein injection for bone marrow transplant in mice, providing similar and more homogenous haematopoietic reconstitution. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  6. Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report.

    PubMed

    Akamatsu, Yosuke; Sato, Kenichi; Endo, Hidenori; Matsumoto, Yasushi; Tominaga, Teiji

    2017-08-01

    Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. The Accuracy of a Near-Infrared Spectroscopy Cerebral Oximetry Device and Its Potential Value for Estimating Jugular Venous Oxygen Saturation

    PubMed Central

    Ikeda, Keita; MacLeod, David B; Grocott, Hilary P.; Moretti, Eugene W.; Ames, Warwick; Vacchiano, Charles

    2014-01-01

    Background An intriguing potential clinical use of cerebral oximeter measurements (SctO2) is the ability to noninvasively estimate jugular bulb venous oxygen saturation (SjvO2). Our purpose in this study was to determine the accuracy of the FORE-SIGHT® (CAS Medical Systems; Branford, CT), which is calibrated to a weighted average of 70% (SjvO2) and 30% arterial saturation, for Food and Drug Administration pre-market approval 510 (k) certification by adapting an industry standard protocol, ISO 9919:2005 [www.ISO.org] (used for pulse oximeters) and to evaluate the use of SctO2 and SpO2 measurements to noninvasively estimate jugular venous oxygen saturation (SnvO2). Methods Paired blood gas samples from the radial artery and the jugular venous bulb were collected from 20 healthy volunteers undergoing progressive oxygen desaturation from 100 to 70%. The blood sample pairs were analyzed via co-oximetry and used to calculate the approximate mixed vascular cerebral blood oxygen saturation, or reference SctO2 values (refSctO2), during increasing hypoxia. These reference values were compared to bilateral FORE-SIGHT SctO2 values recorded simultaneously with the blood gas draws to determine its accuracy. Bilateral SctO2 and SpO2 measurements were then used to calculate SnvO2 values which were compared to SjvO2. Results Two hundred forty-six arterial and 253 venous samples from 18 subjects were used in the analysis. The ipsilateral FORE-SIGHT SctO2 values showed a tolerance interval (TI) of [−10.72 10.90] Lin’s concordance correlation coefficient (CCC) with standard error (SE) of 0.83 ± 0.073 with the refSctO2 values calculated using arterial and venous blood gases. The combined data had a CCC of 0. 81 + 0.059 with TI of [−9.22 9.40] with overall bias was 0.09% and amplitude of the root mean square of error after it was corrected with random effects analysis was 2.92%. The bias and variability values between the ipsilateral and the contralateral FORE-SIGHT SctO2

  8. [Transvenous Embolization by Direct Puncture of the Superior Sagittal Sinus Using Indocyanine Green(ICG)Videoangiography for Treatment of Dural Arteriovenous Fistula of the Transverse-Sigmoid Sinus:A Case Report].

    PubMed

    Matsuzaki, Jo; Kono, Kenichi; Umesaki, Arisa; Kashimura, Yojiro; Matsumoto, Hiroaki; Terada, Tomoaki

    2017-07-01

    We report a case of dural arteriovenous fistula at the left transverse sinus and sigmoid sinus(TS-dAVF), which was treated with transvenous embolization(TVE)by direct puncture of the superior sagittal sinus(SSS)under indocyanine green(ICG)fluoroscopic guidance. A 71-year-old woman presented with pulsatile tinnitus and progressive dementia. A left TS-dAVF with retrograde SSS and cortical venous reflux(Cognard type IIb)was demonstrated on cerebral angiography. The left internal jugular vein and distal portion of the right transverse sinus were occluded. We considered that TVE via the femoral vein would be difficult for complete cure. We performed trepanation of the frontal portion of the SSS. The SSS was directly punctured with an 18-G needle under ICG fluoroscopic guidance. We inserted a 4-Fr sheath into the SSS. A microcatheter was navigated into the affected sinus. Coils were placed through the microcatheter. The dAVF was completely diminished. No complications occurred. The patient's pulsatile tinnitus disappeared and dementia improved. Transvenous approach with direct puncture of the SSS under ICG fluoroscopic guidance was a useful approach for the treatment of dAVF when other approaches were difficult.

  9. The petrosquamosal sinus in humans

    PubMed Central

    San Millán Ruíz, Diego; Gailloud, Philippe; Yilmaz, Hasan; Perren, Fabienne; Rathgeb, Jean-Paul; Rüfenacht, Daniel A; Fasel, Jean H D

    2006-01-01

    This article provides a comprehensive description of the morphology of the human petrosquamosal sinus (PSS) derived from original observations made on 13 corrosion casts of the cranial venous system combined with routine clinical imaging studies in two patients. The PSS is not a rare finding in the adult human. In particular, continuous developments in imaging techniques have made radiologists become increasingly aware of this anatomical entity in recent years. The role of the PSS as a major encephalic drainage pathway and its potential implication in pathological conditions such as intracranial venous hypertension are discussed. PMID:17118059

  10. Sinus Tumors

    MedlinePlus

    ... critical nerves and arteries in the area, 4) maintenance of the function of the nose, sinuses and any other involved structures, and 5) maintenance of separation between the intracranial (brain) and sinonasal ...

  11. Cerebral and Sinus Vein Thrombosis

    MedlinePlus

    ... is a qualified 501(c)(3) tax-exempt organization. *Red Dress™ DHHS, Go Red™ AHA; National Wear Red Day ® is a registered trademark. PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program BBB Accredited Charity Comodo Secured

  12. Reversible cerebral vasoconstriction syndrome: a rare entity in children presenting with thunderclap headache.

    PubMed

    Ghosh, Partha S; Rothner, A David; Zahka, Kenneth G; Friedman, Neil R

    2011-12-01

    Reversible cerebral vasoconstriction syndrome is characterized by a reversible segmental and multifocal vasoconstriction of cerebral arteries, and severe headaches with or without focal neurologic deficits or seizures. A 15-year-old boy presented with thunderclap headache. He had severe hypertension, although his neurologic examination was normal. Initial workup for thunderclap headache to exclude subarachnoid or intracranial hemorrhage, meningitis, pituitary apoplexy, or venous sinus thrombosis was negative. Brain magnetic resonance angiography and cerebral angiography demonstrated bilateral anterior and posterior circulation diffuse, multifocal, vascular irregularities (beading and stenosis) suggestive of underlying vasculopathy or vasculitis. He was started on verapamil. There was complete reversal of the vascular abnormalities in 6 weeks evident by magnetic resonance angiography, with resolution of headache and normalization of blood pressure. Reversible cerebral vasoconstriction syndrome has been rarely reported in children. This case report highlights the diagnostic dilemma and management of the rare childhood presentation of this condition.

  13. [Developmental venous anomaly (DVA)].

    PubMed

    Zimmer, A; Hagen, T; Ahlhelm, F; Viera, J; Reith, W; Schulte-Altedorneburg, G

    2007-10-01

    As congenital anatomic variants of venous drainage, developmental venous anomalies (DVA) represent up to 60% of all cerebral vascular malformations. The prior term "venous angioma" is a misnomer implicating an abnormal vascular structure with an increased bleeding risk. They are often found incidentally and are hardly ever symptomatic. Their morphologic characteristics are dilated vessels in the white matter, which converge on a greater collector vein, forming the typical caput medusae. They drain into the superficial or deep venous system. The frequent association with other, potentially bleeding-prone vascular malformations is clinically relevant, in particular cavernous angioma, which might require therapeutic action. Therefore, coincident vascular lesions need to be actively sought by appropriate additional imaging techniques.

  14. High prevalence of cerebral venous sinus thrombosis (CVST) as presentation of cystathionine beta-synthase deficiency in childhood: molecular and clinical findings of Turkish probands.

    PubMed

    Karaca, Mehmet; Hismi, Burcu; Ozgul, Riza Koksal; Karaca, Sefayet; Yilmaz, Didem Yucel; Coskun, Turgay; Sivri, Hatice Serap; Tokatli, Aysegul; Dursun, Ali

    2014-01-25

    Classical homocystinuria is the most commonly inherited disorder of sulfur metabolism, caused by the genetic alterations in human cystathionine beta-synthase (CBS) gene. In this study, we present comprehensive clinical findings and the genetic basis of homocystinuria in a cohort of Turkish patients. Excluding some CBS mutations, detailed genotype-phenotype correlation for different CBS mutations has not been established in literature. We aimed to make clinical subgroups according to main clinical symptoms and discussed these data together with mutational analysis results from our patients. Totally, 16 different mutations were identified; twelve of which had already been reported, and four are novel (p.N93Y, p.L251P, p.D281V and c.829-2A>T). The probands were classified into three major groups according to the clinical symptoms caused by these mutations. A psychomotor delay was the most common diagnostic symptom (n=12, 46.2% neurological presentation), followed by thromboembolic events (n=6, 23.1% vascular presentation) and lens ectopia, myopia or marfanoid features (n=5, 19.2% connective tissue presentation). Pyridoxine responsiveness was 7.7%; however, with partial responsive probands, the ratio was 53.9%. In addition, five thrombophilic nucleotide changes including MTHFR c.677 C>T and c.1298 A>C, Factor V c.1691 G>A, Factor II c.20210 G>A, and SERPINE1 4G/5G were investigated to assess their contributions to the clinical spectrum. We suggest that the effect of these polymorphisms on clinical phenotype of CBS is not very clear since the distribution of thrombophilic polymorphisms does not differ among specific groups. This study provides molecular findings of 26 Turkish probands with homocystinuria and discusses the clinical presentations and putative effects of the CBS mutations. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

  15. Effect of hypoxia and hypercapnia on ACE activity in the cerebral microcirculation of anesthetized dogs

    SciTech Connect

    Pitt, B.R.; Lister, G.; Dawson, C.A.; Linehan, J.H.

    1986-05-01

    Angiotensin-converting enzyme (ACE) activity of the cerebral microcirculation of anesthetized dogs was measured from cerebral venous outflow curves after bolus injection of a synthetic ACE substrate, (/sup 3/H)benzoyl-phenylalanyl-alanylproline ((/sup 3/H)BPAP), into a common carotid artery. Cerebral BPAP metabolism was quantified by measuring the concentration of (/sup 3/H)benzoyl-phenylalanine (the product of BPAP hydrolysis by ACE) in blood samples from the sagittal sinus after occlusion of the lateral sinuses with bone wax. Instantaneous BPAP metabolism in each sample increased as a function of time after injection, suggestive of perfusion heterogeneity, and averaged 59 +/- 4% (n = 8) over a single pass during normoxia and normocapnia. The ratio of Vmax (the maximal rate of cerebral BPAP metabolism) to Km (the concentration at Vmax/2), was calculated from instantaneous outflow curves using a model based on first-order kinetics. Increases in cerebral blood flow during either hypoxia or hypercapnia significantly reduced BPAP metabolism to 33 +/- 3 (n = 7) and 24 +/- 3% (n = 5), respectively; however, Vmax/Km of ACE activity (0.19 +/- 0.03 ml/s) was not affected by either condition. The lack of change in apparent kinetics of ACE activity (i.e., in Vmax/Km) during hypoxia or hypercapnia suggests that recruitment of cerebral capillaries was not a quantitatively significant factor in controlling BPAP metabolism with this degree of either hypoxia or hypercapnia.

  16. Susceptibility-weighted imaging at 7 T: Improved diagnosis of cerebral cavernous malformations and associated developmental venous anomalies☆☆☆

    PubMed Central

    Frischer, Josa M.; Göd, Sabine; Gruber, Andreas; Saringer, Walter; Grabner, Günther; Gatterbauer, Brigitte; Kitz, Klaus; Holzer, Sabrina; Kronnerwetter, Claudia; Hainfellner, Johannes A.; Knosp, Engelbert; Trattnig, Siegfried

    2012-01-01

    Background and aim In the diagnosis of cerebral cavernous malformations (CCMs) magnetic resonance imaging is established as the gold standard. Conventional MRI techniques have their drawbacks in the diagnosis of CCMs and associated venous malformations (DVAs). The aim of our study was to evaluate susceptibility weighted imaging SWI for the detection of CCM and associated DVAs at 7 T in comparison with 3 T. Patients and methods 24 patients (14 female, 10 male; median age: 38.3 y (21.1 y–69.1 y) were included in the study. Patients enrolled in the study received a 3 T and a 7 T MRI on the same day. The following sequences were applied on both field strengths: a T1 weighted 3D GRE sequence (MP-RAGE) and a SWI sequence. After obtaining the study MRIs, eleven patients underwent surgery and 13 patients were followed conservatively or were treated radio-surgically. Results Patients initially presented with haemorrhage (n = 4, 16.7%), seizures (n = 2, 8.3%) or other neurology (n = 18, 75.0%). For surgical resected lesions histopathological findings verified the diagnosis of CCMs. A significantly higher number of CCMs was diagnosed at 7 T SWI sequences compared with 3 T SWI (p < 0.05). Additionally diagnosed lesions on 7 T MRI were significantly smaller compared to the initial lesions on 3 T MRIs (p < 0.001). Further, more associated DVAs were diagnosed at 7 T MRI compared to 3 T MRI. Conclusion SWI sequences at ultra-high-field MRI improve the diagnosis of CCMs and associated DVAs and therefore add important pre-operative information. PMID:24179744

  17. Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

    SciTech Connect

    Erol, Ilknur Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

    2006-06-15

    A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.

  18. Sinus Anatomy

    MedlinePlus

    ... the nasal passage. The right and left nasal passages are separated in the middle by a vertical plate of cartilage and bone ... Most of the sinuses drain from underneath the middle turbinate, into a region ... through the nasal passage on each side, it streams through the crevices ...

  19. Sinusitis (acute)

    PubMed Central

    2008-01-01

    Introduction Acute sinusitis is defined pathologically, by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1−5% of the adult population each year in Europe. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with clinically diagnosed acute sinusitis, and with radiologically or bacteriologically confirmed acute sinusitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides, different doses [amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides], long-course regimens), antihistamines, cephalosporins or macrolides, decongestants (xylometazoline, phenylephrine, pseudoephedrine), doxycycline, saline nasal washes, steam inhalation, and topical corticosteroids (intra-nasal). PMID:19450327

  20. Perfusion-diffusion compartmental models describe cerebral helium kinetics at high and low cerebral blood flows in sheep.

    PubMed

    Doolette, David J; Upton, Richard N; Grant, Cliff

    2005-03-01

    This study evaluated the relative importance of perfusion and diffusion mechanisms in compartmental models of blood:tissue helium exchange in the brain. Helium has different physiochemical properties from previously studied gases, and is a common diluent gas in underwater diving where decompression schedules are based on theoretical models of inert gas kinetics. Helium kinetics across the cerebrum were determined during and after 15 min of helium inhalation, at separate low and high steady states of cerebral blood flow in seven sheep under isoflurane anaesthesia. Helium concentrations in arterial and sagittal sinus venous blood were determined using gas chromatographic analysis, and sagittal sinus blood flow was monitored continuously. Parameters and model selection criteria of various perfusion-limited or perfusion-diffusion compartmental models of the brain were estimated by simultaneous fitting of the models to the sagittal sinus helium concentrations for both blood flow states. Purely perfusion-limited models fitted the data poorly. Models that allowed a diffusion-limited exchange of helium between a perfusion-limited tissue compartment and an unperfused deep compartment provided better overall fit of the data and credible parameter estimates. Fit to the data was also improved by allowing countercurrent diffusion shunt of helium between arterial and venous blood. These results suggest a role of diffusion in blood:tissue helium equilibration in brain.

  1. Perfusion–diffusion compartmental models describe cerebral helium kinetics at high and low cerebral blood flows in sheep

    PubMed Central

    Doolette, David J; Upton, Richard N; Grant, Cliff

    2005-01-01

    This study evaluated the relative importance of perfusion and diffusion mechanisms in compartmental models of blood:tissue helium exchange in the brain. Helium has different physiochemical properties from previously studied gases, and is a common diluent gas in underwater diving where decompression schedules are based on theoretical models of inert gas kinetics. Helium kinetics across the cerebrum were determined during and after 15 min of helium inhalation, at separate low and high steady states of cerebral blood flow in seven sheep under isoflurane anaesthesia. Helium concentrations in arterial and sagittal sinus venous blood were determined using gas chromatographic analysis, and sagittal sinus blood flow was monitored continuously. Parameters and model selection criteria of various perfusion-limited or perfusion–diffusion compartmental models of the brain were estimated by simultaneous fitting of the models to the sagittal sinus helium concentrations for both blood flow states. Purely perfusion-limited models fitted the data poorly. Models that allowed a diffusion-limited exchange of helium between a perfusion-limited tissue compartment and an unperfused deep compartment provided better overall fit of the data and credible parameter estimates. Fit to the data was also improved by allowing countercurrent diffusion shunt of helium between arterial and venous blood. These results suggest a role of diffusion in blood:tissue helium equilibration in brain. PMID:15649976

  2. Core curriculum illustration: dural venous sinus thrombosis.

    PubMed

    Rajendran, Sibi; Pereira, Alex; Eckerd, Morgan; Pawley, Barbara

    2016-11-28

    This is the 25th installment of a series that will highlight one case per publication issue from the bank of cases available online as a part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at http://www.aseronline.org/curriculum/toc.htm .

  3. Giant arachnoid granulation mimicking dural sinus thrombosis

    PubMed Central

    Ayaz, Ercan; Atalay, Basak; Baysal, Begumhan; Senturk, Senem; Aslan, Ahmet

    2017-01-01

    Arachnoid granulations (AG) are composed of dense, collagenous connective tissue that includes clusters of arachnoid cells. They tend to invaginate into the dural sinuses, through which cerebrospinal fluid enters the venous system. AG are most commonly seen at the junction between the middle and lateral thirds of the transverse sinuses near the entry sites of the superficial veins. Presently described is the case of a 21-year-old female who presented at the clinic with recurrent headaches. Magnetic resonance (MR) imaging revealed a 3.5-cm lesion, which extended from confluens sinuum through the superior sagittal sinus. The lesion had created a scallop-shaped area of erosion in the neighboring occipital bone. To exclude sinus thrombosis, MR venography was performed, which displayed a maintained venous flow around the lesion. Headaches were treated symptomatically with medical therapy. Giant AG can be misdiagnosed as dural sinus thrombosis. MR imaging combined with MR venography is the most useful diagnostic tool to differentiate giant AG from dural sinus thrombosis. PMID:28971178

  4. Giant arachnoid granulation mimicking dural sinus thrombosis.

    PubMed

    Ayaz, Ercan; Atalay, Basak; Baysal, Begumhan; Senturk, Senem; Aslan, Ahmet

    2017-01-01

    Arachnoid granulations (AG) are composed of dense, collagenous connective tissue that includes clusters of arachnoid cells. They tend to invaginate into the dural sinuses, through which cerebrospinal fluid enters the venous system. AG are most commonly seen at the junction between the middle and lateral thirds of the transverse sinuses near the entry sites of the superficial veins. Presently described is the case of a 21-year-old female who presented at the clinic with recurrent headaches. Magnetic resonance (MR) imaging revealed a 3.5-cm lesion, which extended from confluens sinuum through the superior sagittal sinus. The lesion had created a scallop-shaped area of erosion in the neighboring occipital bone. To exclude sinus thrombosis, MR venography was performed, which displayed a maintained venous flow around the lesion. Headaches were treated symptomatically with medical therapy. Giant AG can be misdiagnosed as dural sinus thrombosis. MR imaging combined with MR venography is the most useful diagnostic tool to differentiate giant AG from dural sinus thrombosis.

  5. Operative management of tumors involving the cavernous sinus.

    PubMed

    Sekhar, L N; Møller, A R

    1986-06-01

    In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

  6. Acute hypoxia increases the cerebral metabolic rate – a magnetic resonance imaging study

    PubMed Central

    Lindberg, Ulrich; Aachmann-Andersen, Niels Jacob; Lisbjerg, Kristian; Christensen, Søren Just; Law, Ian; Rasmussen, Peter; Olsen, Niels V; Larsson, Henrik BW

    2015-01-01

    The aim of the present study was to examine changes in cerebral metabolism by magnetic resonance imaging of healthy subjects during inhalation of 10% O2 hypoxic air. Hypoxic exposure elevates cerebral perfusion, but its effect on energy metabolism has been less investigated. Magnetic resonance imaging techniques were used to measure global cerebral blood flow and the venous oxygen saturation in the sagittal sinus. Global cerebral metabolic rate of oxygen was quantified from cerebral blood flow and arteriovenous oxygen saturation difference. Concentrations of lactate, glutamate, N-acetylaspartate, creatine and phosphocreatine were measured in the visual cortex by magnetic resonance spectroscopy. Twenty-three young healthy males were scanned for 60 min during normoxia, followed by 40 min of breathing hypoxic air. Inhalation of hypoxic air resulted in an increase in cerebral blood flow of 15.5% (p = 0.058), and an increase in cerebral metabolic rate of oxygen of 8.5% (p = 0.035). Cerebral lactate concentration increased by 180.3% (p<10-6), glutamate increased by 4.7% (p<10-4) and creatine and phosphocreatine decreased by 15.2% (p<10-3). The N-acetylaspartate concentration was unchanged (p = 0.36). In conclusion, acute hypoxia in healthy subjects increased perfusion and metabolic rate, which could represent an increase in neuronal activity. We conclude that marked changes in brain homeostasis occur in the healthy human brain during exposure to acute hypoxia. PMID:26661163

  7. Chronic sinusitis (image)

    MedlinePlus

    ... and cartilage and lined with a mucous membrane. Sinusitis occurs when the membranes becomes inflamed and painful, ... a result of a blocked sinus opening. Chronic sinusitis is often caused by inflammation and blockage due ...

  8. Plain Language Summary: Adult Sinusitis (Sinus Infection).

    PubMed

    Caspersen, Leslie A; Walter, Lindsey M; Walsh, Sandra A; Rosenfeld, Richard M; Piccirillo, Jay F

    2015-08-01

    This plain language summary serves as an overview in explaining sinusitis (pronounced sign-you-side-tis). The purpose of this plain language summary is to provide patients with standard language explaining their condition in an easy-to-read format. This summary applies to those 18 years of age or older with sinusitis. The summary is featured as an FAQ (frequently asked question) format. The summary addresses how to manage and treat sinusitis symptoms. Adult sinusitis is often called a sinus infection. A healthcare provider may refer to a sinus infection as rhinosinusitis (pronounced rhi-no-sign-you-side-tis). This includes the nose as well as the sinuses in the name. A sinus infection is the swelling of the sinuses and nasal cavity.The summary is based on the published 2015 "Clinical Practice Guideline: Adult Sinusitis." The evidence-based guideline includes research to support more effective diagnosis and treatment of adult sinus infections. The guideline was developed as a quality improvement opportunity for managing sinus infections by creating clear recommendations to use in medical practice. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  9. Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm.

