Science.gov

Sample records for dural venous sinus

  1. Spontaneous Recanalization of Occluded Dural Venous Sinuses after Successful Trans Arterial Embolisation of a Dural Arteriovenous Shunt

    PubMed Central

    Brew, S.; Taylor, W.; Lasjaunias, P.

    2002-01-01

    Summary Dural arteriovenous shunts (DAVS) occur within the walls of dural venous sinuses or their tributaries. They may be related to previous episodes of sinus thrombosis. The presence of impediments to venous outflow results in venous congestion, predisposing to haemorrhage and cerebral parenchymal damage. Cerebral venous congestion is an indication for treatment. This case is unusual in some respects; firstly, the patient was relatively well despite worrisome features on imaging and secondly the occluded dural venous sinuses appeared to spontaneously recanalize after treatment of the DAVS. Anticoagulation may have had a role in avoiding thrombosis of the patient's precarious venous drainage after embolisation and in encouraging recanalization of the thrombosed dural venous sinuses. PMID:20594510

  2. Variations in magnetic resonance venographic anatomy of the dorsal dural venous sinus system in 51 dogs.

    PubMed

    Fenn, Joe; Lam, Richard; Kenny, Patrick J

    2013-01-01

    Variations in intracranial dural venous sinus anatomy have been widely reported in humans, but there have been no studies reporting this in dogs. The purpose of this retrospective study was to describe variations in magnetic resonance (MR) venographic anatomy of the dorsal dural venous sinus system in a sample population of dogs with structurally normal brains. Medical records were searched for dogs with complete phase contrast, intracranial MR venograms and a diagnosis of idiopathic epilepsy. Magnetic resonance venograms were retrieved for each dog and characteristics of the dorsal dural sinuses, symmetry of the transverse sinuses and other anatomic variations were recorded. A total of 51 dogs were included. Transverse sinus asymmetry was present in 58.8% of the dogs, with transverse sinus hypoplasia seen in 39.2%, and aplasia in 23.5% of dogs. For 70.6% of dogs, at least one anatomic variation in the dorsal sagittal sinus was observed, including deviation from the midline (33.3%) and collateral branches from either the dorsal sagittal sinus or dorsal cerebral veins (54.9%). In 5 dogs (9.8%) a vessel was also identified running from the proximal transverse sinus to the distal sigmoid sinus, in a similar location to the occipital sinus previously reported in children. Findings from this study indicated that, as in humans, anatomic variations are common in the intracranial dural venous sinus system of dogs. These anatomic variations should be taken into consideration for surgical planning or diagnosis of cerebrovascular disease.

  3. Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?

    PubMed Central

    Qureshi, Adnan I.; Qureshi, Mushtaq H.; Majidi, Shahram; Gilani, Waqas I.; Siddiq, Farhan

    2014-01-01

    Objective To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results At intraparenchymal balloon inflation of 90 cm3, there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3, there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm3, compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm3 or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180 cm3, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as the supratentorial mass lesion increased from 180 to 200 cm3. Conclusions Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and

  4. 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

  5. Non-standard intracranial connections and alternative pathways between dural venous sinuses and cerebral veins in the rat.

    PubMed

    Kresakova, Lenka; Purzyc, Halina; Schusterova, Ingrid; Fulton, Benjamin; Maloveska, Marcela; Vdoviakova, Katarina; Kravcova, Zuzana; Boldizar, Martin

    2015-06-01

    The aim of this study was to describe the uncommon intracranial venous connections and vein structures that may play a role in the redirection of cerebral blood drainage. The study was carried out on 35 adult Wistar rats. Corrosion casts were prepared from the cerebral venous system and Spofacryl® was used as a casting medium. The highest prevalence of non-standard connections and variations was noted in the region of sinus petrosus dorsalis (SPD) (31.2 %) and v. cerebri magna (VCM) (28.5 %). SPD established a non-standard anastomosis with sinus petrosus ventralis in 8.6 % of cases, with sinus interperiopticus in 2.8 % of cases, with sinus sigmoideus in 5.7 % of cases and with confluens sinuum (CS) in 2.8 % of cases, where higher prevalence was observed on the left side of the brain. In 11.4 % of cases VCM formed a secondary connection between CS and sinus rectus leading to the formation of the loop. In a similar manner, VCM entered the sinus transversus in 8.6 % of cases, while in 5.7 % of cases VCM merged with SPD and formed an unusual connection among dorsal and ventral systems of sinuses. Several sinuses were observed as inconsistent, including sinus occipitalis (14.3 %), sinus intercavernosus rostralis (22.8 %) and sinus interbasilaris (14.3 %). The hypoplastic posterior and anterior anastomotic vein did not reach one another in 20 % of observed cases. Anatomical information concerning different drainage pathways are important in preoperative planning and can provide necessary understanding in experimental studies, including cerebral vein occlusion, venous infarction, or experimentally induced cerebral venous obstruction.

  6. Cerebral venous sinus thrombosis

    PubMed Central

    Allroggen, H.; Abbott, R.

    2000-01-01

    Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. It is very often unrecognised at initial presentation. All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Extensive collateral circulation within the cerebral venous system allows for a significant degree of compensation in the early stages of thrombus formation. Systemic inflammatory diseases and inherited as well as acquired coagulation disorders are frequent causes, although in up to 30% of cases no underlying cause can be identified. The oral contraceptive pill appears to be an important additional risk factor. The spectrum of clinical presentations ranges from headache with papilloedema to focal deficit, seizures and coma. Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. It has now been conclusively shown that intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis because of its efficacy, safety and feasability. Local thrombolysis may be indicated in cases of deterioration, despite adequate heparinisation. This should be followed by oral anticoagulation for 3-6 months. The prognosis of cerebral venous sinus thrombosis is generally favourable. A high index of clinical suspicion is needed to diagnose this uncommon condition so that appropriate treatment can be initiated.


Keywords: cerebral venous sinus thrombosis PMID:10622773

  7. Dural cavernous sinus fistula: an unusual presentation.

    PubMed Central

    Procope, J. A.; Kidwell, E. D.; Copeland, R. A.; Perry, A. F.

    1994-01-01

    This article describes a 22-year-old man who presented to the Howard University Hospital emergency room with acute onset of swelling, proptosis, and decreased vision in the right eye preceded by 24 hours of nausea and vomiting. The patient's visual acuity was count fingers in the involved eye with marked proptosis and limitation of ocular motility. There was no history given of any ocular or head trauma. A computed tomography scan of the orbits showed diffuse symmetric enlargement of the extraocular muscles of the right eye, felt to be consistent with an orbital inflammatory pseudotumor. The patient was treated with intravenous steroids initially, then placed on oral prednisone. After minimal improvement on the steroids, a selective external carotid angiogram showed a moderate-sized dural cavernous sinus fistula. The patient underwent selective embolization of the fistula with rapid resolution of periorbital edema and proptosis. Visual acuity was stabilized at 20/200 in the right eye. The differential diagnosis and pathogenesis of carotid cavernous sinus fistulas and the likely pathogenesis of the fistula in this case are discussed. Images Figure 1 Figure 2 Figure 3 PMID:8046763

  8. Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

    PubMed Central

    Zhang, J.; Lv, X.; Jiang, C.; Li, Y.; Yang, X.; Wu, Z.

    2010-01-01

    Summary We report on the safety and efficacy of transarterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3-42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs. PMID:20977859

  9. 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

  10. A unique type of dural arteriovenous fistula at confluence of sinuses treated with endovascular embolization: a case report.

    PubMed

    Gupta, Rahul; Miyachi, Shigeru; Matsubara, Noriaki; Izumi, Takashi; Naito, Takehiro; Haraguchi, Kenichi; Wakabayashi, Toshihiko

    2013-02-01

    Dural arteriovenous fistula (DAVF) is classically defined as abnormal arteriovenous connections located within the dural leaflets. Though the exact etiology is still not clear, they are generally accepted as acquired lesions. However, some DAVFs formed as the congenital disorders are called dural arteriovenous malformations and these lesions with a marked cortical venous reflux are considered to be aggressive and warrant an early intervention. The authors describe a case of 35-year-old man presented with unique type of DAVF. The fistula was located adjacent to the confluence of venous sinuses with multiple feeders. The feeders drained into a large venous pouch just anterior to the confluence which had a bilateral venous drainage. This was associated with multiple cerebellar venous ectasia along the draining cortical vein. It was managed by staged endovascular procedures and complete cure could be achieved. The pathogenesis and technique of embolization of this complex fistula/malformation are also discussed.

  11. A dural arteriovenous fistula in cavernous sinus developed from viral meningitis.

    PubMed

    Hai, Jian; Zhang, Lin; Wan, Jue-Feng; Su, Shao-Hua; Wang, Fei; Zhang, Gui-Yun

    2011-06-01

    Although hormonal influences, inflammation, trauma, sinus thrombosis, venous hypertension, and congenital origin have been proposed as sources of dural arteriovenous fistulas (DAVFs) in cavernous and sigmoid sinuses, the etiology of these lesions remains controversial. We present a case with a cavernous sinus DAVF developed from viral meningitis which has not been previously described. A 24-year-old male was admitted to our institute because of periorbital pain, decreased vision, pulsatile tinnitus, chemosis, and exophthalmos on the right side after he had suffered viral meningitis four months before. Cerebral angiography demonstrated a cavernous sinus DAVF, which was successfully obliterated with several platinum coils using a transvenous approach. The viral meningitis most likely caused the inflammation, that may be responsible for the occurrence of the cavernous sinus DAVF. Prompt treatment for inflammation may help to prevent the development of DAVFs.

  12. Papilloedema in Behçet's disease: value of MRI in diagnosis of dural sinus thrombosis.

    PubMed Central

    el-Ramahi, K M; al-Kawi, M Z

    1991-01-01

    Behçet's disease is a multisystem disease characterised by the clinical triad of oral ulcers, genital ulcers and uveitis. Nervous system involvement is frequent and occasionally precedes other manifestations. Behcet's disease is not frequently considered in the differential diagnosis of papilloedema. We report four cases of Behcet's disease in which papilloedema occurred with or without dural sinus thrombosis. MRI is of great value in the investigation of such patients as it can demonstrate venous sinus thrombosis non-invasively or suggest the diagnosis by showing the associated parenchymal lesions secondary to small vessel pathology. Images PMID:1955903

  13. Endovascular Treatment of a Dural Arteriovenous Fistula of the Transverse Sinus by Recanalisation, Angioplasty and Stent Deployment

    PubMed Central

    Weber, W.; Kis, B.; Esser, J.; Berlit, P.; Kühne, D.

    2003-01-01

    Summary We report the endovascular treatment of a 40-year-old woman with bilaterally thrombosed transverse sinuses and a dural arteriovenous fistula (DAVF) causing cortical venous reflux by recanalization, angioplasty and stent deployment of the occluded sinus segment followed by occlusion of the DAVF by stent deployment in the fistulous segment. By recanalization of the occluded sinus we re-established normal anterograde venous drainage and eliminated the venous hypertension and cortical venous reflux. After the procedure, the patient was treated with aspirin and clopidogrel for three months. A follow-up examination showed total occlusion of the DAVF, patency of the sinus and a complete resolution of the clinical symptoms. PMID:20591305

  14. Rare dural arteriovenous fistula of the lesser sphenoid wing sinus.

    PubMed

    Khadavi, Nicole M; Mancini, Ronald; Nakra, Tanuj; Tsirbas, Angelo C; Douglas, Raymond S; Goldberg, Robert A; Duckwiler, Gary R

    2009-01-01

    A fistula of the lesser sphenoid wing sinus is a rare dural arteriovenous fistula resulting from a connection between the middle meningeal artery and recipient vein in the sinus of the lesser sphenoid wing. In this report, MRI/magnetic resonance angiography of a 54-year-old man who presented with sudden-onset glaucoma and proptosis revealed a fistula in this anatomic location. Drainage patterns here may account for the absence of serious complications and optimistic prognosis following embolization. Care in diagnosis is required to avoid superfluous procedures, because classic signs of the more common carotid-cavernous fistula are absent. PMID:19966661

  15. 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

  16. Transcranial direct middle meningeal artery puncture for the onyx embolization of dural arteriovenous fistula involving the superior sagittal sinus.

    PubMed

    Oh, Jae-Sang; Yoon, Seok-Mann; Shim, Jai-Joon; Bae, Hack-Gun

    2015-01-01

    A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

  17. Septic cerebral venous sinus thrombosis.

    PubMed

    Khatri, Ismail A; Wasay, Mohammad

    2016-03-15

    Septic cerebral venous sinus thrombosis, once a common and deadly disease, has fortunately become rare now. Not only that the incidence has fallen significantly after the antibiotic era, the morbidity and mortality has also decreased substantially. Cavernous sinus thrombosis is by far the commonest form of septic cerebral venous sinus thrombosis. Due to its rare occurrence, a lot of current generation clinicians have not encountered the entity in person. Despite all the advances in diagnostic modalities, a high index of clinical suspicion remains the mainstay in prompt diagnosis and management of this potentially lethal condition. Keeping this in view, the authors have reviewed the subject including the old literature and have summarized the current approach to diagnosis and management. Septic cavernous thrombosis is a fulminant disease with dramatic presentation in most cases comprised of fever, periorbital pain and swelling, associated with systemic symptoms and signs. The preceding infection is usually in the central face or paranasal sinuses. The disease rapidly spreads to contralateral side and if remains undiagnosed and untreated can result in severe complications or even death. Prompt diagnosis using radiological imaging in suspected patient, early use of broad spectrum antibiotics, and judicial use of anticoagulation may save the life and prevent disability. Surgery is used only to treat the nidus of infection. PMID:26944152

  18. Onyx embolization of dural arteriovenous fistulas of the cavernous sinus through the superior pharyngeal branch of the ascending pharyngeal artery

    PubMed Central

    Pero, Guglielmo; Quilici, Luca; Piano, Mariangela; Valvassori, Luca; Boccardi, Edoardo

    2014-01-01

    We report three cases of dural arteriovenous fistula (DAVF) of the cavernous sinus treated by Onyx injection through the superior pharyngeal branch of the ascending pharyngeal artery. The treatment of choice of DAVFs of the cavernous sinus is endovascular, and it is preferentially done via transvenous occlusion of the cavernous sinus. The cavernous sinus can be reached through either the inferior petrosal sinus or the superior ophthalmic vein. When these venous routes are occluded, the first attempt is to pass through the occluded inferior petrosal sinus, but sometimes this attempt can fail. In some cases there are small transosseous feeders to the fistula arising from the superior pharyngeal branch of the ascending pharyngeal artery. When all of the more conventional approaches are unattainable, this route can be attempted. In our experience, it allowed safe and rapid occlusion of the fistula. PMID:24759156

  19. Torcular dural arteriovenous fistula treated via stent placement and angioplasty in the affected straight and transverse sinuses: case report.

    PubMed

    Takada, Shigeki; Isaka, Fumiaki; Nakakuki, Takuya; Mitsuno, Yuto; Kaneko, Takaaki

    2015-05-01

    The successful obliteration of torcular dural arteriovenous fistula (DAVF) with a diffuse shunt in the affected sinus may require complex treatment strategies. Therapeutic goals include the preservation of normal venous drainage and complete obliteration of shunt flow. The authors report the case of a torcular DAVF. The treatment of this type of AVF may require a combined approach with transarterial and transvenous embolization, open surgery, or radiosurgery and is associated with many problems. Stent placement and angioplasty in the affected sinus result in compression of the fistulous dural wall of the sinus and decrease shunt flow. In cases in which there is a diffuse shunt in the affected sinus and no evident shunt point, such as in AVFs involving venous pouches and parasinuses, sealing the fistula orifice with self-expandable stents and angioplasty (balloon inflation) is considered the best treatment option to preserve normal cerebral venous sinus drainage and obliterate shunt flow. In such cases, the authors recommend using one or more self-expandable and closed-cell stents and using angioplasty to avoid endoleakage into the gap between the stent graft and the vessel wall.

  20. Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.

    PubMed Central

    Chung, Y. G.; Lee, K. C.; Lee, H. K.; Lee, N. J.

    1999-01-01

    A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case. PMID:10485631

  1. Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.

    PubMed

    Chung, Y G; Lee, K C; Lee, H K; Lee, N J

    1999-08-01

    A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case. PMID:10485631

  2. Endovascular treatment of a traumatic dural arteriovenous fistula of the superior sagittal sinus using dual lumen balloon microcatheter.

    PubMed

    Tao, Yihao; Niu, Yin; Zhu, Gang; Chen, Zhi

    2016-04-01

    Dural arteriovenous fistula (DAVFs) induced by trauma in the superior sagittal sinus (SSS) are rare and difficult to treat because of their unique midline location, multiplicity of arterial feeders, and critical venous drainage. We report a case of an endovascular treatment using dual lumen balloon microcatheter on a patient with post-traumatic SSS DAVF. By the use of dual lumen Scepter balloon microcatheter, proximal Onyx reflux was prevented. In this case, complete embolization of the DAVFs was achieved and the outcome of the patient was fairly good. PMID:27094527

  3. Pulsatile Tinnitus with a Dural Arterio-Venous Fistula Diagnosed by Computed Tomography-Angiography

    PubMed Central

    Kim, Sujin; Byun, Jaeyong; Park, Moonsuh

    2013-01-01

    A 43 year-old female patient suffered the sudden onset of pulsatile tinnitus in the left ear 2 months ago. The tinnitus did not subside spontaneously and remained unchanged. The patient had no history of head trauma or surgery of the head and neck. The character of the tinnitus was pulsatile, and it was synchronous with the heart beat. Audiologic examinations were performed and all of the results were normal. Computed tomography with angiography was performed and evidence of an arterio-venous fistula (AVF) was found. 4-vessel angiography was performed to confirm the dural AVF between the external carotid artery and sigmoid sinus. Embolization of the feeder-vessels was done under a fluoroscope and 70% of the fistula flow was controlled after embolization and the tinnitus totally subsided during the embolization. PMID:24653921

  4. A single burr hole approach for direct transverse sinus cannulation for the treatment of a dural arteriovenous fistula

    PubMed Central

    Caplan, Justin M; Kaminsky, Ian; Gailloud, Philippe; Huang, Judy

    2014-01-01

    A 55-year-old woman with a symptomatic Borden II/Cognard IIa+b transverse sinus dural arteriovenous fistula underwent an attempted percutaneous transvenous embolization which was ultimately not possible given the fistula anatomy. She then underwent a partial percutaneous transarterial embolization but the fistula recurred. Given the failed percutaneous interventions, the patient underwent a combined open surgical/transvenous embolization using neuronavigation and a single burr hole craniectomy. She has remained symptom free for 3 months. This case report illustrates the feasibility of combining minimally invasive open surgical access to allow for direct venous cannulation for endovascular embolization of a dural arteriovenous fistula when traditional percutaneous methods are not an option. PMID:24398868

  5. Dural sinus obstruction following head injury: a diagnostic and clinical study.

    PubMed

    Benifla, Mony; Yoel, Uri; Melamed, Israel; Merkin, Vladimir; Cohen, Avi; Shelef, Ilan

    2016-09-01

    OBJECTIVE The aim of this study is to describe the clinical characteristics of patients with skull fracture adjacent to a dural venous sinus (DVS) and evaluate the role of CT venography (CTV) in the diagnosis of the effect of this fracture on the involved DVS. METHODS The study comprised patients with vault or skull base fracture adjacent to a DVS who were admitted to 1 medical center during a 2-year period. The medical records were reviewed for the clinical and radiographic characteristics. All patients had undergone CTV to evaluate potential DVS pathology. The clinical and radiological findings of the patients with DVS pathology were compared with those of the patients with normal DVS. The groups were compared using the chi-square and t-tests for categorical and continuous data, respectively. The potential risk for poor outcome among the patients with DVS pathology was also investigated. RESULTS Of 434 patients with skull fractures, 41 (9.4%) had fractures adjacent to a DVS. DVS pathology was detected in 51% of patients (21 of 41 patients). For 9 (43%) patients, obstruction was extraluminal without thrombosis, and 12 (57%) patients had dural sinus thrombosis (DST). In patients with a positive-CTV scan, the severity of injury according to the Glasgow Coma Scale score at presentation was correlated with the presence of DST (p = 0.007). The sensitivity of noncontrast CT (NCCT) for DVS involvement was 38% among the patients with positive-CTV scans. For patients with DVS pathology, poor outcome was correlated with DST (intraluminal), rather than extraluminal obstruction without thrombosis (p = 0.02), and superior sagittal sinus (SSS) involvement (p = 0.05). CONCLUSIONS NCCT is not sensitive enough to detect DVS obstruction in patients with skull fracture adjacent to a DVS, and CTV should be performed in order to rule it out. A correlation was found between the severity of injury and the presence of DST, rather than extraluminal obstruction. The authors' findings

  6. [Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report].

    PubMed

    Niizuma, Kuniyasu; Sakata, Hiroyuki; Koyama, Shinya; Kon, Hiroyuki; Chonan, Masashi; Sasaki, Tatsuya; Nishijima, Michiharu; Ezura, Masayuki; Tominaga, Teiji

    2012-11-01

    Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.

  7. Endovascular Treatment of Transverse-Sigmoid Sinus Dural Arteriovenous Malformations Presenting as Pulsatile Tinnitus

    PubMed Central

    Shownkeen, Harish; Yoo, Kevin; Leonetti, John; Origitano, T.C.

    2001-01-01

    Transverse-sigmoid sinus dural arteriovenous malformations (DAVM) are uncommon vascular lesions for which complete cure may be difficult to obtain. A wide variety of treatments for these lesions include observation, arterial compression, surgical resection, and endovascular embolization. We propose that transverse-sigmoid sinus DAVM can be completely cured by occluding the ipsilateral dural sinus with detachable balloon and Guglielmi detachable coils (GDC) coils before arterial feeder embolization with histoacryl. Three patients who presented with pulsatile tinnitus and normal magnetic resonance imaging (MRI) studies underwent angiography, which demonstrated transverse-sigmoid sinus DAVM. All three patients wer treated with retrograde transvenous sinus embolization with complete occlusion of the transverse-sigmoid sinus with detachable balloons and GDC coils with preservation of the vein of Labbé. Subsequently, the various feeders from the external carotid artery were embolized. The tentorial arteries arising from the ipsilateral internal carotid arteries were not embolized in any of the cases, which were still contributing to the DAVM. Complete cure with thrombosis of the tentorial branch of the internal carotid artery (ICA) was seen on follow-up angiogram 1 day after embolization in one patient and on 4-week and 6-week follow-up angiograms in the other two patients. Complete occlusion of the transverse sinus proximal to the vein of Labbé, in spite of incomplete arterial feeder embolization, can result in complete cure of the transversesinus dural AVF if adequate time is given for the remaining feeders to occlude, once the fistula is obliterated. ImagesFigure 1Figure 1p18-aFigure 2Figure 3 PMID:17167600

  8. Intravenous digital subtraction angiography of the intracranial veins and dural sinuses

    SciTech Connect

    Modic, M.T.; Weinstein, M.A.; Starnes, D.L.; Kinney, S.E.; Duchesneau, P.M.

    1983-02-01

    The intravenous digital subtraction angiographic (IV DSA) examinations of 100 patients studied for abnormalities unrelated to the intracranial venous structures were reviewed to determine and tabulate the frequency and adequacy of visualizaton of the venous drainage of the brain. In addition, 25 patients were specifically evaluated with IV DSA for abnormalities of the intracranial veins and sinuses. Conditions studied included: compression, displacement, or occlusion of the venous structures; carotid-cavernous sinus fistulas; tumors of the base of the skull, including glomus tumors; and normal variations in the position, size, and course of the venous structures. When combined with computed tomography, IV DSA is usually of sufficient quality to replace conventional angiography in the evaluation of the larger venous structures of the head and neck.

  9. Uncontrolled seizures resulting from cerebral venous sinus thrombosis complicating neurobrucellosis

    PubMed Central

    Faraji, Fardin; Didgar, Farshid; Talaie-Zanjani, Afsoon; Mohammadbeigi, Abolfazl

    2013-01-01

    Cerebral venous sinus thrombosis is a rare form of stroke caused by thrombosis in venous sinuses of the brain. In this study, we reported on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure despite being treated with anti-epileptic drugs at high doses. The case was a 33-year-old woman with a history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month. She was febrile and a brain CT scan indicated hemorrhagic focus in the left posterior parietal and the temporal lobe. Magnetic resonance imaging and magnetic resonance venography also proved venous sinus thrombosis in the left transverse sinus. Besides [In addition], a laboratory assessment confirmed brucellosis. Following the treatment with anti-coagulant, anti-brucellosis, and anti-epileptic agents, the patient was discharged in good condition with medical orders. Clinical suspicion and accurate evaluation of a patient's history is the most important clue in diagnosis and treatment of brucellosis and cerebral venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control. PMID:24250168

  10. 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

  11. Transarterial Onyx Embolization for Patients with Cavernous Sinus Dural Arteriovenous Fistulas Who Have Failed Transvenous Embolization.

    PubMed

    Wen, Jun; Duan, Chuan-Zhi; Huang, Li-Jing; Zhang, Xin; He, Xu-Ying; Li, Xi-Feng

    2015-09-01

    Transvenous embolization is the treatment of choice for cavernous sinus dural arteriovenous fistulas (csDAVFs) despite occasional difficulty in transvenous catheterization. We reported our experience in the treatment of csDAVFs by transarterial Onyx embolization in patients who had failed transvenous catheterization. We reviewed the clinical and radiographic records of csDAVFs patients receiving transarterial Onyx embolization after failed transvenous Onyx embolization at our institution over a period of 31 months. Success was defined as complete or near complete occlusion upon angiographic examination. In seven cases, the microcatheter failed to reach the cavernous sinus; in the remaining case, the internal jugular vein was occlusive. Eight sessions of the embolization and catheterization procedures via the arterial routes were conducted. Among them, five cases via the middle meningeal artery and the other three via the accessory meningeal artery. Angiography, immediately after embolization, revealed complete occlusion in seven cases (87.5 %) and partial occlusion in the remaining case. Angiographic follow-up (range, 6-10 months) showed that all patients achieved complete embolization. In cases where transvenous embolization of the cavernous sinus is difficult, transarterial embolization of the fistulas offers a safe and effective alternative.

  12. Cerebral venous sinus stenting for pseudotumor cerebri: A review

    PubMed Central

    Kanagalingam, Sivashakthi; Subramanian, Prem S.

    2014-01-01

    Pseudotumor cerebri is characterized by headaches, visual field changes, papilledema and an elevated cerebrospinal fluid opening pressure without evidence of an intracranial mass. In the setting of failed medical therapy, surgical options such as ventriculoperitoneal shunts and optic nerve sheath fenestrations are considered. Recently, venous sinus stenting has emerged as a new treatment option for patients with pseudotumor cerebri. We review the role of cerebral venous sinus stenting in the management of patients with medically refractory pseudotumor cerebri. Although long- term studies are needed in this field, the current reports indicate a favorable outcome for preventing vision loss and symptom control. PMID:25859134

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

    PubMed

    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

  14. Cerebral venous sinus thrombosis in children with nephrotic syndrome

    PubMed Central

    Gera, D. N.; Yadav, D. K.; Kute, V. B.; Patil, S. B.; Trivedi, H. L.

    2012-01-01

    Nephrotic syndrome in infancy and childhood can be associated with thromboembolic complications. We describe two cases of nephrotic syndrome who presented with non-specific findings. Magnetic resonance imaging brain with magnetic resonance venography showed thrombosis of multiple venous sinuses. Patients were successfully treated with anticoagulants and there was complete resolution of thrombosis on repeat imaging. PMID:23439670

  15. Embryological Consideration of Dural Arteriovenous Fistulas.

    PubMed

    Tanaka, Michihiro

    2016-09-15

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falco-tentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  16. Embryological Consideration of Dural Arteriovenous Fistulas

    PubMed Central

    TANAKA, Michihiro

    2016-01-01

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falcotentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  17. Abducens Palsy Due to Cerebral Venous Sinus Thrombosis in a Patient with Heart Failure

    PubMed Central

    Özgönül, Cem; Ceylan, Osman Melih; Mutlu, Fatih Mehmet; Altınsoy, Halil İbrahim; Aparcı, Mustafa

    2015-01-01

    Cerebral venous sinus thrombosis has a wide spectrum of presentation. The clinical manifestation depends on the location of the thrombus, its rate of progression, and the extent of venous collateralization. In this case report, we present the findings of cerebral venous sinus thrombosis presenting with abducens palsy and papilloedema in a patient with heart failure, an unusual etiology for cerebral venous sinus thrombosis. PMID:27800228

  18. Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

    PubMed Central

    Prasad, Deepa; Strainic, James P.; Pandya, Khyati; Kouretas, Peter C.

    2016-01-01

    We report a rare causal association between obstructed supracardiac totally anomalous pulmonary venous drainage and coronary sinus ostial atresia. Our 12-week-old patient developed venous myocardial infarction secondary to coronary venous hypertension because her sole route of coronary venous drainage was obstructed. She recovered after the obstruction was relieved by balloon dilation. Surgical repair then included anastomosis of the pulmonary venous confluence to the left atrium, ligation of the vertical vein, and unroofing of the coronary sinus. Coronary sinus ostial atresia is rarely diagnosed before autopsy. PMID:27777530

  19. Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery

    PubMed Central

    Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

    2016-01-01

    Background: Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Case Description: A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Conclusion: Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures. PMID:27313969

  20. Intraventricular hemorrhage caused by intracranial venous sinus thrombosis

    PubMed Central

    Zhang, Hongbo; Song, Shuijiang; Ouyang, Zhiyuan

    2016-01-01

    Abstract Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. The underlying risk factors include hypertension and aneurysms, among others. However, not all the exact etiologies are known. In this study, a case of a 24-year-old man who suffered from a headache and a decline in memory has been reported. A brain computed tomography scan suggested the diagnosis of spontaneous intraventricular hemorrhage. However, brain magnetic resonance imaging, magnetic resonance venography, and other tests eventually confirmed cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis may be one of the causes of intraventricular hemorrhage and should be considered for unexplained intraventricular hemorrhage. PMID:27428184

  1. Caring for cerebral venous sinus thrombosis in children

    PubMed Central

    Hashmi, Mubashira; Wasay, Mohammad

    2011-01-01

    Cerebral venous sinus thrombosis in children is increasingly recognized as diagnostic tools and clinical awareness has improved. It is a multifactorial disease where prothrombotic risk factors and predisposing clinical conditions usually in combination constitute the underlying etiology. Clinical features range from headache, seizures to comatose state. Although symptomatic treatment involving control of infections, seizures and intracranial hypertension is uniform, use of anticoagulation and local thrombolytic therapy is still controversial. Morbidity and mortality can be significant and long-term neurological sequelae include developmental delay, sensorimotor and visual deficits and epilepsy. PMID:21887032

  2. Intracranial venous sinus thrombosis complicating AIDS-associated nephropathy.

    PubMed

    Afsari, Khosrow; Frank, Jeffrey; Vaksman, Yulia; Nguyen, Thanhan V

    2003-03-01

    An alert and oriented 27-year-old African American woman with AIDS presented with a 10-day history of fever, cough productive of yellow sputum, nausea, and vomiting and a 1-day history of excruciating headache and photophobia. Her condition rapidly deteriorated into a coma with decorticate and then decerebrate posture, and she died 3 weeks later. There was evidence of extensive intracranial venous sinus thrombosis (ICVST), renal vein thrombosis (RVT), and multiple cerebral hemorrhagic infarcts due to a hypercoagulable state complicating AIDS-associated nephrotic syndrome. This is the first reported case of fatal ICVST and RVT with extensive cerebral hemorrhagic infarcts complicating nephrotic syndrome in a patient with AIDS.

  3. Neurobrucellosis and venous sinus thrombosis: an uncommon association.

    PubMed

    Lima, Joana Isabel da Silva; Canelas, Cátia Filipa Gomes; Veiga, Andreia Sofia de Sousa Botelho Trindade; Carvalho, Dina Maria Mota

    2016-01-01

    Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis. PMID:27384841

  4. A pivotal role of the vascular endothelial growth factor signaling pathway in the formation of venous hypertension-induced dural arteriovenous fistulas.

    PubMed

    Li, Qiang; Zhang, Qi; Huang, Qing-Hai; Fang, Yi-Bin; Zhang, Zhao-Long; Xu, Yi; Liu, Jian-Min

    2014-05-01

    Dural arteriovenous fistulas (DAVFs) are associated with venous hypertension. Numerous studies have revealed high expression levels of vascular endothelial growth factor (VEGF) in human DAVF specimens, as well as in animal models of experimental venous hypertension. The objective of the present study was to clarify whether the VEGF signaling pathway is important in the development of DAVFs. Rats (n=216) were randomly divided into six groups. In the rats from five groups (groups A and C-E, n=45 in each group; group B, n=12), experimental venous hypertension was induced by right common carotid artery (CCA)‑external jugular vein (EJV) anastomosis, superior sinus occlusion and left transver sinus occlusion, while the remaining group (group F, n=24) underwent sham surgery. The rats in group A received a VEGF recombinant adenovirus injection into the distal section of the right EJV 30 min prior to anastomosis of the CCA and EJV. An equivalent control adenovirus was injected into the right EJV of group B rats prior to anastomosis. The rats in group C received no virus prior to anastomosis and no medicine subsequent to surgery. The group D rats were lavaged with Vatalanib, a VEGF receptor (VEGFR) inhibitor, and the group E rats were lavaged with an equal quantity of saline weekly following surgery. Six rats from groups A-E and one rat from group F were sacrificed in the first, second, fourth and twelfth weeks after surgery for immunohistochemical analysis of VEGF expression and analysis of microvessel density. Cerebral angiography was performed on the remaining rats in each group on the twelfth week after surgery. The results revealed that following transfection with VEGF recombinant adenovirus, angiogenesis in the dura mater of venous hypertensive rats was increased subsequent to the increase in the VEGF expression levels of the brain and dura mater. The rate of DAVF induction by venous hypertension was significantly reduced by the VEGFR antagonist due to reduced

  5. The Organization of the Venous Spaces of the Cavernous Sinus

    PubMed Central

    de Alencastro, Luiz Carlos

    1992-01-01

    The study of the venous channels in the cavernous sinus in 48 sphenoid bones was performed. Thirty-eight bones were electrolyticly decalcified, subsequently embedded in gelatin, and cut in 1 mm thick slices. Microdissection of the other ten specimens complemented the analysis. Every specimen had the venous structure arranged as a plexus, however, although the channels were variable in number, form, and diameter, the two sides were quite symmetrical. Channels of smaller diameter predominated anteriorly. There was no demonstrable muscular layer in these vessels; the endothelial lining was easily visualized. Fatty tissue separated the venous channels from each other and from arteries and nerves. The distance from the carotid artery and the lateral wall increased anteriorly, but there were significant veins between these two structures in only 35% of the cases. In about one third of specimens the oculomotor nerve was placed over the carotid artery. The abducens nerve was found to be intimately related to the lateral wall without any venous channels between them in 92% of the specimens. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7 PMID:17170875

  6. Hyperbaric oxygen therapy for postoperative spinal dural arterio-venous fistula patients: An observational cohort study.

    PubMed

    Chen, Sichang; Ma, Yongjie; Liang, Peipeng; Wang, Xiaohui; Peng, Chao; Bian, Lisong; Liu, Jiang; Ding, Jianzhang; Zhang, Hongqi; Ling, Feng

    2016-09-01

    Spinal dural arterio-venous fistula (SDAVF) is a common type of spinal vascular malformation. Surgical obliteration of the fistula can cure SDAVF anatomically, but the functional outcome is unsatisfactory.The aim of the study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the functional recovery of postoperative SDAVF patients.This prospective cohort study included postoperative SDAVF patients. Patients were divided into control and HBOT groups. Patients in control group received conventional treatment, whereas those in the HBOT group received conventional treatment plus HBOT (2.0 atmospheric pressure absolute, 14 days). Follow-up was done at 1, 3, 6, 12, and 24 months after surgery for evaluation, including symptoms. To assess the effectiveness of HBOT on SDAVF patients, we compared the postoperative magnetic resonance imaging and neurological outcomes of each group with respect to modified Aminoff-Lougue scale and modified Denis Pain and Numbness Scale.From September 1, 2013 to January 31, 2014, 33 SDAVF patients (27 male) treated by microsurgery were included in this study. Sixteen patients were in the HBOT group and 17 patients were in the control group. At 24 months follow-up, the improvement of mDPNS for the HBOT group was significantly larger than those of the control group (2.25 vs 0.88; P = 0.005). In the HBOT group, the average length of hypersignal in magnetic resonance imaging T2 image decrease at 3 months after surgery was 3.25 compared with 2.29 in the control group (P = 0.009). No major adverse effects were reported for all 16 patients who received HBOT.The current findings suggest that HBOT is an effective and safe treatment to relieve lower body pain and numbness for postoperative SDAVF patients. PMID:27631206

  7. Migraine-like headache in cerebral venous sinus thrombosis.

    PubMed

    Tan, Funda Uysal; Tellioglu, Serdar; Koc, Rabia Soylu; Leventoglu, Alev

    2015-01-01

    A 20-year-old female, university student presented with severe, throbbing, unilateral headache, nausea and vomiting that started 2 days ago. The pain was aggravated with physical activity and she had photophobia. She had been taking contraceptive pills due to polycystic ovary for 3 months. Cranial computed tomography was uninformative and she was considered to have the first attack of migraine. She did not benefit from triptan treatment and as the duration of pain exceeded 72 h further imaging was done. Cranial MRI and MR venography revealed a central filling defect and lack of flow in the left sigmoid sinus caused by venous sinus thrombosis. In search for precipitating factors besides the use of contraceptive pills, plasma protein C activity was found to be depressed (42%, normal 70-140%), homocystein was minimally elevated (12.7 μmol/L, normal 0-12 μmol/L) and anti-cardiolipin IgM antibody was close to the upper limit. PMID:25666780

  8. The Impact of Sinus in the Flow Dynamics around Prosthetic Venous Valves

    NASA Astrophysics Data System (ADS)

    Tien, Wei-Hsin; Chen, Henry Y.; Berwick, Zachary; Krieger, Joshua; Chambers, Sean; Dabiri, Dana; Kassab, Ghassan S.

    2013-11-01

    The valves in the venous system are surrounded by a thinner but expandable vein section that forms a pocket region known as the sinus. The exact function of the sinus pocket for the venous valves is not fully understood. This is especially an issue for the bioprostheticvalve, since most of the prosthetic valves do not have a sinus pocket. To determine the impact of the sinus pocket on the flow dynamics to a prosthetic valve, an in-vitro experiment was setup at normal physiological flow conditions to simulate the flow inside a venous system. Two different valve designs were tested in glass tubes simulating the vein vessel with and without the sinus pocket profile using 2-D particle image velocimetry (PIV). Velocity measurements were made, and vorticity and flow shear were calculated. The results show that vortex structures near the valve leaflet tip were preserved better with the sinus present. The jet width at valve exit was found to be narrower with sinus than without sinus, and the effect was more significant with longer leaflet length. The results suggest that the sinus pocket alters the flow around the valve and functions as a flow regulator. For prosthetic valve without sinus, a shorter leaflet would provide similar effect of sinus and thus is more preferable.

  9. 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.

  10. Cerebral venous sinus thrombosis in HIV-infected patients: report of 2 cases

    PubMed Central

    Mwita, Julius Chacha; Baliki, Kgomotso; Tema, Ludo

    2013-01-01

    Infection with the human immunodeficiency virus (HIV) is associated with increased risk of cerebrovascular disease; however Cerebral Venous Sinus Thrombosis (CVST) is rarely associated with HIV-related cerebrovascular events. We describe two cases of HIV-positive patients who, at the same time, presented to our hospital with deep cerebral venous thrombosis and stroke. PMID:24570775

  11. Unusual Case of Cerebral Venous Sinus Thrombosis in Patient with Ulcerative Colitis in Remission.

    PubMed

    Meher, Lalit Kumar; Dalai, Siba Prasad; Panda, Sameer; Hui, Pankaj Kumar; Nayak, Sachidananda

    2016-05-01

    Ulcerative colitis (UC) is an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Cerebral venous sinus thrombosis along with deep vein thrombosis, pulmonary embolism and arterial thrombosis have occasionally been reported as a complication in the active phase of UC being attributed to its pro-thrombotic state. This paper depicts a 38-year-old female with a history of UC in remission who developed sudden onset headache, blurring of vision and seizures. Subsequent diagnosis of cerebral venous sinus thrombosis was made with MRI venography and treated with low molecular weight heparin with complete resolution of symptoms. The highlights of this case underscore the importance of evaluating cerebral venous sinus thrombosis as a cause of acute onset neurological deterioration in a setting of inflammatory bowel disease. It also emphasizes on the hypothesis that the risk of venous thrombosis or other hypercoagulable states have no direct relationship with the disease activity or flare-up. PMID:27437291

  12. Unusual Case of Cerebral Venous Sinus Thrombosis in Patient with Ulcerative Colitis in Remission

    PubMed Central

    Meher, Lalit Kumar; Panda, Sameer; Hui, Pankaj Kumar; Nayak, Sachidananda

    2016-01-01

    Ulcerative colitis (UC) is an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Cerebral venous sinus thrombosis along with deep vein thrombosis, pulmonary embolism and arterial thrombosis have occasionally been reported as a complication in the active phase of UC being attributed to its pro-thrombotic state. This paper depicts a 38-year-old female with a history of UC in remission who developed sudden onset headache, blurring of vision and seizures. Subsequent diagnosis of cerebral venous sinus thrombosis was made with MRI venography and treated with low molecular weight heparin with complete resolution of symptoms. The highlights of this case underscore the importance of evaluating cerebral venous sinus thrombosis as a cause of acute onset neurological deterioration in a setting of inflammatory bowel disease. It also emphasizes on the hypothesis that the risk of venous thrombosis or other hypercoagulable states have no direct relationship with the disease activity or flare-up. PMID:27437291

  13. 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

  14. 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

    2013-01-01

    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.

  15. 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

  16. Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins.

    PubMed

    Baltsavias, Gerasimos; Parthasarathi, Venkatraman; Aydin, Emre; Al Schameri, Rahman A; Roth, Peter; Valavanis, Anton

    2015-04-01

    We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.

  17. 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

  18. Sinus pericranii: advantages of MR imaging.

    PubMed

    Bigot, J L; Iacona, C; Lepreux, A; Dhellemmes, P; Motte, J; Gomes, H

    2000-10-01

    Sinus pericranii is a rare vascular anomaly involving an abnormal communication between the extracranial and intracranial circulations. A 3-year-old girl presented with a 2 x 2-cm, midline soft-tissue mass at the vertex. Plain skull films and CT using bone windows showed erosion of the parietal bones. MRI confirmed the clinical diagnosis by identifying communication of the vascular mass with the intracranial dural venous sinus. The advantages of MRI are discussed. PMID:11075608

  19. Beware of Venous Anomalies in Young Patients with Sick Sinus Syndrome: A Report of Two Cases of Sick Sinus Syndrome with Systemic Venous Anomalies

    PubMed Central

    Rathakrishnan, Shanmuga Sundaram; Kaliappan, Tamilarasu; Gopalan, Rajendiran

    2015-01-01

    We report two young patients with symptomatic sick sinus syndrome admitted for permanent pacemaker implantation (PPI). On evaluation with echocardiography, one of them was found to have persistent left superior vena cava and venography showed absent right superior vena cava also. He underwent PPI with leads inserted via left superior vena cava, coronary sinus, right atrium and right ventricle. The other patient was incidentally found to have interrupted inferior vena cava with azygos continuation while being planned for temporary pacemaker implantation. She underwent successful PPI. We would like to stress the importance of having a high suspicion for these systemic venous anomalies in patients presenting with sick sinus syndrome especially at young age. If we could diagnose preoperatively, we can avoid on table surprises. PMID:27326354

  20. HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy

    PubMed Central

    Dag, Zeynep Ozcan; Işik, Yuksel; Simsek, Yavuz; Tulmac, Ozlem Banu; Demiray, Demet

    2014-01-01

    Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy. PMID:25317347

  1. Retrograde leptomeningeal venous approach for dural arteriovenous fistulas at foramen magnum.

    PubMed

    Mendes, George Ac; Caire, François; Saleme, Suzana; Ponomarjova, Sanita; Mounayer, Charbel

    2015-04-01

    A 72-year-old man presented with sudden right homonymous hemianopsia. Work-up imaging revealed a left occipital haematoma and an arteriovenous fistula supplied by the meningeal branches to the clivus from the left vertebral artery (VA) with a rostral venous reflux into cortical veins. A microcatheter was advanced through brainstem veins into the venous collector. A compliant balloon was placed in the left VA facing the origin of feeders. The balloon was inflated to protect the vertebrobasilar circulation from embolic migration. Onyx was injected by the transvenous catheter. Control angiogram revealed exclusion of the lesion. Informed consent was obtained from the patient. PMID:25964442

  2. 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

  3. Cerebral venous sinus thrombosis as presenting feature of ulcerative colitis.

    PubMed

    Ennaifer, R; Moussa, A; Mouelhi, L; Salem, M; Bouzaidi, S; Debbeche, R; Trabelsi, S; Najjar, T

    2009-01-01

    Thrombosis is a well recognized complication of inflammatory bowel disease that occurs in 1.3 to 6.4% of patients, however, cerebral vascular involvement is unusual. We present the case of a 16-year-old female in whom cerebral venous thrombosis was the presenting symptom of an active ulcerative pancolitis. Thrombophilia screen (plasma levels of proteins C and S, antithrombin, antibeta2-glycoprotein, lupus anticoagulant and anticardiolipin antibodies, activated protein C resistance, homocystein level antinuclear antibodies) was negative. The patient was successfully treated with anticoagulant therapy, phenobarbital and sulfasalazine. Cerebral venous thrombosis is an exceptional presenting feature of ulcerative colitis. Disease activity may play a major role in the occurrence of thrombosis. PMID:19902870

  4. 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

  5. Transarterial Onyx embolization of jugular foramen dural arteriovenous fistula with spinal venous drainage manifesting as myelopathy-a case report and review of the literature.