    PubMed

    Stahrenberg, Raoul; Weber-Krüger, Mark; Seegers, Joachim; Edelmann, Frank; Lahno, Rosine; Haase, Beatrice; Mende, Meinhard; Wohlfahrt, Janin; Kermer, Pawel; Vollmann, Dirk; Hasenfuss, Gerd; Gröschel, Klaus; Wachter, Rolf

    2010-12-01

    Diagnosis of paroxysmal atrial fibrillation is difficult but highly relevant in patients presenting with cerebral ischemia yet free from atrial fibrillation on admission. Early initiation and prolongation of continuous Holter monitoring may improve diagnostic yield compared with the standard of care including a 24-hour Holter recording. In the observational Find-AF trial (ISRCTN 46104198), consecutive patients presenting with symptoms of cerebral ischemia were included. Patients free from atrial fibrillation at presentation received 7-day Holter monitoring. Two hundred eighty-one patients were prospectively included. Forty-four (15.7%) had atrial fibrillation documented by routine electrocardiogram on admission. All remaining patients received Holter monitors at a median of 5.5 hours after presentation. In those 224 patients who received Holter monitors but had no previously known paroxysmal atrial fibrillation, the detection rate with early and prolonged (7 days) Holter monitoring (12.5%) was significantly higher than for any 24-hour (mean of 7 intervals: 4.8%, P = 0.015) or any 48-hour monitoring interval (mean of 6 intervals: 6.4%, P = 0.023). Of those 28 patients with new atrial fibrillation on Holter monitoring, 15 (6.7%) had been discharged without therapeutic anticoagulation after routine clinical care (ie, with data from 24-hour Holter monitoring only). Detection rates were 43.8% or 6.3% for short supraventricular runs of ≥ 10 beats or prolonged episodes (> 5 hours) of atrial fibrillation, respectively. Diagnostic yield appeared to be only slightly and not significantly increased during the first 3 days after the index event. Prolongation of Holter monitoring in patients with symptoms of cerebral ischemic events increases the rate of detection of paroxysmal atrial fibrillation up to Day 7, leading to a relevant change in therapy in a substantial number of patients. Early initiation of monitoring does not appear to be crucial. Hence, prolonged Holter

  10. Petrosal sinus sampling: technique and rationale.

    PubMed

    Miller, D L; Doppman, J L

    1991-01-01

    Bilateral simultaneous sampling of the inferior petrosal sinuses is an extremely sensitive, specific, and accurate test for diagnosing Cushing disease and distinguishing between that entity and the ectopic ACTH syndrome. It is also valuable for lateralizing small hormone-producing adenomas within the pituitary gland. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Advance preparation is required for petrosal sinus sampling. Teamwork is a critical element, and each member of the staff should know what he or she will be doing during the procedure. The samples must be properly labeled, processed, and stored. Specific needles, guide wires, and catheters are recommended for this procedure. The procedure is performed with specific attention to the three areas of potential technical difficulty: catheterization of the common femoral veins, crossing the valve at the base of the left internal jugular vein, and selective catheterization of the inferior petrosal sinuses. There are specific methods for dealing with each of these areas. The sine qua non of correct catheter position in the inferior petrosal sinus is demonstration of reflux of contrast material into the ipsilateral cavernous sinus. Images must always be obtained to document correct catheter position. Special attention must be paid to two points to prevent potential complications: The patient must be given an adequate dose of heparin, and injection of contrast material into the inferior petrosal sinuses and surrounding veins must be done gently and carefully. When the procedure is performed as outlined, both inferior

  11. [Dural sinus thrombosis: case report].

    PubMed

    Falavigna, Asdrubal; Pontalti, João Luis; Teles, Alisson Roberto

    2006-06-01

    We report the case of a 24 year-old pregnant woman, seen at the neurology service by presenting agitation, hallucinations, mental confusion, headache, vision loss, aphasia and seizures. The neuroradiologic exam was compatible with thrombosis in dural sinus and cortical veins. Treatment with abciximab was accomplished and the mechanical lysis of the thrombus was made obtaining restoration of cerebral vein flow. After the procedure, she presented frontal hematoma which was withdrawn surgically. We discuss this infrequent pathology in clinical picture, pathogenesis, image exams and therapeutics.

  12. Comparison of Partial Volume Effects in Arterial and Venous Contrast Curves in CT Brain Perfusion Imaging

    PubMed Central

    Riordan, Alan J.; Bennink, Edwin; Dankbaar, Jan Willem; Viergever, Max A.; Velthuis, Birgitta K.; Smit, Ewoud J.; de Jong, Hugo W. A. M.

    2014-01-01

    Purpose In brain CT perfusion (CTP), the arterial contrast bolus is scaled to have the same area under the curve (AUC) as the venous outflow to correct for partial volume effects (PVE). This scaling is based on the assumption that large veins are unaffected by PVE. Measurement of the internal carotid artery (ICA), usually unaffected by PVE due to its large diameter, may avoid the need for partial volume correction. The aims of this work are to examine i) the assumptions behind PVE correction and ii) the potential of selecting the ICA obviating correction for PVE. Methods The AUC of the ICA and sagittal sinus were measured in CTP datasets from 52 patients. The AUCs were determined by i) using commercial CTP software based on a Gaussian curve-fitting to the time attenuation curve, and ii) by simple integration of the time attenuation curve over a time interval. In addition, frames acquired up to 3 minutes after first bolus passage were used to examine the ratio of arterial and venous enhancement. The impact of selecting the ICA without PVE correction was illustrated by reporting cerebral blood volume (CBV) measurements. Results In 49 of 52 patients, the AUC of the ICA was significantly larger than that of the sagittal sinus (p = 0.017). Measured after the first pass bolus, contrast enhancement remained 50% higher in the ICA just after the first pass bolus, and 30% higher 3 minutes later. CBV measurements were significantly lowered when the ICA was used without PVE correction. Conclusions Contradicting the assumptions underlying PVE correction, contrast in the ICA was significantly higher than in the sagittal sinus, even 3 minutes after the first pass of the contrast bolus. PVE correction might lead to overestimation of CBV if the CBV is calculated using the AUC of the time attenuation curves. PMID:24858308

  13. Closure of the sigmoid sinus in lateral skull base surgery.

    PubMed

    Zanoletti, E; Cazzador, D; Faccioli, C; Martini, A; Mazzoni, A

    2014-06-01

    Closure of the sigmoid-jugular complex is generally planned during various surgical procedures on the skull base, either to repair a jugular foramen lesion or as the oncological boundary of the resection. A series of 218 cases of skull base tumour surgeries was analysed in which closure of the sigmoid-jugular complex was systematically planned (bilaterally in one case) in patients treated for jugular foramen paragangliomas, squamous cell carcinomas and other temporal bone tumours. Surgery was performed via a petro-occipital trans-sigmoid approach in 61 cases, an infratemporal A in 128, en bloc subtotal temporal bone resections in 10 and other approaches in 20. In our experience, planned unilateral (and, in one case, bilateral) closure of the sigmoid-jugular complex had no clinical consequences. The vicarious drainage of the skull base was always assessed preoperatively, revealing no contraindications to intraoperative sinus closure. Given the scarcity of literature on this subject, the present report shows that the procedure is associated with low morbidity and helps to improve our understanding of cerebral venous discharge.

  14. Venous Ulcers

    PubMed Central

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  15. [A case of cavernous sinus aspergillosis].

    PubMed

    Hase, Tomomi; Kurita, Hideharu; Matsumoto, Eiji; Kuroda, Hajime; Hashimoto, Masaaki; Shinoda, Souji

    2013-10-01

    We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.

  16. [Origin of the common pulmonary vein, septation of the primary sinus venosus atrial situs and theory of the "sinus man"].

    PubMed

    Dor, X; Corone, P; Jonhson, E

    1987-04-01

    Situated at the entry to the heart, the sinus venosus regulates at an early stage the distribution of the veins. Originally symmetrical, it receives on either side an omphalomesenteric vein, a common cardinal vein (duct of Cuvieri, ductus cuvieri) and a common pulmonary vein. This symmetrical pattern disappears with the obliteration of the rough right pulmonary vein and the invagination of the left ductus cuvieri into the sinusal cavity. Thus, the pulmonary venous blood is kept on the left side and the systemic venous blood is transferred to the right side. This is the usual situs solitus arrangement. Situs inversus is the opposite arrangement. In situs ambiguus the original symmetry is preserved. A sufficiently early cauterization of the left wall of the sinus venosus prevents the left ductus cuvieri from invaginating and results in "absence of coronary sinus"; this arrangement, where part of the original symmetry is preserved, is in fact similar to situs ambiguus. The situs of the liver and stomach is thought not to be determined by these organs but imposed to them by the sinus venosus, more precisely by the invagination--or lack of invagination--of a ductus cuvieri. This would explain the concordance between their situs and that of the sinus venosus and atria. It would appear that two errors are frequently made: the common pulmonary vein is said to originate from the left atrium, whereas it originates from the sinus venosus and only belongs to the left atrium when the sinus is incorporated in the atrium; the transverse septation of the sinus is incorporated to a shift to the right of the left sinoatrial fold which separates the sinus from the primitive atrium. This fold is indeed displaced to the right, but it is more distal and corresponds, in fact, to the cephalic border of the left ductus cuvieri, and its shift is produced by the invagination of that duct.

  17. Sinusitis (For Parents)

    MedlinePlus

    ... and mucus can become trapped in the sinuses. Bacteria, viruses, and fungi can grow there and lead to ... cases of sinusitis thought to be caused by bacteria. Some doctors may recommend ... usually goes away without medical treatment. Acetaminophen, ibuprofen, ...

  18. Approaching chronic sinusitis.

    PubMed

    Sarber, Kathleen M; Dion, Gregory Robert; Weitzel, Erik K; McMains, Kevin C

    2013-11-01

    Chronic sinusitis is a common disease that encompasses a number of syndromes that are characterized by sinonasal mucosal inflammation. Chronic sinusitis can be defined as two or more of the following symptoms lasting for more than 12 consecutive weeks: discolored rhinorrhea, postnasal drip, nasal obstruction, facial pressure or pain, or decreased sense of smell. Chronic sinusitis is further classified as chronic sinusitis with polyposis, chronic sinusitis without polyposis, or allergic fungal sinusitis using physical examination, and histologic and radiographic findings. Treatment methods for chronic sinusitis are based upon categorization of the disease and include oral and inhaled corticosteroids, nasal saline irrigations, and antibiotics in selected patients. Understanding the various forms of chronic sinusitis and managing and ruling out comorbidities are key to successful management of this common disorder.

  19. Computed Tomography (CT) -- Sinuses

    MedlinePlus Videos and Cool Tools

    ... evaluate the paranasal sinus cavities – hollow, air-filled spaces within the bones of the face surrounding the ... cavities. The paranasal sinuses are hollow, air-filled spaces located within the bones of the face and ...

  20. [Maxillary sinus hypoplasia].

    PubMed

    Plaza, G; Ferrando, J; Martel, J; Toledano, A; de los Santos, G

    2001-03-01

    Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.

  1. Complications of Sinusitis

    MedlinePlus

    ... Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste Upper Respiratory Infections Nasal Congestion & Snoring CSF ... Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste Upper Respiratory Infections Nasal Congestion & Snoring CSF ...

  2. Sinusitis in adults - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000563.htm Sinusitis in adults - aftercare To use the sharing features on this page, please enable JavaScript. Your sinuses are chambers in ... They are filled with air. Sinusitis is an infection of these chambers, which causes ...

  3. Sinus x-ray

    MedlinePlus

    Paranasal sinus radiography; X-ray - sinuses ... sinus x-ray is taken in a hospital radiology department. Or the x-ray may be taken ... Brown J, Rout J. ENT, neck, and dental radiology. In: Adam A, Dixon AK, Gillard JH Schaefer- ...

  4. Sinusitis (For Teens)

    MedlinePlus

    ... caused by infection. Our sinuses are the moist air spaces within the bones of the face around the nose. The frontal sinuses are located in the area near the eyebrows; the ... our sinuses are filled with air, making our facial bones less dense and much ...

  5. Computed Tomography (CT) -- Sinuses

    MedlinePlus

    ... More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Sinuses Computed tomography (CT) of the sinuses uses special x-ray equipment to evaluate the paranasal sinus cavities – hollow, air-filled spaces within the bones of the face surrounding the ...

  6. Mixed total anomalous pulmonary venous connection: Case report with bilateral venous collectors.

    PubMed

    Cayre, Raul O; Civetta, Julio D; Roldan, Alberto O; Rousseau, Juan J; Knudson, Ole A; Valdes-Cruz, Lilliam M

    2003-01-01

    We present a case report of a 3-month-old boy with a mixed total anomalous pulmonary venous connection. The patient had situs solitus, small atrial septal defect, and 2 separate venous collectors. The right pulmonary veins drained through a right-sided venous collector into the coronary sinus. The left-sided pulmonary veins drained through the left-sided venous collector directly into the right superior vena cava. The use of the echocardiogram and Doppler color flow mapping to establish a detailed morphologic analysis, the sites of connection, and the presence of pulmonary venous obstructions as well as the value of this information to facilitate a successful surgical repair are discussed.

  7. Absence of the superior petrosal veins and sinus: Surgical considerations

    PubMed Central

    Matsushima, Ken; Ribas, Eduardo Santamaria Carvalhal; Kiyosue, Hiro; Komune, Noritaka; Miki, Koichi; Rhoton, Albert L.

    2015-01-01

    Background: The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups. Methods: This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent. Results: The superior petrosal veins, described as 1–3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface. Conclusions: In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes. PMID:25745589

  8. Developmental Venous Anomaly: Benign or Not Benign.

    PubMed

    Aoki, Rie; Srivatanakul, Kittipong

    2016-09-15

    Developmental venous anomalies (DVAs), previously called venous angiomas, are the most frequently encountered cerebral vascular malformations. However, DVA is considered to be rather an extreme developmental anatomical variation of medullary veins than true malformation. DVAs are composed of dilated medullary veins converging centripetally into a large collecting venous system that drains into the superficial or deep venous system. Their etiology and mechanism are generally accepted that DVAs result from the focal arrest of the normal parenchymal vein development or occlusion of the medullary veins as a compensatory venous system. DVAs per se are benign and asymptomatic except for under certain unusual conditions. The pathomechanisms of symptomatic DVAs are divided into mechanical, flow-related causes, and idiopathic. However, in cases of DVAs associated with hemorrhage, cavernous malformations (CMs) are most often the cause rather than DVAs themselves. The coexistence of CM and DVA is common. There are some possibilities that DVA affects the formation and clinical course of CM because CM related to DVA is generally located within the drainage territory of DVA and is more aggressive than isolated CM in the literature. Brain parenchymal abnormalities surrounding DVA and cerebral varix have also been reported. These phenomena are considered to be the result of venous hypertension associated with DVAs. With the advance of diagnostic imagings, perfusion study supports this hypothesis demonstrating that some DVAs have venous congestion pattern. Although DVAs should be considered benign and clinically silent, they can have potential venous hypertension and can be vulnerable to hemodynamic changes.

  9. Developmental Venous Anomaly: Benign or Not Benign

    PubMed Central

    AOKI, Rie; SRIVATANAKUL, Kittipong

    2016-01-01

    Developmental venous anomalies (DVAs), previously called venous angiomas, are the most frequently encountered cerebral vascular malformations. However, DVA is considered to be rather an extreme developmental anatomical variation of medullary veins than true malformation. DVAs are composed of dilated medullary veins converging centripetally into a large collecting venous system that drains into the superficial or deep venous system. Their etiology and mechanism are generally accepted that DVAs result from the focal arrest of the normal parenchymal vein development or occlusion of the medullary veins as a compensatory venous system. DVAs per se are benign and asymptomatic except for under certain unusual conditions. The pathomechanisms of symptomatic DVAs are divided into mechanical, flow-related causes, and idiopathic. However, in cases of DVAs associated with hemorrhage, cavernous malformations (CMs) are most often the cause rather than DVAs themselves. The coexistence of CM and DVA is common. There are some possibilities that DVA affects the formation and clinical course of CM because CM related to DVA is generally located within the drainage territory of DVA and is more aggressive than isolated CM in the literature. Brain parenchymal abnormalities surrounding DVA and cerebral varix have also been reported. These phenomena are considered to be the result of venous hypertension associated with DVAs. With the advance of diagnostic imagings, perfusion study supports this hypothesis demonstrating that some DVAs have venous congestion pattern. Although DVAs should be considered benign and clinically silent, they can have potential venous hypertension and can be vulnerable to hemodynamic changes. PMID:27250700

  10. Complex Partial Epilepsy Associated with Temporal Lobe Developmental Venous Anomaly.

    PubMed

    Sohail, Amna; Xiong, Zhengming; Qureshi, Mushtaq H; Qureshi, Adnan I

    2015-05-01

    Developmental venous anomalies (DVA) are found incidentally but sometimes patients with these anomalies present with varying degrees of neurologic manifestations. We report a patient with early onset complex partial epilepsy and associated DVA and discuss the natural history, neuroimaging and clinical characteristics, and management. A 21-year-old man presented with a history of complex partial epilepsy with secondary generalization which started at the age of 4 years. An electroencephalogram (EEG) was performed which demonstrated spike and wave discharges predominantly in the left frontotemporal region. A magnetic resonance imaging (MRI) was performed which demonstrated a linear flow void suggestive of a DVA. The angiogram demonstrated DVA that connected with the left transverse venous sinus and an anastomotic vein between the straight sinus and the transverse venous sinus traversing the brain parenchyma. He was started on carbamezipine for the treatment of complex partial seizures. Temporal lobe DVA may be associated with complex partial seizures and can be diagnosed by MRI and angiographic findings.

  11. Allergic Fungal Sinusitis.

    PubMed

    Correll, Daniel P; Luzi, Scott A; Nelson, Brenda L

    2015-12-01

    A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot-Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy.

  12. Bilateral Maxillary Sinus Hypoplasia

    PubMed Central

    Khanduri, Sachin; Agrawal, Sumit; Goyal, Swati

    2014-01-01

    Maxillary sinus hypoplasia (MSH) is an uncommon abnormality of paranasal sinuses noted in clinical practice. Computed tomography (CT) scan helps in diagnosing the anomaly along with any anatomical variation that may be associated with it. MSH is usually associated with other anomalies like uncinate process hypoplasia. Three types of MSH have been described. Type 1 MSH shows mild maxillary sinus hypoplasia, type 2 shows significant sinus hypoplasia with narrowed infundibular passage and hypoplastic or absent uncinate process, and type 3 is cleft like maxillary sinus hypoplasia with absent uncinate process. CT and endoscopic examination usually complement each other in diagnosing MSH. PMID:25548709

  13. Carotid and cranial nerve reconstruction after removal of cavernous sinus lesions.

    PubMed

    Sekhar, L N; Sen, C N; Lanzino, G; Pomonis, S

    1991-12-01

    During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Bilateral inferior petrosal sinus sampling

    PubMed Central

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  15. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  16. Recurrent cerebral abscess secondary to a persistent left superior vena cava.

    PubMed

    Menachem, Jonathan N; Sundaram, Senthil N; Rhodes, John F

    2014-01-01

    Cerebral abscess is a serious neurological condition that is often of unclear etiology. Management is usually medical therapy with or without direct drainage, and when patients have recurrent episodes a structural abnormality should be considered. Persistent left superior vena cava is an uncommon condition in the absence of other forms of congenital heart disease. This venous connection most often enters the right-sided atrium through the coronary sinus but occasionally can connect directly to the left atrium near the wall between the orifice of the left pulmonary veins and left atrial appendage. This later congenital connection results in systemic venous return entering the left atrium directly. Thus allowing unfiltered, lower saturation blood entering the systemic system. This then places the patient at risk for systemic hypoxemia, paradoxical embolic events, and cerebral abscess. In our case report with recurrent cerebral abscess and a persistent left superior vena cava, we demonstrate when to consider this diagnosis, how to make the diagnosis, and a nonsurgical approach to repair the veno-atrial shunt. © 2013 Wiley Periodicals, Inc.

  17. [Deep venous thrombosis related to cranioencephalic injury].

    PubMed

    Yáñez Baña, R M; Rossi López, R E; Romero López, J; Pareja Grande, J A; González-Elipe, J

    1989-09-01

    The clinical onset of cerebral venous thrombosis (CVT) is very variable and the causes that may lead to its development are also quite numerous. Although characteristic CT diagnostic signs have been described, in most cases only nonspecific findings are present and angiography is required to confirm the diagnosis. The prognosis is variable. Classically, the mortality is high when the deep venous system is involved. We report a male with CVT involving Galen's vein and its major tributary vessels, who had a favorable outcome with heparin therapy and drugs for cerebral edema. We discuss the etiologic factors in this patient, the characteristic neuroradiologic findings, and their evolution during the course of therapy.

  18. Using near-infrared spectroscopy to measure cerebral metabolic rate of oxygen under multiple levels of arterial oxygenation in piglets.

    PubMed

    Tichauer, Kenneth M; Elliott, Jonathan T; Hadway, Jennifer A; Lee, David S; Lee, Ting-Yim; St Lawrence, Keith

    2010-09-01

    Improving neurological care of neonates has been impeded by the absence of suitable techniques for measuring cerebral hemodynamics and energy metabolism at the bedside. Currently, near-infrared spectroscopy (NIRS) appears to be the technology best suited to fill this gap, and techniques have been proposed to measure both cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2). We have developed a fast and reliable bolus-tracking method of determining CMRO2 that combines measurements of CBF and cerebral venous oxygenation [venous oxygen saturation (CSvO2)]. However, this method has never been validated at different levels of arterial oxygenation [arterial oxygen saturation (SaO2)], which can be highly variable in the clinical setting. In this study, NIRS measurements of CBF, CSvO2, and CMRO2 were obtained over a range of SaO2 in newborn piglets (n=12); CSvO2 values measured directly from sagittal sinus blood samples were collected for validation. Two alternative NIRS methods that measure CSvO2 by manipulating venous oxygenation (i.e., head tilt and partial venous occlusion methods) were also employed for comparison. Statistically significant correlations were found between each NIRS technique and sagittal sinus blood oxygenation (P<0.05). Correlation slopes were 1.03 (r=0.91), 0.73 (r=0.73), and 0.73 (r=0.81) for the bolus-tracking, head tilt, and partial venous occlusion methods, respectively. The bolus-tracking technique displayed the best correlation under hyperoxic (SaO2=99.9±0.03%) and normoxic (SaO2=86.9±6.6%) conditions and was comparable to the other techniques under hypoxic conditions (SaO2=40.7±9.9%). The reduced precision of the bolus-tracking method under hypoxia was attributed to errors in CSvO2 measurement that were magnified at low SaO2 levels. In conclusion, the bolus-tracking technique of measuring CSvO2, and therefore CMRO2, is accurate and robust for an SaO2>50% but provides reduced accuracy under more severe hypoxic levels.

  19. Microbiology of sinusitis.

    PubMed

    Brook, Itzhak

    2011-03-01

    Most sinus infections are viral, and only a small proportion develops a secondary bacterial infection. Rhinoviruses, influenza viruses, and parainfluenza viruses are the most common causes of sinusitis. The most common bacteria isolated from pediatric and adult patients with community-acquired acute purulent sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Staphylococcus aureus and anaerobic bacteria (Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.) are the main isolates in chronic sinusitis. Pseudomonas aeruginosa and other aerobic and facultative gram-negative rods are commonly isolated from patients with nosocomial sinusitis, the immunocompromised host, those with HIV infection, and in cystic fibrosis. Fungi and Pseudomonas aeruginosa are the most common isolates in neutropenic patients. The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.

  20. Human paranasal sinuses and selective brain cooling: a ventilation system activated by yawning?

    PubMed

    Gallup, Andrew C; Hack, Gary D

    2011-12-01

    The function of the paranasal sinuses has been a controversial subject since the time of Galen, with many different theories advanced about their biological significance. For one, the paranasal sinuses have been regarded as warmers of respiratory air, when in actuality these structures appear to function in cooling the blood. In fact, human paranasal sinuses have been shown to have higher volumes in individuals living in warmer climates, and thus may be considered radiators of the brain. The literature suggests that the transfer of cool venous blood from the paranasal sinuses to the dura mater may provide a mechanism for the convection process of cooling produced by the evaporation of mucus within human sinuses. In turn, the dura mater may transmit these temperature changes, initiated by the cool venous blood from the heat-dissipating surfaces of the sinuses, to the cerebrospinal fluid compartments. Furthermore, it has recently been demonstrated in cadaveric dissections that the thin bony posterior wall of the maxillary sinus serves as an origin for both medial and lateral pterygoid muscle segments, an anatomic finding that had been previously underappreciated in the literature. The present authors hypothesize that the thin posterior wall of the maxillary sinus may flex during yawning, operating like a bellows pump, actively ventilating the sinus system, and thus facilitating brain cooling. Such a powered ventilation system has not previously been described in humans, although an analogous system has been reported in birds.

  1. Lower extremity venous reflux

    PubMed Central

    Baliyan, Vinit; Tajmir, Shahein; Ganguli, Suvranu; Prabhakar, Anand M.

    2016-01-01

    Venous incompetence in the lower extremity is a common clinical problem. Basic understanding of venous anatomy, pathophysiologic mechanisms of venous reflux is essential for choosing the appropriate treatment strategy. The complex interplay of venous pressure, abdominal pressure, venous valvular function and gravitational force determine the venous incompetence. This review is intended to provide a succinct review of the pathophysiology of venous incompetence and the current role of imaging in its management. PMID:28123974

  2. The role of intracarotid cold saline infusion on a theoretical brain model incorporating the circle of willis and cerebral venous return.

    PubMed

    Neimark, Matthew A; Konstas, Angelos-Aristeidis; Choi, Jae H; Laine, Andrew F; Pile-Spellman, John

    2007-01-01

    This study describes a theoretical model of brain cooling by intracarotid cold saline infusion which takes into account redistribution of cold perfusate through the circle of Willis (CoW) and cold venous return (VR) from the head. This model is developed in spherical coordinates on a four tissue layer hemispherical geometrical configuration. Temperature evolution is modeled according to the Pennes bioheat transfer equation. Simulations were run over a 1 hour period and 30 ml/min of freezing cold saline with the baseline model (no VR, no CoW), VR model (without CoW), and CoW model (with VR). The VR model demonstrates continuing temperature drop in the treatment region of the brain not observed in the baseline model and its final mean ipsilateral anterior temperature was approximately 31 degrees C. The temperature effect in the CoW model was present but less robust in the ipsilateral anterior region, as final temperature was 32 degrees C. However, cooling was also achieved in contralateral and posterior brain regions. This model continues to demonstrate the feasibility of intracarotid cold saline infusion for ischemic stroke therapy.

  3. Venous endothelial injury in central nervous system diseases

    PubMed Central

    2013-01-01

    The role of the venous system in the pathogenesis of inflammatory neurological/neurodegenerative diseases remains largely unknown and underinvestigated. Aside from cerebral venous infarcts, thromboembolic events, and cerebrovascular bleeding, several inflammatory central nervous system (CNS) diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and optic neuritis, appear to be associated with venous vascular dysfunction, and the neuropathologic hallmark of these diseases is a perivenous, rather than arterial, lesion. Such findings raise fundamental questions about the nature of these diseases, such as the reasons why their pathognomonic lesions do not develop around the arteries and what exactly are the roles of cerebral venous inflammation in their pathogenesis. Apart from this inflammatory-based view, a new hypothesis with more focus on the hemodynamic features of the cerebral and extracerebral venous system suggests that MS pathophysiology might be associated with the venous system that drains the CNS. Such a hypothesis, if proven correct, opens new therapeutic windows in MS and other neuroinflammatory diseases. Here, we present a comprehensive review of the pathophysiology of MS, ADEM, pseudotumor cerebri, and optic neuritis, with an emphasis on the roles of venous vascular system programming and dysfunction in their pathogenesis. We consider the fundamental differences between arterial and venous endothelium, their dissimilar responses to inflammation, and the potential theoretical contributions of venous insufficiency in the pathogenesis of neurovascular diseases. PMID:24228622

  4. Cerebral emboli of paradoxical origin.

    PubMed

    Jones, H R; Caplan, L R; Come, P C; Swinton, N W; Breslin, D J

    1983-03-01

    A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

  5. Quantifying the cerebral metabolic rate of oxygen by combining diffuse correlation spectroscopy and time-resolved near-infrared spectroscopy.

    PubMed

    Verdecchia, Kyle; Diop, Mamadou; Lee, Ting-Yim; St Lawrence, Keith

    2013-02-01

    Preterm infants are highly susceptible to ischemic brain injury; consequently, continuous bedside monitoring to detect ischemia before irreversible damage occurs would improve patient outcome. In addition to monitoring cerebral blood flow (CBF), assessing the cerebral metabolic rate of oxygen (CMRO2) would be beneficial considering that metabolic thresholds can be used to evaluate tissue viability. The purpose of this study was to demonstrate that changes in absolute CMRO2 could be measured by combining diffuse correlation spectroscopy (DCS) with time-resolved near-infrared spectroscopy (TR-NIRS). Absolute CBF was determined using bolus-tracking TR-NIRS to calibrate the DCS measurements. Cerebral venous blood oxygenation (SvO2) was determined by multiwavelength TR-NIRS measurements, the accuracy of which was assessed by directly measuring the oxygenation of sagittal sinus blood. In eight newborn piglets, CMRO2 was manipulated by varying the anesthetics and by injecting sodium cyanide. No significant differences were found between the two sets of SvO2 measurements obtained by TR-NIRS or sagittal sinus blood samples and the corresponding CMRO2 measurements. Bland-Altman analysis showed a mean CMRO2 difference of 0.0268 ± 0.8340 mLO2/100 g/min between the two techniques over a range from 0.3 to 4 mL O2/100 g/min.

  6. Quantifying the cerebral metabolic rate of oxygen by combining diffuse correlation spectroscopy and time-resolved near-infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Verdecchia, Kyle; Diop, Mamadou; Lee, Ting-Yim; St. Lawrence, Keith

    2013-02-01

    Preterm infants are highly susceptible to ischemic brain injury; consequently, continuous bedside monitoring to detect ischemia before irreversible damage occurs would improve patient outcome. In addition to monitoring cerebral blood flow (CBF), assessing the cerebral metabolic rate of oxygen (CMRO2) would be beneficial considering that metabolic thresholds can be used to evaluate tissue viability. The purpose of this study was to demonstrate that changes in absolute CMRO2 could be measured by combining diffuse correlation spectroscopy (DCS) with time-resolved near-infrared spectroscopy (TR-NIRS). Absolute CBF was determined using bolus-tracking TR-NIRS to calibrate the DCS measurements. Cerebral venous blood oxygenation (SvO2) was determined by multiwavelength TR-NIRS measurements, the accuracy of which was assessed by directly measuring the oxygenation of sagittal sinus blood. In eight newborn piglets, CMRO2 was manipulated by varying the anesthetics and by injecting sodium cyanide. No significant differences were found between the two sets of SvO2 measurements obtained by TR-NIRS or sagittal sinus blood samples and the corresponding CMRO2 measurements. Bland-Altman analysis showed a mean CMRO2 difference of 0.0268±0.8340 mL O2/100 g/min between the two techniques over a range from 0.3 to 4 mL O2/100 g/min.

  7. Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experience.

    PubMed

    Couturier, Marie-Anne; Huguet, Françoise; Chevallier, Patrice; Suarez, Felipe; Thomas, Xavier; Escoffre-Barbe, Martine; Cacheux, Victoria; Pignon, Jean-Michel; Bonmati, Caroline; Sanhes, Laurence; Bories, Pierre; Daguindau, Etienne; Dorvaux, Véronique; Reman, Oumedaly; Frayfer, Jamile; Orvain, Corentin; Lhéritier, Véronique; Ifrah, Norbert; Dombret, Hervé; Hunault-Berger, Mathilde; Tanguy-Schmidt, Aline

    2015-11-01

    Central nervous system (CNS) thrombotic events are a well-known complication of acute lymphoblastic leukemia (ALL) induction therapy, especially with treatments including l-asparaginase (l-ASP). Data on risk factors and clinical evolution is still lacking in adult patients. We report on the clinical evolution of 22 CNS venous thrombosis cases occurring in 708 adults treated for ALL or lymphoblastic lymphoma (LL) with the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-induction protocol, which included eight L-ASP (6,000 IU/m(2) ) infusions. The prevalence of CNS thrombosis was 3.1%. CNS thrombosis occurred after a median of 18 days (range: 11-31) when patients had received a median of three l-ASP injections (range: 2-7). Patients with CNS thrombosis exhibited a median antithrombin (AT) nadir of 47.5% (range: 36-67%) at Day 17 (range: D3-D28), and 95% of them exhibited AT levels lower than 60%. There were no evident increase in hereditary thrombotic risk factors prevalence, and thrombosis occurred despite heparin prophylaxis which was performed in 90% of patients. Acquired AT deficiency was frequently detected in patients with l-ASP-based therapy, and patients with CNS thrombosis received AT prophylaxis (45%) less frequently than patients without CNS thrombosis (83%), P = 0.0002). CNS thrombosis was lethal in 5% of patients, while 20% had persistent sequelae. One patient received all planned l-ASP infusions without recurrence of CNS thrombotic whereas l-ASP injections were discontinued in 20 patients during the management of thrombosis without a significant impact on overall survival (P = 0.4).

  8. [Dental foreign body sinusitis].

    PubMed

    Thévoz, F; Arza, A; Jaques, B

    2000-01-01

    Unilateral chronic maxillary sinusitis is frequently attributed to dental origin. The goal of this retrospective study is to determine the frequency of maxillary sinusitis due to a foreign body of dental origin and its characteristics. Review of 197 sinusitis cases with maxillary sinus involvement operated in our department from 1991 to 1999. Selection of the 17 cases preoperatively suspect to be due to a foreign body of dental origin. 9% of the 197 maxillary sinusitis were classified "odontogenic". Intra-sinusal foreign bodies were identified in 5%: 2% of dental origin, 1% dental or radicular remnants, 2% of "pseudo" foreign bodies of mycotic origin. Chronic maxillary sinusitis attributable to a dental foreign body is rare and overestimated. There exists an important disproportion between the number of intra-sinusal dental foreign bodies and the number of patients who are symptomatic. Treatment is surgical by oral antrotomy and/or endonasal meatotomy. Only a prospective study could give a real estimation of the proportion of symptomatic cases and determine the predisposing factors.

  9. [Clinical features and management of cavernous and venous angiomas in the head].

    PubMed

    Tokunaga, Koji; Date, Isao

    2011-01-01

    Cerebral cavernous angiomas consist of well-circumscribed collections of thin-walled sinusoidal vascular channels lacking the intervening brain tissue. They are present in 0.4-0.8% of the population, and can occur in a sporadic or familial form. Most common symptoms are seizures, hemorrhage, and focal neurological deficits. The annual bleeding rate of the patient is reported to be 0.25%-20%. High-resolution magnetic resonance imaging (MRI) is a useful diagnostic tool with a high degree of sensitivity and specificity. Microsurgical excision of the lesion is a good treatment choice for cavernous angiomas in the brain, even in the brainstem. Although stereotactic radiosurgery may reduce the incidence of rebleeding and the frequency of seizures, its indication should be carefully investigated because of the relatively high rate of radiation-induced side effects. Less frequently, cavernous angiomas can be located at the extra-axial regions of the head, which include the cavernous sinus, the orbit, and the cranial nerves. Cavernous angiomas in the cavernous sinus pose a neurosurgical challenge due to the high vascularity and involvement of the neurovascular structures, and stereotactic radiosurgery is considered as an additional option. Surgical resection is recommended for symptomatic cavernous angiomas in the orbit; however, the rate of complications after resection is not necessarily low for cavernous angiomas within the apex. Venous angiomas are anomalies of normal venous drainage, which show characteristic appearance of the drainage system in the late phase of angiography (caput medusae). They are found either alone or in combination with other vascular malformations. Conservative treatment is recommended except for patients with a large hematoma or with a coexisting cavernous angioma.

  10. Sustained high-altitude hypoxia increases cerebral oxygen metabolism

    PubMed Central

    Smith, Zachary M.; Krizay, Erin; Guo, Jia; Shin, David D.; Scadeng, Miriam

    2013-01-01

    Acute mountain sickness (AMS) is a common condition occurring within hours of rapid exposure to high altitude. Despite its frequent occurrence, the pathophysiological mechanisms that underlie the condition remain poorly understood. We investigated the role of cerebral oxygen metabolism (CMRO2) in AMS. The purpose of this study was to test 1) if CMRO2 changes in response to hypoxia, and 2) if there is a difference in how individuals adapt to oxygen metabolic changes that may determine who develops AMS and who does not. Twenty-six normal human subjects were recruited into two groups based on Lake Louise AMS score (LLS): those with no AMS (LLS ≤ 2), and those with unambiguous AMS (LLS ≥ 5). [Subjects with intermediate scores (LLS 3–4) were not included.] CMRO2 was calculated from cerebral blood flow and arterial-venous difference in O2 content. Cerebral blood flow was measured using arterial spin labeling MRI; venous O2 saturation was calculated from the MRI of transverse relaxation in the superior sagittal sinus. Arterial O2 saturation was measured via pulse oximeter. Measurements were made during normoxia and after 2-day high-altitude exposure at 3,800 m. In all subjects, CMRO2 increased with sustained high-altitude hypoxia [1.54 (0.37) to 1.82 (0.49) μmol·g−1·min−1, n = 26, P = 0.045]. There was no significant difference in CMRO2 between AMS and no-AMS groups. End-tidal Pco2 was significantly reduced during hypoxia. Low arterial Pco2 is known to increase neural excitability, and we hypothesize that the low arterial Pco2 resulting from ventilatory acclimatization causes the observed increase in CMRO2. PMID:23019310

  11. Facial vein thrombophlebitis: an uncommon complication of sinusitis.

    PubMed

    Cotes, Claudia; Riascos, Roy; Swischuk, Leonard E

    2015-07-01

    Facial vein thrombophlebitis is an uncommon complication of sinusitis. In cases where periorbital swelling complicating sinusitis is diagnosed, clinical findings of swelling and erythema extending beyond the orbital region into the cheek should alert the physician about this unusual complication and the need for further contrast-enhanced imaging and venography. The radiologist must be particularly careful in the evaluation of vascular structures of the face and neck in these children. CT and MRI with contrast material and MR venography are studies that clearly demonstrate the vascular anatomy and possible complications. However, MR venography confirms flow abnormalities within the venous system with the advantage of avoiding radiation exposure to the pediatric patient.

  12. Computed tomographic observations pertinent to intracranial venous thrombotic and occulsive disease in childhood: state of the art, some new data, and hypotheses

    SciTech Connect

    Segall, H.D.; Ahmadi, J.; McComb, J.G.; Zee, C.S.; Becker, T.S.; Han, J.S.

    1982-05-01

    Selected topics are discussed and new observations recorded regarding computed tomographic (CT) evaluation of intracranial venous thrombotic and occlusive disease in childhood. High density of the vein of Galen and adjacent venous sinuses (relative to brain) can be seen normally in children. A number of potential pitfalls in the diagnosis of superior sagittal sinus thrombosis are also disclosed. A case of cavernous sinus thrombosis with abnormal CT changes is included. In addition, the normal CT appearance of the cavernous sinus is described. In some cases, filling defects occur which appear to correlate with normal cranial nerves. An unusual case of venous sinus occlusion by neoplasm (sarcoma) is presented. Finally, new findings in the Sturge-Weber syndrome are analyzed. Enhancement of the brain in this condition may have its basis in altered circulation resulting from fundamental venous abnormalities.

  13. [Multiplane postmortem cerebral computed angiotomography--Part II. Normal anatomy of cerebral vessels on the modified coronal, Towne and semisagittal planes].

    PubMed

    Yamamoto, Y; Satoh, T; Asari, S; Sadamoto, K

    1982-06-01

    In order to obtain a detailed knowledge of the cerebral vasculature on computed tomographic (CT) images, multiplane CT scannings on the axial, coronal, Towne and sagittal planes are required. Previous reports have concerned only the axial CT images of the cerebral vasculature, and no mention has been made about the vasculature on the coronal, Towne or sagittal images. This paper concerns the normal anatomy of the cerebral vessels on the modified coronal, Towne (half-axial) and semisagittal CT planes using 9 fresh cadavers. They received postmortem injection of contrast agents and were scanned by GE-CT/T 8800 as mentioned in Part I. Scanning planes were the modified 50-60 degrees coronal, Towne (40-45 degrees off the canthomeatal line), and the semisagittal (45 degrees toward the sagittal plane). The main vascular structures visualized on the modified coronal CT plane resembled the antero-posterior view of the carotid angiogram, and they were as follows: internal carotid arteries (supra-clinoid portion), posterior communicating arteries, anterior choroidal arteries, anterior cerebral arteries (horizontal and ascending portions, pericallosal and callosomarginal arteries and other cortical branches), middle cerebral arteries (horizontal, insular, opercular and terminal portions with identification of the angiographic Sylvian point), lenticulostriate arteries, posterior cerebral arteries, basal vein of Rosenthal (BVR), internal cerebral veins (ICV), subependymal veins which drain into BVR and ICV, choroid veins, vein of Galen, and venous sinuses. As for the demonstration of the lenticulostriate arteries or the Moyamoya vessels in clinical cases, the modified coronal plane is preferred to the axial one. On Towne plane, the vertebro-basilar arteries and the ascending portion of anterior cerebral artery were demonstrated as linear densities, which were demonstrated as spotty densities on the axial plane. On the semisagittal plane, the median or paramedian vasculatures of

  14. Infantile Dural Arteriovenous Fistula of the Transverse Sinus Presenting with Ocular Symptoms, Case Reports and Review of Literature

    PubMed Central

    Hassan, Tamer

    2016-01-01

    Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure.This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula. PMID:27226864

  15. Capillo-venous flow in the brain: significance of intravascular RBC aggregation for venous flow regulation.

    PubMed

    Tomita, Minoru; Tanahashi, Norio; Takeda, Hidetaka; Schiszler, Istvan; Osada, Takashi; Unekawa, Miyuki; Suzuki, Norihiro

    2006-01-01

    Despite numerous reports on the regulation of cerebral arterial blood flow, little work has been done on that of the capillary and venous system. We have examined capillo-venous blood flow in the rat intraparenchymal cerebral cortex, employing a high-speed video confocal fluorescence microscope and our own software (KEIOIS-2) to track individual RBCs and to document velocity changes in single capillaries and veins. We found temporal and spatial heterogeneous changes in capillary RBC density (hematocrit), RBC recruitment, oscillation of capillary flow or vasomotion, and capillary density unrelated to arteriolar diametric changes. In veins, blood flow was also quite variable in time and space, and at a high frame rate venous blood per se was observed as a moving column of amorphous RBC aggregates with irregular edges; we believe this is the first report of such an observation under physiological conditions. The formation of such intravascular RBC aggregates would enforce slowing of blood flow and vice versa: RBC aggregation was in turn entirely flow-dependent. In rapid venous flow, RBCs appeared as a straight gathering of individually separated and dispersed cells. At capillo-venous junctions, an "RBC pouring" process appeared to occur, with RBCs either being sucked up from the capillary, merging, or being held back in the capillary. Changes in venous blood viscosity due to RBC aggregation are likely to be involved in this process. These findings suggest that the capillo-venous junction somehow participates in the regulation of appropriate tissue capillary flow in toto.

  16. [Diagnosing venous and venous/arterial ulcers].

    PubMed

    Perceau, Géraldine

    2012-01-01

    A venous ulcer can be diagnosed on the basis of elements arising from the questioning and the clinical examination of the patient. A venous Doppler ultrasound can specify the type of reverse flow (superficial and/or deep). Measuring the ankle brachial pressure index helps to eliminate or confirm any arterial involvement. Depending on the systolic pressure index, the ulcer will be considered as purely venous, mixed (arterial-venous) or predominantly arterial.