    PubMed

    Jin, Hengwei; Lv, Xianli; Li, Youxiang

    2016-10-01

    We report a rare case of jugular foramen dural arteriovenous fistula (DAVF) with spinal venous drainage. A 48-year-old woman suffered from progressive weakness of lower extremities and incontinence of urine and feces for 14 days. Magnetic resonance imaging (MRI) revealed a tortuous posterior medullary vein at C2-T2 and ischemic signal at C2-C4 of the spinal cord. Brain MRI revealed an abnormal high signal near the left jugular foramen. Digital subtraction angiography of the spinal vascular was negative, while brain angiography showed a left jugular foramen DAVF with spinal perimedullary venous drainage. The patient recovered completely soon after endovascular embolization with Onyx-18. Diagnosis of a DAVF presenting with myelopathy is challenging. Early diagnosis and treatment are essential for a favorable outcome.

  6. 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

  7. Quantitative MRV is Correlated with Intravenous Pressures Before and After Venous Sinus Stenting: Implications for Treatment and Monitoring

    PubMed Central

    Esfahani, Darian R.; Stevenson, Matthew; Moss, Heather E; Amin-Hanjani, Sepideh; Aletich, Victor; Jain, Sachin; Charbel, Fady T.; Alaraj, Ali

    2015-01-01

    BACKGROUND Endovascular stenting is an effective treatment for patients with clinically significant cerebral venous sinus stenosis. Traditionally, stenting is indicated in patients with elevated intravenous pressures on conventional venography; however, noninvasive monitoring is more desirable. Quantitative magnetic resonance angiography is an imaging modality that allows blood flow assessment noninvasively. Established in the arterial system, applications to the venous sinuses have been limited to date. OBJECTIVE In this study, we examined quantitative magnetic resonance venography (qMRV) flow in patients before and after venous stenting and correlated these results with intravenous pressure measurements and clinical outcomes. METHODS Five patients with intracranial hypertension (IH) secondary to venous sinus stenosis underwent cerebral venous stenting between 2009 and 2013 at a single institution. Preoperatively venous sinus flow was determined using qMRV, and intravenous pressure measured during venography. After stenting, intravenous pressure, qMRV flow, and clinical outcomes were assessed and compared. RESULTS A mean prestenotic intravenous pressure of 45.2 mmHg was recorded before stenting which decreased to 27.4mmHg afterwards (Wilcoxon signed rank test P=.04). Total jugular outflow on qMRV increased by 260.2 ml/min. Analysis of the change in intravenous pressure and qMRV flow identified a linear relationship (Pearson's correlation r= .926). All patients displayed clinical improvement, including vision. CONCLUSION Venous outflow by qMRV increases after endovascular stenting and correlates with significantly improved intravenous pressures. These findings establish qMRV as a useful adjunct to measure venous flow after stenting, and as a potential tool in the selection and postoperative surveillance of the cerebral venous sinus stenosis patient. PMID:25860429

  8. 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. ...

  9. Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient

    PubMed Central

    Gist, Taylor L; Rangel-Castilla, Leonardo; Krishna, Chandan; Roman, Gustavo C; Cech, David A; Diaz, Orlando

    2013-01-01

    A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension. PMID:23475992

  10. Contralateral transvenous approach and embolization with 360° guglielmi detachable coils for the treatment of cavernous sinus dural fistula.

    PubMed

    Zenteno, Marco; Jorge, Santos-Franco; Rafael, Moscote-Salazar Luis; Raphael, AlvisMiranda Hernando; Gabriel, Alcala-Cerra; Ángel, Lee

    2015-01-01

    carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis. They are clinically characterized by ophthalmological symptoms and pulsatile tinnitus. A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity. Caotid-cavernous fistula wes diagnosed, for the technical difficulty inherent in the case was made a contralateral transvenous approach and embolization with 360° GDG coils, with successful evolution of the patient. The endovascular management of these lesions is currently possible with excellent results.

  11. Contralateral transvenous approach and embolization with 360° guglielmi detachable coils for the treatment of cavernous sinus dural fistula.

    PubMed

    Zenteno, Marco; Jorge, Santos-Franco; Rafael, Moscote-Salazar Luis; Raphael, AlvisMiranda Hernando; Gabriel, Alcala-Cerra; Ángel, Lee

    2015-01-01

    carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis. They are clinically characterized by ophthalmological symptoms and pulsatile tinnitus. A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity. Caotid-cavernous fistula wes diagnosed, for the technical difficulty inherent in the case was made a contralateral transvenous approach and embolization with 360° GDG coils, with successful evolution of the patient. The endovascular management of these lesions is currently possible with excellent results. PMID:25767589

  12. 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

  13. 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

  14. Does Warden's procedure reduce sinus node dysfunction after surgery for partial anomalous pulmonary venous connection?

    PubMed

    Okonta, Kelechi E; Agarwal, Vijay

    2012-06-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Does Warden's procedure reduce sinus node dysfunction (SND) after surgery for partial anomalous pulmonary venous connection?' Altogether 101 papers were found using the reported search; of which 10 papers provided the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, length of follow-up and results of these studies were tabulated. There was a particular reference to Warden's procedure, avoidance of incision across the cavoatrial junction and the postoperative sinus node status. There was a direct reference to the adoption of Warden's procedure in nine studies while one study emphasized the careful use of incision across the cavoatrial junction as a way of averting postoperative SND. The evidence supports the notion that preservation of the sinus node and its blood supply through the adoption of Warden's technique results in near-absent SND during long-term follow-up. The incidence of SND ranged from 0 to 6.5% when Warden's procedure was used, increasing to 18.1% when the atrial incision was extended across the cavoatrial junction into the superior vena cava and reaching as high as 55% in double-patch repair. The study limitations include the lack of randomized controlled trial, absence of 24 h Holter monitoring in most of the patients and shorter periods of follow-up.

  15. 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

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

    PubMed

    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

    2016-08-01

    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. Considering the

  17. Sinus thrombectomy for purulent cerebral venous sinus thrombosis utilizing a novel combination of the Trevo stent retriever and the Penumbra ACE aspiration catheter: the stent anchor with mobile aspiration technique.

    PubMed

    Mascitelli, Justin R; Pain, Margaret; Zarzour, Hekmat K; Baxter, Peter; Ghatan, Saadi; Mocco, J

    2015-01-01

    Intracranial complications of sinusitis are rare but life threatening. We present a case of a 17-year-old woman with sinusitis who deteriorated over the course of 12 days from subdural empyema and global purulent cerebral venous sinus thrombosis. The patient was managed with surgery and mechanical thrombectomy utilizing a novel 'stent anchor with mobile aspiration technique', in which a Trevo stent retriever (Stryker) was anchored in the superior sagittal sinus (SSS) while a 5 MAX ACE reperfusion catheter (Penumbra) was passed back and forth from the SSS to the sigmoid sinus with resultant dramatic improvement in venous outflow. The patient was extubated on postoperative day 3 and was discharged with minimal lower extremity weakness on postoperative day 11. This is the first report using the Trevo stent retriever for sinus thrombosis. It is important to keep these rare complications in mind when evaluating patients with oral and facial infections. PMID:26002667

  18. Comparison of the lateral tail vein and the retro-orbital venous sinus routes of antibody administration in pharmacokinetic studies.

    PubMed

    Schoch, Angela; Thorey, Irmgard S; Engert, Julia; Winter, Gerhard; Emrich, Thomas

    2014-03-01

    In pharmacokinetic studies, intravenous (i.v.) administration of antibodies to mice is usually done via the lateral tail vein. This approach can cause stress to the mice and has a high rate of failure because it is challenging to perform correctly. Administration via the retro-orbital venous sinus has been suggested as a good alternative to tail vein i.v. administration of antibodies. Evidence is still needed, however, to determine whether the route of administration has an effect on the absorption or the pharmacokinetic activity of the injected antibody. The authors compared serum concentrations and pharmacokinetic parameters of a therapeutic antibody administered via tail vein injection or via retro-orbital injection. The findings suggest that there is no difference in the absorption or pharmacokinetic activity of therapeutic antibodies when administered via the lateral tail vein versus the retro-orbital venous sinus.

  19. Endovascular treatment resolves non-hemorrhagic brainstem dysfunction due to tentorial dural AV fistula.

    PubMed

    Panagiotopoulos, V; Kastrup, O; Wanke, I

    2009-02-01

    Tentorial dural arteriovenous fistulas (tDAVF) clinically present usually with subarachnoid and/or intraparenchymal hemorrhage. Reported rates range from 58% to 92% and neurological deficits occur in 79% to 92% of patients. This is due to venous congestion resulting from retrograde leptomeningeal venous drainage, which rarely, can be clinically silent. A 69-year-old woman presented with vertigo, double vision and gait instability. Cerebral digital subtraction angiography revealed a tDAVF with retrograde cerebellar venous drainage directed through the vein of Galen into the straight sinus. MRI showed extensive cerebellar edema due to venous congestion. Clinical manifestations of cerebellar and brainstem dysfunction resolved completely after transarterial embolization with N-butylcyanoacrylate.

  20. 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.

  1. Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access

    PubMed Central

    Lee, Darrin J; Latchaw, Richard E; Dahlin, Brian C; Dong, Paul R; Verro, Piero; Muizelaar, J Paul; Shahlaie, Kiarash

    2014-01-01

    Superior sagittal sinus (SSS) thrombosis has high morbidity and mortality, and urgent recanalization is critical for severe cases. Standard endovascular techniques for thrombolysis and thrombectomy use retrograde venous access, an approach that may be unsuccessful in cases with extensive firm clot burden involving the dural sinuses distal to the SSS. An anterior open transcranial approach to the SSS for catheter sheath placement to facilitate antegrade mechanical thrombectomy and thrombolysis of the SSS and more distal sinuses has not been previously described. Here we describe a case in which multiple unsuccessful attempts at retrograde endovascular access were attempted. Thus, a burr hole over the anterior SSS was performed for daily endovascular antegrade procedures using the Angiojet rheolytic catheter device and chemical thrombolysis. Near-complete recanalization of the SSS was achieved with venous outflow via dilated left transverse and left sigmoid sinuses, along with significant collateral flow in multiple cerebral veins. PMID:24692369

  2. "Venous congestion" as a cause of subcortical white matter T2 hypointensity on magnetic resonance images.

    PubMed

    Kamble, Jayaprakash Harsha; Parameswaran, Krishnan

    2016-01-01

    Subcortical T2 hypointensity is an uncommon finding seen in very limited conditions such as multiple sclerosis, Sturge-Weber syndrome, and meningitis. Some of the conditions such as moyamoya disease, severe ischemic-anoxic insults, early cortical ischemia, and infarcts are of "arterial origin." We describe two conditions in which "venous congestion" plays a major role in T2 hypointensity - cerebral venous sinus thrombosis (CVST) and dural arteriovenous fistula (dAVF). The third case is a case of meningitis, showing T2 hypointensity as well, and can be explained by the "venous congestion" hypothesis. The same hypothesis can explain few of the other conditions causing subcortical T2 hypointensity. PMID:27570403

  3. 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.

  4. 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

  5. An anatomical study of the laterotrigeminal venous system.

    PubMed

    Simões, S

    1993-04-01

    The middle cranial fossa of 100 cadavers were dissected under stereoscopic loupe in order to identify and systematize the venous vessels located along the lateral margin of the trigeminal cave. The author found that at the sensitive root and trigeminal ganglion level a dural venous canal was present in most individuals examined and that the upper side of this canal communicated with the superior petrosal sinus. However, at the level of the lateral border of the intracranial segment of the mandibular nerve, venous lacunae were found to prevail, and these lacunae communicated with several other venous formations in the peritrigeminal region. The author concludes that the venous vascularization of this area constitutes a major risk in surgical interventions made in the middle cranial fossa. In addition, it is a relevant factor in the hemodynamics of the intracranial circulation.

  6. Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus.

    PubMed

    Arshad, Adeel; Nabi, Shahzaib; Panhwar, Muhammad Siyab; Rahil, Ali

    2015-01-01

    Tolosa-Hunt syndrome, an idiopathic granulomatous inflammation of the cavernous sinus, is primarily a diagnosis of exclusion. The majority of patients present with unilateral orbital pain and features suggestive of paralysis of one or more of the cranial nerves passing through the cavernous sinus and/or superior orbital fissure. MRI of the head may show unilateral enhancement of the cavernous sinus and orbital apex. Treatment is with high-dose intravenous steroids followed by tapering oral steroids. Rapid amelioration of pain within 24-48 h supports this rare diagnosis. Resolution of neuropathies may take longer. We describe a case of a young man who presented with left periorbital pain, complete ophthalmoplaegia and ptosis of the left eye. MRI showed enhancement of the left cavernous sinus and orbital apex. High dose steroids led to complete resolution of pain, while ptosis and ophthalmoplaegia improved gradually. PMID:26294359

  7. [Intracranial dural arteriovenous fistula draining into spinal cord veins: case report].

    PubMed

    Seda, Lauro Franco; Pieruccetti, Marco Antonio; Freitas, José Maria Modenesi; Listik, Sérgio; Pereira, Clemente Augusto Brito

    2002-09-01

    We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its etiological, physiopathological, diagnostic and therapeutic aspects.

  8. Direct Superficial Temporal Vein Approach for Dural Carotid Cavernous Fistula

    PubMed Central

    Matsubara, S.; Kazekawa, K.; Aikawa, H.; Onizuka, M.; Tsutsumi, M.; Ikou, M.; Kodama, T.; Nii, K.; Nagata, S.; Tanaka, A.

    2007-01-01

    Summary We present an alternative endovascular approach to treat dural carotid cavernous fistulae (dural CCF) that drain only into the superior ophthalmic vein. Four cases of cavernous dural AVFs that could not be treated via the inferior petrosal vein were accessed via the direct superficial temporal vein approach through the superior ophthalmic vein. Successful embolization was documented radiographically and clinically in all patients. The trans-superficial temporal vein approach is safe and useful for inaccessible dural CCFs through the inferior petrosal sinus. PMID:20566079

  9. Dural enhancement and thickening in acute mastoiditis

    PubMed Central

    Shemesh, Shay; Marom, Tal; Raichman, Dominique Ben Ami

    2015-01-01

    Dural enhancement and thickening in imaging studies observed in acute mastoiditis patients is an uncommon phenomenon. It is infrequently seen in dural sinus thrombosis, and may be caused by infiltration of inflammatory cells and an increased number of thin-walled blood vessels. We present a three-year-old boy who presented with acute mastoiditis, complicated by subperiosteal abscess. Computerized tomography (CT) demonstrated subperiosteal abscess, and the child underwent mastoidectomy. Despite adequate treatment, symptoms worsened and neurological sequelae were suspected. CT and magnetic resonance imaging (MRI) studies demonstrated an atypical dural enhancement at the sigmoid perisinus and suboccipital abscess. The child underwent revision mastoidectomy and drainage of the abscess. Following the second procedure, resolution of symptoms was noted. Follow-up MRI did not demonstrate any dural pathologies. PMID:25963158

  10. Bilateral and simultaneous venous sampling of inferior petrosal sinuses for ACTH and PRL determination: preoperative localization of ACTH-secreting microadenomas.

    PubMed

    Vignati, F; Berselli, M E; Scialfa, G; Boccardi, E; Loli, P

    1989-04-01

    We report our experience on venous sampling of the inferior petrosal sinuses for basal and CRH-stimulated ACTH and PRL gradients in 8 patients with surgically proven Cushing's disease who had normal preoperative neuroradiological studies. In 7 patients basal plasma ACTH concentrations in the inferior petrosal sinus ipsilateral to the tumor were higher than in the contralateral sinus; the gradients were enhanced by oCRH administration. In one out of two patients who had previously undergone unsuccessful pituitary microsurgery, neither basal nor oCRH-induced ACTH increases led to correct localization of the microadenoma within the pituitary. In 4 out of 7 patients basal serum PRL concentrations in the inferior petrosal sinus ipsilateral to the tumor were higher than in the contralateral; only two out of 4 showed an increase in PRL levels after oCRH injection. Our study confirms that simultaneous and bilateral venous sampling of inferior petrosal sinuses is a valuable means to identify the site of microadenomas in patients with Cushing's disease without neuroradiological evidence of the tumor. This procedure may give misleading results in patients previously operated on. Unilateral or predominant increases of PRL concentration during catheterization of the inferior petrosal sinuses, when present, always lateralize to the side of the corticotroph adenoma, providing a possible additional signal of the presence of the tumor.

  11. [Venous sinus thrombosis which occurred during treatment of a 15-years old girl with t cell non-Hodgkin lymphoma - case report].

    PubMed

    Maloney, Eliza; Ociepa, Tomasz; Kamieńska, Elzbieta; Zielezińska, Karolina; Richter, Błazej; Urasiński, Tomasz

    2008-01-01

    Venous thrombosis (VT) is a rare condition in childhood, being usually associated with congenital predisposition or acquired risk factors. The incidence of VT among children with cancer is between 1 and 36%. The highest incidence is among children with acute lymphoblastic leukaemia, followed by those with lymphoma and solid tumours. Malignancy and/or chemotherapy complications are considered as triggering factors. We report a case of a 15-year-old girl with non-Hodgkin lymphoma who developed generalized seizures during chemotherapy. Head computed tomography revealed right transverse and sagittal sinus thrombosis. Anticoagulation treatment using heparin as well as thrombolytic treatment with recombinant human tissue plasminogen activator (rhtPA) were introduced. The immediate application of rhtPA resulted in recanalisation of initially involved vessels which led to recovery with no neurological deficits. The reported case of severe venous thrombosis suggests that systemic treatment with rhtPA is effective and safe in children with cerebral venous sinus thrombosis.

  12. An adult case of polysplenia syndrome associated with sinus node dysfunction, dextrocardia, and systemic venous anomalies.

    PubMed

    Fukuda, Kentaro; Onda, Toshihito; Kimura, Yuki; Miura, Seiji; Matsumori, Rie; Masaki, Yoshiyuki; Nishino, Akihisa; Inoue, Kenji; Fujiwara, Yasumasa; Sumiyoshi, Masataka

    2015-01-01

    A 54-year-old woman was referred to our hospital for symptomatic sinus bradyarrhythmia with a sinus pause of 8 seconds. She was diagnosed with dextrocardia during childhood and discovered to have heterotaxy syndrome when she had an appendectomy during her teenager years. Chest and abdominal examinations by computed tomography showed multiple spleens located on the right side and abnormal drainages of the superior and inferior vena cava. Left isomerism was diagnosed by bilaterally bilobed lungs. Because of a patent bilateral superior vena cava, pacemaker leads were implanted using the right cephalic vein approach. Her fainting symptoms disappeared after pacemaker implantation.

  13. An adult case of polysplenia syndrome associated with sinus node dysfunction, dextrocardia, and systemic venous anomalies.

    PubMed

    Fukuda, Kentaro; Onda, Toshihito; Kimura, Yuki; Miura, Seiji; Matsumori, Rie; Masaki, Yoshiyuki; Nishino, Akihisa; Inoue, Kenji; Fujiwara, Yasumasa; Sumiyoshi, Masataka

    2015-01-01

    A 54-year-old woman was referred to our hospital for symptomatic sinus bradyarrhythmia with a sinus pause of 8 seconds. She was diagnosed with dextrocardia during childhood and discovered to have heterotaxy syndrome when she had an appendectomy during her teenager years. Chest and abdominal examinations by computed tomography showed multiple spleens located on the right side and abnormal drainages of the superior and inferior vena cava. Left isomerism was diagnosed by bilaterally bilobed lungs. Because of a patent bilateral superior vena cava, pacemaker leads were implanted using the right cephalic vein approach. Her fainting symptoms disappeared after pacemaker implantation. PMID:25948350

  14. Relation between intraocular pressure and size of transverse sinuses.

    PubMed

    Kantarci, Mecit; Dane, Senol; Gumustekin, Kenan; Onbas, Omer; Alper, Fatih; Okur, Adnan; Aslankurt, Murat; Yazici, Ahmet Taylan

    2005-01-01

    There are asymmetries in the sizes of transverse sinus and intraocular pressure. The purpose of this study was to investigate possible relationships between the asymmetry of transverse sinuses in TOF MR venography and intraocular pressures of right and left eyes. In this study, subjects were 63 male and 42 female medical school students, aged 18-21 years (mean+/-SD; 19.72+/-0.67 years). Subjects with neurological and ophthalmologic disease, particularly dural sinus thrombosis, myopia, trauma and glaucoma, were excluded the study. Subjects were divided into five groups according to the magnitudes of the right- and left-transverse sinuses in MR venography results. There is a functional relation between intraocular pressures of the right and left eyes and asymmetry of the transverse sinus. If the transverse sinus on one side is larger and its venous drainage is greater, the intraocular pressure of the eye on this side is lower. It can be speculated that the transverse sinus size may be associated with pathogenesis of diseases with increased intraocular pressure such as glaucoma. We aim to determine the relation between the size and drainage of transverse sinuses in TOF MR venography and intraocular pressure in patients with open-angle glaucoma in our next study. PMID:15647949

  15. [Cerebral venous sinus thrombosis associated with hyperhomocysteinemia due to combined deficiencies of folate and vitamin B12].

    PubMed

    Kanaya, Yuhei; Neshige, Shuichiro; Takemaru, Makoto; Shiga, Yuji; Takeshima, Shinichi; Kuriyama, Masaru

    2016-01-01

    A 63-year-old man was admitted to our hospital because of convulsive seizures. Radiological examinations revealed cerebral venous sinus thrombosis in the anterior part of the superior sagittal sinus. He had marked hyperhomocysteinemia (93.5 nmol/ml) due to combined deficiencies of folate and vitamin B12. He was T/T homozygous for methylene tetrahydrofolate reductase C677T polymorphism. He received a supplement therapy of vitamins. First, he was administered folate orally. After 3 months, the serum level of homocysteine decreased to 22.6 nmol/ml (an 86% reduction), but was still above the normal level. Next, an additional supplement therapy of vitamin B12 lowered the homocysteine level to normal (12.3 nmol/ml) after 4 months. These results showed that the increase of homocysteine levels in this patient was mainly caused by the deficiency of folate. Additionally, acquired risk factors like vitamin deficiencies increased the level of serum homocysteine to almost 100 nmol/ml. PMID:26797484

  16. 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.

  17. 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.

  18. Left vein of Labbé thrombosis associated with ipsilateral dural sinus thrombosis: non-enhanced CT and contrast-enhanced CT (CTV) findings.