  17. Three-dimensional printing of a sinus pericranii model: technical note.

    PubMed

    Simonin, Alexandre; Martinerie, Sébastien; Levivier, Marc; Daniel, Roy Thomas

    2017-03-01

    Sinus pericranii (SP) is a rare venous malformation consisting of a single or multiple abnormal emissary veins communicating between intracranial sinuses and dilated epicranial veins. There is no consensus concerning diagnosis, management, and treatment of SP. We report the case of a 4-month-old infant with a SP for whom we used a three-dimensional printed model in order to define the angioarchitecture, improve management, and help parents' understanding of this uncommon condition.

  18. Endoscopic Sinus Surgery

    MedlinePlus

    ... information in the popular media may not reflect reality. Although useful, balloon sinuplasty is not for everyone. In many cases standard endoscopic sinus surgery or medical therapy may be the best treatment. However, in some ...

  19. Expectations of Sinus Surgery

    MedlinePlus

    ... your doctor at a clinic appointment after surgery. Irrigations – The most important thing you can do to ... regularly irrigate your nose and sinuses with saline irrigations after surgery. Your doctor will show you how ...

  20. Sinusitis Q and A

    MedlinePlus

    ... to find multiple bacteria present in a single culture sample. In addition, these organisms may demonstrate drug ... are often based on the results of sinus cultures and are prescribed for 3-4 weeks time. ...

  1. Complications of Sinus Surgery

    MedlinePlus

    ... further intracranial surgeries. Impaired sense of taste or smell : The sense of smell usually improves after the procedure because airflow is ... in their voice after sinus surgery. Impairment of smell or taste: (see above) Infection: The most common ...

  2. Sinus MRI scan

    MedlinePlus

    ... sinuses. The test is noninvasive. MRI uses powerful magnets and radio waves instead of radiation. Signals from ... in the eyes. Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and ...

  3. Fibrin Glue Injection for Cavernous Sinus Hemostasis Associated with Cranial Nerve Deficit: A Case Report

    PubMed Central

    Tavanaiepour, Daryoush; Jernigan, Sarah; Abolfotoh, Mohamad; Al-Mefty, Ossama

    2015-01-01

    Fibrin glue injection has been used to control intraoperative cavernous sinus (CS) venous bleeding. There have been no reported complications related to this maneuver. We present a case where a patient developed a sensory trigeminal nerve deficit after injection of fibrin glue into the posterior CS during resection of a petrosal meningioma. We believe that this deficit was due to the compression of the trigeminal ganglion similar to balloon compression procedures. Although fibrin glue injection may achieve satisfactory cavernous sinus homeostasis, the volume and rate of injection should be kept in mind to avoid a compressive lesion on traversing cranial nerves and surrounding structures, or retrograde filling of the venous tributaries. PMID:26251815

  4. Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.

    1996-01-01

    Human venous compliance hypothetically decreases from upper to lower body as a mechanism for maintenance of the hydrostatic indifference level 'headward' in the body, near the heart. This maintains cardiac filling pressure, and thus cardiac output and cerebral perfusion, during orthostasis. This project entailed four steps. First, acute whole-body tilting was employed to alter human calf and neck venous volumes. Subjects were tilted on a tilt table equipped with a footplate as follows: 90 deg, 53 deg, 30 deg, 12 deg, O deg, -6 deg, -12 deg, -6 deg, O deg, 12 deg, 30 deg, 53 deg, and 90 deg. Tilt angles were held for 30 sec each, with 10 sec transitions between angles. Neck volume increased and calf volume decreased during head-down tilting, and the opposite occurred during head-up tilt. Second, I sought to cross-validate Katkov and Chestukhin's (1980) measurements of human leg and neck venous pressures during whole-body tilting, so that those data could be used with volume data from the present study to calculate calf and neck venous compliance (compliance = (Delta)volume/(Delta)pressure). Direct measurements of venous pressures during postural chances and whole-body tilting confirmed that the local changes in venous pressures seen by Katkov and Chestukhin (1980) are valid. The present data also confirmed that gravitational changes in calf venous pressure substantially exceed those changes in upper body venous pressure. Third, the volume and pressure data above were used to find that human neck venous compliance exceeds calf venous compliance by a factor of 6, thereby upholding the primary hypothesis. Also, calf and neck venous compliance correlated significantly with each other (r(exp 2) = 0.56). Fourth, I wished to determine whether human calf muscle activation during head-up tilt reduces calf venous compliance. Findings from tilting and from supine assessments of relaxed calf venous compliance were similar, indicating that tilt-induced muscle activation is

  5. Rhinitis and sinusitis.

    PubMed

    Dykewicz, Mark S; Hamilos, Daniel L

    2010-02-01

    Rhinitis and sinusitis are among the most common medical conditions and are frequently associated. In Western societies an estimated 10% to 25% of the population have allergic rhinitis, with 30 to 60 million persons being affected annually in the United States. It is estimated that sinusitis affects 31 million patients annually in the United States. Both rhinitis and sinusitis can significantly decrease quality of life, aggravate comorbid conditions, and require significant direct medical expenditures. Both conditions also create even greater indirect costs to society by causing lost work and school days and reduced workplace productivity and school learning. Management of allergic rhinitis involves avoidance, many pharmacologic options, and, in appropriately selected patients, allergen immunotherapy. Various types of nonallergic rhinitis are treated with avoidance measures and a more limited repertoire of medications. For purposes of this review, sinusitis and rhinosinusitis are synonymous terms. An acute upper respiratory illness of less than approximately 7 days' duration is most commonly caused by viral illness (viral rhinosinusitis), whereas acute bacterial sinusitis becomes more likely beyond 7 to 10 days. Although the mainstay of management of acute bacterial sinusitis is antibiotics, treatment of chronic sinusitis is less straightforward because only some chronic sinusitis cases have an infectious basis. Chronic rhinosinusitis (CRS) has been subdivided into 3 types, namely CRS without nasal polyps, CRS with nasal polyps, and allergic fungal rhinosinusitis. Depending on the type of CRS present, a variety of medical and surgical approaches might be required. Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  6. Chronic sinusitis in children.

    PubMed

    Calderon, E; O'Neal, M L; Fox, R W; Calderon-Moncloa, J

    1996-01-01

    Chronic sinusitis is now recognized as a common clinical syndrome in adults and children. An astute physician can diagnose chronic sinusitis during the physical exam, but fiber-optic rhinoscopy and x-rays (plain films and computerized tomography) are required to confirm this diagnosis, evaluate the severity of the sinusitis and determine follow-up treatment. Appropriate treatment plans are prescribed for an adequate duration to eliminate infection and inflammatory components of the pathologic process of the sinuses involved. Antibiotics, decongestants, and inhaled or systemic corticosteroids are required in the treatment of patients with chronic sinusitis. When combined with close clinical follow-up, successful resolution is expected. Surgical intervention is needed in the medically refractory and symptomatic cases, or when complications develop. The frequent diagnosis of chronic sinusitis in the past 1-2 decades is, in part, due to the enhanced awareness and clinical skills of the treating physicians, but other concerns about environmental influences such as frequent respiratory tract infections in childhood and air quality issues are considered potentially important.

  7. [Prothrombotic states and cerebral ischemia].

    PubMed

    Barinagarrementeria, F; González-Duarte, A; Cantú-Brito, C

    1998-01-01

    Hematological disorders per se represent unusual causes of cerebral ischemia, explaining in young people 4% of strokes. Hematological disorders that induce a thrombotic tendency contribute to overall ischemic stroke risk and may directly cause cerebral ischemia in patients without other risk factors. The frequency of cerebral infarctions caused by prothrombotic states is not known. This review will focus on disorders such as prothrombotic coagulopaties, including resistance to activated protein C and antiphospholipid syndrome as cause of cerebral infarction. Cerebral venous thrombosis and cerebral infarction from arterial origin are the most common form of neurological involvement. Pathophysiological mechanism of stroke in these patients are multiple and can include as in antiphospholipid syndrome embolism from valves abnormalities related to hematological disturbance, as well as thrombosis of extracranial or intracranial vessels. Is clear, however, that prothrombotic states could explains a high percentage of cases of those so called cryptogenic cerebral infarction in young people.

  8. [Cerebral salt wasting syndrome and traumatic vasospasm after head trauma: report of two cases].

    PubMed

    Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira

    2009-08-01

    While patients with cerebral salt wasting syndrome and traumatic cerebral arterial spasms have been reported, the underlying pathogenesis of these events remains unclear. We encountered 2 patients with head trauma and cerebral infarction who presented with cerebral salt-wasting syndrome and cerebral arterial spasms. Our findings suggested hypothalamic dysfunction due to venous congestion around the hypothalamus caused cerebral salt wasting syndrome and traumatic cerebral arterial spasms.

  9. Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage.

    PubMed

    Fukuda, Hitoshi; Miyake, Kosuke; Kunieda, Takenobu; Murao, Kenichi

    2014-07-01

    Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. One patient revealed complete obliteration of dAVF by a single session of transarterial embolization (TAE). As part of strategic TAE for this complex dAVF, we used a novel approach to create a complete flow-arrest condition in which coils and an occlusion balloon were combined. A liquid agent was then injected across the pathological fistula and into the parent venous apparatus, thereby occluding the lesion. The other patient was treated with percutaneous TVE after TAE was unsuccessful. With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.

  10. Sinus preservation management for frontal sinus fractures in the endoscopic sinus surgery era: a systematic review.

    PubMed

    Carter, Kenny B; Poetker, David M; Rhee, John S

    2010-09-01

    We systematically reviewed the existing literature supporting the efficacy and safety of sinus preservation management for frontal sinus fractures in the modern era of endoscopic frontal sinus surgery. A systematic review of the English literature for the targeted objective was conducted using the PubMed database between January 1995 and August 2008. The PubMed database was queried using two major search terms of frontal sinus fracture or frontal sinus injury along with manual review of citations within bibliographies. Citations acquired from the primary search were filtered and relevant abstracts were identified that merited full review. Articles were identified that included any cohort of patients with frontal sinus fractures involving the frontal sinus outflow tract or posterior wall with sinus preservation management. A total of 231 citations were generated, and 56 abstracts were identified as potentially relevant articles. Sixteen articles merited full review, with seven articles meeting inclusion criteria for sinus preservation. There were 515 total patients in the studies with 350 patients managed with frontal sinus preservation. Similar short-term complications and effectiveness were found between fractures managed with sinus preservation and those with traditional management. Sinus preservation appears to be a safe and effective management strategy for select frontal sinus fractures. More transparent reporting of management strategies for individual cases or cohorts is needed. A standardized algorithm and categorization framework for future studies are proposed. Longer-term follow-up and larger prospective studies are necessary to assess the safety and efficacy of sinus preservation protocols.

  11. Cerebrospinal fluid absorption block at the vertex in chronic hydrocephalus: obstructed arachnoid granulations or elevated venous pressure?

    PubMed Central

    2014-01-01

    Background The lack of absorption of CSF at the vertex in chronic hydrocephalus has been ascribed to an elevation in the arachnoid granulation outflow resistance (Rout). The CSF infusion studies measuring Rout are dependent on venous sinus pressure but little is known about the changes in pressure which occur throughout life or with the development of hydrocephalus. Methods Twenty patients with chronic hydrocephalus underwent MR venography and MR flow quantification techniques. The venous outflow pressure was estimated from the sinus blood flow and the cross-sectional area of the transverse sinuses. Adult controls as well as a normal young cohort were selected to estimate the change in sinus pressure which occurs throughout life and following the development of hydrocephalus. Significance was tested with a Student’s t-test. Results The size of the transverse sinuses was unchanged from the 1st to the 5th decade of life, indicating a stable outflow resistance. However, the blood flow was reduced by 42%, indicating a likely similar reduction in pressure gradient across the sinuses. The sinuses of hydrocephalus patients were 38% smaller than matched controls, indicating a 2.5 times increase in resistance. Despite the 24% reduction in blood flow, a significant increase in sinus pressure is suggested. Conclusions The size of the venous sinuses normally does not change over the age range investigated but sinus pressure is reduced proportional to an age-related blood flow reduction. Hydrocephalus is associated with much smaller sinuses than normal and an elevation in venous pressure may explain the lack of CSF absorption into the arachnoid granulations in chronic hydrocephalus. PMID:24955236

  12. Get Smart: Know When Antibiotics Work - Sinus Infection (Sinusitis)

    MedlinePlus

    ... Glossary For Patients Common Illnesses Bronchitis (Chest Cold) Common Cold & Runny Nose Ear Infection Influenza (Flu) Sinus Infection ( ... A previous respiratory tract infection, such as the common cold Structural problems within the sinuses A weak immune ...

  13. A simulation model to study the role of the extracranial venous drainage pathways in intracranial hemodynamics.

    PubMed

    Gadda, G; Taibi, A; Sisini, F; Gambaccini, M; Sethi, S K; Utriainen, D; Haacke, E M; Zamboni, P; Ursino, M

    2015-01-01

    Alterations in the extracranial venous circulation due to posture changes, and/or extracranial venous obstructions in patients with vascular diseases, can have important implications on cerebral hemodynamics. A hemodynamic model for the study of cerebral venous outflow was developed to investigate the correlations between extracranial blood redistributions and changes in the intracranial environment. Flow data obtained with both magnetic resonance (MR) and Echo-Color Doppler (ECD) technique are used to validate the model. The very good agreement between simulated supine and upright flows and experimental results means that the model can correctly reproduce the main factors affecting the extracranial venous circulation.

  14. Headaches and sinus disease.

    PubMed

    Blumenthal, H J

    2001-10-01

    Modern diagnostic tools like fiberoptic nasal endoscopy and CT imaging of the sinuses are very sensitive in helping clinicians diagnose sinus disease; we may now reevaluate the symptoms and signs most useful in making a clinical diagnosis of rhinosinusitis. Two major systems of classification and diagnostic criteria relating headaches and sinus disease have achieved currency-that of the International Headache Society (IHS) (1988) and the more recent task force recommendations of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) (1997). This report compares and contrasts the different starting points, certain assumptions, and conflicting conclusions of these two classification systems and recommends a cooperative alliance of the IHS and AAO-HNS when these diagnostic criteria are revised.

  15. Mucopyocele of the maxillary sinus

    PubMed Central

    Kshar, Avinash; Patil, Abhijeet; Umarji, Hemant; Kadam, Sonali

    2014-01-01

    Mucoceles are defined as chronic, cystic lesions in the paranasal sinuses. When the mucocele content becomes infected, the lesion is defined as mucopyocele. Most mucoceles are located in the frontal and anterior ethmoid sinuses and normally they involve the frontal-ethmoid complex, expanding to the superior-medial region of the orbit, leading to ocular disorders; maxillary sinus presentation is rare. In the present article, the authors described a rare case of mucopyocele in the maxillary sinus. PMID:24688571

  16. [Percussional auscultation of frontal sinuses].

    PubMed

    Akopian, R G

    2000-01-01

    Percussional auscultation of the frontal sinuses is used for diagnosis of frontal sinusitides. Phonendoscope placed by the sinus walls auscultates sounds forming as a result of comparative percussion of the anterior sinus walls. Three main percussional tones are singled out. This method was employed for diagnosis in 48 patients with frontal sinusitis. The technique is easy to perform, safe and precise (90%). The trend in frontal sinusitides development can be followed up.

  17. [Mucormycosis in paranasal sinuses].

    PubMed

    Volkenstein, S; Unkel, C; Neumann, A; Sudhoff, H; Dermoumi, H; Jahnke, K; Dazert, S

    2009-08-01

    Three patients with mucormycosis of the paranasal sinuses were treated in the University ENT departments in Bochum and Essen in recent years. All patients were immunocompromised for different reasons and had reduced resistance against microorganism infection. They presented with symptoms of orbital complications of sinusitis. The further progress of these life-threatening fungal infections with a mortality rate between 35 and 70% depends on early and definitive diagnosis and radical surgical therapy to reduce the amount of infectious agent. The difficulties of early diagnosis by imaging, histology, microbiology, or molecular biology and postoperative therapeutic options especially with amphotericin B, liposomal amphotericin B, and posaconazole are illustrated and discussed.

  18. Standing equine sinus surgery.

    PubMed

    Barakzai, Safia Z; Dixon, Padraic M

    2014-04-01

    Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the procedure used, appropriate indications for surgery, good patient selection, and familiarity with regional anatomy and surgical techniques are imperative for good results. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Central venous catheter placement: where is the tip?

    PubMed

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  20. [Histopathologic study of chronic sinusitis].

    PubMed

    Wayoff, M; Parache, R M; Bodelet, B; Gazel, P

    1983-01-01

    The conventional histopathology of the sinus is a criterium for the therapeutic indication, since it is possible to distinguish between granulomatous chronic sinusitis, chronic sinusitis with oedema and nasal polyposis. Each one of these clinical pictures has his own etiology and requires a specific therapeutic approach.

  1. Noninvasive, optoacoustic detection and characterization of intra- and extracranial hematomas and cerebral hypoxia

    NASA Astrophysics Data System (ADS)

    Petrov, Andrey; Prough, Donald S.; Petrov, Yuriy; Petrov, Irene Y.; Robertson, Claudia S.; Asokan, Vasantha; Agbor, Adaeze; Esenaliev, Rinat O.

    2015-03-01

    Early diagnosis of intracranial hematomas is necessary to improve outcome in patients with traumatic brain injury (TBI). CT and MRI can diagnose intracranial hematomas, but cannot be used until the patient arrives at a major healthcare facility, resulting in delayed diagnosis. Near infrared spectroscopy may suggest the presence of unilateral intracranial hematomas, but provides minimal information on hematoma type and location due to limitations associated with strong light scattering. We have used optoacoustics (which combines high endogenous optical contrast with the resolution of ultrasound) to diagnose hematomas and monitor cerebral oxygenation. We performed animal and clinical studies on detection and characterization of hematomas and on monitoring cerebral hypoxia by probing the superior sagittal sinus (SSS). Recently, we built a medical grade, multi-wavelength, OPO-based optoacoustic system tunable in the near infrared spectral range. We developed new patient interfaces for noninvasive, transcranial measurements in the transmission mode in the presence of dense hair and used it in patients with TBI. The optoacoustic system was capable of detecting and characterizing intra- and extracranial hematomas. SSS blood oxygenation was measured as well with the new interface. The obtained results indicate that the optoacoustic system in the transmission mode provides detection and characterization of hematomas in TBI patients, as well as cerebral venous blood oxygenation monitoring. The transmission mode approach can be used for optoacoustic brain imaging, tomography, and mapping in humans.

  2. Noninvasive cerebral blood oxygenation monitoring: clinical test of multiwavelength optoacoustic system

    NASA Astrophysics Data System (ADS)

    Petrov, Y. Y.; Prough, D. S.; Petrova, I.; Patrikeev, I. A.; Cicenaite, I.; Esenaliev, R. O.

    2007-02-01

    Continuous monitoring of cerebral blood oxygenation is critically important for treatment of patients with life-threatening conditions like severe brain injury or during cardiac surgery. We designed and built a novel multiwavelength optoacoustic system for noninvasive, continuous, and accurate monitoring of cerebral blood oxygenation. We use an Optical Parametric Oscillator as a light source. We successfully tested the system in vitro as well as in vivo in large animals (sheep) through thick tissues overlying blood vessels which drain venous blood out of the brain (e.g., superior sagittal sinus or jugular vein). Here we present the results of clinical tests of the system for continuous noninvasive cerebral blood oxygenation monitoring in the internal jugular vein of healthy volunteers. We applied our custom-built optoacoustic probe (which incorporated a wide-band acoustic transducer and an optical fiber) to the neck area overlying the internal jugular vein. We performed measurements with volunteers at 18 wavelengths in the near-infrared spectral range. Despite a thick layer of overlying connective tissue and low energy used in the experiments, we recorded signals with high signal-to-noise ratios for all volunteers. We found that the temporal (independent of signal amplitude) parameters of recorded profiles for different levels of blood oxygenation correlated well with the spectrum of effective attenuation coefficients of blood.

  3. Technical considerations in continuous jugular venous oxygen saturation measurement.

    PubMed

    Dearden, N M; Midgley, S

    1993-01-01

    Fibreoptic reflection oximetry allows continuous in-vivo estimation of jugular venous oxygen saturation. In combination with pulse oximetry the oxygen extraction ratio SaO2-SjO2/SaO2 can be derived enabling identification of states of global luxury perfusion, normal coupling of global cerebral blood flow with global cerebral metabolism, global cerebral hypoperfusion and global cerebral ischemia. Several technical difficulties may arise affecting the accuracy of SjO2 recordings which must be recognised by the clinician before medical intervention is contemplated.

  4. Complementary echo and CCTA findings with superior sinus venosus atrial septal defect.

    PubMed

    Turner, Jason; Turner, Michael C; Kerut, Edmund K

    2016-10-01

    A young female developed progressive dyspnea on minimal exertion. Echocardiography demonstrated a large right heart with severe pulmonary hypertension. Cardiac computed tomographic angiography then demonstrated a superior sinus venosus atrial septal defect with an anomalous right upper pulmonary venous drainage. Echo and CCTA were complementary in making a proper diagnosis. © 2016, Wiley Periodicals, Inc.

  5. Looks like a stroke, acts like a stroke, but it's more than a stroke: a case of cerebral mucormycosis.

    PubMed

    Ermak, David; Kanekar, Sangam; Specht, Charles S; Wojnar, Margaret; Lowden, Max

    2014-09-01

    Mucormycosis is a fungus that exhibits angiocentric growth and can cause a thrombotic arteritis. Infection with this organism is uncommon and cerebral involvement is most often secondary to direct invasion through the paranasal sinuses. Here, we present a case of mucormycosis with cerebral involvement without sinus disease, which resulted in ischemic stroke with rapid progression resulting in death.

  6. Chronic odontogenic maxillary sinusitis.

    PubMed

    Ugincius, Paulius; Kubilius, Ricardas; Gervickas, Albinas; Vaitkus, Saulius

    2006-01-01

    The aim of the present study was to estimate average age of the patients in both sexes treated for MS, distribution by sex, amount of dexter and sinister MS with and without the fistulas into the maxillary sinus, with and without the foreign-bodies, length of stay in the Department of Maxillofacial Surgery at Kaunas Hospital of University of Medicine during the period from 1999 till 2004. The retrospective data analysis of the patients' treated from chronic MS was made. 346 patients (213 females and 133 males) were treated for chronic MS. 55 cases of chronic dexter MS with a fistula into maxillary sinus, 98 cases of chronic dexter MS without a fistula, 45 cases of chronic sinister MS with a fistula, 112 cases chronic sinister MS without a fistula, 16 cases of foreign-bodies in dexter maxillary sinus, 20 cases of foreign-bodies in sinister maxillary sinus have been detected. The main age of the female was 46.6+/-15.0, the main age of the men was 42.1+/-14.4. Statictically significant difference in the age difference of the women and the men was found (p=0.0024). It was determined, that females diagnosed and treated with chronic MS were 1.6 times more than males during the period from 1999 till 2004 in Kaunas Hospital of University of Medicine. Females treated for chronic MS were 4.5 years older than males.

  7. Nasal dermoid sinus cyst.

    PubMed

    Cauchois, R; Laccourreye, O; Bremond, D; Testud, R; Küffer, R; Monteil, J P

    1994-08-01

    Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.

  8. Light and scanning electron microscopical study of the cavernous sinus of the monkey, Macaca fascicularis.

    PubMed Central

    Rajendran, K; Ling, E A

    1985-01-01

    The cavernous sinus of Macaca fascicularis is in many respects similar to the human sinus. It consists predominantly of one main venous channel that, together with the internal carotid artery, occupies a meningo-endocranial compartment lateral to the pituitary gland. Trabeculae are few and do not in any way cause the sinus to appear cavernous. They are mostly flattened in the direction of the main venous channel. Cranial nerves three, four, six and the ophthalmic division of five are all located in the lateral wall of the meningo-endocranial compartment with cranial nerve six located most medially adjacent to the internal carotid artery. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:4077687

  9. Personal Computer System for Automatic Coronary Venous Flow Measurement

    PubMed Central

    Dew, Robert B.

    1985-01-01

    We developed an automated system based on an IBM PC/XT Personal computer to measure coronary venous blood flow during cardiac catheterization. Flow is determined by a thermodilution technique in which a cold saline solution is infused through a catheter into the coronary venous system. Regional temperature fluctuations sensed by the catheter are used to determine great cardiac vein and coronary sinus blood flow. The computer system replaces manual methods of acquiring and analyzing temperature data related to flow measurement, thereby increasing the speed and accuracy with which repetitive flow determinations can be made.

  10. Apixaban or Dalteparin in Reducing Blood Clots in Patients With Cancer Related Venous Thromboembolism

    ClinicalTrials.gov

    2017-07-10

    Cerebral Vein Thrombosis; Deep Vein Thrombosis; Gonadal Thrombosis; Hepatic Thrombosis; Malignant Neoplasm; Mesenteric Thrombosis; Metastatic Malignant Neoplasm; Portal Vein Thrombosis; Pulmonary Embolism; Renal Vein Thrombosis; Splenic Thrombosis; Venous Thromboembolism

  11. Transverse and Sigmoid Sinus Dural Arteriovenous Fistula Mimicking Idiopathic Intracranial Hypertension and Carotid Cavernous Fistula.

    PubMed

    Spitze, Arielle; Gersztenkorn, David; Al-Zubidi, Nagham; Yalamanchili, Sushma; Diaz, Orlando; Lee, Andrew G

    2014-01-01

    Intracranial dural arteriovenous fistulas (dAVFs) can produce a variety of symptoms depending on fistula location, size, and venous drainage. Although cavernous sinus fistulas (CCFs) classically present with symptoms of orbital venous congestion due to retrograde venous drainage into the superior ophthalmic vein (i.e. an arterialised "red eye") (Miller NR. Neurosurg Focus 2007;23:1--15), dAVFs not localised to the cavernous sinus rarely present with a "red eye" and instead produce increased intracranial pressure, which can mimic idiopathic intracranial hypertension (IIH). The authors present a unique case of an intracranial dAVF with clinical features suggestive of both CCF and IIH. Clinicians should be aware of this possibility to avoid delayed diagnosis of the intracranial dAVF.

  12. Carotid-cavernous fistula after functional endoscopic sinus surgery.

    PubMed

    Karaman, Emin; Isildak, Huseyin; Haciyev, Yusuf; Kaytaz, Asim; Enver, Ozgun

    2009-03-01

    Carotid-cavernous fistulas (CCFs) are anomalous communications between the carotid arterial system and the venous cavernous sinus. They can arise because of spontaneous or trauma causes. Most caroticocavernous fistulas are of spontaneous origin and unknown etiology. Spontaneous CCF may also be associated with cavernous sinus pathology such as arteriosclerotic changes of the arterial wall, fibromuscular dysplasia, or Ehler-Danlos syndrome. Traumatic CCFs may occur after either blunt or penetrating head trauma. Their clinical presentation is related to their size and to the type of venous drainage, which can lead to a variety of symptoms, such as visual loss, proptosis, bruit, chemosis, cranial nerve impairment, intracranial hemorrhage (rare), and so on. Treatment by endovascular transarterial embolization with electrolytically detachable coils is a very effective method for CCF with good outcomes. Carotid-cavernous fistulas have been rarely reported after craniofacial surgery and are uncommon pathologies in otolaryngology practice. In this study, we report a 40-year-old woman with CCF secondary to blunt trauma of functional endoscopic sinus surgery.

  13. Extensive dural sinus thrombosis and bilateral lateral rectus palsy as an uncommon complication of chronic suppurative otitis media.

    PubMed

    Balasubramanian, Anusha; Mohamad, Irfan; Sidek, Dinsuhaimi

    2013-01-25

    Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.

  14. [Orbital complications of sinusitis].

    PubMed

    Šuchaň, M; Horňák, M; Kaliarik, L; Krempaská, S; Koštialová, T; Kovaľ, J

    2014-12-01

    Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal

  15. Mini-invasive Implant Placement in Combination with Maxillary Sinus Membrane Perforation During Transcrestal Sinus Floor Elevation: A Retrospective Study.

    PubMed

    Toscano, Paolo; Toscano, Calogero; Del Fabbro, Massimo

    2016-01-01

    The aim of this retrospective study was to report preliminary outcomes of a modified technique for transcrestal sinus floor elevation with simultaneous implant placement. A total of 165 implants were placed in 110 patients using a modified Summers technique. During implant site preparation, after fracturing the sinus floor, a small perforation of the membrane was made using the first osteotome. After grafting with anorganic bovine bone mixed with venous blood, standard-length implants were inserted. The prosthetic phase occurred after 4 to 5 months. Patients were followed for at least 2 years after loading. During the follow-up, sinus condition was assessed by cone beam computed tomography. Periapical radiographs were taken to assess graft height and peri-implant bone levels. Three implants failed within 2 months of placement, yielding an overall implant survival of 98.2%. The mean follow-up was 38.3 months (range: 28 to 60 months) from placement. All other implants were stable and peri-implant soft tissues were healthy throughout the observation period. Peri-implant bone loss averaged 0.62 ± 0.26 mm after 1 year of function. No biologic or biomechanical complications occurred. No evidence of graft material dispersion into the sinus space was detected, except for two cases that resolved spontaneously. After 1 year of loading the graft height averaged 4.8 ± 1.3 mm above the sinus floor level. In the presence of sinus membrane perforation, the proposed modified osteotome technique may allow a predictable rehabilitation of the atrophic posterior maxilla by means of standard length implants without the occurrence of adverse events.

  16. Odontogenic maxillary sinusitis: a review.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Vaitkus, Saulius

    2014-01-01

    Maxillary sinusitis of odontogenic origin is a well-known condition in both the dental and otolaryngology communities. It occurs when the Schneiderian membrane is violated by conditions arising from dentoalveolar unit. This type of sinusitis differs in its pathophysiology, microbiology, diagnostics and management from sinusitis of other causes, therefore, failure to accurately identify a dental cause in these patients usually lead to persistent symptomatology and failure of medical and surgical therapies directed toward sinusitis. Unilateral recalcitrant disease associated with foul smelling drainage is a most common feature of odontogenic sinusitis. Also, high-resolution CT scans and cone-beam volumetric computed tomography can assist in identifying dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent functional endoscopic sinus surgery or Caldwell-Luc operation is required. The aim of this article is to give a review of the most common causes, symptoms, diagnostic and treatment methods of odontogenic maxillary sinusitis. Search on Cochrane Library, PubMed and Science Direct data bases by key words resulted in 35 articles which met our criteria. It can be concluded that the incidence of odontogenic sinusitis is likely underreported in the available literature.

  17. Clinical significance of unilateral sinusitis.

    PubMed Central

    Shin, H. S.

    1986-01-01

    In general, the etiologic factors of chronic paranasal sinusitis are systemic conditions such as nutrition, predisposition, allergy, and local factors such as nasal anatomic conditions. Among these factors, the development of unilateral sinusitis is a model case verifying the influence of local factors. In my study of 640 cases over a certain period of time, a comparison was made between 161 cases of unilateral sinusitis and 479 cases of bilateral sinusitis in order to verify the effects of local factors in the development of this disease. Patients with a history of previous sinus surgery or tumors were eliminated from the cases. 1. The male-female incidence rate, and the age distribution of the patients at the initial visit showed no prominent differences between unilateral and bilateral cases. 2. It was found that a larger number of cases of unilateral sinusitis had a duration of less than one year as compared to bilateral sinusitis which were longer than and year. Therefore it can be said that the duration of unilateral sinusitis is usually shorter than that of bilateral sinusitis. 3. In unilateral cases the patients with moderate to severe nasal septal deviation, one number of patients with septal deviation towards the diseased side was twice as high as that on the non-affected side. 4. The incidence rate of polyps occurring in the middle meatus was shown to be about twice as high in bilateral cases as in unilateral cases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2856589

  18. Understanding Biofilms in Chronic Sinusitis.

    PubMed

    Tajudeen, Bobby A; Schwartz, Joseph S; Palmer, James N

    2016-02-01

    Chronic sinusitis is a burdensome disease that has substantial individual and societal impact. Although great advances in medical and surgical therapies have been made, some patients continue to have recalcitrant infections. Microbial biofilms have been implicated as a cause of recalcitrant chronic sinusitis, and recent studies have tried to better understand the pathogenesis of chronic sinusitis as it relates to microbial biofilms. Here, we provide an overview of biofilms in chronic sinusitis with emphasis on pathogenesis, treatment, and future directions. In addition, recent evidence is presented, elucidating the role of bitter taste receptors as a possible key factor leading to biofilm formation.

  19. [Pott's puffy tumor: a rare complication of frontal sinusitis].

    PubMed

    Aínsa Laguna, D; Pons Morales, S; Muñoz Tormo-Figueres, A; Vega Senra, M I; Otero Reigada, M C

    2014-05-01

    Pott's puffy tumor is a rare complication of frontal sinusitis characterized by swelling and edema in the brow due to a subperiosteal abscess associated with frontal osteomyelitis. Added complications are cellulitis by extension to the orbit and intracranial infection by posterior extension, with high risk of meningitis, intracranial abscess, and venous sinus thrombosis. Early diagnosis and aggressive medical or surgical treatment are essential for optimal recovery of affected patients. In the antibiotic age it is extremely rare, with very few cases described in the recent literature. A case is presented of a Pott inflammatory tumor in a 7 year-old boy, as a complication of acute pansinusitis who presented with front preseptal swelling and intracranial involvement with thrombosis of ophthalmic and superior orbital veins and frontal epidural abscess extending to the subarachnoid space. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  20. Difference between Sinusitis and a Cold

    MedlinePlus

    ... Disabilities Obesity Orthopedic Prevention Sexually Transmitted ... is an inflammation of the lining of the nose and sinuses. It is a very common infection in children. Viral sinusitis usually accompanies a cold. Allergic sinusitis may ...

  1. Non-invasive Quantification of Whole-brain Cerebral Metabolic Rate of Oxygen by MRI

    PubMed Central

    Xu, Feng; Ge, Yulin; Lu, Hanzhang

    2009-01-01

    Cerebral metabolic rate of oxygen (CMRO2) is an important marker for brain function and brain health. Existing techniques for quantification of CMRO2 with Positron Emission Tomography (PET) or MRI involve special equipment and/or exogenous agent, and may not be suitable for routine clinical studies. In the present study, a non-invasive method is developed to estimate whole-brain CMRO2 in humans. This method applies phase-contrast MRI for quantitative blood flow measurement and T2-Relaxation-Under-Spin-Tagging (TRUST) MRI for venous oxygenation estimation, and uses the Fick principle of arteriovenous difference for the calculation of CMRO2. Whole-brain averaged CMRO2 values in young, healthy subjects were 132.1±20.0 μmol/100g/min, in good agreement with literature reports using PET. Various acquisition strategies for phase-contrast and TRUST MRI were compared, and it was found that non-gated phase-contrast and sagittal sinus TRUST MRI were able to provide the most efficient and accurate estimation of CMRO2. In addition, blood flow and venous oxygenation were found to be positively correlated across subjects. Owing to the non-invasive nature of this method, it may be a convenient and useful approach for assessment of brain metabolism in brain disorders as well as under various physiologic conditions. PMID:19353674

  2. Epidemiology of venous thromboembolism.

    PubMed Central

    Coon, W W

    1977-01-01

    This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease. PMID:329779

  3. Partial anomalous pulmonary venous connection (including scimitar syndrome).

    PubMed

    van de Woestijne, Pieter C; Verberkmoes, Niels; Bogers, Ad J J C

    2013-01-01

    Partial anomalous pulmonary venous connection (PAPVC) is defined to exist when some but not all venous drainage enters the left atrium, while the remaining veins connect to the right-sided circulation. Scimitar syndrome is a specialized example, in which an anomalous pulmonary vein descends from the right lung and drains into the inferior caval vein. PAPVC is associated with sinus venosus-type atrial septal defect (ASD). Diagnosis was, in the past, based on echocardiographic imaging and could be difficult. Multislice spiral computed tomography and magnetic resonance imaging improved the imaging quality. The surgical correction is dependent on the type of anomalous connection and the presence of an ASD. Outcome is good but obstructed venous return is an important issue.

  4. New insights into the mechanisms of venous thrombosis.

    PubMed

    Mackman, Nigel

    2012-07-01

    Venous thrombosis is a leading cause of morbidity and mortality in industrialized countries, especially in the elderly. Many risk factors have been identified for venous thrombosis that alter blood flow, activate the endothelium, and increase blood coagulation. However, the precise mechanisms that trigger clotting in large veins have not been fully elucidated. The most common site for initiation of the thrombus appears to be the valve pocket sinus, due to its tendency to become hypoxic. Activation of endothelial cells by hypoxia or possibly inflammatory stimuli would lead to surface expression of adhesion receptors that facilitate the binding of circulating leukocytes and microvesicles. Subsequent activation of the leukocytes induces expression of the potent procoagulant protein tissue factor that triggers thrombosis. Understanding the mechanisms of venous thrombosis may lead to the development of new treatments.

  5. Calibrated BOLD using direct measurement of changes in venous oxygenation.

    PubMed

    Driver, Ian D; Hall, Emma L; Wharton, Samuel J; Pritchard, Susan E; Francis, Susan T; Gowland, Penny A

    2012-11-15

    Calibration of the BOLD signal is potentially of great value in providing a closer measure of the underlying changes in brain function related to neuronal activity than the BOLD signal alone, but current approaches rely on an assumed relationship between cerebral blood volume (CBV) and cerebral blood flow (CBF). This is poorly characterised in humans and does not reflect the predominantly venous nature of BOLD contrast, whilst this relationship may vary across brain regions and depend on the structure of the local vascular bed. This work demonstrates a new approach to BOLD calibration which does not require an assumption about the relationship between cerebral blood volume and cerebral blood flow. This method involves repeating the same stimulus both at normoxia and hyperoxia, using hyperoxic BOLD contrast to estimate the relative changes in venous blood oxygenation and venous CBV. To do this the effect of hyperoxia on venous blood oxygenation has to be calculated, which requires an estimate of basal oxygen extraction fraction, and this can be estimated from the phase as an alternative to using a literature estimate. Additional measurement of the relative change in CBF, combined with the blood oxygenation change can be used to calculate the relative change in CMRO(2) due to the stimulus. CMRO(2) changes of 18 ± 8% in response to a motor task were measured without requiring the assumption of a CBV/CBF coupling relationship, and are in agreement with previous approaches.

  6. Acute bacterial sinusitis in children.

    PubMed

    DeMuri, Gregory; Wald, Ellen R

    2013-10-01

    On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.

  7. Managing acute invasive fungal sinusitis.

    PubMed

    Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph

    2016-01-01

    Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.

  8. Routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects

    SciTech Connect

    Freed, M.D.; Nadas, A.S.; Norwood, W.I.; Castaneda, A.R.

    1984-08-01

    Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. The clinical characteristics and treatment of cerebral AVM in pregnancy

    PubMed Central

    Lv, Xianli; Liu, Peng

    2015-01-01

    Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few, and they provide different results, pregnancy will increase the hemorrhagic risk of AVM and ruptured cerebral AVM in pregnancy should be actively treated. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. Results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy was below the safety value and was safe. For an unruptured AVM in pregnancy, if there are no bleeding factors, e.g. no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, then it should be observed conservatively. PMID:26246089

  10. The clinical characteristics and treatment of cerebral AVM in pregnancy

    PubMed Central

    Lv, Xianli

    2015-01-01

    Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few and there are different results between them, pregnancy will increase the hemorrhagic risk of AVM, and ruptured cerebral AVM in pregnancy should be treated actively. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. The results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy is below the safety value and is safe. Unruptured AVM in pregnancy, if there is no bleeding factor, such as no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, should be observed conservatively. PMID:26427890

  11. Aura attacks from acute convexity subarachnoid haemorrhage not due to cerebral amyloid angiopathy.

    PubMed

    Field, D K; Kleinig, T J

    2011-02-01

    Convexity subarachnoid haemorrhage (cSAH) has recently been recognised as a cause of recurrent aura-like symptoms, mimicking transient ischaemic attacks (TIAs). Subarachnoid haemorrhage and recurrent aura-like episodes can occur in patients with cerebral amyloid angiopathy (CAA), which has been the presumed cause in the majority of reported cases. However, this syndrome can occur following cSAH secondary to other conditions, and it is important for clinicians to investigate and manage such patients appropriately. Case series. We describe two patients who presented with recurrent stereotyped transient neurological symptoms in the setting of acute cSAH identified on MRI. In one patient, SAH occurred secondary to cerebral venous sinus thrombosis. In the other, SAH was due to extension of a traumatic subdural haematoma. Conditions other than CAA can cause the clinicoradiological syndrome of cSAH with recurrent TIA-like events. Gradient echo or susceptibility-weighted imaging should be included in the diagnostic work-up of patients presenting with such events. When cSAH is detected, the full differential diagnosis for this should be considered. Aetiologies other than CAA can cause this syndrome and management can vary greatly depending on the underlying cause.

  12. Mycotic encephalitis, sinus osteomyelitis, and guttural pouch mycosis in a 3-year-old Arabian colt.

    PubMed

    Hunter, Barbara; Nation, Patrick N

    2011-12-01

    Mycotic encephalitis caused severe ataxia and other neurologic deficits in a horse. The finding of a single, large focus of cerebral malacia, with histopathologic evidence of fungal elements, suggested infection was a result of direct transfer from the frontal sinuses, rather than hematogenous spread from the guttural pouch.

  13. Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage.

    PubMed

    Baltsavias, Gerasimos; Spiessberger, Alex; Hothorn, Torsten; Valavanis, Anton

    2015-04-01

    Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0%). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5%). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical

  14. Northern Sinus Meridiani Stereo

    NASA Technical Reports Server (NTRS)

    2003-01-01

    MGS MOC Release No. MOC2-341, 25 April 2003

    This is a stereo (3-d anaglyph) composite of Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) wide angle images of northern Sinus Meridiani near 2oN, 0oW. The light-toned materials at the south (bottom) end of the picture are considered to be thick (100-200 meters; 300-600 ft) exposures of sedimentary rock. Several ancient meteor impact craters are being exhumed from within these layered materials. To view in stereo, use '3-d' glasses with red over the left eye, and blue over the right. The picture covers an area approximately 113 km (70 mi) wide; north is up.

  15. Northern Sinus Meridiani Stereo

    NASA Technical Reports Server (NTRS)

    2003-01-01

    MGS MOC Release No. MOC2-341, 25 April 2003

    This is a stereo (3-d anaglyph) composite of Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) wide angle images of northern Sinus Meridiani near 2oN, 0oW. The light-toned materials at the south (bottom) end of the picture are considered to be thick (100-200 meters; 300-600 ft) exposures of sedimentary rock. Several ancient meteor impact craters are being exhumed from within these layered materials. To view in stereo, use '3-d' glasses with red over the left eye, and blue over the right. The picture covers an area approximately 113 km (70 mi) wide; north is up.

  16. Balloon protection of the Labbé vein during transarterial embolization of a dural arterio-venous fistula

    PubMed Central

    Manisor, Monica; Wolff, Valérie; Aloraini, Ziad; Tigan, Leonardo; Kehrli, Pierre; Marescaux, Christian; Beaujeux, Rémy

    2015-01-01

    Introduction Endovascular treatment of type III dural arterio-venous fistulas can be challenging if the fistulous point is close to a functionally important cortical vein. Methods A technique is described for temporary balloon protection of the vein of Labbé during transarterial Onyx embolization of a type III dural arterio-venous fistula. One illustrative case is presented. Careful anatomic consideration of the concerned venous segment (at the insertion point into the lateral sinus) and the choice of balloon minimized the risk of venous rupture. Results Using this method, satisfactory progression of Onyx was obtained within the arterio-venous shunt while preserving the patency of the Labbé vein. Conclusion Temporary balloon protection of the Labbé vein is a feasible option to preserve its patency during embolization of dural arterio-venous fistulas. To the authors’ knowledge, this is the first report on the use of temporary balloon protection of a cortical vein. PMID:26438051

  17. Management of Frontal Sinus Tumors.

    PubMed

    Selleck, Anne Morgan; Desai, Dipan; Thorp, Brian D; Ebert, Charles S; Zanation, Adam M

    2016-08-01

    The most common primary tumors of the frontal sinus are osteomas and inverted papillomas, although a variety of other tumors involving this space have been reported. With the advent of new surgical techniques and instrumentation, an endoscopic approach to this region has become feasible. The preoperative assessment and decision making must take into account the complexity of frontal sinus anatomy, tumor type, tumor location, and associated attachments. These procedures allow adequate visualization, tumor removal, and postoperative monitoring, and preserve fairly normal sinus function. Open techniques may also be required and should be in the surgeon's armamentarium.

  18. [Ostium of maxillary sinus in endoscopic sinus surgery].