    PubMed

    Stýblo-Sramek, D I; De Temmerman, G; Verbist, B M

    2012-01-01

    A rare case of aseptic thrombosis of the left vein of Labbé in a young woman is reported. Cerebral venous thrombosis was suggested by computed tomography and confirmed after intravenous administration of contrast by computed tomography venography. The combination of the clinical setting with the findings on the non-enhanced CT may favour the diagnosis of vein of Labbé thrombosis. The diagnosis can be confirmed on computed tomography venography. PMID:23019987

  19. Three cases of dural arteriovenous fistula of the anterior condylar vein within the hypoglossal canal.

    PubMed

    Ernst, R; Bulas, R; Tomsick, T; van Loveren, H; Aziz, K A

    1999-01-01

    Dural arteriovenous fistulas (DAVFs) of the anterior condylar vein are an uncommon but important subset of fistulas occurring at the skull base that can be confused with DAVFs of the marginal sinus on angiography. MR angiography source images can document the intraosseous extent and the relationship to the hypoglossal canal of this type of fistula, which can have significant clinical implications. We present the imaging features of angiography, CT, and MR angiography of three cases of DAVFs localized to the anterior condylar vein and within the hypoglossal canal, which were confirmed by source images from MR angiography. Transvenous coil embolization was curative in two of three cases and would seem to be the treatment of choice when venous access is available. PMID:10588137

  20. Single-session, transarterial complete embolization of Galenic dural AV fistula.

    PubMed

    Laviv, Yosef; Kasper, Ekkehard; Perlow, Eliyahu

    2016-02-01

    Galenic dural arteriovenous fistula (DAVF) represents a unique, hard to treat subgroup of tentorial DAVFs. We present an unusual case of hemorrhagic Galenic DAVF in a 54-year-old woman. The fistula drained directly to the vein of Galen through multiple feeders. Complete occlusion of the fistula was achieved through transarterial embolization. Deep venous drainage remained intact and the patient recovered well. To our knowledge, this is the first report on complete closure of hemorrhagic Galenic DAVF using transarterial embolization with complete obliteration of vein of Galen. The presence of nonfunctioning straight sinus may have contributed to the success of treatment and it may be considered as a predictive marker for endovascular embolization.

  1. Dural arteriovenous fistulas of the hypoglossal canal: systematic review on imaging anatomy, clinical findings, and endovascular management.

    PubMed

    Spittau, Björn; Millán, Diego San; El-Sherifi, Saad; Hader, Claudia; Singh, Tejinder Pal; Motschall, Edith; Vach, Werner; Urbach, Horst; Meckel, Stephan

    2015-04-01

    Dural arteriovenous fistulas (DAVFs) of the hypoglossal canal (HCDAVFs) are rare and display a complex angiographic anatomy. Hitherto, they have been referred to as various entities (for example, "marginal sinus DAVFs") solely described in case reports or small series. In this in-depth review of HCDAVF, the authors describe clinical and imaging findings, as well as treatment strategies and subsequent outcomes, based on a systematic literature review supplemented by their own cases (120 cases total). Further, the involved craniocervical venous anatomy with variable venous anastomoses is summarized. Hypoglossal canal DAVFs consist of a fistulous pouch involving the anterior condylar confluence and/or anterior condylar vein with a variable intraosseous component. Three major types of venous drainage are associated with distinct clinical patterns: Type 1, with anterograde drainage (62.5%), mostly presents with pulsatile tinnitus; Type 2, with retrograde drainage to the cavernous sinus and/or orbital veins (23.3%), is associated with ocular symptoms and may mimic cavernous sinus DAVF; and Type 3, with cortical and/or perimedullary drainage (14.2%), presents with either hemorrhage or cervical myelopathy. For Types 1 and 2 HCDAVF, transvenous embolization demonstrates high safety and efficacy (2.9% morbidity, 92.7% total occlusion). Understanding the complex venous anatomy is crucial for planning alternative approaches if standard transjugular access is impossible. Transarterial embolization or surgical disconnection (morbidity 13.3%-16.7%) should be reserved for Type 3 HCDAVFs or lesions with poor venous access. A conservative strategy could be appropriate in Type 1 HCDAVF for which spontaneous regression (5.8%) may be observed. PMID:25415064

  2. 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

  3. The relationship of intracranial venous pressure to hydrocephalus.

    PubMed

    Portnoy, H D; Branch, C; Castro, M E

    1994-01-01

    Little is known about intracranial venous pressure in hydrocephalus. Recently, we reported that naturally occurring hydrocephalus in Beagle dogs was associated with an elevation in cortical venous pressure. We proposed that the normal pathway for cerebrospinal fluid (CSF) absorption includes transcapillary or transvenular absorption of CSF from the interstitial space and that the increase in cortical venous pressure is an initial event resulting in decreased absorption and subsequent hydrocephalus. Further analysis, however, suggests that increased cortical venous pressure reflects the effect of the failure of transvillus absorption with increase in CSF pressure on the venous pressure gradient between ventricle and cortex. Normally, the cortical venous pressure is maintained above CSF pressure by the Starling resistor effect of the lateral lacunae. A similar mechanism is absent in the deep venous system, and thus the pressure in the deep veins is similar to that in the dural sinuses. Decreased CSF absorption causes an increase in CSF pressure followed by an increase in cortical venous pressure without a similar increase in periventricular venous pressure. The periventricular CSF to venous (transparenchymal) pressure (TPP) gradient increases. In contrast, cortical vein pressure remains greater than CSF pressure (negative TPP). The elevated periventricular TPP gradient causes ventricular dilatation and decreased periventricular cerebral blood flow (CBF), a condition that persists even if the CSF pressure returns to normal, particularly if tissue elastance is lessened by tissue damage. If deep CBF is to be maintained, periventricular venous pressure must increase. Since the veins are in a continuum, cortical venous pressure will further increase above the CSF pressure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8194060

  4. Straight sinus: ultrastructural analysis aimed at surgical tumor resection.

    PubMed

    Amato, Marcelo Campos Moraes; Tirapelli, Luis Fernando; Carlotti, Carlos Gilberto; Colli, Benedicto Oscar

    2016-08-01

    OBJECTIVE Accurate knowledge of the anatomy of the straight sinus (SS) is relevant for surgical purposes. During one surgical procedure involving the removal of part of the SS wall, the authors observed that the venous blood flow was maintained in the SS, possibly through a vein-like structure within the dural sinus or dural multiple layers. This observation and its divergence from descriptions of the histological features of the SS walls motivated the present study. The authors aimed to investigate whether it is possible to dissect the SS walls while keeping the lumen intact, and to describe the histological and ultrastructural composition of the SS wall. METHODS A total of 22 cadaveric specimens were used. The SS was divided into three portions: anterior, middle, and posterior. The characteristics of the SS walls were analyzed, and the feasibility of dissecting them while keeping the SS lumen intact was assessed. The thickness and the number of collagen fibers and other tissues in the SS walls were compared with the same variables in other venous sinuses. Masson's trichrome and Verhoeff's stains were used to assess collagen and elastic fibers, respectively. The data were analyzed using Zeiss image analysis software (KS400). RESULTS A vein-like structure independent of the SS walls was found in at least one of the portions of the SS in 8 of 22 samples (36.36%). The inferior wall could be delaminated in at least one portion in 21 of 22 samples (95.45%), whereas the lateral walls could seldom be delaminated. The inferior wall of the SS was thicker (p < 0.05) and exhibited less collagen and greater amounts of other tissues-including elastic fibers, connective tissue, blood vessels, and nerve fibers (p < 0.05)-compared with the lateral walls. Transmission electron microscopy revealed the presence of muscle fibers at a level deeper than that of the subendothelial connective tissue in the inferior wall of the SS, extending from its junction with the great cerebral vein

  5. Straight sinus: ultrastructural analysis aimed at surgical tumor resection.

    PubMed

    Amato, Marcelo Campos Moraes; Tirapelli, Luis Fernando; Carlotti, Carlos Gilberto; Colli, Benedicto Oscar

    2016-08-01

    OBJECTIVE Accurate knowledge of the anatomy of the straight sinus (SS) is relevant for surgical purposes. During one surgical procedure involving the removal of part of the SS wall, the authors observed that the venous blood flow was maintained in the SS, possibly through a vein-like structure within the dural sinus or dural multiple layers. This observation and its divergence from descriptions of the histological features of the SS walls motivated the present study. The authors aimed to investigate whether it is possible to dissect the SS walls while keeping the lumen intact, and to describe the histological and ultrastructural composition of the SS wall. METHODS A total of 22 cadaveric specimens were used. The SS was divided into three portions: anterior, middle, and posterior. The characteristics of the SS walls were analyzed, and the feasibility of dissecting them while keeping the SS lumen intact was assessed. The thickness and the number of collagen fibers and other tissues in the SS walls were compared with the same variables in other venous sinuses. Masson's trichrome and Verhoeff's stains were used to assess collagen and elastic fibers, respectively. The data were analyzed using Zeiss image analysis software (KS400). RESULTS A vein-like structure independent of the SS walls was found in at least one of the portions of the SS in 8 of 22 samples (36.36%). The inferior wall could be delaminated in at least one portion in 21 of 22 samples (95.45%), whereas the lateral walls could seldom be delaminated. The inferior wall of the SS was thicker (p < 0.05) and exhibited less collagen and greater amounts of other tissues-including elastic fibers, connective tissue, blood vessels, and nerve fibers (p < 0.05)-compared with the lateral walls. Transmission electron microscopy revealed the presence of muscle fibers at a level deeper than that of the subendothelial connective tissue in the inferior wall of the SS, extending from its junction with the great cerebral vein

  6. [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

    antecedentes: el conocimiento de la ubicación y características morfométricas del seno venoso lateral (transverso y sigmoides), así como de su relación con este y otros puntos de referencia anatómicos superficiales, es imprescindible durante los abordajes posterolaterales de la fosa craneal posterior para evitar lesionar las estructuras vasculares y las complicaciones quirúrgicas. Objetivo: determinar un área anatómica de seguridad para realizar un trépano que permita ingresar en la fosa craneal posterior sin lesionar estructuras adyacentes, y estudiar las características morfométricas del asterion, el seno lateral y puntos de referencia óseos de la superficie posterolateral del cráneo. Material y métodos: estudio observacional, transversal y descriptivo efectuado en el Departamento de Anatomía Humana de las Facultad de Medicina y de Odontología de la Universidad Autónoma de Nuevo León. Se analizaron 176 hemicráneos secos, estructuralmente íntegros y sin ninguna patología o anormalidad evidente. Se utilizó una broca de 1.3 mm de diámetro con la que se perforaron ambos lados de 88 cráneos secos (176 hemicráneos). Los puntos de referencia anatómicos estudiados fueron: asterion, vértice de la apófisis mastoides, espina suprameatal, plano horizontal de Frankfurt, raíz posterior del arco cigomático, protuberancia occipital externa y su relación con el seno venoso lateral. Resultados: el asterion tipo I prevalece en 74.4% de las piezas. En 82.4% de los cráneos el seno venoso lateral se encuentra a nivel del asterion inferior a éste en 12.5% y superior en 5.1%. Conclusiones: con los datos obtenidos de esta y otras investigaciones, el trépano inicial debe situarse 15 mm por debajo del asterion inferior y 15 mm posterior a éste para disminuir los riesgos de lesión del seno venoso lateral.

  7. Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy. Case report.

    PubMed

    Friedman, J A; Meyer, F B; Nichols, D A; Coffey, R J; Hopkins, L N; Maher, C O; Meissner, I D; Pollock, B E

    2001-05-01

    The authors report the case of a man who suffered from progressive, disseminated posttraumatic dural arteriovenous fistulas (DAVFs) resulting in death, despite aggressive endovascular, surgical, and radiosurgical treatment. This 31-year-old man was struck on the head while playing basketball. Two weeks later a soft, pulsatile mass developed at his vertex, and the man began to experience pulsatile tinnitus and progressive headaches. Magnetic resonance imaging and subsequent angiography revealed multiple AVFs in the scalp, calvaria, and dura, with drainage into the superior sagittal sinus. The patient was treated initially with transarterial embolization in five stages, followed by vertex craniotomy and surgical resection of the AVFs. However, multiple additional DAVFs developed over the bilateral convexities, the falx, and the tentorium. Subsequent treatment entailed 15 stages of transarterial embolization; seven stages of transvenous embolization, including complete occlusion of the sagittal sinus and partial occlusion of the straight sinus; three stages of stereotactic radiosurgery; and a second craniotomy with aggressive disconnection of the DAVFs. Unfortunately, the fistulas continued to progress, resulting in diffuse venous hypertension, multiple intracerebral hemorrhages in both hemispheres, and, ultimately, death nearly 5 years after the initial trauma. Endovascular, surgical, and radiosurgical treatments are successful in curing most patients with DAVFs. The failure of multimodal therapy and the fulminant progression and disseminated nature of this patient's disease are unique.

  8. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspectives

    PubMed Central

    Aggarwal, Neelam; Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Dharan, Baiju S.; Chigurupati, Keerthi; Babu, Saravana

    2016-01-01

    Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages) and mean ± SD respectively. Results: A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period. Conclusion: The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction. PMID:27052072

  9. Venous congestion” as a cause of subcortical white matter T2 hypointensity on magnetic resonance images

    PubMed Central

    Kamble, Jayaprakash Harsha; Parameswaran, Krishnan

    2016-01-01

    Subcortical T2 hypointensity is an uncommon finding seen in very limited conditions such as multiple sclerosis, Sturge-Weber syndrome, and meningitis. Some of the conditions such as moyamoya disease, severe ischemic-anoxic insults, early cortical ischemia, and infarcts are of “arterial origin.” We describe two conditions in which “venous congestion” plays a major role in T2 hypointensity — cerebral venous sinus thrombosis (CVST) and dural arteriovenous fistula (dAVF). The third case is a case of meningitis, showing T2 hypointensity as well, and can be explained by the “venous congestion” hypothesis. The same hypothesis can explain few of the other conditions causing subcortical T2 hypointensity. PMID:27570403

  10. The vertebral venous plexuses: the internal veins are muscular and external veins have valves.

    PubMed

    Stringer, Mark D; Restieaux, Matthew; Fisher, Amanda L; Crosado, Brynley

    2012-07-01

    The internal and external vertebral venous plexuses (VVP) extend the length of the vertebral column. Authoritative sources state that these veins are devoid of valves, permitting bidirectional blood flow and facilitating the hematogenous spread of malignant tumors that have venous connections with these plexuses. The aim of this investigation was to identify morphologic features that might influence blood flow in the VVP. The VVP of 12 adult cadavers (seven female, mean age 79.5 years) were examined by macro- and micro-dissection and representative veins removed for histology and immunohistochemistry (smooth muscle antibody staining). A total of 26, mostly bicuspid, valves were identified in 19 of 56 veins (34%) from the external VVP, all orientated to promote blood flow towards the internal VVP. The internal VVP was characterized by four main longitudinal channels with transverse interconnections; the maximum caliber of the longitudinal anterior internal VVP veins was significantly greater than their posterior counterparts (P < 0.001). The luminal architecture of the internal VVP veins was striking, consisting of numerous bridging trabeculae (cords, thin membranes and thick bridges) predominantly within the longitudinal venous channels. Trabeculae were composed of collagen and smooth muscle and also contained numerous small arteries and nerve fibers. A similar internal venous trabecular meshwork is known to exist within the dural venous sinuses of the skull. It may serve to prevent venous overdistension or collapse, to regulate the direction and velocity of venous blood flow, or is possibly involved in thermoregulation or other homeostatic processes. PMID:21976364

  11. Near-infrared fluorescent imaging of cerebral thrombi and blood-brain barrier disruption in a mouse model of cerebral venous sinus thrombosis.

    PubMed

    Kim, Dong-Eog; Schellingerhout, Dawid; Jaffer, Farouc A; Weissleder, Ralph; Tung, Ching-Hsuan

    2005-02-01

    An intravital microscopy imaging method was developed to visualize active cerebral thrombus and blood-brain barrier (BBB) disruption using Near Infrared Fluorescent (NIRF) probes. A circular craniotomy was made in CD-1 mice. Thrombi were formed by applying 10%-FeCl3 to the entire exposed superior sagittal sinus (SSS, 5 mm), or to the posterior 2.5 mm of the SSS for 5 mins. Control animals were pretreated with heparin (50 U/kg) before thrombus induction. Three hours after thrombus formation, a FXIIIa-targeted NIRF imaging probe (A15) was intravenously injected, and the SSS was imaged by intravital microscopy. This was followed by injection of indocyanine green (ICG) to assess BBB permeability. The A15 optical probe bound to thrombus, and the fluorescent signal emitted by the bound agent corresponded well with histologically confirmed thrombus. A15 initially remained intravascular, followed by excretion and subsequent decrease in all tissues except for thrombus, where it was retained. The subsequent ICG was also intravascular immediately after injection, but then began to leak into the cerebral parenchyma at 3 to 5 mins. The sites of leakage were adjacent to thrombosed areas. Heparin pretreatment prevented thrombus formation and reduced ICG leakage significantly. This demonstrates the feasibility of simultaneous in vivo monitoring of thrombus and BBB permeability in an animal model of cerebral venous thrombosis.

  12. 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

  13. The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis

    PubMed Central

    Afshari, Daryoush; Moradian, Nasrin; Nasiri, Freshteh; Razazian, Nazanin; Bostani, Arash; Sariaslani, Payam

    2015-01-01

    Objective: To compare the efficacy and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) in the treatment of patients with cerebral venous sinus thrombosis (CVST), and to provide an appropriate treatment option in these patients. Method: This is a randomized double blind clinical trial conducted between December 2013 and December 2014. The subjects were selected among patients referred to Neurology Department, Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran. Fifty-two cases of CVST were included in this study and randomly divided into 2 groups. Twenty-six cases received LMWH and the other 26 cases received UFH. The primary outcomes include hospital mortality rate and neurologic deficits as assessed by the National Institutes of Health Stroke Scale (NIHSS). The secondary end point was disability as measured by the Modified Rankin Scale (MRS). Results: We observed the rate of mortality and neurological deficits and disability based on NIHSS, and the MRS did not differ between the 2 groups. Conclusion: The efficacy of LMWH and UFH in reduction of neurologic deficit and functional disability in patients with CVST are similar. PMID:26492115

  14. Cerebral venous thrombosis-a primer for the haematologist.

    PubMed

    Thorell, Sofia E; Parry-Jones, Adrian R; Punter, Martin; Hurford, Robert; Thachil, Jecko

    2015-01-01

    Cerebral venous thrombosis (CVT) is a condition that can affect all age groups and can often be difficult to diagnose and treat. The difficulties in diagnosis are mainly due to the non-specific presenting features of CVT, which can range from isolated headache and visual or auditory problems, to serious symptoms such as hemiparesis and coma. Therefore, it can present to various specialists including general physicians, obstetricians and neurologists. In recent years, more widespread use of cerebral imaging has led to the diagnosis being made more often. Since thrombosis is the key component, haematologists are consulted in the management of these patients including for identification of a causative factor for CVT. In this regard, the pivotal International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) has shed more light on its epidemiology and management options. This review aims to provide guidance to haematologists when faced with a patient with CVT, based on the currently available evidence. PMID:25282690

  15. Dural tears in spine surgery.

    PubMed

    Espiritu, Michael T; Rhyne, Alfred; Darden, Bruce V

    2010-09-01

    Dural tears are among the most commonly seen complications in spine surgery. Most studies in the literature indicate that long-term outcomes are not negatively affected, provided that the tears are diagnosed early and managed appropriately. Direct suture repair remains the preferred method for the management of durotomy caused by or found during surgery. However, recent literature reports encouraging results with sutureless repair. Understanding dural anatomy, dural healing, and cerebrospinal fluid dynamics is helpful in choosing among the available management options for dural tear.

  16. An unusual presentation of spinal dural arteriovenous fistula: A case report

    PubMed Central

    Saadat, Payam; Adabi, Marzie

    2016-01-01

    Background: Spinal dural AVF is the most common type of spinal vascular malformation. However, presenting symptoms differ according to site of spinal involvement. This study described a case of arteriovenous malformation with paraparesis and incontinence. Case Presentation: Diagnosis of patient was confirmed by clinical and imaging examination using magnetic resonance image and ruling out other possibilities Result: A definitive diagnosis of arterio venous fistula was confirmed by clinical and MRI examination and demonstrated abnormalities compatible with dural arteriovenous fistula. Conclusion: Dural arteriovenous fistula should be considered in patients with paresis in both lower extremities. PMID:27757211

  17. History of the vertebral venous plexus and the significant contributions of Breschet and Batson.

    PubMed

    Nathoo, Narendra; Caris, Elizabeth C; Wiener, Judith A; Mendel, Ehud

    2011-11-01

    Before the 18th century, the vertebral venous plexus (VVP) received scant mention, had no clinical relevance, and was largely ignored by anatomists, most likely because of its location and nondistensible nature. Gilbert Breschet in 1819 provided the first detailed anatomic description of the VVP, describing it as a large plexiform valveless network of vertebral veins consisting of 3 interconnecting divisions and spanning the entire spinal column with connections to the cranial dural sinuses distributed in a longitudinal pattern, running parallel to and communicating with the venae cavae, and having multiple interconnections. More than a century passed before any work of significance on the VVP was noted. In 1940, Oscar V. Batson reported the true functionality of the VVP by proving the continuity of the prostatic venous plexus with the VVP and proposed this route as the most plausible explanation for the distribution of prostate metastatic disease. With his seminal work, Batson reclassified the human venous system to consist of the caval, pulmonary, portal, and vertebral divisions. Further advances in imaging technology confirmed Batson's results. Today, the VVP is considered part of the cerebrospinal venous system, which is regarded as a unique, large-capacitance, valveless plexiform venous network in which flow is bidirectional that plays an important role in the regulation of intracranial pressure with changes in posture and in venous outflow from the brain, whereas in disease states, it provides a potential route for the spread of tumor, infection, or emboli.

  18. Transvenous Coil Embolization for Dural Arteriovenous Fistulas of the Ophthalmic Sheath: Report of Two Cases and Review of the Literature

    PubMed Central

    Hwang, Juyoung; Jo, Kyung-Il; Yeon, Je Young; Hong, Seung-Chyul

    2016-01-01

    We present two patients with a dural arteriovenous fistula (dAVF) of the ophthalmic sheath who developed progressive exophthalmos, conjunctival chemosis, and visual loss. These symptoms mimic those of cavernous sinus dAVFs. Dural AVFs of the ophthalmic sheath are extremely rare and their clinical management is controversial. We successfully treated these two patients by transvenous coil embolization. Transvenous embolization appears to be a safe and effective method to treat dAVFs of the ophthalmic sheath.