    PubMed

    Tan, G; Sun, H; Chen, J

    1998-06-01

    To determine the clinical significance and operative method of maxillary sinus ostium in the treatment of chronic sinusitis and nasal polyps. Fifty-six patients (112 sides) undergone endoscopic sinus surgery were studied. The patency rates of the maxillary ostia in patients with enlarged and unchanged maxillary ostia were 92.9% and 80.4% respectively. Fifty-one patients (64 sides) undergone Caldwell-Luc operations were retrospectively studied. The patency rate of inferior antrostomy was 40.6%. CT scans of the sinuses of 38 cases with unilateral sinisitis or nasal polyps were reviewed. The scaled values of the maxillary hiatus on CT images showed no difference between the normal group and the diseased group. Pneumatization and proliferation of middle turbinate and bent uncinate process were the most common anatomic variation in the diseased group. The results suggest that management of anatomic variations surrounding the ostia is very important in the treatment of maxillary ostium.

  19. [Chronic venous insufficiency (CVI)].

    PubMed

    Renner, R; Simon, J

    2009-10-01

    Chronic venous insufficiency (CVI) is an important and frequent disease for dermatologists, phlebologists and general practitioners. There are various hypotheses for the ethiopathology in CVI, e. g. hormone receptors and impairments concerning the venous contraction or relaxation of the vessel wall and the venous valves might play an important role. At the moment, colour doppler-duplex sonography seems to be the diagnostic method of choice. Modern therapeutic options include compression systems alone or in combination with topical or systemic treatment including minimal invasive methods like endovenous laser or radiofrequency obliteration or foam sclerotherapy.

  20. Dealing with the venous congestion of free flaps: venous catheterization.

    PubMed

    Gürsoy, Koray; Kankaya, Yüksel; Uysal, Afşin; Koçer, Uğur

    2008-11-01

    For head and neck reconstruction after tumor ablation surgery, free flaps are mostly the chosen treatment modality for most of the centers. Coping with venous insufficiency and increasing venous outflow of the flap during this process increases the success rate. To increase venous outflow, triple-lumen central venous catheter is inserted to one of the donor veins of the flap that has venous insufficiency and one intact vein anastomosis.

  1. STUDIES ON THE VENOUS PULSE. I : A STUDY OF THE DIASTOLIC WAVES OF THE VENOUS PULSE, WITH ESPECIAL REFERENCE TO THE POSSIBILITY OF A WAVE DUE TO THE CONTRACTION OF THE VENOUS REGION OF THE MAMMALIAN HEART.

    PubMed

    Eyster, J A

    1910-05-01

    A wave is described occurring in the venous pulse of man late in the diastolic period. This wave is a diastolic wave, since in an increase in length of the cardiac cycle it follows the h wave at its regular interval and becomes separated from the a wave of the next cardiac cycle. There is no wave on the venous pulse in man which can be referred to a contraction of the region of the great veins or sinus region of the heart. The h wave is a normal occurrence in the venous pulse curve from man and the dog. It occurs, according to the experience in this work, in all normal individuals in which the heart rate is sufficiently slow to prevent its obliteration by the a wave. The x wave, while not infrequent, is not always present in man even when the cardiac cycle is of sufficient length to prevent its obliteration by the a wave. This wave has not been observed in the dog. There is no wave on the venous pulse curve of the dog that can be referred to a contraction of the sinus region of the heart. Extra-systoles from stimulation of the venous region of the dog's heart produce no contraction of this region sufficiently pronounced to be recorded on a venous pulse tracing. After an interval of from 0.07 to 0.I second, representing the interval of veno-auricular conduction plus the latent period of the auricle, the auricle contracts. Extrasystoles from stimulation of the right auricle show, after an interval following the stimulus much shorter than that noted above and representing the latent period of the auricle, an a wave followed by ventricular systole after the usual a-c interval. It would seem probable that the sinus region of the heart, while capable of irritability, conductivity and rhythmicity (Erlanger and Blackman (I6)), does not normally manifest contractility.

  2. Pseudomastoiditis in lateral sinus thrombosis: a rare presentation with review of literature.

    PubMed

    Thota, Ramadass; Narayanan, Nithya; Mathuram, Dhanraj

    2011-07-01

    Lateral sinus thrombosis due to mastoiditis, is now a relic of the past. Gone are the days when septic lateral sinus thrombosis was a common complication of unsafe suppurative otitis media. In the present era, the neurologists more commonly see cortical venous thrombosis with lateral sinus thrombosis. This entity has been termed as non-septic lateral sinus thrombosis in literature. The incidence is found to be more in females due to the use of oral contraceptives (Rosen and Scher in Laryngoscope 107(5):680-683, 1). In this manuscript, we report a series of three cases of non-septic lateral sinus thrombosis with mastoiditis, seen in a span of 1 month, which is uncommon. All the patients presented to the neurologist with intractable headache and lateral sinus thrombosis with mastoiditis, was detected by magnetic resonance imaging and magnetic resonance venogram. All the three patients were males and had involvement of the right mastoid in magnetic resonance imaging pictures. We have reviewed the literature and discussed about the etiopathogenesis, diagnostic criteria and management.

  3. Intercavernous Venous Communications in the Human Skull Base

    PubMed Central

    Aquini, Mauro Guidotti; Marrone, Antonio Carlos Huf; Schneider, Felipe Luis

    1994-01-01

    The intercavernous communications of the skull base were studied in 32 sphenoid blocks using electrolytic decalcification techniques, vascular filling, x-rays, and serial anatomical sections. In this study four intercavernous connections were found: anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), inferior intercavernous sinus (IIS), and basilar plexus (BP). The AIS was present in 100% of the cases, with diameters ranging from 0.57 mm to 5.43 mm; in 17 cases (53.12%) it took up the whole anterior wall of the hypophyseal fossa. The PIS was also detected in 100% of the cases, and its diameters ranged from 0.71 mm to 4.14 mm. The IIS was identified in 31 cases (96.9%), assuming three different forms: plexuslike, venous lake, and mixed. The BP was found in 100% of the material analyzed; in 23 cases (71.9%) it proved to be the widest intercavernous communication. In 12 cases of this series the hypophysis was completely enveloped by venous structures, except at the level of the sellar diaphragm. ImagesFigure 1Figure 2Figure 3 PMID:17171164

  4. Paranasal sinus obliteration in Wegener granulomatosis

    SciTech Connect

    Paling, M.R.; Roberts, R.L.; Fauci, A.S.

    1982-08-01

    The authors report 14 cases of Wegener granulomatosis in which one or more paranasal sinuses were obliterated by bone. The maxillary antra were involved in all cases, with the other sinuses being affected less frequently. These changes are thought to result from chronic bacterial sinusitis superimposed on the granulomatous vasculitic process. Computed tomography dramatically demonstrated the bone changes, consisting of a combination of sinus wall thickening and trabeculated new bone formation within the sinuses.

  5. Spontaneous thrombosis of a giant cerebral varix in a pediatric patient.

    PubMed

    Ozturk, Mesut; Aslan, Serdar; Ceyhan Bilgici, Meltem; Idil Soylu, Aysegul; Aydin, Keramettin

    2017-07-20

    Cerebral cortical venous aneurysm also known as cerebral varix is a rare entity that usually occurs in relation to high-flow draining veins of arteriovenous fistulas, arteriovenous malformations, and venous angioma. Isolated cerebral varix is an extremely rare entity. We present a 1-year-old male with isolated cerebral varix. During follow-up, the varix thrombosed spontaneously without causing any neurological deficits. To the best of our knowledge, spontaneous asymptomatic thrombosis of an isolated cerebral varix without any clinical finding was reported for the first time in the literature.

  6. [Blood gas analytical study on cerebral circulation under the influence of dihydroergotoxin (author's transl)].

    PubMed

    Liesegang, J; Bock, W J; Seibert, H; Schumacher, W

    1976-01-01

    The demand for sufficient blood supply and oxygenation of cerebral tissue after brain surgery or severe head injuries requires the clinical investigation of drugs which are supposed to improve cerebral blood flow and metabolism. We have therefore used the hydrogenated derivatives of the ergotoxin components of the secale alcaloids in the post-operative and posttraumatic period of neurosurgical patients, respectively, and studied their effect on cerebral metabolism by successive analysis of blood gases in the arterial and venous blood. A significant increase of cerebral venous CO2-concentration following the administration of dihydroergotoxin in these patients in all probability is attributable to an improved O2-utilisation in the cerebral tissue.

  7. Cavernous sinus meningiomas: imaging and surgical strategy.

    PubMed

    Sindou, Marc; Nebbal, Mustapha; Guclu, Bulent

    2015-01-01

    Cavernous sinus (CS) meningiomas which are by definition those meningiomas which originate from the parasellar region are difficult skull base tumors to deal with. For deciding the most appropriate surgical strategy, surgeons need detailed preoperative neuroimaging. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. Thin section CT scan with bone windows, 3D spiral CT reconstruction, MRI, MR angiography, and DSA performed with selective arteriography including late venous phases give those required detailed informations about the tumor and its relation with neurovascular and bony structures. The type of craniotomy and complementary osteotomy and the usefulness of an extradural anterior clinoidectomy with unroofing the optic canal can be decided from preoperative neuroimaging. Data collected also help in determining whether extensive exposure of the middle cranial fossa is necessary to ensure substantial devascularization of the tumor and whether proximal control of the internal carotid artery (ICA) at its intrapetrosal portion might be useful. Study of the capacity of blood supply of the Willis circle is wise for deciding the need and way of performing an extra-intracranial bypass together with tumor removal. Currently the concept of operating only the tumors with extracavernous extensions and to limit resection to only their extracavernous portions is the most accepted way of treating these tumors. It was that strategy that was adopted in the senior author's 220-patient series.Radiosurgery or stereotactic fractionated radiotherapy may complement surgery or can be only reserved for growing remnants.

  8. [Bacteriological study of maxillary sinusitis].

    PubMed

    Renon, P; Casanova, M; Verdier, M; Asperge, A; Le Mouel, C

    1984-01-01

    Suppurated maxillary sinusitis are frequent diseases. Diameatic puncture allows bacteriological investigations. Our results are positive in two thirds of cases. The bacterial flora is very varied, whose identification and antibiograms involve efficient treatment with daily washing and in situ antibiotherapy.

  9. [Sinusitis--judicious antibiotic treatment].

    PubMed

    Niedzielska, Grazyna

    2007-01-01

    The paper presents different forms of sinusitis in children and adults as well as the patomechanism of sinusitis of infective and non-infective origin. The role of bacterial infection has been discussed. Participation of major pathogens of URTI such as S. pneumoniae, H. influenzae and M. catarrhalis has been highlighted and the factors influencing growth of their antibiotic-resistant stains. Guidelines concerning antibiotic therapy in children and adults, depending on disease course, age and factors influencing growth of resistant stains have been presented. Causes of failure in treatment of sinusitis have been analysed eg. in case of bacterial biofilm growth or non-neutrophilic inflammation forms. Antimicrobial treatment concerns mainly acute and aggravated infections. In case of chronic sinusitis, antibiotic therapy is complementary to surgical treatment.

  10. Radiography of the Paranasal Sinuses

    MedlinePlus

    ... your back or over your lap. This head. Radiography of the paranasal sinuses apron will protect your ... face, especially when lowering his or her head. Radiography of sitting and others while you are standing. ...

  11. Evaluating Complications of Chronic Sinusitis

    PubMed Central

    Hong, Phillip; Pereyra, Charles A.; Breslin, Adam; Melville, Laura

    2017-01-01

    Chronic sinusitis is a relatively common diagnosis throughout the US. In patients with an otherwise unremarkable medical history the treatment is typically supportive, requiring only clinical evaluation. We present the case of a 25-year-old male with a history of chronic sinusitis that was brought to our emergency department with new-onset seizure. Three days before he had presented to his usual care facility with two days of headache and fever and was discharged stating headache, subjective fever, and neck stiffness. After further investigation he was diagnosed with a mixed anaerobic epidural abscess. The evaluation and management of chronic sinusitis are based on the presence of symptoms concerning for complication. Prompt investigation of complicated sinusitis is essential in preventing debilitating and fatal sequelae. Our case study underscores the importance of early diagnosis and appropriate management. PMID:28163938

  12. [Surgical dilemmas. Sinus floor elevation].

    PubMed

    ten Bruggenkate, C M; Schulten, E A J M; Zijderveld, S A

    2008-12-01

    Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a 'top hinge door', that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

  13. Venous thrombosis: an overview

    SciTech Connect

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  14. MC-19 Margaritifer Sinus Region

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Mars digital-image mosaic merged with color of the MC-19 quadrangle, Margaritifer Sinus region of Mars. Heavily cratered highlands, which dominate the Margaritifer Sinus quadrangle, are marked by large expanses of chaotic terrain. In the northwestern part, the major rift zone of Valles Marineris connects with a broad canyon filled with chaotic terrain. Latitude range -30 to 0, longitude range 0 to 45 degrees.

  15. MC-20 Sinus Sabeus Region

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Mars digital-image mosaic merged with color of the MC-20 quadrangle, Sinus Sabeus region of Mars. Heavily cratered highlands dominate the Sinus Sabeus quadrangle. The northern part is marked by a large impact crater, Schiaparelli. Schiaparelli is an ancient remnant of the many large impact events that occurred during the period of heavy bombardment. Latitude range -30 to 0 degrees, longitude range -45 to 0.

  16. Venous ulcer review

    PubMed Central

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

  17. Diagnosing Deep Venous Thrombosis

    PubMed Central

    Doyle, D. Lynn

    1992-01-01

    Patients often present with unexplained lower limb pain and swelling. It is important to exclude deep venous thrombosis in the diagnosis because of the threat of sudden death. Simple clinical diagnosis is unacceptable, and noninvasive tests should be used initially. Serial testing detects proximal extension of isolated calf thrombi. Multiple diagnostic modalities are employed to diagnose a new deep venous thrombosis in patients with postphlebitic syndrome. PMID:21221369

  18. Cerebral circulation during acceleration stress

    NASA Astrophysics Data System (ADS)

    Cirovic, Srdjan

    A mathematical model of the cerebrovascular system has been developed to examine the influence of acceleration on cerebral circulation. The objective is to distinguish the main factors that limit cerebral blood flow in pilots subjected to accelerations which exceed the gravitational acceleration of the earth (Gz > 1). The cerebrovascular system was approximated by an open-loop network of elastic tubes and the flow in blood vessels was modeled according to a one-dimensional theory of flow in collapsible tubes. Since linear analysis showed that the speed of pulse propagation in the intracranial vessels should not be modified by the skull constraint, the same governing equations were used for the intracranial vessels as for the rest of the network. The steady and pulsatile components of the cerebrospinal fluid pressure were determined from the condition that the cranial volume must be conserved. After the qualitative aspects of the model results were verified experimentally, the open-loop geometry was incorporated into a global mathematical model of the cardiovascular system. Both the mathematical models and the experiment show that cerebral blood flow diminishes for Gz > 1 due to an increase in the resistance of the large veins in the neck, which collapse as soon as the venous pressure becomes negative. In contrast, the conservation of the cranial volume requires that the cerebrospinal and venous pressure always be approximately the same, and the vessels contained in the cranial cavity do not collapse. Positive pressure breathing provides protection by elevating blood arterial and venous pressures at the heart, thus preventing the venous collapse and maintaining the normal cerebral vascular resistance.

  19. Frontal Sinus Fractures: Current Concepts

    PubMed Central

    Strong, E. Bradley

    2009-01-01

    Frontal sinus injuries may range from isolated anterior table fractures resulting in a simple aesthetic deformity to complex fractures involving the frontal recess, orbits, skull base, and intracranial contents. The risk of long-term morbidity can be significant. Optimal treatment strategies for the management of frontal sinus fractures remain controversial. However, it is critical to have a thorough understanding of frontal sinus anatomy as well as the current treatment strategies used to manage these injuries. A thorough physical exam and thin-cut, multiplanar (axial, coronal, and sagittal) computed tomography scan should be performed in all patients suspected of having a frontal sinus fracture. The most appropriate treatment strategy can be determined by assessing five anatomic parameters including the: frontal recess, anterior table integrity, posterior table integrity, dural integrity, and presence of a cerebrospinal fluid leak. A well thought out management strategy and meticulous surgical techniques are critical to success. The primary surgical goal is to provide a safe sinus while minimizing patient morbidity. This article offers an anatomically based treatment algorithm for the management of frontal sinus fractures and highlights the key steps to surgical repair. PMID:22110810

  20. Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis.

    PubMed

    Ladner, Travis R; Davis, Brandon J; He, Lucy; Mawn, Louise A; Mocco, J

    2014-10-29

    Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST. 2014 BMJ Publishing Group Ltd.

  1. Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis.

    PubMed

    Ladner, Travis R; Davis, Brandon J; He, Lucy; Mawn, Louise A; Mocco, J

    2015-12-01

    Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Persistent Left Superior Vena Cava Draining into the Coronary Sinus: A Case Report

    PubMed Central

    Kurtoglu, Ertugrul; Cakin, Ozlem; Akcay, Selahaddin; Akturk, Erdal; Korkmaz, Hasan

    2011-01-01

    Persistent left superior vena cava (PLSVC) is a congenital anomaly of the thoracic venous system resulting from the abnormal persistence of an embryological vessel that normally regresses during early fetal life. This anomaly is often discovered incidentally during surgery, cardiovascular imaging or invasive cardiovascular procedures. In most cases, a PLSVC drains into the right atrium through the coronary sinus. In the remainder of cases, it enters directly or through the pulmonary veins into the left atrium. A dilated coronary sinus on echocardiography should always raise the suspicion of a PLSVC as it has important clinical implications. The diagnosis should be confirmed by saline contrast echocardiography. We report a patient with persistent left superior vena cava with an enlarged coronary sinus and normal right superior vena cava.

  3. Blood sinuses in the submucosa of the large airways of the sheep.

    PubMed Central

    Hill, P; Goulding, D; Webber, S E; Widdicombe, J G

    1989-01-01

    We have studied the airway vasculature in sheep using light and transmission electron microscopy, as well as arterial and venous (retrograde) injections of anatomical corrosion compound and latex. Vascular casts were viewed by scanning electron microscopy. There is a complex network of blood sinuses of large diameter (up to 500 microns) in the submucosa of the large airways. The vessels have thin walls formed by a single layer of flattened endothelium with tight junctions and without pericytes or smooth muscle cells. Characteristically the sinuses lie between the cartilage and lamina propria of the trachea or between cartilage and smooth muscle in the bronchi. Sinuses of greater than 50 microns transverse diameter are not found in airways less than 1.0 mm across. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 7 PMID:2808119

  4. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency.

    PubMed

    Zaniewski, Maciej; Simka, Marian

    2012-05-01

    This article discusses the biophysical aspects of venous outflow from the brain in healthy individuals and in patients with chronic cerebrospinal venous insufficiency. Blood flows out of the brain differently, depending on body position. In the supine position it flows out mainly through internal jugular veins, while in the upright position it uses the vertebral veins. This phenomenon is probably not due to the active regulation of the flow but instead results from the collapse of jugular veins when the head is elevated. Such a collapse is associated with a significant increase in flow resistance, which leads to redirection of the flow towards the vertebral pathway. Theoretical calculations respecting the rules of fluid mechanics indicate that the pressure gradients necessary for moving blood from the brain toward the heart differ significantly between the supine and upright positions. The occlusion of internal jugular veins, according to fluid mechanics, should result in significant increase in the flow resistance and the restriction of cerebral flow, which is in line with clinical observations. Importantly, the biophysical analysis of cerebral venous outflow implies that the brain cannot easily compensate for increased peripheral venous resistance (namely, an occlusion of the large extracranial veins draining this organ), either by elevating the pressure gradient or by decreasing the vascular resistance through the recruitment of additional drainage pathways. This may mean that chronic cerebrospinal venous insufficiency may cause the destruction of the delicate nervous tissue of the central nervous system.

  5. [Disseminated arterial occlusions revealing bilateral venous thrombosis with paradoxical embolisms].

    PubMed

    Elsendoorn, A; Desport, E; Vialle, R; Frat, J-P; Bridoux, F; Touchard, G

    2009-06-01

    Paradoxical embolism is a diagnosis of exclusion. Clinical triad associates deep venous thrombosis with or without pulmonary embolism, arterial embolism, and intracardiac communication with right-to-left shunt. The intracardiac communication is generally related to a patent foramen ovale (PFO). We report a 75-year-old patient, who presented with bilateral deep venous thrombosis of the legs, complicated by massive pulmonary embolism and paradoxical embolisms through a PFO. This resulted in cerebral, mesenteric, splenic and bilateral kidney infarctions. A promptly initiated anticoagulant treatment allowed a favourable outcome.

  6. Monitoring cerebral tissue oxygen saturation during surgery: a clinician's perspective

    NASA Astrophysics Data System (ADS)

    Meng, Lingzhong; Gelb, Adrian W.; Cerussi, Albert E.; Mantulin, William W.; Tromberg, Bruce J.

    2013-03-01

    Organ protection and physiology optimization are important goals when taking care of anesthetized patients undergoing surgery. Postoperative cognitive dysfunction and perioperative stroke are unwarranted potential outcomes. Neurovascular coupling, the match between cerebral metabolic demand and substrate supply, should be regarded as the essential cerebral physiology which needs to be monitored during surgery. The brain-targeting near-infrared spectroscopy (NIRS) technology has the potential to fulfill this goal. Proposition of why and how to monitor essential cerebral physiology via advanced NIRS technologies is discussed. We also discussed the limits of the current NIRS technologies which merely measure cerebral tissue oxygen saturation in pooled cerebral arterial, capillary, and venous blood.

  7. Changes in intracranial venous blood flow and pulsatility in Alzheimer's disease: A 4D flow MRI study.

    PubMed

    Rivera-Rivera, Leonardo A; Schubert, Tilman; Turski, Patrick; Johnson, Kevin M; Berman, Sara E; Rowley, Howard A; Carlsson, Cynthia M; Johnson, Sterling C; Wieben, Oliver

    2016-01-01

    Cerebral blood flow, arterial pulsation, and vasomotion may be important indicators of cerebrovascular health in aging and diseases of aging such as Alzheimer's disease. Noninvasive markers that assess these characteristics may be helpful in the study of co-occurrence of these diseases and potential additive and interacting effects. In this study, 4D flow MRI was used to measure intra-cranial flow features with cardiac-gated phase contrast MRI in cranial arteries and veins. Mean blood flow and pulsatility index as well as the transit time of the peak flow from the middle cerebral artery to the superior sagittal sinus were measured in a total of 104 subjects comprising of four groups: (a) subjects with Alzheimer's disease, (b) age-matched controls, (c) subjects with mild cognitive impairment, and (d) a group of late middle-aged with parental history of sporadic Alzheimer's disease. The Alzheimer's disease group exhibited: a significant decrease in mean blood flow in the superior sagittal sinus, transverse sinus, middle cerebral artery, and internal carotid arteries; a significant decrease of the peak and end diastolic blood flow in the middle cerebral artery and superior sagittal sinus; a faster transmission of peak flow from the middle cerebral artery to the superior sagittal sinus and increased pulsatility index along the carotid siphon.