  19. Woman with Sickle Cell Disease with Current Sigmoid Sinus Thrombosis and History of Inadequate Warfarin Use during a Past Thrombotic Event

    PubMed Central

    Çelikbilek, Asuman; Çelikbilek, Mehmet; Bozkurt, Alper; Karakurum Göksel, Başak; Tan, Meliha; Özdoğu, Hakan

    2009-01-01

    We report a 20-year-old woman with sickle cell disease (SCD) who presented with a severe pulsating headache, nausea, and vomiting. Her history was significant for a past thrombotic event during which she had not used anticoagulation therapy as prescribed. Her mental status was mildly confused. On funduscopic examination, papilledema and retinal hemorrhages were found. Results of a computed tomogram were normal. A lumbar puncture demonstrated increased intracranial pressure (60 cm H2O). Magnetic resonance venography demonstrated a right sigmoid sinus thrombosis. Although SCD has been reported as a cause of thrombotic dural venous sinus events, this case increases the knowledge about neurological complications of SCD. The patient was treated with low molecular weight heparin, blood transfusions, acetazolamide, and methylprednisolone, and her symptoms and signs resolved. PMID:20847926

  20. Enhanced global mathematical model for studying cerebral venous blood flow.

    PubMed

    Müller, Lucas O; Toro, Eleuterio F

    2014-10-17

    Here we extend the global, closed-loop, mathematical model for the cardiovascular system in Müller and Toro (2014) to account for fundamental mechanisms affecting cerebral venous haemodynamics: the interaction between intracranial pressure and cerebral vasculature and the Starling-resistor like behaviour of intracranial veins. Computational results are compared with flow measurements obtained from Magnetic Resonance Imaging (MRI), showing overall satisfactory agreement. The role played by each model component in shaping cerebral venous flow waveforms is investigated. Our results are discussed in light of current physiological concepts and model-driven considerations, indicating that the Starling-resistor like behaviour of intracranial veins at the point where they join dural sinuses is the leading mechanism. Moreover, we present preliminary results on the impact of neck vein strictures on cerebral venous hemodynamics. These results show that such anomalies cause a pressure increment in intracranial cerebral veins, even if the shielding effect of the Starling-resistor like behaviour of cerebral veins is taken into account. PMID:25169660

  1. Lateral sellar compartment O.T. (cavernous sinus): history, anatomy, terminology.

    PubMed

    Parkinson, D

    1998-08-01

    Claudios Galen (119-199 a.d.) dissected lower animals with parasellar carotid retia bathed in venous blood and transposed his findings to human anatomy. Andreas Vesalius (1514-1564) corrected most of Galen's errors but apparently never looked into this small, extradural compartment, nor, apparently, did Winslow (Exposition Anatomique de la Structure du Corps Humain. London: N. Prevast, 1734), who christened it the "cavernous sinus," (CS) presumably thinking that it would resemble the corpora cavernosa of the penis. Multiple surgical explorations, gross dissections, microscopic views, and vascular casts from early fetuses to an 81 year old have been examined and reviewed. The CS is not a dural sinus nor is it cavernous. The compartment is extradural, and the venous structures contained within consist of a greatly variable plexus of extremely thin-walled veins. The name, CS, is a barrier to the understanding of the structure and function of this extradural anatomical jewel box, which contains fat, myelinated and nonmyelinated nerves, arteries, and a plexus of veins. It is proposed that this name be changed, because it is inaccurate and misleading. The replacement should leave no doubt about its meaning. The lateral sellar compartment is descriptive and accurate. The veins within are a parasellar plexus. PMID:9713986

  2. Non-otogenic lateral sinus thrombosis: a complication of acute sphenoid sinusitis.

    PubMed

    Somerville, Jessica M; Lyman, Erik; Thompson, Jerome W; Stocks, Rosemary

    2014-08-01

    The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.

  3. Dural tear of unusual cause

    PubMed Central

    Kechna, Hicham; Loutid, Jaouad; Ouzzad, Omar; Hanafi, Sidi Mohamed; Hachimi, Moulay Ahmed

    2015-01-01

    Epidural analgesia is highly recommended in cancer anorectal surgery. In addition to the fight against pain it provides some benefit in allowing early rehabilitation of patients. One of the risks of this practice is the dural tear creating a cerebrospinal fluid leak (CSF) in the epidural space (EPD). Clinical features the typical positional headache, a procession of various more or less severe symptoms: nausea, vomiting, dizziness, visual or hearing impairment or radicular pain. We report a dural of unusual cause secondary of the obstruction of tuohy catheter by vertebral cartilage. PMID:26113920

  4. Sinus Anatomy

    MedlinePlus

    ... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... ANATOMY > Sinus Anatomy Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ...

  5. Endovascular Management of Anterior Cranial Fossa Dural Arteriovenous Malformations

    PubMed Central

    Mack, W.J; Gonzalez, N.R.; Jahan, R.; Vinuela, F.

    2011-01-01

    Summary Dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa have traditionally been treated by open surgical disconnection. Safe navigation through the ophthalmic artery or fragile cortical veins has historically provided a barrier to effective endovascular occlusion of these lesions. Using current microcatheter technology and embolic materials, safe positioning within the distal ophthalmic artery, beyond the origin of the central retinal artery, is achievable. We describe two cases in which anterior cranial fossa dAVFs were treated by exclusively endovascular strategies, and highlight the pertinent technical and anatomic considerations. We discuss the clinical symptoms resulting from the differing venous drainage patterns. PMID:21561565

  6. Onyx embolization of anterior condylar confluence dural arteriovenous fistula.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2014-03-01

    The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material.

  7. Onyx embolization of anterior condylar confluence dural arteriovenous fistula.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2013-01-01

    The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material.

  8. 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

  9. Developmental venous anomalies (DVA): the so-called venous angioma.

    PubMed

    Lasjaunias, P; Burrows, P; Planet, C

    1986-01-01

    Following a review of the literature it is possible to demonstrate the "normality" of the so called venous angiomas. They should be named Developmental Venous Anomaly (DVA). They illustrate in their two extreme types (superficial and deep) the hemodynamic equilibrium of the transcortical venous drainage in the periependymal zones. Venous ectasias and varices which can be encountered, associated with DVA constitute an acquired feature in relation to a venous outlet obstacle. The sinus pericranii represents an extracerebral DVA, but also corresponds to a normal variation. As any extreme anatomical variant, each DVA corresponds to a weak situation which may express itself clinically; only rare situations justify a radical treatment.

  10. 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

  11. The Dural AV-Fistula (DAVF), the Most Frequent Acquired Vascular Malformation of the Central Nervous System (CNS).

    PubMed

    Wanke, I; Rüfenacht, D A

    2015-10-01

    Acquired arteriovenous malformations, such as is the case with dural arteriovenous fistulae (DAVF), are the consequence of a pathological new arterial ingrowth into venous spaces that reaches directly the venous lumen, without interposition of a capillary network, thereby creating an AV-shunt.The following concise text will provide elements in regards to diagnosis, indication for treatment discussion and choice of endovascular treatment (EVT) method. PMID:26308245

  12. Sinus Tumors

    MedlinePlus

    ... Tumors Nasal Deformities Choanal Atresia Epiphora (Excessive Tearing) Disclosure Statement Printer Friendly Sinus Tumors Abtin Tabaee, MD Introduction Tumors of the nose and paranasal sinuses are rare, accounting for fewer than 1% of all tumors. These ...

  13. Adult 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 ...

  14. Pediatric Sinusitis

    MedlinePlus

    ... scan may help to determine how completely your child's sinuses are developed, where any blockage has occurred, and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infection, including structural ...

  15. [Cerebral venous thrombosis during tuberculous meningoencephalitis].

    PubMed

    Guenifi, W; Boukhrissa, H; Gasmi, A; Rais, M; Ouyahia, A; Hachani, A; Diab, N; Mechakra, S; Lacheheb, A

    2016-05-01

    Cerebral venous thrombosis is a rare disease characterized by its clinical polymorphism and multiplicity of risk factors. Infections represent less than 10% of etiologies. Tuberculosis is not a common etiology, only a few observations are published in the literature. Between January 2005 and March 2015, 61 patients were hospitalized for neuro-meningeal tuberculosis. Among them, three young women had presented one or more cerebral venous sinus thromboses. No clinical feature was observed in these patients; vascular localizations were varied: sagittal sinus (2 cases), lateral sinus (2 cases) and transverse sinus (1 case). With anticoagulant and antituberculosis drugs, the outcome was favorable in all cases. During neuro-meningeal tuberculosis, the existence of consciousness disorders or neurological focal signs is not always the translation of encephalitis, hydrocephalus, tuberculoma or ischemic stroke; cerebral venous sinus thrombosis may be the cause and therefore should be sought. PMID:27090100

  16. Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

    PubMed Central

    Oh, Jae-Sang; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

    2016-01-01

    Objective Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route. PMID:26885282

  17. 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.

  18. Trigeminal Cardiac Reflex Caused by Onyx Embolization of Intracranial Dural Arteriovenous Fistula.

    PubMed

    Wang, Jian; Wu, Huan-Cheng; Wang, Wei-Wei; Zhao, Hong-Sen; Dao, Ri-Na; Liu, Wei-Min; Zhou, Dong-Zhe; Wang, Hui-Yu; DU, Chao

    2016-01-01

    Trigeminocardiac reflex (TCR) is a reflexive response of bradycardia, hypotension and gastric hypermotility which is observed upon mechanical stimulation in the distribution of the trigeminal nerve. Previous articles have described TCR during intracranial operations, ophthalmic surgery, microcompression of the trigeminal ganglion and radiofrequency lesioning of the trigeminal ganglion. TCR may occur during transarterial embolization of dural arteriovenous fistula (DAVF) with Onyx, leading to a significant decrease in heart rate under a standard anesthetic protocol. TCR may also occur due to chemical stimulus of dimethyl sulfoxide (DMSO) in transvenous Onyx embolization of dural cavernous sinus fistula. Slow rate of injection may give DMSO enough time to dissipate in the blood stream which is important for the prevention of toxicity. This report confirms that the reflex was blunted by the anticholinergic effects of atropine and there was no harm to patients if stopped immediately.

  19. Dural-based infantile hemangioma of the posterior fossa: Case report

    PubMed Central

    Shakir, Hakeem J.; McBride, Paul; Reynolds, Renée M.

    2016-01-01

    Background: The authors present the unique case of a dural-based, infantile hemangioma located in the posterior fossa of a 15-day-old infant. Case Description: The patient presented with hydrocephalus. The lesion was identified by magnetic resonance imaging and was subsequently resected. Diagnosis of the lesion was confirmed with immunohistochemistry staining. The patient's hospital course was complicated by transverse sinus thrombosis and a cerebrospinal fluid leak that were treated with anticoagulation therapy and ventriculoperitoneal shunt placement, respectively. Conclusion: Although hemangiomas are benign entities, our patient's lesion was in the posterior fossa causing compression and hydrocephalus that necessitated resection. We encourage others to consider the possibility of hemangioma in the differential diagnosis of dural-based posterior fossa lesions in infants. PMID:27213106

  20. Trigeminal Cardiac Reflex Caused by Onyx Embolization of Intracranial Dural Arteriovenous Fistula.

    PubMed

    Wang, Jian; Wu, Huan-Cheng; Wang, Wei-Wei; Zhao, Hong-Sen; Dao, Ri-Na; Liu, Wei-Min; Zhou, Dong-Zhe; Wang, Hui-Yu; DU, Chao

    2016-01-01

    Trigeminocardiac reflex (TCR) is a reflexive response of bradycardia, hypotension and gastric hypermotility which is observed upon mechanical stimulation in the distribution of the trigeminal nerve. Previous articles have described TCR during intracranial operations, ophthalmic surgery, microcompression of the trigeminal ganglion and radiofrequency lesioning of the trigeminal ganglion. TCR may occur during transarterial embolization of dural arteriovenous fistula (DAVF) with Onyx, leading to a significant decrease in heart rate under a standard anesthetic protocol. TCR may also occur due to chemical stimulus of dimethyl sulfoxide (DMSO) in transvenous Onyx embolization of dural cavernous sinus fistula. Slow rate of injection may give DMSO enough time to dissipate in the blood stream which is important for the prevention of toxicity. This report confirms that the reflex was blunted by the anticholinergic effects of atropine and there was no harm to patients if stopped immediately. PMID:27161455

  1. Dural invasion by pituitary tumours.

    PubMed

    Shaffi, O M; Wrightson, P

    1975-04-23

    In 12 cases of pituitary tumour the dura mater of the sella turcica or diaphragma sellae in contact with the tumour was examined histologically. In nine cases tumour cells were found lying deep in the substance of the dura. Dura from the sella of seven subjects without pituitary disease, obtianed at autopsy, showed no inclusions of pituitary tissue. Four of the cases studied were known before death to suffer from an invasive pituitary adenoma. Of eight surviving cases operated upon in the last two years, five showed dural invasion by tumour. The present report suggests that the condition may be more frequent than expected and that with more study it may provide an index of prognosis. It also defines a requirement for the surgeon aiming to prevent recurrence of tumour after operation or to achieve a complete endocrine ablation.

  2. 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.

  3. Acute subarachnoid hemorrhage in posterior condylar canal dural arteriovenous fistula: imaging features with endovascular management

    PubMed Central

    Mondel, Prabath Kumar; Saraf, Rashmi; Limaye, Uday S

    2014-01-01

    A 43-year-old man presented with acute subarachnoid hemorrhage. He was investigated and found to have a rare posterior condylar canal dural arteriovenous fistula (DAVF). DAVFs of the posterior condylar canal are rare. Venous drainage of the DAVF was through a long, tortuous, and aneurysmal bridging vein. We describe the clinical presentation, cross sectional imaging, angiographic features, and endovascular management of this patient. The patient was treated by transarterial embolization of the fistula through the ascending pharyngeal artery. This is the first report of an acutely bled posterior condylar canal DAVF treated by transarterial Onyx embolization with balloon protection in the vertebral artery. The patient recovered without any neurological deficit and had an excellent outcome. On 6 month follow-up angiogram, there was stable occlusion of the dural fistula. PMID:24990846

  4. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

    PubMed Central

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg

    2016-01-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  5. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula.

    PubMed

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg; Park, Seung Won

    2016-06-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  6. The preservation and reconstruction of cerebral veins and sinuses.

    PubMed

    Sekhar, Laligam N; Chanda, Amitabha; Morita, Akio

    2002-07-01

    Although cerebral veins and venous sinuses are very important to the neurosurgeon, they have received adequate attention only recently. The consequences of cerebral venous occlusion are well known. When the venous outflow is compromised due to a lack of adequate collateral circulation, venous infarction follows, with swelling, haemorrhage and neuronal death. The clinical consequences will depend upon the region of involvement of the brain and the site of the infarcted tissue. The symptoms may include seizures, hemiplegia, aphasia, coma and death. Similarly, the consequences of cerebral venous sinus occlusion depend upon the availability of collateral circulation. When such collaterals are not available, papilledema and visual loss and a pseudotumour cerebri syndrome are observed in milder cases, whereas, severe diffuse brain swelling, coma and death may be observed in severe cases. Acute venous or venous sinus occlusion is potentially very dangerous, whereas slow and chronic venous or venous sinus occlusion is better tolerated. Even in such patients, some neurological manifestations may follow, when the collaterals are poor. PMID:12217667

  7. [Semiotics of lesions of the cerebral venous collectors on application of noninvasive techniques of x-ray diagnosis].

    PubMed

    Semenov, S; Abalmasov, V

    2001-01-01

    The study included application of a complex of the noninvasive diagnostic techniques such as MR tomography, MR venography, duplex scanning of the internal jugular veins, and transcranial Doppler sonography. The authors provide a detailed description of the semiotics of the MR signs of cerebral venous collector lesion in patients with thrombosis, extravasal compression, aneurysms, and developmental anomalies. Present the quantitative ultrasound parameters of hemodynamics in the efferent vessels of the brain accessible to inspections describe the effect of spontaneous echo-opacification in the internal jugular veins, which is assumed to be a predictor of thrombosis. Intravenous injection of magnevist resulted in an appreciable refinement of visualization of small dural sinuses at MR venography thereby allowing for the diagnosis of their thrombosis. It is suggested that the use of the entire complex of the x-ray modalities under consideration may lead to a more complete and noninvasive evaluation of the nature of cerebral venous insufficiency and of the degree of hemodynamic significance. Moreover, this will make it possible to outline approaches to therapeutic or surgical correction of the disease.

  8. Endovascular Management of Sigmoid Sinus Diverticulum

    PubMed Central

    Paramasivam, Srinivasan; Furtado, Sunil; Shigamatsu, Tomoyoshi; Smouha, Eric

    2016-01-01

    Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment. PMID:27610124

  9. Endovascular Management of Sigmoid Sinus Diverticulum.

    PubMed

    Paramasivam, Srinivasan; Furtado, Sunil; Shigamatsu, Tomoyoshi; Smouha, Eric

    2016-06-01

    Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment. PMID:27610124

  10. 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

  11. Penetrating intracranial gunshot wound transecting the right transverse sinus

    PubMed Central

    Beaty, Narlin Bennet; Diaz, Cara; Crandall, Kenneth; Sansur, Charles

    2012-01-01

    A 23-year-old man sustained a gunshot wound to the posterior head. Imaging demonstrated a transection of the right transverse sinus, a retained bullet fragment and significant cerebellar oedema. The patient emergently underwent suboccipital decompression associated with brisk bleeding from the transverse sinus. Reported examples of surgical management of cerebral venous sinuses include: packing, grafting, patching and ligation. Our patient had a codominant transverse sinus and underwent successful unilateral ligation. His postoperative course was uneventful, however, he did require a ventriculoperitoneal shunt. He was subsequently discharged to rehab with a favourable outcome. PMID:22987903

  12. Intracranial dural arteriovenous fistula as a cause for symptomatic superficial siderosis: A report of two cases and review of the literature

    PubMed Central

    Baum, Griffin R.; Turan, Nefize; Buonanno, Ferdinando S.; Pradilla, Gustavo; Nogueira, Raul G.

    2016-01-01

    Background: Superficial siderosis (SS) is the occult deposition of hemosiderin within the cerebral cortex due to repeat microhemorrhages within the central nervous system. The collection of hemosiderin within the pia and superficial cortical surface can lead to injury to the nervous tissue. The most common presentation is occult sensorineural hearing loss although many patients have been misdiagnosed with diseases such as multiple sclerosis and amyotrophic lateral sclerosis before being diagnosed with SS. Only one case report exists in the literature describing an intracranial dural arteriovenous fistula (dAVF) as the putative cause for SS. Case Description: We describe two cases of SS caused by a dAVF. Both patients had a supratentorial, cortical lesion supplied by the middle meningeal artery with venous drainage into the superior sagittal sinus. In both patients, symptoms improved after endovascular embolization. The similar anatomic relationship of both dAVFs reported presents an interesting question about the pathogenesis of SS. Similar to the pathologic changes seen in the formation of intracranial arterial aneurysms; it would be possible that changes in the blood vessel lining and wall might predispose a patient to chronic, microhemorrhage resulting in SS. Conclusions: We describe the second and third cases of a dAVF as the cause of SS, and the first cases of successful treatment of SS-associated dAVF with endovascular embolization. As noninvasive imaging techniques become more sensitive and easily obtained, one must consider their limitations in detecting occult intracranial vascular malformations such as dAVF as a possible etiology for SS. PMID:27127712

  13. Double-lumen arterial balloon catheter technique for Onyx embolization of dural arteriovenous fistulas: initial experience

    PubMed Central

    Chiu, Albert Ho Yuen; Aw, Grace; Wenderoth, Jason David

    2014-01-01

    Background Dural arteriovenous fistulas are vascular malformations with variable clinical symptoms that range in severity from completely asymptomatic to seizures, dementia, loss of vision and intracranial hemorrhage. Historically, surgical obliteration was the treatment of choice but, more recently, endovascular embolization has become the first-line treatment. The liquid embolic agent Onyx (ethyl vinyl copolymer) has become the agent of choice, but problems with reflux around the delivery microcatheter and inadvertent venous penetration have arisen. Methods and results We present six cases in which the double-lumen balloon microcatheter was used to transarterially embolize dural arteriovenous fistulas via injection of Onyx through the wire lumen. Depending on the individual pathology a venous balloon was also used in some cases. The advantages and disadvantages of the use of these devices are discussed. Conclusions We consider that the use of the double-lumen balloon technique for fistula embolization has the potential for reducing overall procedural times, procedural failures and catheter retention in certain situations. In such cases we would advocate this as a first-line technique. When lower profile, more navigable balloon catheters become available, this may become the standard of care. PMID:23749795

  14. Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography

    PubMed Central

    Bai, Ya; Song, Wen; Chen, Yongchao; Li, Dongxue; Han, Hui; Liu, Bin

    2015-01-01

    Purpose Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). Methods Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared. Results Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented. Conclusion The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery. PMID:26658152

  15. Saline Sinus Rinse Recipe

    MedlinePlus

    ... Saline Sinus Rinse Recipe Share | Saline Sinus Rinse Recipe Saline sinus rinses can bring relief to patients ... at a fraction of the cost. Saline Rinse Recipe Ingredients 1. Pickling or canning salt-containing no ...

  16. Pneumocephalus in frontal sinus osteoma: a case report.

    PubMed

    Rappaport, J M; Attia, E L

    1994-12-01

    Osteomas are the most commonly encountered neoplasms of the frontal sinus. Extension of these lesions through the posterior table can result in life-threatening complications. We present the case of a 70-year-old man with yellow nail syndrome who complained of persistent rhinorrhea and the sensation of "sloshing" when moving his head. Radiographic investigation revealed a frontal mucocele that had extended to a dramatic intracerebral pneumatocele. This occurred secondary to a frontal sinus osteoma that had been incidentally noted seven years earlier. Surgical exploration via an osteoplastic flap approach allowed us to excise both the osteoma and the associated pneumatomucocele. The resulting dural defect was resurfaced using a flap of pericranium to facilitate anterior cranialization. The features of this interesting case are discussed as an illustration of the potential complications of frontal sinus osteomas. The literature is reviewed regarding management of these lesions and their complications.

  17. [Venous ulcer].

    PubMed

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms. PMID:27405863

  18. Acute sinusitis.

    PubMed

    Feldt, Brent; Dion, Gregory R; Weitzel, Erik K; McMains, Kevin C

    2013-10-01

    Sinusitis is a common patient complaint that carries with it a large economic burden. It is one of the most common reasons patients visit their primary care physician. Acute bacterial rhinosinusitis (ABRS) can be distinguished from other forms of rhinosinusitis based on symptom duration of <4 weeks in a patient with purulent rhinorrhea associated with facial pain or pressure. Native upper aerodigestive tract bacteria are the most common etiologic agents. Treatment of ABRS is targeted primarily at symptom improvement. Amoxicillin can be used based on the clinical scenario and patient comorbidities. Computed tomographic scans are reserved for complicated presentations or when there is concern for intracranial extension or other complications. A systematic approach to ABRS will allow for improved patient quality of life and a decreased overall economic burden of this common entity.

  19. Management of superior sagittal sinus injury encountered in traumatic head injury patients: Analysis of 15 cases

    PubMed Central

    Behera, Sanjay K.; Senapati, Satya Bhusan; Mishra, Sudhansu Sekhar; Das, Srikant

    2015-01-01

    Background: Significant dural sinus injury occurs in 1.5- 5% of all head injuries and injury to superior sagittal sinus accounts for 70-80% of these. Its management is also a challenging issue to every neurosurgeon. Materials and Methods: In a period of one year (Aug 2011 to july2012) out of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have superior sagittal sinus injury. Three dimensional reconstruction of skull bone during CT scan helped us to diagnose possible dural sinus injury pre-operatively. Results: SSS injury was due to direct impact of fracture segment (5 cases), extension of fracture line over sinus area (4 cases) or due to coronal suture diastases (6 cases). Injury to anterior third of sagittal sinus occurred in 12 cases (80%) and injury to middle third occurred in 3 cases (20%). Small tear over superior sagittal sinus was found in 7 cases (46.66%) and was managed with Gelfoam® compression only and in two cases (13.33%) were large tear, which was managed with sinoraphy. In four cases (36.34%) hitch stitches over Gelfoam® to adjacent bone given and in rest two cases (13.33%) a strip of bone was left over the sinus area and bilateral hitch stitches were applied. Conclusion: Injury to SSS in traumatic head injury patient though rarely encountered during surgery, the management is challenging to every neurosurgeon. Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate. PMID:25767570

  20. Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas.

    PubMed

    Griessenauer, Christoph J; He, Lucy; Salem, Mohamed; Chua, Michelle H; Ogilvy, Christopher S; Thomas, Ajith J

    2016-09-01

    Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non-tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718-728, 2016. © 2016 Wiley Periodicals, Inc.

  1. Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas.

    PubMed

    Griessenauer, Christoph J; He, Lucy; Salem, Mohamed; Chua, Michelle H; Ogilvy, Christopher S; Thomas, Ajith J

    2016-09-01

    Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non-tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718-728, 2016. © 2016 Wiley Periodicals, Inc. PMID:27148680

  2. 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

  3. Venous Ulcers.

    PubMed

    Caprini, J A; Partsch, H; Simman, R

    2012-09-01

    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.

  4. Bilateral cavernous sinus and superior ophthalmic vein thrombosis in the setting of facial cellulitis

    PubMed Central

    Bell, Bruce; Hise, Joseph; Philip, Joseph; Spak, Cedric; Opatowsky, Michael J.

    2016-01-01

    Cavernous sinus thrombosis is a rare, potentially fatal cause of cerebral venous thrombosis. Infectious causes typically arise from the mid face, orbit, or sinonasal region. We present a case of bilateral cavernous sinus and superior ophthalmic thrombosis secondary to an extreme case of facial cellulitis. PMID:26722163

  5. Bilateral cavernous sinus and superior ophthalmic vein thrombosis in the setting of facial cellulitis.

    PubMed

    Syed, Almas; Bell, Bruce; Hise, Joseph; Philip, Joseph; Spak, Cedric; Opatowsky, Michael J

    2016-01-01

    Cavernous sinus thrombosis is a rare, potentially fatal cause of cerebral venous thrombosis. Infectious causes typically arise from the mid face, orbit, or sinonasal region. We present a case of bilateral cavernous sinus and superior ophthalmic thrombosis secondary to an extreme case of facial cellulitis. PMID:26722163

  6. Epidural analgesia complicated by dural ectasia in the Marfan syndrome

    PubMed Central

    Gray, Chelsea; Hofkamp, Michael P.; Noonan, Patrick T.; McAllister, Russell K.; Pilkinton, Kimberly A.; Diao, Zhiying

    2016-01-01

    Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance.

  7. Epidural analgesia complicated by dural ectasia in the Marfan syndrome

    PubMed Central

    Gray, Chelsea; Hofkamp, Michael P.; Noonan, Patrick T.; McAllister, Russell K.; Pilkinton, Kimberly A.; Diao, Zhiying

    2016-01-01

    Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance. PMID:27695168

  8. Neonatal dural arteriovenous fistula at the confluence presenting with paralysis of the orbicularis oris muscle.

    PubMed

    Iizuka, Y; Koda, E; Tsutsumi, Y; Konishi, Y; Ashida, H; Nakanishi, T; Funabiki, M

    2013-02-01

    A male neonate presented a dural arteriovenous fistula (DAVF) at the confluence with paralysis of the orbicularis oris muscle. The interesting features in our case were the clinical symptoms (orbicularis oris muscle paralysis at birth), angioarchitecture (high-flow arteriovenous shunts at the confluence) and the size and hemodynamic flow (mid-sized venous pouch) of the fistula. Additionally, the embolization technique (i.e., occipital artery approach, closing shunts with pure glue) automatically resulted in the immediate and complete closure of accessory feeders without any additional treatment, and the midterm clinical outcome was good. We succeeded improving the symptoms of a neonate with a congenital high-flow DAVF by closing a fistula using a small amount of glue.

  9. Simple solution for preventing cerebrospinal fluid loss and brain shift during multitrack deep brain stimulation surgery in the semisupine position: polyethylene glycol hydrogel dural sealant capping: rapid communication.

    PubMed

    Takumi, Ichiro; Mishina, Masahiro; Hironaka, Kohei; Oyama, Kenichi; Yamada, Akira; Adachi, Koji; Hamamoto, Makoto; Kitamura, Shin; Yoshida, Daizo; Teramoto, Akira

    2013-01-01

    This study evaluated preliminary findings on the efficacy of polyethylene glycol (PEG) hydrogel dural sealant capping for the prevention of cerebrospinal fluid (CSF) leakage and pneumocephalus during deep brain stimulation (DBS) surgery in the semisupine position. Group A consisted of 5 patients who underwent bilateral subthalamic nucleus (STN)-DBS surgery without PEG hydrogel dural sealant capping. Group B consisted of 5 patients who underwent bilateral STN-DBS surgery with PEG hydrogel dural sealant capping. The immediate postoperative intracranial air volume was measured in all patients and compared between the 2 groups using the Welch test. Adverse effects were also examined in both groups. The intracranial air volume in Group A was 32.3 ± 12.3 ml (range 19.1-42.5 ml), whereas that in Group B was 1.3 ± 1.5 ml (range 0.0-3.5 ml), showing a significant difference (p < 0.005). No hemorrhage or venous air embolisms were observed in either group. The effect of brain shift was discriminated by STN recordings in Group B. These preliminary findings indicate that PEG hydrogel dural sealant capping may reduce adverse effects related to CSF leakage and brain shift during DBS surgery. PMID:23358161

  10. The Current Role of Venous Sampling in the Localization of Endocrine Disease

    SciTech Connect

    Lau, Jeshen H. G. Drake, William; Matson, Matthew

    2007-07-15

    Endocrine venous sampling plays a specific role in the diagnosis of endocrine disorders. In this article, we cover inferior petrosal sinus sampling, selective parathyroid venous sampling, hepatic venous sampling with arterial stimulation, adrenal venous sampling, and ovarian venous sampling. We review their indications and the scientific evidence justifying these indications in the diagnosis and management of Cushing's syndrome, hyperparathyroidism, pancreatic endocrine tumors, Conn's syndrome, primary hyperaldosteronism, pheochromocytomas, and androgen-secreting ovarian tumors. For each sampling technique, we compare its diagnostic accuracy with that of other imaging techniques and, where possible, look at how it impacts patient management. Finally, we incorporate venous sampling into diagnostic algorithms used at our institution.

  11. Sick sinus syndrome

    MedlinePlus

    ... sinus node or SA node. This keeps the heart beat steady and regular. Sick sinus syndrome is a ... Fatigue Dizziness or lightheadedness Sensation of feeling the heart beat ( palpitations ) Shortness of breath , possibly only with physical ...

  12. [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. PMID:11428268

  13. 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 ...

  14. Sick sinus syndrome.

    PubMed

    Wahls, S A

    1985-03-01

    Disease in the sinus node may cause bradyarrhythmias or tachyarrhythmias. Bradyarrhythmias occur because of impaired automaticity (with or without sinus arrest) or because of sinus node exit block. Reentrant or automatic rhythms may produce tachyarrhythmias. Symptoms and signs of sick sinus syndrome include lightheadedness, palpitation, syncope and peripheral or cerebral emboli. After diagnosis by Holter monitoring, symptomatic patients usually improve with placement of a permanent cardiac pacemaker. PMID:3976454

  15. Sagittal sinus thrombosis in adult minimal change nephrotic syndrome.

    PubMed

    Urch, C; Pusey, C D

    1996-02-01

    Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. The mechanisms are as yet unclear, but numerous alterations in coagulant and anti-coagulant factors have been reported [Llach et al. 1985, Harris and Ismail 1994]. The most common clinical features in adults are renal vein thrombosis, femoral vein thrombosis and pulmonary embolism, although thrombosis in numerous other arterial and venous sites has been described [Cameron 1984, Llach et al. 1985]. Intracranial thrombosis is rare, although in adult nephrotic syndrome arterial thrombosis is well recognized [Fuh et al. 1991]. We report a patient with minimal change nephrotic syndrome who developed venous sinus thrombosis detected by magnetic resonance (MR) scanning.

  16. Subacute methotrexate neurotoxicity and cerebral venous sinus thrombosis in a 12-year-old with acute lymphoblastic leukemia and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism: homocysteine-mediated methotrexate neurotoxicity via direct endothelial injury.

    PubMed

    Mahadeo, Kris M; Dhall, Girish; Panigrahy, Ashok; Lastra, Carlos; Ettinger, Lawrence J

    2010-02-01

    From as early as the 1970s methotrexate has been associated with disseminated necrotizing leukoencephalopathy and other neurotoxic sequelae. Yet, a clear mechanism for methotrexate-induced neurotoxicity has not been established. The authors describe the case of a 12-year-old male with acute lymphoblastic leukemia and a homozygous methylenetetrahydrofolate reductase C677T mutation, who developed subacute methotrexate-induced toxicity and cerebral venous thrombosis after receiving intrathecal methotrexate. The role of homocysteine as a possible mediator in methotrexate-induced neurotoxicity via direct endothelial injury is discussed. PMID:20121554

  17. Compression of superior sagittal sinus by neonatal calvarial molding.

    PubMed

    Newton, T H; Gooding, C A

    1975-06-01

    Compression of the superior sagittal sinus may result from overlapping of the parietal and occipital bones in the newborn infant. Such compression has been documented angiographically and the resultant decreased blood flow confirmed with a Doppler ultrasound probe. This compression may increase intracerebral venous pressures and thereby contribute to the high incidence of intracerebral hemorrhage in premature infants with respiratory distress syndrome.

  18. Bilateral maxillary sinus hypoplasia.

    PubMed

    Khanduri, Sachin; Agrawal, Sumit; Chhabra, Saakshi; 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

  19. 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. PMID:27352844

  20. 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.

  1. 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

  2. Clinical aspects of venous thrombophilia.

    PubMed

    Girolami, Antonio; Fabris, Fabrizio; Girolami, Bruno

    2002-01-01

    Venous thrombophilia is the result of clotting changes namely of a hypercoagulable state together with blood flow and vessel wall changes. There is no need for all these components to be present in order for thrombosis to occur. As the matter of fact, thrombosis may occur even if only one of these conditions is present. In clinical practice a combination of factors is usualy seen. In comparison with arterial thrombophilia, clotting changes and blood flow seen to play a major role in venous thrombosis. Venous thrombophilia may remain asynptomatic or may result in a series of clinical syndromes. The commonest of these are: 1. Superficial vein thrombosis, 2. Deep vein thrombosis of legs, 3. Deep vein thrombosis of arms, 4. Caval veins thrombosis, 5. Portal vein thrombosis, 6. Hepatic veins thrombosis, 7. Renal vein thrombosis, 8. Cerebral sinuses thrombosis, 9. Right heart thrombosis, 10. Miscellaneous (ovarian, adrenal veins thrombosis, etc.). Since the first two are widely and easily recognized, these is no need for an extensive discussion. Deep vein thromboses of upper limbs are not as frequent as those of lower limbs or of superficial phlebitis but they can still be recognized on clinical grounds and non invasive techniques. The remaining 7 syndromes are less common and therefore less frequently suspected and recognized. Of particular interest, among these less common manifestations of venous thrombophilia are hepatic vein and renal vein thrombosis. Hepatic veins thrombosis, sometimes part of inferior vena cava thrombosis is most frequently due to an isolated occlusion of hepatic veins thereby causing a form of venocclusive disease. Occasionally diagnosis may be difficult because of slow onset of symptoms (hepatomegaly, right flank pain, fever, ascites etc.). The same is true for renal vein thrombosis which may also be of difficult diagnosis since it causes proteinuria and flank pain. The proteinuria is often interpreted as due to a nephrotic syndrome which

  3. Spinal dural ossification causing neurological signs in a cat.

    PubMed

    Antila, Johanna M; Jeserevics, Janis; Rakauskas, Mindaugas; Anttila, Marjukka; Cizinauskas, Sigitas

    2013-06-19

    A six-year-old Ragdoll cat underwent examination due to a six-month history of slowly progressive gait abnormalities. The cat presented with an ambulatory tetraparesis with a neurological examination indicating a C1-T2 myelopathy. Radiographs of the spine showed a radiopaque irregular line ventrally in the vertebral canal dorsal to vertebral bodies C3-C5. In this area, magnetic resonance imaging revealed an intradural extramedullary/extradural lesion compressing the spinal cord. The spinal cord was surgically decompressed. The cause of the spinal cord compression was dural ossification, a diagnosis confirmed by histopathological examination of the surgically dissected sample of dura mater. The cat gradually improved after the procedure and was ambulating better than prior to the surgery. The cat's locomotion later worsened again due to ossified plaques in the dura causing spinal cord compression on the same cervical area as before. Oral prednisolone treatment provided temporary remission. Ten months after surgery, the cat was euthanized due to severe worsening of gait abnormalities, non-ambulatory tetraparesis. Necropsy confirmed spinal cord compression and secondary degenerative changes in the spinal cord on cervical and lumbar areas caused by dural ossification. To our knowledge, this is the first report of spinal dural ossification in a cat. The reported cat showed neurological signs associated with these dural changes. Dural ossification should be considered in the differential diagnosis of compressive spinal cord disorders in cats.

  4. Spinal dural ossification causing neurological signs in a cat

    PubMed Central

    2013-01-01

    A six-year-old Ragdoll cat underwent examination due to a six-month history of slowly progressive gait abnormalities. The cat presented with an ambulatory tetraparesis with a neurological examination indicating a C1-T2 myelopathy. Radiographs of the spine showed a radiopaque irregular line ventrally in the vertebral canal dorsal to vertebral bodies C3-C5. In this area, magnetic resonance imaging revealed an intradural extramedullary/extradural lesion compressing the spinal cord. The spinal cord was surgically decompressed. The cause of the spinal cord compression was dural ossification, a diagnosis confirmed by histopathological examination of the surgically dissected sample of dura mater. The cat gradually improved after the procedure and was ambulating better than prior to the surgery. The cat’s locomotion later worsened again due to ossified plaques in the dura causing spinal cord compression on the same cervical area as before. Oral prednisolone treatment provided temporary remission. Ten months after surgery, the cat was euthanized due to severe worsening of gait abnormalities, non-ambulatory tetraparesis. Necropsy confirmed spinal cord compression and secondary degenerative changes in the spinal cord on cervical and lumbar areas caused by dural ossification. To our knowledge, this is the first report of spinal dural ossification in a cat. The reported cat showed neurological signs associated with these dural changes. Dural ossification should be considered in the differential diagnosis of compressive spinal cord disorders in cats. PMID:23777582

  5. 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.

  6. 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. PMID:21906886

  7. Creutzfeldt-Jakob disease via dural and corneal transplants.

    PubMed

    Lang, C J; Heckmann, J G; Neundörfer, B

    1998-10-01

    A review of all published cases of iatrogenic Creutzfeldt-Jakob disease (CJD) via dural (N=71) and corneal (N=4) transplants is given. All but three of the dural cases were obviously due to a commercial product recalled in 1996. Two of the corneal grafts were taken from patients who had died of sporadic CJD. These cases differed from CJD due to human growth hormone injections and the new variant. Instead. they were akin to sporadic cases, but memory loss, disorders of higher cerebral functions and extrapyramidal signs were fewer, while cerebellar abnormalities were more frequent. Progressive dysarthria and gait disorder/gait ataxia were prominent signs during the early stages, myocloni the most salient feature later. A nonperiodic EEG did not contradict the diagnosis. Using current diagnostic criteria the disease was underdiagnosed ante mortem. Utmost care is needed in selecting, harvesting and handling dural and corneal grafts to avoid inadvertent transmission of CJD.

  8. Double connections in total anomalous pulmonary venous connection.

    PubMed

    Arciprete, P; McKay, R; Watson, G H; Hamilton, D I; Wilkinson, J L; Arnold, R M

    1986-07-01

    Three infants who underwent operation for total anomalous pulmonary venous connection had unobstructed drainage of all the pulmonary veins to both the coronary sinus and left vertical vein. In one patient the anatomy was demonstrated preoperatively and complete correction accomplished without difficulty, but in two patients the second connection was discovered only at postoperative reinvestigation. Arbitrary classification of total anomalous pulmonary venous connection into cardiac, supracardiac, infracardiac, and mixed types does not lend itself to description of such lesions and may obscure their clinical importance. For these less common variants of total anomalous pulmonary venous connection, a more detailed and precise definition of morphology facilitates accurate surgical repair.

  9. 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.

  10. [The use of magnetic resonance venography in diagnosis of cerebral venous blood flow disorders].

    PubMed

    Semenov, S E; Abalmasov, V G

    2000-01-01

    The paper presents an examination of 85 patients aged 16-72 years with cerebral venous dyscirculation resulted from the obstruction of cerebral venous sinuses, major veins of the neck and upper regions of the mediastenum. 70 healthy volunteers were also observed. Magnetic-resonance venography of brachyocephal veins and venous sinuses and ultrasound duplex scanning of internal jugular veins together with colored mapping of the blood flow were performed. Both the causes and the magnetic-resonance semiotics of the obstructive damages of brachyocephal veins and of the cerebral venous sinuses were described. The criteria for hemodynamic significance of the obstruction of brachyocephal veins were defined in case of extravasal compression of brachyocephal veins.

  11. Why paranasal sinuses?

    PubMed

    Blaney, S P

    1990-09-01

    This essay attempts to address the perennial question 'Why Paranasal Sinuses?'. In doing so it highlights the flaws in many much-favoured but ill-founded theories concerning the role of these sinuses in humans. It is concluded that the question can only be fully answered through a greater understanding of differential growth changes within the craniofacial massif.

  12. Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization.

    PubMed

    Kim, Hyun-Jung; Yang, Ji-Ho; Lee, Hong-Jae; Lee, Hyung-Jin

    2015-09-01

    Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which has high risk of intracranial hemorrhage. We present two cases of tentorial DAVF which were successfully treated with single trial of transarterial embolization using Onyx. We briefly reviewed the types of the tentorial DAVF and strategies of treatment. PMID:26539273

  13. Frontal sinus osteoma with osteoblastoma-like histology and associated intracranial pneumatocele.

    PubMed

    Lehmer, Larisa M; Kissel, Phillip; Ragsdale, Bruce D

    2012-09-01

    Osteomas of the cranial sinuses are rare, benign bony tumors that can be complicated by the formation of an intracranial pneumatocele. If not treated promptly, a pneumatocele can lead to abscess formation, meningitis, or ventriculitis. In the present case, an intracerebral pneumatocele was formed when an 18 cm(3) osteoma breached the posterior wall of the frontal sinus creating a one-way valve through which air could enter the intracranial cavity. The patient presented after forceful sneezing with nonspecific symptoms of headache, nausea, and vomiting. CT demonstrated a frontal collection of loculated air with mass effect within the left cerebral hemisphere. A partly mineralized mass occupied the left superior nasal ethmoid sinus and left frontal sinus. Of interest pathologically in this case, the tumor had a substantial osteoblastoma-like component. Surgical repair involved frontal craniotomy to remove the osteoma and debride frontal sinus mucosa, plugging the frontal nasal ducts and sinus with fat and bone wax, and dural restoration using an underwater closed drainage system to vent intracranial air and stabilize the patient.

  14. Computed Tomography (CT) -- Sinuses

    MedlinePlus

    ... further information please consult the ACR Manual on Contrast Media and its references. The risk of serious allergic ... X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Computed Tomography (CT) - Sinuses About ...

  15. Sinus MRI scan

    MedlinePlus

    ... that may have been exposed to small metal fragments should receive a skull x-ray. This is ... due to: Cancer or tumor Infection in the bones of the sinuses (osteomyelitis) Infection of the tissues ...

  16. Endoscopic Sinus Surgery

    MedlinePlus

    ... The nasal endoscope is a small, lighted metal telescope placed into the nostril. The endoscope allows the ... sinus surgery involves the use of a small telescope (nasal endoscope) that is inserted through the nostril ...

  17. 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 ...

  18. Sinusitis Q and A

    MedlinePlus

    ... and hydration. Medications, such as decongestants, mucolytics and pain relievers, may be offered by your physician to help decrease the severity of your symptoms. The mainstay of treatment for acute bacterial sinusitis is an appropriate antibiotic, ...