  8. Jugular venous reflux affects ocular venous system in transient monocular blindness.

    PubMed

    Chung, Chih-Ping; Hsu, Hung-Yi; Chao, A-Ching; Cheng, Ching-Yu; Lin, Shing-Jong; Hu, Han-Hwa

    2010-01-01

    The frequency of jugular venous reflux (JVR) is higher in patients with transient monocular blindness (TMB). We hypothesize that JVR influences ocular venous outflow, and resulting disturbances in cerebral and ocular venous circulation might be a cause of TMB. To substantiate this hypothesis, we aimed to demonstrate that: (1) TMB patients have vasculature changes in their retinal venules, and (2) JVR could influence ocular venous outflow, as revealed by dilated retinal venules. This study has 2 parts. The case-control study included 31 TMB patients and 31 age/gender-matched normal individuals, who all received fundus photography for retinal venule diameter comparisons. The Valsalva maneuver (VM) experiment included 30 healthy volunteers who received both color Doppler imaging of the internal jugular vein and fundus photography for retinal venule diameter measurement. In the case-control study, TMB patients had a wider retinal venule diameter (184.5 +/- 17.5 vs. 174.3 +/- 16.2 microm, right eye, p = 0.023; 194.20 +/- 24.6 vs. 176.6 +/- 19.5 microm, left eye, p = 0.017), especially TMB patients with JVR. The VM experiments showed that the presence of JVR was associated with a greater increase in retinal venule diameters during VM in the subjects' right eye (14.27 +/- 11.16 vs. 2.75 +/- 3.51%, JVR vs. non-JVR, p = 0.0002) and left eye (10.06 +/- 6.42 vs. 1.80 +/- 2.03%, p = 0.0003). These findings provide evidence that frequently occurring JVR associated with TMB impedes ocular venous outflow, and the subsequent disturbances in ocular venous circulation may be a cause of TMB. (c) 2009 S. Karger AG, Basel.

  9. Delayed intracranial hypertension and cerebellar tonsillar necrosis associated with a depressed occipital skull fracture compressing the superior sagittal sinus. Case report.

    PubMed

    Vender, John R; Bierbrauer, Karin

    2005-11-01

    Depressed skull fractures overlying the major venous sinus are often managed nonoperatively because of the high associated risks of surgery in these locations. In the presence of clinical and radiographic evidence of sinus occlusion, however, surgical therapy may be necessary. The authors present the case of a 9-year-old boy with a depressed skull fracture overlying the posterior third of the superior sagittal sinus. After initial conservative treatment, delayed signs of intracranial hypertension and a symptomatic tonsillar herniation with tonsillar necrosis developed. Possible causes as well as diagnostic and treatment options are reviewed.

  10. Antithrombin Cambridge II(A384S) mutation frequency and antithrombin activity levels in 120 of deep venous thrombosis and 150 of cerebral infarction patients in a single center in Southern China.

    PubMed

    Zhang, Guang-sen; Tang, Yang-ming; Tang, Mei-qing; Qing, Zi-Ju; Shu, Chang; Tang, Xiang-qi; Deng, Ming-yang; Tan, Li-ming

    2010-09-01

    Antithrombin Cambridge II(A384S) mutation shows a relatively high frequency in western population. Some studies suggest that the mutation is an independent genetic risk factor both for deep vein thrombosis (DVT) and for arterial thrombosis, but whether the mutation has racial difference or has a general significance for thrombophilia remains unclear. In this study we performed an analysis of the prevalence of the mutation in Chinese southern population; Also, the antithrombin activity levels were evaluated in each investigated individual. The studies included 120 patients with DVT, 150 patients with cerebral infarction, and 110 controls. The mutation was detected using polymerase chain reaction/PvuII restrictive fragment length polymorphism procedures. Antithrombin activity assay was done using chromogenic substrate method. The results showed that no antithrombin Cambridge II mutation was detected in all three groups (DVT, cerebral infarction and controls), the incidence was 0/380. Plasma antithrombin activity was 91.37% +/- 16.15% in the DVT patients and 102.68% +/- 13.10% in the controls; the antithrombin activity was significantly reduced in the DVT group (P < 0.0001). In DVT patients, eight cases were identified as primary antithrombin deficiency, accounting for an incidence of 6.7%. No significant difference was found for antithrombin activity between cerebral infarction group and controls. These results suggest that antithrombin Cambridge II mutation has a racial difference, and may not be a valuable risk factor of thrombophilia in Asian population, and antithrombin deficiency remains a major genetic risk factor for DVT patients in China.

  11. Cerebral Arterial Thrombosis in Ulcerative Colitis

    PubMed Central

    Casella, Giovanni; Cortelezzi, Claudio Camillo; Marialuisa, DeLodovici; Cariddi Lucia, Princiotta; Elena Pinuccia, Verrengia; Baldini, Vittorio; Segato, Sergio

    2013-01-01

    Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature. PMID:23864966

  12. Cerebral arterial thrombosis in ulcerative colitis.

    PubMed

    Casella, Giovanni; Cortelezzi, Claudio Camillo; Marialuisa, Delodovici; Cariddi Lucia, Princiotta; Elena Pinuccia, Verrengia; Baldini, Vittorio; Segato, Sergio

    2013-01-01

    Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature.

  13. Regional brain blood flow and cerebral cortical O2 consumption during sevoflurane anesthesia in healthy isocapnic swine.

    PubMed

    Manohar, M

    1986-01-01

    Regional distribution of brain blood flow was examined in seven previously catheterized healthy isocapnic swine while awake (control), and during 1.0 and 1.5 minimum alveolar concentration (MAC--2.66 and 3.99% end-tidal, respectively) sevoflurane anesthesia using radionuclide-labeled 15-micron diameter microspheres that were injected into the left atrium. In six additional pigs, the superior sagittal sinus was also catheterized so that cerebral cortical O2 consumption could be ascertained during these conditions. Control values of blood flow in the cerebral cortical gray matter, white matter, and caudate nuclei were 117 +/- 9, 38 +/- 2 and 105 +/- 8 ml X min-1 X 100 g-1, respectively. At 1.0 MAC sevoflurane, blood flow in these regions decreased to 66, 76, and 75% of respective control values, and these values were not different from those recorded at 1.5 MAC anesthesia. Cerebral cortical O2 consumption decreased by 50 and 52% at 1.0 and 1.5 MAC sevoflurane anesthesia, but the hemoglobin-O2 saturation in the cerebral cortical venous drainage (57 +/- 3% and 69 +/- 3% at 1.0 and 1.5 MAC) consistently exceeded control value (42 +/- 1%), suggesting that cortical O2 supply during both levels of sevoflurane anesthesia remained adequate. In cerebellum, blood flow decreased from 86 +/- 5 (control) to 68 +/- 4 ml X min-1 X 100 g-1 with 1.0 MAC sevoflurane, but returned toward control value at 1.5 MAC anesthesia. The thalamohypothalamic perfusion decreased to 59 and 75% of the control value with 1.0 and 1.5 MAC sevoflurane anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Acute venous thromboembolic disease and paradoxical embolism.

    PubMed

    Pérez R, Diego; Maldonado J, Daniela; Andresen H, Max

    2015-04-01

    We report two cases of paradoxical cerebral embolism associated with acute venous thromboembolic disease. The first case corresponds to a 49-year-old woman with sudden onset of dyspnea and syncope, followed by right upper extremity paresis, aphasia and dysarthria. The admission brain computed tomography (CT) was unremarkable, but lung CT showed multilobar and multisegmentary pulmonary embolism. Echocardiography showed dilated right ventricle with impaired systolic function, moderate tricuspid regurgitation, moderate pulmonary hypertension and positive bubble test, suggestive of a patent foramen ovale (PFO) which was successfully closed by endovascular Amplatzer device placement. The patient was discharged with anticoagulation therapy and permanent antiplatelet aggregation therapy. The second case is a 60-year-old woman found unconscious. Neurological examination revealed expressive aphasia, right hemianopsia, right central facial paralysis and right-sided paresis with a National institute of Health Stroke Scale of 19. Brain CT showed signs of acute left middle cerebral artery infarction. Later, she developed greater impairment of consciousness. A new brain CT showed significant edema with mass effect requiring a decompressive craniotomy. Echocardiography showed PFO and lower extremities' Doppler ultrasound showed a left infrapopliteal posterior tibial right deep venous thrombosis. An inferior vena cava filter was placed and two days after surgery, anticoagulation was started.

  15. A novel multipurpose mini-endoscope for frontal sinus endoscopy "sinus view".

    PubMed

    Al Kadah, Basel; Bozzato, Victoria; Bozzato, Alessandro; Papaspyrou, George; Schick, Bernhard

    2015-07-01

    Endoscopic frontal sinus surgery has been proven to enable the treatment of most frontal sinus pathologies but may be challenging for the surgeon in regard to the variable frontal sinus anatomy. Frontal sinus drainage identification and frontal sinus visualization are an essential part of successful frontal sinus surgery. We demonstrate a novel modular mini-endoscopic system for frontal sinus surgery. Fifty-two patients (37 male, 15 female) with a chronic rhino-sinusitis were enrolled. In this study, all patients were subjected to standard endonasal endoscopic sinus surgery with use of the fibre optic endoscope "Sinus View" (1.1 mm diameter, 10,000 pixels, irrigation channel and additional working channel) accessing the frontal sinus. A frontal sinus drainage type I in 38 cases, a frontal sinus drainage type IIa in 9 cases and a frontal sinus drainage type IIb in 5 cases according to Draf were performed. The modular mini-endoscopic system "Sinus view" was used to identify frontal sinus drainage in ten patients before ethmoidectomy and in the remaining patients (N = 42) after ethmoidectomy. Visualization of the frontal sinus drainage or the frontal sinus itself was easily carried out after irrigation. A clear identification of the frontal sinus by illumination was achieved in all cases. In addition the working channel of the endoscope was successfully used to perform visualized balloon dilatation at the frontal sinus drainage or for biopsy. The endonasal visualization of the frontal sinus drainage and frontal sinus itself is facilitated by also using a modular mini-endoscope with the option to use the working channel of the endoscope for biopsy or balloon dilatation.

  16. [Homocysteine and venous thromboembolism].

    PubMed

    Monnerat, C; Hayoz, D

    1997-09-06

    Congenital homocysteinuria is a rare inherited metabolic disorder with early onset atherosclerosis and arterial and venous trombosis. Moderate hyperhomocysteinemia is more frequently encountered and is recognized as an independent cardiovascular risk factor. Several case-control studies demonstrate an association between venous thromboembolism and moderate hyperhomocysteinemia. A patient with moderate hyperhomocysteinemia has a 2-3 relative risk of developing an episode of venous thromboembolism. The occurrence of mild hyperhomocysteinemia in heterozygotes for the mutation of Leiden factor V involves a 10-fold increase in the risk of venous thromboembolism. The biochemical mechanism by which homocysteine may promote thrombosis is not fully recognized. Homocysteine inhibits the expression of thrombomodulin, the thrombin cofactor responsible for protein C activation, and inhibits antithrombin-III binding. Treatment with folic acid reduces the plasma level of homocysteinemia, but no study has demonstrated its efficacy in reducing the incidence of venous thromboembolism or atherosclerosis. Hyperhomocysteinemia should be included in the screening of abnormalities of hemostasis and thrombosis in patients with idiopathic thromboembolism, and mild hyperhomocysteinemia may justify a trial of folic acid.

  17. Developmental venous anomaly in the newborn brain.

    PubMed

    Horsch, S; Govaert, P; Cowan, F M; Benders, M J N L; Groenendaal, F; Lequin, M H; Saliou, G; de Vries, L S

    2014-07-01

    Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age.

  18. Can developmental venous anomalies cause seizures?

    PubMed

    Dussaule, Claire; Masnou, Pascal; Nasser, Ghaïdaa; Archambaud, Frédérique; Cauquil-Michon, Cécile; Gagnepain, Jean-Paul; Bouilleret, Viviane; Denier, Christian

    2017-03-17

    Developmental venous anomalies (DVAs) are congenital anatomical variants of normal venous drainage of normal brain. Although DVAs are often discovered on the occasion of a seizure, their involvement in epilepsy is poorly studied. Our objective was to determine whether DVA can cause seizures, in the cases where there is no associated lesion, including no cavernoma or dysplasia. Based on clinical history, cerebral MRI, EEG recording, and (18)F-FDG PET, we report 4 patients with DVA revealed by seizures. The first patient had a convulsive seizure caused by a hemorrhagic infarction due to thrombosis of her DVA. The second patient had a left temporo-parietal DVA next to a nonspecific lesion, possibly a sequelae of a venous infarction. The last two patients disclosed an isolated and uncomplicated DVA with a concordant epileptic focus confirmed on ictal video EEG recording. We reviewed literature and identified 21 other published cases of seizures caused by complications of a DVA and 9 patients that may have a direct link between epilepsy and an isolated and uncomplicated DVA. Seizures are linked to a DVA in two main situations: presence of an associated epileptogenic lesion, such as cavernoma or dysplasia, and occurrence of a complication of the DVA. Before concluding that a seizure is caused by a DVA, it is essential to perform full MRI protocols to search them. It remains rare and uncertain that isolated and uncomplicated DVA can cause seizures. In this last situation, physiopathological processes are probably different in each patient.

  19. Unusual presentation of total anomalous systemic venous connection.

    PubMed

    Vaidyanathan, Swaminathan; Kothandam, Sivakumar; Kumar, Rajesh; Pradhan, Priya M; Agarwal, Ravi

    2017-07-01

    A 9-year-old girl who presented with dyspnea on exertion was diagnosed with total anomalous systemic venous connection to the left atrium (both venae cavae), no left superior vena cava, and a moderate-sized atrial septal defect with severe pulmonary arterial hypertension and ectopic atrial rhythm. She underwent septation of the common atrium using autologous pericardium, thereby rerouting the superior vena cava, inferior vena cava, and coronary sinus to the right atrium. Her postoperative course was uneventful. This case is reported for its rarity of presentation with severe pulmonary arterial hypertension and ectopic atrial rhythm.

  20. Cyanosis in a 9-month-old child after repair of total anomalous pulmonary venous return.

    PubMed

    Latus, Heiner; Hussain, Tarique; Krasemann, Thomas; Greil, Gerald F

    2012-06-01

    A 9-month-old girl presented with cyanosis after correction of total anomalous pulmonary venous return (TAPVR) to the coronary sinus in the neonatal period. During corrective surgery, the right superior vena cava (RSVC) was damaged and re-anastomosed to the right atrium. Echocardiography showed increased flow velocity in the pulmonary venous confluence. Therefore, pulmonary venous obstruction was suspected. However, subsequent cardiac MRI revealed a stenosed RSVC as well as a dilated left superior vena cava (LSVC) draining from the left innominate vein into the pulmonary venous confluence. The re-recruited LSVC drained deoxygenated blood into the systemic circulation, causing cyanosis. After uncomplicated placement of a stent in the narrowed RSVC and occlusion of the LSVC, transcutaneous saturations normalised immediately.

  1. Venous Oxygenation Mapping using Velocity-Selective Excitation and Arterial Nulling (VSEAN)

    PubMed Central

    Guo, Jia; Wong, Eric C.

    2011-01-01

    A new MRI technique to map the oxygenation of venous blood is presented. The method uses velocity-selective excitation and arterial nulling pulses, combined with phase sensitive signal detection to isolate the venous blood signal. The T2 of this signal along with a T2-Y calibration curve yields estimates of venous oxygenation in situ. Results from phantoms and healthy human subjects under normoxic and hypoxic conditions are shown, and venous saturation levels estimated from both sagittal sinus and grey matter based ROIs are compared to the related techniques TRUST and QUIXOTIC. In addition, combined with an additional scan without arterial nulling pulses, the oxygen saturation level on arterial side can also be estimated. PMID:22294414

  2. Sex determination using maxillary sinus

    PubMed Central

    Kanthem, Ranjith Kumar; Guttikonda, Venkateswara Rao; Yeluri, Sivaranjani; Kumari, Geetha

    2015-01-01

    Background: Individual identification is a subtle concept and often one of the most important priorities in mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases. Matching specific features detected on the cadaver with data recorded during the life of an individual is an important aspect in forensics, and can be performed by fingerprint analysis, deoxyribonucleic acid matching, anthropological methods, radiological methods and other techniques which can facilitate age and sex identification. Sinus radiography is one such method that has been used for determination of the sex of an individual. Hence, an attempt is being made to use the different dimensions of the maxillary sinus in the determination of sex using coronal and axial sections of plain computed tomography (CT) scan. Materials and Methods: A total of 30 patients including 17 male and 13 female, visiting the Outpatient Department of the Mamata General Hospital were included as the study subjects. The dimensions of right and left maxillary sinuses of 30 subjects from plain CT were measured using SYNGO software and statistical analysis was done. Results: Sex determination using height, length, width, and volume of the maxillary sinus on both sides showed statistically significant results with a higher percentage of sexual dimorphism in the case of volume. Conclusion: Volume of the right maxillary sinus can be used as accurate diagnostic parameter for sex determination. PMID:26005308

  3. Autonomic dysfunction: a unifying multiple sclerosis theory, linking chronic cerebrospinal venous insufficiency, vitamin D(3), and Epstein-Barr virus.

    PubMed

    Sternberg, Zohara

    2012-12-01

    Multiple sclerosis (MS) is a disease with multiple etiologies. The most recent theory of the vascular etiology of MS, Chronic Cerebrospinal Venous Insufficiency (CCSVI), suggests that cerebral venous obstruction could lead to cerebral venous reflux, promoting local inflammatory processes. This review article offers strong evidence that the route of the observed narrowing of cerebral veins arises from autonomic nervous system dysfunction, particularly cardiovascular autonomic dysfunction. The dysfunction of this system has two major effects: 1) the reduction of mean arterial blood pressure, which has the potential to reduce the cerebral perfusion pressure and the transmural pressure, and 2) the failure of cerebral autoregulation to maintain constant cerebral blood flow in the face of fluctuations in cerebral perfusion pressure. Alterations in cerebral autoregulation could in turn raise the critical closure pressure, indicated to be the cerebral perfusion pressure at which the transmural pressure will be sub-sufficient to overcome the active tension imparted by the smooth muscle layer of the vessel. These two effects of autonomic nervous system dysfunction (reduction in arterial blood pressure and alterations in cerebral autoregulation), when combined with inflammation-induced high levels of nitric oxide in the brain, will lower transmural pressure sufficiently to the point where the threshold for critical closure pressure is reached, leading to venous closure. In addition, cerebral vessels fail to overcome the closure as a result of low central venous pressure, which is also regulated by autonomic nervous system function. Furthermore, through their neuroregulatory effects, infectious agents such as the Epstein-Barr virus and vitamin D(3) are able to alter the functions of the autonomic nervous system, influencing the rate of CCSVI occurrence. The absence of CCSVI specificity for MS, observed in recent clinical studies, may stem from a high prevalence of autonomic

  4. Cerebral Aneurysms

    MedlinePlus

    ... cerebral aneurysm may be required to restore deteriorating respiration and reduce abnormally high pressure within the brain. ... cerebral aneurysm may be required to restore deteriorating respiration and reduce abnormally high pressure within the brain. ...

  5. Cerebral Palsy

    MedlinePlus

    ... ol (Spanish) Recommend on Facebook Tweet Share Compartir Cerebral palsy (CP) is a group of disorders that affect ... resource—it highlights the ADDM Network’s data on cerebral palsy in a way that is useful for stakeholders ...

  6. Cerebral Palsy

    MedlinePlus

    Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance ... do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have ...

  7. Venous thromboembolism prophylaxis.

    PubMed

    Laryea, Jonathan; Champagne, Bradley

    2013-09-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile.

  8. Venous Thromboembolism Prophylaxis

    PubMed Central

    Laryea, Jonathan; Champagne, Bradley

    2013-01-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile. PMID:24436666

  9. Central venous access.

    PubMed

    Ganeshan, Arul; Warakaulle, Dinuke R; Uberoi, Raman

    2007-01-01

    Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article.

  10. Unexpected location of pilonidal sinuses.

    PubMed

    Sion-Vardy, N; Osyntsov, L; Cagnano, E; Osyntsov, A; Vardy, D; Benharroch, D

    2009-12-01

    Pilonidal sinuses usually occur in the sacrococcygeal area in young men, and occasionally can be found in other ectopic sites. We present a retrospective case review on unusual locations of pilonidal sinuses in the past 4 years. The lesion sites were as follows: one on the penis, two on the scalp, two on the abdomen, one on the neck, two in the groin and two in the axilla. Abdominal and penile lesions are uncommon, but the other locations reported are unusually rare. To our knowledge, the groin has not been reported previously as a site of a pilonidal sinus, although the histological appearance of hidradenitis suppurativa may well resemble it. When trying to clarify the pathogenesis of these occurrences, we found that recurrent hair removal was a common characteristic of the patients we contacted, and this may have been the initiating trauma.

  11. Modeling the Carotid Sinus Baroreceptor

    PubMed Central

    Srinivasan, Ramachandra; Nudelman, Harvey B.

    1972-01-01

    A mathematical model that describes the relationship between sinus pressure and nerve discharge frequency of the carotid sinus baroreceptor is presented. It is partly based upon the single-fiber data obtained by Clarke from the sinus nerve of a dog. The model takes into account what is currently known about the physiology of the baroreceptor. It consists of two nonlinear ordinary differential equations and eight free parameters. With one set of values for these eight parameters, the model reproduces well the experimental results reported by Clarke for positive ramp pressure inputs. Only three parameters needed to be adjusted in order to fit the dynamic data. The remaining five were obtained from static and steady-state data. PMID:5056961

  12. Fulminant cerebral infarction of anterior and posterior cerebral circulation after ascending type of facial necrotizing fasciitis.