  19. Development and structures of the venous pole of the heart.

    PubMed

    Anderson, Robert H; Brown, Nigel A; Moorman, Antoon F M

    2006-01-01

    In the past, our interpretations of cardiac development depended on analysis of serially sectioned embryos, supported by three-dimensional reconstructions. It was not possible, using these techniques, to trace the fate of the various embryonic building blocks. This has all changed with the advent of the new techniques in molecular biology. Combining our experience with these new techniques and our previous studies using the classic approach, we have reviewed how the recent advances clarify controversies that still exist concerning the development of the venous pole. The arguments devolve on whether the pulmonary vein is itself a new development or whether its primordium is derived from the systemic venous tributaries, the so-called sinus venosus. The new techniques show that, rather than developing in the form of a segmented tube, the heart is built up by addition of material to both its arterial and venous poles. At no stage is it possible to recognize a discrete part of the tube that can be identified as the sinus venosus. The confluence of the systemic venous tributaries does not become recognizable as a discrete anatomic entity until compartmented into the newly formed right atrium concomitant with formation of the venous valves. The new molecular techniques show that the pulmonary vein is a new structure, anatomically and developmentally, that is derived from mediastinal myocardium. It gains its connection to the morphologically left atrium between the right- and left-sided systemic venous tributaries. PMID:16193508

  20. Fluid dynamics of venous valve closure.

    PubMed

    Qui, Y; Quijano, R C; Wang, S K; Hwang, N H

    1995-01-01

    In vitro experiment was performed on a stented bovine jugular vein valve (VV, 14 mm I.D. x 2 cm long) and a stentless bovine jugular vein valve conduit (10 mm I.D. x 6 cm long) in a hydraulic flow loop with a downstream oscillatory pressure source to mimic respiratory changes. Simultaneous measurements were made on the valve opening area, conduit and sinus diameter changes using a specially designed laser optic system. Visualization of flow fields both proximal and distal to the venous valve, and the valve opening area were simultaneously recorded by using two video cameras. Laser Doppler anemometer surveys were made at three cross sections: the valve inlet, the valve exist, and 2 cm downstream of the venous valve to quantity flow reflux at valve closure. The experiment confirmed that the VV is a pressure-operated rather than a flow-driven device and that little or no reflux is needed to close the valve completely. The experiment further demonstrated that the VV sinus expands rapidly against back pressure, a critical character to consider in venous prosthesis design. PMID:8572425

  1. Endovascular Treatment of Acute Thrombosis of Cerebral Veins and Sinuses

    PubMed Central

    Yakovlev, Sergey Borisovich; Bocharov, Aleksei Vasilievich; Mikeladze, Ketevan; Gasparian, Sergey Surenovich; Serova, Natalia Konstantinovna; Shakhnovich, Alexander Romanovich

    2014-01-01

    Summary Acute thrombosis of cerebral veins and sinuses (ATCVS) is a multifactorial disease with grave consequences. Because of its rare occurrence there are no proven treatment guidelines. Sixteen patients with ATCVS were treated. The final diagnosis was confirmed by digital subtraction angiography. Sinus catheterization was performed via transfemoral venous access. Treatment included mechanical manipulation of thrombi and thrombolytic therapy. A regression of clinical symptoms with a concomitant decrease of intracranial hypertension was achieved in all patients. Long-term results were studied in eight patients: none presented clinical signs of intracranial hypertension. Endovascular transvenous recanalization is an effective treatment for acute thrombosis of cerebral veins and sinuses. Along with the local thrombolysis, significant potential in the treatment of this complex pathology lies in the transvenous endovascular techniques of mechanical thrombus extraction, especially in patients with intracranial hemorrhage for whom the use of thrombolytic agents is restricted. PMID:25196622

  2. Dural arteriovenous fistula involving the anterior condylar canal.

    PubMed

    Cyril, Chivot; Ofélia, Marabotto; Hervé, Deramond

    2013-07-01

    Dural arteriovenous fistula (DAVF) of the anterior condylar canal is a rare subgroup of posterior fossa DAVF. Successful treatment of this DAVF requires an accurate image diagnosis and the knowledge of the anatomy of the anterior condylar confluent. We present the imaging features of angiography and MR angiography of a 54-year-old man, who presented progressive right synchronous tinnitus due to a DAVF of the anterior condylar confluent, successfully treated by transvenous embolization. PMID:22607489

  3. PRESUMED SINUS-RELATED STRABISMUS

    PubMed Central

    Ludwig, Irene H; Smith, Joe Frank

    2004-01-01

    ABSTRACT Purpose To determine whether sinus disease may cause acquired strabismus. Methods Patients with idiopathic acquired (nonaccommodative) esotropia and/or hypotropia were questioned in detail about possible contributing factors (trauma; family history of strabismus; thyroid, neurologic, or rheumatologic disorders). Acute versus chronic onset was ascertained. Those without obvious cause of strabismus were investigated for possible sinus disease with sinus computed tomographic scan and otolaryngologic consultation. Results Over a period of 5 years, 59 patients were identified with sinus disease that correlated to their strabismus pattern(s). Twenty-three had “possible” sinus-related strabismus. They had sinus findings that correlated with the strabismus pattern (eg, hypotropia and adjacent maxillary sinus disease). Twenty-six had “likely” sinus-related strabismus. These patients had additional features, such as their own recognition that strabismus worsened along with sinus symptoms, or unusually severe sinus disease. Ten were diagnosed with “very likely” sinus-related strabismus. They had strong correlation between treatment of sinus disease and strabismus improvement. Eighteen patients required sinus surgery owing to failure of medical control. Age at onset of strabismus ranged from 6 months to 81 years. Forty patients required strabismus surgery. All had restriction of motility on forced duction testing under anesthesia. Control of sinus disease combined with range-of-motion eye exercise improved symptoms in 19 who did not require strabismus surgery. Conclusions Occult sinus disease may cause acquired strabismus. Perhaps sinusitis leads to inflammation and secondary contracture in adjacent extraocular muscles. Although difficult to prove owing to the high frequencies of both strabismus and sinus disease, the association between the two may prove significant to strabismus treatment and long-term control. PMID:15747754

  4. Cystic Fibrosis Sinusitis.

    PubMed

    Le, Christopher; McCrary, Hilary C; Chang, Eugene

    2016-01-01

    Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the CF transmembrane conductance regulator gene(CFTR) resulting in impaired ion transport. Nearly all people with CF will develop chronic rhino-sinusitis (CRS) and present with the characteristic viscous mucus, impaired mucociliary clearance and chronic inflammation/infection of the sinonasal cavity. While some individuals with CF can appear relatively asymptomatic in terms of their sinus disease, commonly reported symptoms include anosmia, headache, facial pain, nasal obstruction, chronic congestion and nasal discharge. Nasal endoscopy typically reveals mucosal edema, purulent discharge and nasal polyposis. Computed tomography (CT) imaging classically demonstrates the distinguishing findings of sinus hypoplasia or aplasia with generalized opacification, medial bulging of the lateral sinonasal sidewall and a demineralized uncinate process. Current treatment for CF sinusitis includes the use of hypertonic saline, topical and systemic steroids, antibiotics and endoscopic surgery. Research investigating novel therapies designed at targeting the primary defect of CF is showing promise for reversal of CF sinus disease, in addition to potential for disease prevention. PMID:27466844

  5. Central venous catheters - ports

    MedlinePlus

    Central venous catheter - subcutaneous; Port-a-Cath; InfusaPort; PasPort; Subclavian port; Medi - port; Central venous line - port ... Catheters are used when you need medical treatment over a long period of time. For example, you ...

  6. Hemangioma of the maxillary sinus.

    PubMed

    Most, D S

    1985-11-01

    Hemangiomas of the maxillary sinus are rare. Hemangiomas of the maxillary sinus with an associated phlebolith have not been previously reported. Severe bleeding can occur upon surgical removal of hemangiomas. PMID:3864111

  7. Frontal sinus mucocele with intracranial extension associated with osteoma in the anterior cranial fossa.

    PubMed

    Sakamoto, Hiroki; Tanaka, Toshihide; Kato, Naoki; Arai, Takao; Hasegawa, Yuzuru; Abe, Toshiaki

    2011-01-01

    A 70-year-old man presented with a rare case of paranasal osteoma with secondary mucocele extending intracranially, manifesting as a generalized convulsion. Computed tomography showed a large calcified tumor adjacent to the cystic mass in the left frontal lobe. He underwent left frontal craniotomy, and the cystic lesion was totally removed. Histological examination confirmed the diagnosis of osteoma and mucocele. The giant paranasal sinus osteoma prevented growth of the mucocele into orbital recess and extension into the orbital space and paranasal sinus. The mucocele disrupted the dura in the anterior cranial fossa, resulting in a giant cystic intracranial lesion. Frontal osteoplastic craniotomy was effective for exposing both lesions and plastic repair of the dural perforation to prevent cerebrospinal fluid leakage and secondary infection.

  8. Sphenoid sinus mucocele

    PubMed Central

    Bahgat, Mohammed; Bahgat, Yassin; Bahgat, Ahmed

    2012-01-01

    The authors present their experience of managing an interesting case of a 65-year-old woman who presented to their clinic with 1-month history of persistent deep-seated headache. The patient sought medical advice in neurology and ophthalmology clinics before being referred to the ear, nose and throat clinic. CT imaging revealed isolated opacification and expansion of both sphenoid sinuses with bony continuity along the periphery of the sinuses features consistent with mucocele. MRI was needed to fully evaluate the extension of the lesion. The lesion was diagnosed as bilateral sphenoid sinuses mucoceles. Transnasal endoscopic drainage of the sphenoid mucoceles leads to gradual improvement of the symptoms. We discuss the clinical presentation, diagnosis and treatment of this case as well as a review of the literature. PMID:23093506

  9. 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

  10. [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.

  11. Paranasal sinus radiology, Part 3B: Sphenoidal sinus.

    PubMed

    Dolan, K D

    1983-01-01

    Mucoceles involving the sphenoidal sinus are not as common as those affecting the frontal and ethmoidal sinuses. The subtle expansile change produced by a sphenoidal sinus mucocele often requires conventional tomography or computed tomography examination to be detected. Similarly, involvement of surrounding structures by a sphenoidal mucocele may require special study, which this section illustrates. The sphenoidal enlargement and density change produced by fibrous dysplasia may mimic sinus disease. Focal or widespread bone destruction resulting from neoplastic involvement of the sphenoidal sinus requires special examination similar to that used with mucoceles.

  12. Acute fulminant invasive fungal sinusitis with cavernous sinus syndrome.

    PubMed

    Chi, Tzu-Hang; Chen, Hsien-Shen; Yuan, Chien-Han; Su, Feng-Ming

    2014-11-01

    Acute fulminant invasive fungal sinusitis is most commonly found in immunocompromised patients with conditions such as diabetes mellitus, malignancies and acquired immune deficiency syndrome. The most common pathogens are Aspergillus and Mucoraceae and the sinus most frequently involved is the maxillary sinus. Fever, rhinorrhea, facial pain, headache, and diplopia are common presenting symptoms. Complications of this infection include intracranial and / or intraorbital spread of the infection; the prognosis is poor. Here, a rare case of acute fulminant invasive fungal sinusitis with cavernous sinus syndrome is reported.

  13. Treatment of the Superior Sagittal Sinus Thrombosis with the Mechanical Thrombectomy Using Stent-Retriever Device.

    PubMed

    Kim, Hoon; Kim, Seong Rim; Park, Ik Seong; Kim, Young Woo

    2016-09-01

    Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.

  14. Treatment of the Superior Sagittal Sinus Thrombosis with the Mechanical Thrombectomy Using Stent-Retriever Device

    PubMed Central

    Kim, Hoon; Kim, Seong Rim; Park, Ik Seong

    2016-01-01

    Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences. PMID:27651872

  15. Treatment of the Superior Sagittal Sinus Thrombosis with the Mechanical Thrombectomy Using Stent-Retriever Device

    PubMed Central

    Kim, Hoon; Kim, Seong Rim; Park, Ik Seong

    2016-01-01

    Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.

  16. Treatment of the Superior Sagittal Sinus Thrombosis with the Mechanical Thrombectomy Using Stent-Retriever Device.

    PubMed

    Kim, Hoon; Kim, Seong Rim; Park, Ik Seong; Kim, Young Woo

    2016-09-01

    Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences. PMID:27651872

  17. 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. PMID:27025504

  18. Anomalous connection of the left hepatic vein to coronary sinus in a child with PAPVD. Surgical significance and diagnostic difficulties

    PubMed Central

    Mądry, Wojciech; Zacharska-Kokot, Ewa

    2016-01-01

    Left hepatic vein (LHV) that drains blood into a coronary sinus (CS) is an extremely rare congenital anomaly of systemic vein drainage with only single reports published. In most of these cases the unusual venous connection was found incidentally during diagnostics or surgery. The case of a two-year-old boy in whom the anomaly was discovered during open heart surgery for partial anomalous pulmonary venous drainage (PAPVD) is presented. Difficulties in obtaining proper diagnosis preoperatively are confronted with postoperative echo findings. Embryology and evolution of sinus venosus are discussed to explain the persistent connection between hepatic venous circulation and a coronary sinus. The authors attempt to recapitulate the possible surgical consequences of LHV-CS continuity. PMID:27212980

  19. Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention

    PubMed Central

    Srikant, Banumathy; Balasubramaniam, Srikant

    2013-01-01

    Thrombosis of venous sinuses associated with thyrotoxicosis is rare, and isolated transverse and sigmoid sinus thrombosis is rarer and reported only once previously. We present a case of Graves disease, who suffered unilateral sigmoid and transverse sinus thrombosis with intracranial hemorrhage. A 42-year-old female, a diagnosed case of Graves disease, presented to us with headache, drowsiness, and hemiparesis. Computed Tomography revealed a large right temporo-parieto-occipital venous infarct. The patient needed surgical intervention in the form of decompressive craniotomy following which she improved, and on follow-up is having no deficits. Thrombophilia profile showed a low Protein S and Anti thrombin III (AT III) levels. Deranged thrombophilia profile in combination with the hypercoagulable state in thyrotoxicosis, most likely precipitated the thrombotic event. Timely surgical intervention can be offered in selective cases with a good clinical outcome. PMID:24403961

  20. Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention.

    PubMed

    Srikant, Banumathy; Balasubramaniam, Srikant

    2013-07-01

    Thrombosis of venous sinuses associated with thyrotoxicosis is rare, and isolated transverse and sigmoid sinus thrombosis is rarer and reported only once previously. We present a case of Graves disease, who suffered unilateral sigmoid and transverse sinus thrombosis with intracranial hemorrhage. A 42-year-old female, a diagnosed case of Graves disease, presented to us with headache, drowsiness, and hemiparesis. Computed Tomography revealed a large right temporo-parieto-occipital venous infarct. The patient needed surgical intervention in the form of decompressive craniotomy following which she improved, and on follow-up is having no deficits. Thrombophilia profile showed a low Protein S and Anti thrombin III (AT III) levels. Deranged thrombophilia profile in combination with the hypercoagulable state in thyrotoxicosis, most likely precipitated the thrombotic event. Timely surgical intervention can be offered in selective cases with a good clinical outcome.

  1. Adverse pacemaker hemodynamics evaluated by pulmonary venous flow monitoring.

    PubMed

    Stierle, U; Krüger, D; Mitusch, R; Potratz, J; Taubert, G; Sheikhzadeh, A

    1995-11-01

    The pacemaker syndrome refers to symptoms and signs in the pacemaker patient caused by an inadequate timing of atrial and ventricular contractions. The lack of normal atrioventricular synchrony may result in a decreased cardiac output and venous cannon A waves. The objective of this study was to define the left atrial and pulmonary venous flow response to ventricular pacing in a group of 14 unselected consecutive patients with total heart block and sinus rhythm. Pulmonary venous flow was assessed by transesophageal pulsed Doppler echocardiography in the VVI and DDD pacing modes. An inappropriate atrial timing caused a marked augmentation of the normally small pulmonary venous z wave in all patients ("negative atrial kick," peak z wave in DDD pacing 14.5 +/- 4.6 cm/s, VVI pacing 51.8 +/- 15.0 cm/s). Restoration of AV synchrony (DDD pacing, AV interval 100 ms) abolished these "cannon z waves" in all patients, and a normal pattern of pulmonary venous flow was achieved. Abnormal pulmonary venous flow characteristics were observed in 2 of 14 patients during DDD pacing with short AV intervals (100 ms). The Doppler pattern was similar to the findings seen in VVI pacing. Assessment of pulmonary venous flow by transesophageal pulsed Doppler echocardiography may provide a simple, sensitive, and relatively noninvasive technique to evaluate patients with suspected pacing induced adverse hemodynamics.

  2. When Sinuses Attack!

    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 ...

  3. Pediatric cavernous sinus thrombosis

    PubMed Central

    Vossough, Arastoo; Vorona, Gregory A.; Beslow, Lauren A.; Ichord, Rebecca N.; Licht, Daniel J.

    2015-01-01

    Objective: To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature. Methods: Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis. Results: Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. Conclusion: Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed. PMID:26231260

  4. The dural sheath of the optic nerve: descriptive anatomy and surgical applications.

    PubMed

    Francois, P; Lescanne, E; Velut, S

    2011-01-01

    The aim of this work was to clarify the descriptive anatomy of the optic dural sheath using microanatomical dissections on cadavers. The orbit is the rostral part of the extradural neural axis compartment; the optic dural sheath forms the central portion of the orbit.In order to describe this specific anatomy, we carefully dissected 5 cadaveric heads (10 orbits) up to the meningeal structure of the orbit and its contents. 1 cadaveric head was reserved for electron microscopy to add to our knowledge of the collagen structure of the optic dural sheath.In this chapter, we describe the anatomy of the interperiostal-dural concept and the anatomy of the orbit. The optic dural sheath contains three portions: the intracranial, the intracanalicular and the intraorbital segment. Each one has specific anatomic relations which result in particular surgical considerations.

  5. Cerebral venous thrombosis in a patient with acute postinfectious glomerulonephritis

    PubMed Central

    Morkhandikar, S.; Priyamvada, P. S.; Srinivas, B. H.; Parameswaran, S.

    2016-01-01

    Thrombosis of the cerebral venous sinuses (CVT) is described in nephrotic syndrome. A 13-year-old girl was admitted with acute post-infectious glomerulonephritis (APIGN). Subsequently she developed recurrent seizures with focal neurological deficits. On evaluation, she was found to have CVT. To the best of our knowledge, this is the first report of CVT in APIGN. Identifying this complication is imperative, as timely diagnosis and treatment could be lifesaving. PMID:27194837

  6. Cerebral Venous Thrombosis in the Mediterranean Area in Children

    PubMed Central

    Menascu, S.; Lotan, A.; Ben Zeev, B.; Nowak-Gottl, U:; Kenet, G.

    2011-01-01

    Cerebral Venous Sinus (sinovenous) Thrombosis (CSVT) is a serious and rare disorder, increasingly recognized and diagnosed in pediatric patients. The etiology and pathophisiology has not yet been completely clarified, and unlike adults with CSVT, management in children and neonates remains controversial. However, morbidity and mortality are significant, highlighting the continued need for high-quality studies within this field. The following review will highlight aspects of CSVT in the mediteranian area in children. PMID:21869915

  7. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula

    PubMed Central

    Sung, Kyoung-Su; Song, Young-Jin

    2016-01-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system. PMID:27446527

  8. Dural arteriovenous fistula coexisting with a lumbar lipomeningocele. Case report.

    PubMed

    Rajeev, Kariyattil; Panikar, Dilip

    2005-11-01

    The authors describe the case of a 44-year-old woman who presented with recent onset of progressive paraparesis and bladder involvement; she had an asymptomatic lumbosacral lipomatous swelling that was present since birth. Magnetic resonance imaging confirmed the diagnosis of a lipomeningocele. It also revealed intramedullary hyperintensity on T2-weighted images and serpiginous flow voids suggestive of a dural arteriovenous fistula (DAVF) at the same level; the lesion was confirmed by spinal angiography. Both lesions were surgically managed, and the patient subsequently experienced neurological improvement. The coexistence of a DAVF and a lipomeningocele at the same level is unusual and can lead to treatment failure if missed.

  9. Tentorial dural arteriovenous fistula of the medial tentorial artery.

    PubMed

    Liu, Syrone; Lee, Dane C; Tanoura, Tad

    2016-09-01

    The medial tentorial artery arises from the meningohypophyseal trunk, a branch of the cavernous internal carotid artery, and it is poorly visualized on angiography in the absence of pathologically increased blood flow. We present the case of a 38-year-old man with intraventricular hemorrhage from a tentorial dural arteriovenous fistula (DAVF) singularly supplied by a robust medial tentorial artery. Tentorial DAVFs comprise a rare but high-risk subset of DAVFs. The diagnosis was suggested by computed tomography and magnetic resonance imaging findings and confirmed with digital subtraction angiography. PMID:27594958

  10. [Cerebral venous thrombosis in minimal change nephrotic syndrome].

    PubMed

    Hirata, M; Kuroda, M; Koni, I

    1999-06-01

    A 46-year old man presented with an eight-day history of edema and was found to be nephrotic, with a plasma albumin level of 1.1 g/dl and urine protein excretion of 13.3 g/24 hrs. The level of plasma creatinine was normal at 1.0 mg/dl. A finding of renal biopsy was consistent with minimal change glomerulopathy. On the 6th hospital day, he suddenly developed a severe headache and was noted to have bilateral papilledema. Lumbar puncture revealed an opening pressure of 250 mm of water. Magnetic resonance venography showed an irregular flow in the superior sagittal sinus and right transverse sinus, a finding consistent with thrombus. The diagnosis of cerebral venous thrombosis was made, and the patient was given both Warfarin 2 mg/day and prednisolone 60 mg/day. A complete recovery from nephrotic syndrome was achieved within eight weeks. Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. The most common clinical features are renal vein thrombosis, femoral vein thrombosis, and pulmonary embolism, however, cerebral venous sinus thrombosis is rare in patients with nephrotic syndrome. It is important to be aware of this complication, since prompt treatment with anticoagulation and control of nephrotic syndrome can lead to a successful outcome.

  11. Arterial and venous coronary pressure-flow relations in anesthetized dogs. Evidence for a vascular waterfall in epicardial coronary veins.

    PubMed

    Uhlig, P N; Baer, R W; Vlahakes, G J; Hanley, F L; Messina, L M; Hoffman, J I

    1984-08-01

    The coronary circulation of anesthetized dogs was tested for the presence of vascular waterfalls by manipulating coronary arterial and coronary venous pressures. The left main coronary artery and the coronary sinus were cannulated, and relationships between coronary artery pressure, coronary sinus pressure, and coronary flow were studied. Experiments were conducted during diastolic arrests, under steady state conditions, in the absence of autoregulation. Relations of coronary flow to coronary sinus pressure at constant coronary artery pressure were consistent with the presence of a vascular waterfall in the coronary sinus. When the great cardiac vein was cannulated, relations of great vein flow to great vein pressure at constant coronary artery pressure were consistent with the presence of a vascular waterfall in the great vein, indicating that waterfall behavior can occur in epicardial veins other than the coronary sinus. In dogs on right heart bypass, with the coronary sinus and great vein uncannulated, the relationship between right atrial pressure and coronary sinus pressure showed a waterfall pattern, indicating that the waterfall is not an artifact of venous cannulation. In the right heart bypass experiments, venous waterfall behavior was seen in beating hearts as well as during diastolic arrests. We conclude that a vascular waterfall is present in epicardial coronary veins which can significantly influence coronary blood flow. PMID:6611215

  12. Arterial and venous coronary pressure-flow relations in anesthetized dogs. Evidence for a vascular waterfall in epicardial coronary veins.

    PubMed

    Uhlig, P N; Baer, R W; Vlahakes, G J; Hanley, F L; Messina, L M; Hoffman, J I

    1984-08-01

    The coronary circulation of anesthetized dogs was tested for the presence of vascular waterfalls by manipulating coronary arterial and coronary venous pressures. The left main coronary artery and the coronary sinus were cannulated, and relationships between coronary artery pressure, coronary sinus pressure, and coronary flow were studied. Experiments were conducted during diastolic arrests, under steady state conditions, in the absence of autoregulation. Relations of coronary flow to coronary sinus pressure at constant coronary artery pressure were consistent with the presence of a vascular waterfall in the coronary sinus. When the great cardiac vein was cannulated, relations of great vein flow to great vein pressure at constant coronary artery pressure were consistent with the presence of a vascular waterfall in the great vein, indicating that waterfall behavior can occur in epicardial veins other than the coronary sinus. In dogs on right heart bypass, with the coronary sinus and great vein uncannulated, the relationship between right atrial pressure and coronary sinus pressure showed a waterfall pattern, indicating that the waterfall is not an artifact of venous cannulation. In the right heart bypass experiments, venous waterfall behavior was seen in beating hearts as well as during diastolic arrests. We conclude that a vascular waterfall is present in epicardial coronary veins which can significantly influence coronary blood flow.

  13. [A case of acute intracranial epidural hematoma caused by chronic nasal sinusitis].