    PubMed

    Lee, Jun Ho; Choi, Hui-Chul; Kim, Chulho; Sohn, Jong Hee; Kim, Heung Cheol

    2014-01-01

    Necrotizing fasciitis is a soft tissue infection that is characterized by extensive necrosis of the subcutaneous fat, neurovascular structures, and fascia. Cerebral infarction after facial necrotizing fasciitis has been rarely reported. A 61-year-old woman with diabetes was admitted with painful swelling of her right cheek. One day later, she was stuporous and quadriplegic. A computed tomographic scan of her face revealed right facial infection in the periorbital soft tissue, parotid, buccal muscle, and maxillary sinusitis. A computed tomographic scan of the brain revealed cerebral infarction in the right hemisphere, left frontal area, and both cerebellum. Four days later, she died from cerebral edema and septic shock. Involvement of the cerebral vasculature, such as the carotid or vertebral artery by necrotizing fasciitis, can cause cerebral infarction. Facial necrotizing fasciitis should be treated early with surgical treatment and the appropriate antibiotic therapy.

  13. Protective effect of coronary sinus obstruction from primary ischemia-induced ventricular fibrillation in the dog.

    PubMed

    Kralios, A C; Anderson, F L; Kralios, F A

    1993-04-01

    We examined whether partial coronary sinus obstruction affects the latency of the early ventricular fibrillation (VF) of acute ischemia. During baseline trials 15 of 19 open-chest dogs fibrillated repeatedly and predictably within 2 to 5 minutes (251.6 +/- 64 seconds) after reversible, double coronary artery occlusion without developing profound hemodynamic deterioration. The effect of partial coronary sinus obstruction sufficient to increase coronary sinus pressure to 40 mm Hg could be adequately tested in 11 dogs. Coronary sinus obstruction consistently prevented VF in five dogs, significantly prolonged the VF latency in three (p < 0.01 to p < 0.001), and had no clear effect in another three. The overall effect was significant at the p < 0.01 level. VF latency prolongation/prevention was also positively correlated to the residual coronary sinus pressure at the time of VF (r = 0.76; p < 0.008), as well as the baseline VF latency (r = 0.75; (p < 0.008). The protective effect of coronary venous hypertension most likely reflects preservation of adequate extracellular fluid in the ischemic region after the perfusion arrest. This extracellular fluid may constitute a key component in the prevention of early ischemic arrhythmias by preserving interstitial hydraulic continuity and tissue homogeneity through enhanced dilution and diffusion of solutes.

  14. The jugular venous pressure revisited

    PubMed Central

    CHIACO, JOHN MICHAEL S. CHUA; PARIKH, NISHA I.; FERGUSSON, DAVID J.

    2016-01-01

    Assessment of the jugular venous pressure is often inadequately performed and undervalued. Here, we review the physiologic and anatomic basis for the jugular venous pressure, including the discrepancy between right atrial and central venous pressures. We also describe the correct method of evaluating this clinical finding and review the clinical relevance of the jugular venous pressure, especially its value in assessing the severity and response to treatment of congestive heart failure. Waveforms reflective of specific conditions are also discussed. PMID:24085809

  15. Treatment for Inappropriate Sinus Tachycardia.

    PubMed

    Salazar Adum, Juan Pablo; Arora, Rohit

    Inappropriate Sinus Tachycardia (IST) is a chronic medical condition with a wide variety of clinical presentations making it, sometimes, very insidious at the time of the diagnosis. Several therapeutic options, including, pharmacotherapy, cardiac rehabilitation, and modification or ablation of the sinus node, have been proposed for the management of IST, but because of the complexity and lack of understanding of pathophysiology, it can be difficult to manage, despite the numerous treatment options currently available. The purpose of this review is to analyze the treatment for IST, focusing on the role of newer therapy and the potential benefits in the management of this cardiac rhythm disturbance.

  16. Parenchymal abnormalities associated with developmental venous anomalies.

    PubMed

    San Millán Ruíz, Diego; Delavelle, Jacqueline; Yilmaz, Hasan; Gailloud, Philippe; Piovan, Enrico; Bertramello, Alberto; Pizzini, Francesca; Rüfenacht, Daniel A

    2007-12-01

    To report a retrospective series of 84 cerebral developmental venous anomalies (DVAs), focusing on associated parenchymal abnormalities within the drainage territory of the DVA. DVAs were identified during routine diagnostic radiological work-up based on magnetic resonance imaging (MRI) (60 cases), computed tomography (CT) (62 cases) or both (36 cases). Regional parenchymal modifications within the drainage territory of the DVA, such as cortical or subcortical atrophy, white matter density or signal alterations, dystrophic calcifications, presence of haemorrhage or a cavernous-like vascular malformation (CVM), were noted. A stenosis of the collecting vein of the DVA was also sought for. Brain abnormalities within the drainage territory of a DVA were encountered in 65.4% of the cases. Locoregional brain atrophy occurred in 29.7% of the cases, followed by white matter lesions in 28.3% of MRI investigations and 19.3% of CT investigations, CVMs in 13.3% of MRI investigations and dystrophic calcification in 9.6% of CT investigations. An intracranial haemorrhage possibly related to a DVA occurred in 2.4% cases, and a stenosis on the collecting vein was documented in 13.1% of cases. Parenchymal abnormalities were identified for all DVA sizes. Brain parenchymal abnormalities were associated with DVAs in close to two thirds of the cases evaluated. These abnormalities are thought to occur secondarily, likely during post-natal life, as a result of chronic venous hypertension. Outflow obstruction, progressive thickening of the walls of the DVA and their morphological organization into a venous convergence zone are thought to contribute to the development of venous hypertension in DVA.

  17. Obstruction of Venous Drainage Linked to Transient Global Amnesia

    PubMed Central

    Han, Ke; Chao, A-Ching; Chang, Feng-Chi; Chung, Chih-Ping; Hsu, Hung-Yi; Sheng, Wen-Yung; Wu, Jiang; Hu, Han-Hwa

    2015-01-01

    Abnormal extracranial venous drainage modality has been considered an etiology of transient global amnesia (TGA). Evidence suggests that the transmission of the intrathoracic/intraabdominal pressure during a Valsalva maneuver (VM) is mainly through the vertebral venous system, and patency of internal jugular vein (IJV) is essential for venous drainage and pressure releasing. We hypothesize that obstruction of IJV venous drainage is a contributing factor in TGA pathogenesis. A magnetic resonance (MR) imaging protocol was used in 45 TGA patients and 45 age- and sex-matched controls to assess the morphologies of IJV, brachiocephalic vein (BCV) and asymmetry of transverse sinus (TS). The IJV was divided into the upper- and middle-IJV segments. Compared to the controls, TGA patients had significantly higher rates of moderate and severe compression/stenosis at the bilateral upper-IJV segment (left: 37.8% vs. 17.8%, P = 0.0393; right: 57.8% vs.15.6%, P<0.0012), in left BCV (60% vs. 8.9%, P<0.0004), and in TS hypoplasia (53.3%% vs. 31.1%, P = 0.0405). The prevalence of at least one site of venous compression/stenosis in IJV or BCV was significantly higher in patients than in controls (91.1% vs. 33.3%, P<0.0004). The diameter of the left TS in MRV, but not in T1 contrast imaging, was significantly smaller in TGA patients than in controls (0.31±0.21 vs. 0.41±0.19, P = 0.0290), which was compatible with downstream venous stenosis/obstruction. TGA patients have a higher prevalence of compression/stenosis of the bilateral IJV and the left BCV and TS hypoplasia, which is new evidence that supports the role of extracranial veins in TGA pathogenesis. PMID:26173146

  18. Compression and venous surgery for venous leg ulcers.

    PubMed

    Mosti, Giovanni

    2012-07-01

    This article reviews published data on the effects of surgery and compression in the treatment of venous ulcers and the best options for compression therapy. Randomized controlled studies reveal that surgery and compression have similar effectiveness in healing ulcers but surgery is more effective in preventing recurrence. Most leg ulcers have a venous pathophysiology and occur because of venous ambulatory hypertension caused by venous reflux and impairment of the venous pumping function. Proposed surgical interventions range from crossectomy and stripping to perforator vein interruption and endovascular procedures (laser, radiofrequency). More conservative procedures (foam sclerotherapy, conservative hemodynamic treatment) have also been proposed. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Jugular venous reflux on magnetic resonance angiography and radionuclide venography

    PubMed Central

    Okada, Tomohisa; Okuchi, Sachi; Yamamoto, Akira; Kanagaki, Mitsunori; Fujimoto, Koji; Togashi, Kaori

    2016-01-01

    Background The relationship between the signal from retrograde venous flow on magnetic resonance angiography (MRA) and retrograde upward flow from the left brachiocephalic vein has not been explored. Purpose To reveal the frequency of jugular venous reflux using MRA and nuclear venography in patients being evaluated for cerebral volume and blood flow. Material and Methods A total of 229 patients with cognitive disturbance who had undergone brain magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) on the same day to evaluate cerebral blood flow were evaluated. Jugular venous reflux was measured on MRA and nuclear venography, which was conducted just after injection of N-isopropyl-123I-p-iodoamphetamine for the SPECT study. Results MRA showed jugular reflux in seven patients on the right side, and in 22 on the left. Nuclear venography showed jugular reflux in six patients on the right side, and in 20 on the left. Conclusion Jugular venous reflux was observed mostly on the left side. Retrograde flow was observed on both MRA and nuclear venography in half of the cases, with the rest only on one of the modalities. PMID:27994882

  20. Venous oxygen saturation.

    PubMed

    Hartog, Christiane; Bloos, Frank

    2014-12-01

    Early detection and rapid treatment of tissue hypoxia are important goals. Venous oxygen saturation is an indirect index of global oxygen supply-to-demand ratio. Central venous oxygen saturation (ScvO2) measurement has become a surrogate for mixed venous oxygen saturation (SvO2). ScvO2 is measured by a catheter placed in the superior vena cava. After results from a single-center study suggested that maintaining ScvO2 values >70% might improve survival rates in septic patients, international practice guidelines included this target in a bundle strategy to treat early sepsis. However, a recent multicenter study with >1500 patients found that the use of central hemodynamic and ScvO2 monitoring did not improve long-term survival when compared to the clinical assessment of the adequacy of circulation. It seems that if sepsis is recognized early, a rapid initiation of antibiotics and adequate fluid resuscitation are more important than measuring venous oxygen saturation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. [Venous access in oncology].

    PubMed

    Lesimple, T; Béguec, J F; Levêque, J M

    1998-10-31

    Many treatments administered to cancer patients require venous access either via a peripheral vein or a larger central vein at the risk of local or systemic infection, thrombus formation or venous occlusion and dysfunction. Insertion of a central catheter is an invasive procedure which must be conducted under conditions of rigorous asepsia. Strict rules based on well-defined protocols must be applied throughout its use. Local or systemic infectious complications account for 18 to 25% of all nosocomial infections and are often related to colonisation of the puncture site by a Gram positive germ. In case of infection, ablation of the central catheter is not mandatory for diagnosis or antibiotic treatment. Reported at varying frequencies in the literature from 4 to 42%, thrombus formation is unpredictable and often difficult to diagnose. Anticoagulants or fibrolytic agents are indicated but it may also be necessary to withdraw the catheter. Displacement, rupture, obstruction and extravasation are frequent complications. Back flow must be checked in all venous accesses and free flow carefully verified. The access must remain patent throughout the period of use, guaranteed by a standard heparinization and rinsing protocol. This complications must not mask the important progress achieved with the use of central venous access for specific and symptomatic treatment in cancer patients.

  2. Cerebral Accidents in Pediatric Diabetic Ketoacidosis: Different Complications and Different Evolutions.

    PubMed

    Mozzillo, Enza; D'Amico, Alessandra; Fattorusso, Valentina; Carotenuto, Barbara; Buono, Pietro; De Nitto, Elena; Falco, Mariateresa; Franzese, Adriana

    2015-01-01

    Diabetic ketoacidosis (DKA) may be associated with neurologic complications: the most common is cerebral edema while the risk of venous and arterial stroke is rare. There is a pathogenetic link between DKA, hypercoagulability and stroke, whose risk is underestimated by clinicians. Our cases present a wide spectrum of cerebral accidents during DKA, the first one being diffuse cerebral edema, the second one venous stroke after 5 days of DKA resolution, while the third one multifocal edema suspected to be extrapontine myelinolysis although without electrolyte imbalance. Our cases suggest that DKA requires very accurate treatment, particularly at an early age, and it can be complicated by cerebral accidents even with appropriate medical care.

  3. Bacterial colonization or infection in chronic sinusitis.

    PubMed

    Pandak, Nenad; Pajić-Penavić, Ivana; Sekelj, Alen; Tomić-Paradžik, Maja; Cabraja, Ivica; Miklaušić, Božana

    2011-12-01

    The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.

  4. Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein.

    PubMed

    Michels, Kevin S; Ng, John D; Falardeau, Julie; Roberts, Warren G; Petersen, Bryan; Nesbit, Gary M; Barnwell, Stanley L

    2007-01-01

    A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.

  5. Predicted burden of venous disease.

    PubMed

    Onida, Sarah; Davies, Alun Huw

    2016-03-01

    Chronic venous disease is a common condition with clinical signs and symptoms ranging from spider veins, to varicose veins, to active venous ulceration. Both superficial and deep venous dysfunction may be implicated in the development of this disease. Socio-economic factors are shaping our population, with increasing age and body mass index resulting in significant pressure on healthcare systems worldwide. These risk factors also lead to an increased risk of developing superficial and/or deep venous insufficiency, increasing disease prevalence and morbidity. In this chapter, the authors review the current and future burden of chronic venous disease from an epidemiological, quality of life and economic perspective.

  6. Oncocytic Schneiderian papilloma of frontal sinus.

    PubMed

    Kalfert, David; Laco, Jan; Celakovský, Petr; Smatanová, Katarína; Ludvíková, Marie

    2013-01-01

    Oncocytic Schneiderian papilloma (OSP) is one of the three morphologically distinct tumors that arise from Schneiderian membrane (the others include exophytic papilloma and inverted papilloma). OSP almost always occurs unilaterally in the paranasal sinuses, usually in the maxillary sinus, ethmoid cells or sphenoid sinus. We report a case of a 64-year-old woman with OSP arising from the left frontal sinus. In the report herein, we describe an OSP originating in the region of frontal sinus, which, to the best of our knowledge, represents the first documented example in English literature of OSP developing in this anatomical site.

  7. Overview of Frontal Sinus Pathology and Management.

    PubMed

    Vázquez, Alejandro; Baredes, Soly; Setzen, Michael; Eloy, Jean Anderson

    2016-08-01

    The frontal sinus is the most complex of all paranasal sinuses. Given its proximity to the cranial vault and orbit, frontal sinus pathology can progress to involve these structures and lead to significant morbidity, or even mortality. Surgical management of the frontal sinus is technically challenging. Various open and endoscopic surgical techniques are available to the otolaryngologist. This article presents an overview of the major disease entities that affect the frontal sinus, with a special emphasis on treatment principles and surgical management. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. When Sinuses Attack! (For Kids)

    MedlinePlus

    ... you have a cold? continue When Good Sinuses Go Bad What about that cold that won't go away? A cold virus can: damage the delicate ... if you are feeling well enough, you can go to school or go outside and play. In ...

  9. Pneumatization of the sphenoid sinus.

    PubMed

    Terra, E R; Guedes, F R; Manzi, F R; Bóscolo, F N

    2006-01-01

    This paper describes a case of pneumatization of the sphenoid sinus in the pterygoid process and greater wing of the sphenoid bone, observed on a panoramic radiograph. Conventional radiographs and computerized tomography in axial and coronal sections confirmed the presence of the pneumatization of these structures.

  10. Allergic fungal sinusitis causing nasolacrimal duct obstruction.

    PubMed

    Kim, Charles; Kacker, Ashutosh; Chee, Ru-Ik; Lelli, Gary J

    2013-04-01

    Allergic fungal sinusitis is thought to represent a chronic autoimmune reaction directed against fungal elements within the sinuses, and is commonly seen in individuals with a history of chronic sinusitis that is refractory to medical therapy. The authors present a case of allergic fungal sinusitis involving the lacrimal drainage system. A 54-year-old woman initially presented with recurrent erythema and induration of the left nasolacrimal sac due to dacryocystitis, which was unresponsive to treatment with topical and systemic antibiotics. Radiological evaluation demonstrated the presence of multiple soft tissue masses along the medial canthi. During subsequent endoscopic dacryocystorhinostomy, significant amounts of allergic mucin were found within the sinuses and marked eosinophilia was present within tissue obtained from the lacrimal sac, findings highly suggestive of allergic fungal sinusitis. A diagnosis of allergic fungal sinusitis should be considered in patients presenting with epiphora in the appropriate clinical context. However, involvement of the lacrimal drainage system is an exceedingly unusual presentation.

  11. Cavopulmonary window: an extreme form of sinus venosus defect.

    PubMed

    Aramendi, José I; Cubero, Alain; Hamzeh, Gadah; Rey, Estibaliz

    2014-02-01

    We present an unusual variant of the sinus venosus defect in which an obvious window is formed between a single pulmonary vein and the superior vena cava, the pulmonary vein retaining its connection to the left atrium. Two patients were operated on via right anterior minithoracotomy. A large single right pulmonary vein was found connecting to the left atrium. There was a large side-to-side communication between the superior vena cava and the pulmonary vein resulting in partially anomalous pulmonary venous drainage. A side-biting clamp was applied in the superior vena cava and the pulmonary vein at both sides of the communication, and the vein was divided. The incision in both veins was closed with a running suture.

  12. Cerebral thrombosis at altitude: its pathogenesis and the problems of prevention and treatment.

    PubMed

    Song, S Y; Asaji, T; Tanizaki, Y; Fujimaki, T; Matsutani, M; Okeda, R

    1986-01-01

    In analyzing cerebral thrombosis at altitude--own case and in the literature--we anatomically confirmed that cerebral thrombi in mountain sickness were all of venous origin. All climbers went higher than 5,000 m and most stayed in that altitude longer than 3 weeks. Hemoconcentration was confirmed in two cases, including our own patient. It was suspected that hemoconcentration resulting from secondary polycythemia and dehydration at altitude, as well as cerebral circulatory disturbance produced by high-altitude cerebral edema, played a major role in the development of cerebral thrombosis. The problems of prevention and treatment of cerebral thrombosis at altitude are discussed.

  13. Ex vivo comparative study on three sinus lift tools for transcrestal detaching maxillary sinus mucosa.

    PubMed

    Li, Yanfeng; Hu, Pin; Han, Yishi; Fan, Jiadong; Dong, Xinming; Ren, Huan; Yang, Chunhao; Shi, Tingting; Xia, Dong

    2017-07-04

    The objective of this study was to comparatively evaluate 3 different sinus lift tools, namely umbrella-shaped sinus lift curette YSL-04, our recently designed probe-improved sinus lift curettes, and our newly invented elevator 014, using our previous developed goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time. Goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time were generated according to our previously developed protocol. The effectiveness for each tool was evaluated through the length of sinus mucosa detached in mesial and distal directions or buccal and palatal directions, and the space volume created by detaching maxillary sinus mucosa in mesial, distal, buccal and palatal directions. The results showed that all 3 sinus lift tools could transcrestally detach the maxillary sinus mucosa and create extra space under the elevated sinus floor on the goat ex vivo sinus models. Moreover, our newly invented elevator 014 had advantages over the other 2 in term of the capability to detach the sinus mucosa. Our newly invented elevator 014 might be a promising tool for detaching maxillary sinus mucosa in transcrestal maxillary sinus floor elevation.

  14. Relationship between prognosis of dental implants and maxillary sinusitis associated with the sinus elevation procedure.

    PubMed

    Kim, Young-Kyun; Hwang, Jin-Young; Yun, Pil-Young

    2013-01-01

    The aims of this study were to evaluate the incidence of maxillary sinusitis associated with the sinus elevation procedure and to analyze the influence of maxillary sinusitis on the prognosis of dental implants. Data were collected from medical records and dental radiographic findings of patients who received dental implant therapy along with a sinus elevation procedure at Seoul National University Bundang Hospital from June 2003 to December 2008. A total of 338 sinus elevation cases (643 implants) were included in this study, out of which maxillary sinusitis was reported in 33 cases (9.8%). The type of surgical approach used and the occurrence of sinus membrane perforation could be considered factors affecting maxillary sinusitis associated with the sinus elevation procedure. The implants at the site of the maxillary sinusitis associated with the sinus elevation procedure showed lower survival rates in male patients. Better clinical outcomes were achieved in the group receiving combined medical and surgical therapy for sinusitis associated with the sinus elevation procedure. Postoperative maxillary sinusitis decreased the survival rates of implants, whereas early diagnosis and combined medical and surgical therapy had the opposite effect.

  15. Evaluating the safety of frontal sinus trephination.

    PubMed

    Lee, Annie S; Schaitkin, Barry M; Gillman, Grant S

    2010-03-01

    The depth of the frontal sinus was measured using axial computed tomography (CT) images to examine the safety of frontal sinus trephination at selected distances from the midline. Review of 200 sinus CT scans. Two hundred sinus CT scans (400 frontal sinuses) were reviewed to measure the frontal sinus depth at 5 mm, 10 mm, and 15 mm from midline. Males had a significantly deeper frontal sinus than females at all measurements points (P < .001). The measurements revealed a considerable number of small but nonhypoplastic frontal sinuses, which were shallower than the length of standard frontal trephine instruments (7 mm) and would risk penetration of the posterior table of the sinus. Of all frontal sinuses studied, 9.54% were <7 mm deep at 5 mm from the midline, 10.12% at 10 mm, and 8.96% at 15 mm from the midline. Overall, 15.3% of all frontal sinuses studied had at least one point where the measured depth was <7 mm. Although the majority of patients have frontal sinuses deep enough to accommodate standard trephine instruments, surgeons should recognize that up to 15% of nonhypoplastic frontal sinuses may not be sufficiently deep at a given point to allow safe trephination without risking unintentional transgression of the posterior table. This study suggests that trephination routinely carried out at a given predetermined distance from the midline may be an unsafe practice. Careful evaluation of the imaging is essential in every case to avoid inadvertent injury and to help select the safest distance from the midline for frontal sinus trephination.

  16. Anatomical aspects of sinus floor elevations.

    PubMed

    van den Bergh, J P; ten Bruggenkate, C M; Disch, F J; Tuinzing, D B

    2000-06-01

    Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sin