    PubMed

    Kihara, Kazunori; Sato, Motoki; Kado, Ken; Fukuda, Kazumasa; Nakamura, Takao; Yamakami, Iwao

    2015-01-01

    Non-traumatic intracranial acute epidural hematoma(EDH)is rare. It is mostly caused by coagulation disorders, dural metastasis, or vascular malformations of the dura. We report a case of non-traumatic acute EDH caused by chronic nasal sinusitis and review the literature comprising 10 cases of acute EDH caused by chronic nasal sinusitis. A 16-year-old boy visited our outpatient clinic with a 2-day history of severe headache. He did not have fever or neurological abnormalities and showed no evidence of head trauma. Cranial computed tomography(CT)revealed sphenoid sinusitis and a small amount of epidural air in the middle fossa, but no other intracranial abnormalities. After eight days with no subsequent history of trauma, radiological exams showed a massive acute epidural hematoma in the left middle fossa and temporal convexity without any vascular lesion or skull fracture. The patient underwent a hematoma evacuation that revealed neither a skull fracture nor a vascular abnormality. In this adolescent, chronic nasal sinusitis caused fragility of the meningeal artery wall, an air collection in the epidural space, and the detachment of the dura mater from the inner surface of the skull, thereby resulting in a non-traumatic acute EDH.

  14. Intraoperative Brain Shift Compensation: Accounting for Dural Septa

    PubMed Central

    Chen, Ishita; Coffey, Aaron M.; Ding, Siyi; Dumpuri, Prashanth; Dawant, Benoit M.; Thompson, Reid C.

    2013-01-01

    Biomechanical models that describe soft tissue deformation provide a relatively inexpensive way to correct registration errors in image-guided neurosurgical systems caused by nonrigid brain shift. Quantifying the factors that cause this deformation to sufficient precision is a challenging task. To circumvent this difficulty, atlas-based methods have been developed recently that allow for uncertainty, yet still capture the first-order effects associated with deformation. The inverse solution is driven by sparse intraoperative surface measurements, which could bias the reconstruction and affect the subsurface accuracy of the model prediction. Studies using intraoperative MR have shown that the deformation in the midline, tentorium, and contralateral hemisphere is relatively small. The dural septa act as rigid membranes supporting the brain parenchyma and compartmentalizing the brain. Accounting for these structures in models may be an important key to improving subsurface shift accuracy. A novel method to segment the tentorium cerebelli will be described, along with the procedure for modeling the dural septa. Results in seven clinical cases show a qualitative improvement in subsurface shift accuracy making the predicted deformation more congruous with previous observations in the literature. The results also suggest a considerably more important role for hyperosmotic drug modeling for the intraoperative shift correction environment. PMID:21097376

  15. 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

  16. Septic Lateral Sinus Thrombosis: Sinus Exploration Is Unnecessary

    PubMed Central

    Singh, Gautam Bir; Arora, Rubeena; Garg, Sunil; Kumar, Deepak; Ranjan, Shruti

    2016-01-01

    The algorithm of treatment of septic lateral sinus thrombosis (SLST) has undergone a paradigm shift with the understanding of the natural history of sigmoid sinus thrombosis. Thus, the recent medical literature promulgates the management of these cases with no sinus exploration. However, in view of marked paucity of literature on the cited subject, not much is known about this form of treatment. We present our experience of treating two paediatric cases of SLST with mastoid surgery and no sinus exploration: both cases had excellent recovery. Finally, conclusions are drawn in light of contemporary literature on this subject. PMID:26881164

  17. Reoperative venous access.

    PubMed

    Juno, Russell J; Knott, Andrew W; Racadio, John; Warner, Brad W

    2003-05-01

    The maintenance of long-term venous access is critical to the livelihood of children in a variety of clinical situations, especially those who are dependent on parenteral nutrition. Whereas the traditional routes of either peripheral or central venous access are initially adequate, most of these sites eventually succumb to the pitfalls associated with long-term venous access. This review provides a comprehensive and multidisciplinary approach to the management of reoperative venous access with regard to preoperative planning and imaging and specific techniques in interventional radiology and surgery.

  18. Venous insufficiency at work.

    PubMed

    Hobson, J

    1997-07-01

    Chronic venous disease of the lower limbs is one of the most common conditions affecting humankind. It has been postulated that certain workplace conditions may be risk factors for venous insufficiency and varicose veins in particular. This paper examines the evidence for a link between occupation and the prevalence of venous disease. It also reviews recent French research carried out to estimate the prevalence of chronic venous insufficiency in a working population; work and nonwork risk factor and the cost to industry from this condition are also examined. PMID:9242155

  19. 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

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

    PubMed

    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

  1. Sinusitis. A review for generalists.

    PubMed Central

    Reuler, J B; Lucas, L M; Kumar, K L

    1995-01-01

    A frequent complication of the common cold, sinusitis is one of the most prevalent problems seen in general medical and emergency department practices. In addition, nosocomial sinus infection, particularly in intensive care units, is being recognized more frequently. Decision making about managing patients with sinusitis is based primarily on the history and, to a lesser extent, the findings of the physical examination. Images Figure 2. Figure 3. PMID:7667982

  2. [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

  3. 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

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

    PubMed

    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

  5. 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.

  6. [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.

  7. 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.

  8. Pilonidal sinus disease and tuberculosis.

    PubMed

    Gupta, P J

    2012-01-01

    Pilonidal disease is a disease of young people, usually men, which can result in an abscess, draining sinus tracts, and moderate debility for some. It probably results from hair penetration beneath the skin, for reasons that are not totally clear. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, and fistulae. The infection is usually chronic and non-specific. However, few reports of granulomatous infection like tuberculosis and actinomycosis in pilonidal sinus have been observed. The presentation of tuberculosis in these sinuses may have wide forms, with atypical and uncharacteristic clinical picture, making it difficult to make a diagnosis preoperatively. This paper discusses about pilonidal sinus disease and tubercular infiltration in these sinuses. The diagnosis of tuberculosis in pilonidal sinus disease is elusive, necessitating a high index of suspicion. The literature on the tubercular affliction of pilonidal sinus is scant. Novel diagnostic modalities such as adenosine deaminase levels and polymerase chain reaction (PCR) can be useful in doubtful situations. Physicians should obtain a thorough history focusing on risk behaviors for human immunodeficiency virus infection (HIV) and tuberculosis. Treatment comprises of standard regimen of antitubercular medication and a modest surgical approach towards the sinuses. PMID:22338544

  9. Powered functional endoscopic sinus surgery.

    PubMed

    Krouse, H J; Parker, C M; Purcell, R; Krouse, J H; Christmas, D A

    1997-09-01

    The use of powered instrumentation in functional endoscopic sinus surgery has been a revolutionary development in the surgical treatment of chronic sinusitis. Several studies have demonstrated the safety, efficacy, and ease of use of this new technique. To provide support and coordinate the surgical process in powered functional endoscopic sinus surgery procedures, perioperative nurses must have an appreciation for its specific equipment handling and for appropriate patient care. This article describes a specific protocol that perioperative nurses can use to facilitate efficient and safe surgical environments for patients who undergo powered endoscopic sinus surgery procedures.

  10. Computed tomography and magnetic resonance imaging of the coronary sinus: anatomic variants and congenital anomalies.

    PubMed

    Chen, Yingming Amy; Nguyen, Elsie T; Dennie, Carole; Wald, Rachel M; Crean, Andrew M; Yoo, Shi-Joon; Jimenez-Juan, Laura

    2014-10-01

    The coronary sinus (CS) is an important vascular structure that allows for access into the coronary veins in multiple interventional cardiology procedures, including catheter ablation of arrhythmias, pacemaker implantation and retrograde cardioplegia. The success of these procedures is facilitated by the knowledge of the CS anatomy, in particular the recognition of its variants and anomalies. This pictorial essay reviews the spectrum of CS anomalies, with particular attention to the distinction between clinically benign variants and life-threatening defects. Emphasis will be placed on the important role of cardiac CT and cardiovascular magnetic resonance in providing detailed anatomic and functional information of the CS and its relationship to surrounding cardiac structures. Teaching Points • Cardiac CT and cardiovascular magnetic resonance offer 3D high-resolution mapping of the coronary sinus in pre-surgical planning.• Congenital coronary sinus enlargement occurs in the presence or absence of a left-to-right shunt.• Lack of recognition of coronary sinus anomalies can lead to adverse outcomes in cardiac procedures.• In coronary sinus ostial atresia, coronary venous drainage to the atria occurs via Thebesian or septal veins.• Coronary sinus diverticulum is a congenital outpouching of the coronary sinus and may predispose to cardiac arrhythmias.

  11. The novel anti-migraine agent rizatriptan inhibits neurogenic dural vasodilation and extravasation.

    PubMed

    Williamson, D J; Shepheard, S L; Hill, R G; Hargreaves, R J

    1997-06-01

    These studies in anaesthetised rats showed, using intravital microscopy, that the novel anti-migraine agent, rizatriptan, significantly reduced electrically stimulated dural vasodilation but had no effect on increases in dural vessel diameter produced by exogenous substance P or calcitonin gene-related peptide (CGRP). Rizatriptan also significantly inhibited dural plasma protein extravasation produced by high intensity electrical stimulation of the trigeminal ganglion. We suggest that rizatriptan inhibits the release of sensory neuropeptides from perivascular trigeminal nerves to prevent neurogenic vasodilation and extravasation in the dura mater. These prejunctional inhibitory effects may be involved in the anti-migraine action of rizatriptan. PMID:9203569

  12. Isolated deep venous thrombosis--case series, literature review and long term follow up.

    PubMed

    Kamal, Ayeesha K; Itrat, Ahmed; Shoukat, Sana; Khealani, Asumal; Kamal, Kamran

    2006-11-01

    Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are reported. Even when one patient required intubation and mechanical ventilation for stupor, both had excellent neurologic recovery. Over 6 years of follow up there has been no recurrence. In spite of stupor at presentation, complete recovery is possible without long term recurrence.

  13. Rizatriptan has central antinociceptive effects against durally evoked responses.

    PubMed

    Cumberbatch, M J; Hill, R G; Hargreaves, R J

    1997-06-01

    The 5-HT(1B/1D) receptor agonist rizatriptan constricts intracranial, extracerebral blood vessels, inhibits neurogenic vasodilation and extravasation in the meninges and is effective clinically against migraine. The present study has investigated whether rizatriptan may also have activity at 5-HT(1B/1D) receptors within the central nervous system (CNS) that contributes to its antimigraine effects. Action potentials evoked by electrical stimulation of the dura-mater were recorded extracellularly from single neurones in the trigeminal nucleus caudalis in anaesthetized rats. Rizatriptan dose dependently inhibited these nociceptive dural responses by up to 63 +/- 9% after 3 mg/kg, i.v. Rizatriptan therefore has central activity which may contribute to its efficacy against migraine headache. PMID:9203565

  14. Maxillary sinus carcinoma

    SciTech Connect

    Lee, F.; Ogura, J.H.

    1981-01-01

    Primary site control, anatomical site of failure, survival, and complications of treatment were determined in a retrospective review of primary maxillary sinus carcinoma. Sixty-one patients were treated by radiation followed by surgery and 35 by radiation alone. Primary tumor control was achieved in 69% of patients receiving combined treatment, 14% of patients treated with radiation alone, and 49% of all patients. Local control did not differ with histological type. Virtually all epidermoid and undifferentiated carcinoma recurrences occurred within 2 years, but 27% of adenocarcinomas recurred after 2 years.

  15. 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.

  16. 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.

  17. Oncocytoma of the maxillary sinus.

    PubMed

    Handler, S D; Ward, P H

    1979-03-01

    A case of oncocytoma of minor salivary gland origin of the left maxillary sinus is presented. No previous reports of oncocytoma confined entirely to the maxillary sinus were found in an extensive computerized search (Medline and Cancerline) of the world literature. The diagnosis and management of these histologically benign but locally aggressive tumors occurring in the head and neck are discussed.

  18. Case report: chronic sub-dural hematoma following high-speed ejection.

    PubMed

    Warburton, R

    1993-06-01

    This paper reports a case of chronic sub-dural hematoma occurring in a pilot after a high-speed ejection that was within the survival envelope of the Mark 10 Martin Baker ejection seat. The events leading up to the ejection, his subsequent hospitalization for treatment of immediate injuries and late development of neurological signs, 6 weeks after the ejection, are presented. (A thorough search of literature has failed to reveal any previously published account of chronic sub-dural hematoma as a post-ejection complication.) His surgical treatment, recovery, and final assessment are discussed together with the possible causes of his sub-dural hematoma. Flight surgeons should take careful note of the events in this case. Sub-dural hematoma is frequently difficult to diagnose but it should not be discounted as a potential late complication from an ejection which is within the parameters of survivability and which yields, initially, only signs of relatively minor injury. PMID:8338501

  19. [Volumetric valuation of dural sac by standard measurement on radiographs and saccoradiculographs (author's transl)].

    PubMed

    Surace, A; Balestra, R

    1979-08-01

    The Authors have planned to connect unexplained osphyalgias with dural pouch disease, through roentgenographic research. The Authors suggest a standard measurement primer to single out narrow pouches, in order to settle surgical operation.

  20. Bilateral transverse sinus thrombosis secondary to a homozygous C677T MTHFR gene mutation.

    PubMed

    Kanaan, Ziad M; Mahfouz, Rami; Taher, Ali; Sawaya, Raja A

    2008-09-01

    We describe the case of a previously healthy young man who presented with headache, diplopia, nausea, vomiting, and bilateral papilledema. Magnetic resonance venography of the brain revealed thrombosis of the right transverse sinus. Blood tests showed elevated homocysteine levels, and coagulation studies revealed a homozygous C677T mutation and a heterozygous A1298C mutation of the methylenetetrahydrofolate reductase (MTHFR) gene. The patient had no other etiology for venous thrombosis. We recommend screening patients who present with sinus thrombosis for MTHFR gene mutations. PMID:18666857

  1. Bilateral optic disc swelling as a presenting sign of superior sagittal sinus thrombosis

    PubMed Central

    Pakter, Grant Jason

    2012-01-01

    The case of a 59-year-old Caucasian man who presented with a 6-week history of intermittent blurring of vision and diplopia is reported. Fundoscopy revealed asymmetrical, bilateral optic disc swelling with peripapillary haemorrhages. An initial CT scan and D-dimer level were reported as normal. A subsequent MRI revealed a recanalising superior sagittal sinus thrombosis. Cerebral venous sinus thrombosis is a rare and potentially fatal condition. The author suggests that it should be part of the differential diagnosis of bilateral optic disc swelling and that a normal unenhanced CT scan and D-dimer would not rule out this potentially devastating condition. PMID:22987907

  2. Surgical repair of coronary sinus orifice atresia with persistent left superior vena cava in heterotaxia.

    PubMed

    Takabayashi, Shin; Shimpo, Hideto; Yokoyama, Kazuto

    2007-05-01

    A 6-month-old boy was diagnosed with coronary sinus orifice atresia, double-outlet right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and moderate common atrioventricular valve regurgitation associated with heterotaxy syndrome. Cardiac venous flow drained through a persistent left superior vena cava. We decided to perform coronary sinus orifice unroofing through the right atrium under a guide using a bougie. The persistent left superior vena cava was divided. Bidirectional Glenn anastomosis and edge-to-edge common atrioventricular valve repair were concomitantly performed. After a 1-year follow-up period, the patient is alive and well without any ischemic event.

  3. CD34 and dural fibroblasts: the relationship to solitary fibrous tumor and meningioma.

    PubMed

    Cummings, T J; Burchette, J L; McLendon, R E

    2001-10-01

    Intracranial solitary fibrous tumors (SFTs) are typically dural-based, CD34-positive neoplasms of uncertain histogenesis. We examined ten cases of meninges obtained at autopsy from patients with no history of neurological illness, head trauma, or neurosurgical intervention, and ten cases of typical meningiomas with attached dural margins not involved by tumor. All cases were immunostained with CD34. CD34 reactivity was noted in the long, thin delicate processes of dural fibroblasts preferentially located in the meningeal portion of the dura rather than the periosteal portion. No CD34 reactivity was identified in the arachnoid or pia mater, except in some endothelial cells. One supratentorial dural-based fibrous nodule and one SFT within the confines of the fourth ventricle showed strong and diffuse reactivity to CD34, bcl-2, and vimentin, and were negative for epithelial membrane antigen (EMA), S-100 protein, glial fibrillary acidic protein, smooth muscle actin, and desmin. We also describe a meningothelial meningioma within which a well circumscribed SFT-like nodule was embedded. The SFT-like nodule was strongly CD34 positive and EMA negative, and the meningioma was strongly EMA positive and CD34 negative. Fibroblasts of the dural border cell layer are attached to the underlying arachnoid, and their inclusion with arachnoidal stromal elements and pial-based tela choroidea during formation of choroid plexus interstitium may account for intraventricular SFTs. Our results suggest that SFTs and dural-based fibrous nodules derive from CD34-positive dural-based fibroblasts, and that CD34 reactivity in meningiomas may result from inclusion of dural fibroblasts within the neoplasm.

  4. Effects of Voluntary Locomotion and Calcitonin Gene-Related Peptide on the Dynamics of Single Dural Vessels in Awake Mice

    PubMed Central

    Gao, Yu-Rong

    2016-01-01

    The dura mater is a vascularized membrane surrounding the brain and is heavily innervated by sensory nerves. Our knowledge of the dural vasculature has been limited to pathological conditions, such as headaches, but little is known about the dural blood flow regulation during behavior. To better understand the dynamics of dural vessels during behavior, we used two-photon laser scanning microscopy (2PLSM) to measure the diameter changes of single dural and pial vessels in the awake mouse during voluntary locomotion. Surprisingly, we found that voluntary locomotion drove the constriction of dural vessels, and the dynamics of these constrictions could be captured with a linear convolution model. Dural vessel constrictions did not mirror the large increases in intracranial pressure (ICP) during locomotion, indicating that dural vessel constriction was not caused passively by compression. To study how behaviorally driven dynamics of dural vessels might be altered in pathological states, we injected the vasodilator calcitonin gene-related peptide (CGRP), which induces headache in humans. CGRP dilated dural, but not pial, vessels and significantly reduced spontaneous locomotion but did not block locomotion-induced constrictions in dural vessels. Sumatriptan, a drug commonly used to treat headaches, blocked the vascular and behavioral the effects of CGRP. These findings suggest that, in the awake animal, the diameters of dural vessels are regulated dynamically during behavior and during drug-induced pathological states. SIGNIFICANT STATEMENT The vasculature of the dura has been implicated in the pathophysiology of headaches, but how individual dural vessels respond during behavior, both under normal conditions and after treatment with the headache-inducing peptide calcitonin gene-related peptide (CGRP), is poorly understood. To address these issues, we imaged individual dural vessels in awake mice and found that dural vessels constricted during voluntary locomotion, and

  5. Development of a sutureless dural substitute from Bombyx mori silk fibroin.

    PubMed

    Flanagan, Kelly E; Tien, Lee W; Elia, Roberto; Wu, Julian; Kaplan, David

    2015-04-01

    Silk solvent casting, electrospinning, and electrogelation techniques were used to create a biodegradable, biocompatible silk fibroin dural substitute. The all-silk system was designed and produced to improve on currently available materials, grafts and tissue sealants used for dural closure in neurosurgery. The silk biomaterial was successfully fabricated as a dual layer adhesive system designed to seal durotomies while also functioning as a dural regeneration scaffold. The mechanical characteristics, biocompatibility, biodegradability, and hydrodynamic sealing capability of the material were evaluated. Results showed that the biomaterial was biocompatible with neural cells and fibroblasts, had mechanical properties mimicking the natural dura, was biodegradable with controllable degradation, and was able to seal against a hydrodynamic pressure of 205 mmHg, which greatly exceeds the maximum cerebrospinal fluid pressure seen in both cranial and spinal dural closures of 50 mmHg. Based on its design and experimental results, the adhesive silk dual layer composite biomaterial shows potential as a sutureless dural repair system that would improve on current dural closure techniques. PMID:24919581

  6. [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. PMID:19826982

  7. [Treatment of arterial and venous brain ischemia. Experts' recommendations: stroke management in the intensive care unit].

    PubMed

    Calvet, D; Bracard, S; Mas, J-L

    2012-06-01

    glycoprotein IIb/IIIa receptor is not recommended. Urgent anticoagulation using heparin, low-molecular-weight heparins or danaparoid with the goal to treat ischemic stroke patients is not recommended. Secondary prevention by anticoagulation can be used, immediately or within the first days, after minor ischemic stroke or TIA in patients with a high risk for cardioembolism, if uncontrolled hypertension is absent. In patients with large infarcts and a high risk for cardioembolism, the timing for initiating anticoagulation must be decided on a case-by-case basis. In patients with anticoagulation who had an ischemic stroke, the decision to temporarily stop or maintain anticoagulation must be made on a case-by-case basis, depending on thromboembolic risk, level of anticoagulation at stroke onset and estimated risk of hemorrhagic transformation. It is not recommended to use neuroprotective agents in ischemic stroke patients. Patients with cerebral venous thrombosis must be treated with therapeutic doses of heparin, even in case of concomitant intracranial hemorrhage related to cerebral venous thrombosis. If the patient's status worsens despite adequate anticoagulation, thrombolysis may be used in selected cases. The optimal administration route (local or intravenous), thrombolytic agent (urokinase or alteplase) and dose are unknown. There is currently no recommendation with regard to local thrombolytic therapy in patients with dural sinus thrombosis. Urgent blood transfusions are recommended to reduce hemoglobin S to <30% in patients with sickle cell disease and acute ischemic stroke. PMID:22647807

  8. 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

  9. Mesenteric venous thrombosis.

    PubMed

    Hmoud, Bashar; Singal, Ashwani K; Kamath, Patrick S

    2014-09-01

    Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival.

  10. 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.

  11. Internal jugular vein valve incompetence and intracranial venous anatomy in transient global amnesia

    PubMed Central

    Schreiber, S; Doepp, F; Klingebiel, R; Valdueza, J

    2005-01-01

    Background: Recently a causal relation between internal jugular vein valve incompetence (IJVVI) and transient global amnesia (TGA) has been suggested. IJVVI is postulated to provoke a transient mesiotemporal ischaemia by venous congestion. This mechanism requires a patent venous pathway from the affected IJV through the transverse sinus, confluens, straight sinus (SS), vein of Galen into the basal vein of Rosenthal and the internal cerebral veins. Objective: To study IJVVI in TGA patients in relation to the intracranial venous anatomy. Methods: IJVVI was defined if a repeated Valsalva manoeuvre (VM) led to a retrograde jugular flow detected by extracranial duplex ultrasound. Non-contrast venous MR angiography (MRA) was performed to analyse intracranial drainage patterns of the SS in relation to the side of the IJVVI. SS drainage was differentiated into three groups: predominantly right, left, and bilateral drainage. Ultrasound studies were performed in 25 TGA patients and 85 age matched controls. Twenty patients underwent venous MRA. Results: Sixty eight per cent of patients and 33% of controls showed unilateral or bilateral IJVVI (p = 0.0025). In 36% of patients a TGA preceding VM was reported. Drainage pattern of SS and side of IJVVI corresponded in five of eight patients (63%) with VM and four of 12 patients without VM (33%, p = 0.0994). Conclusion: Our study confirms the significantly higher prevalence of IJVVI in TGA patients. However, no specific IJVVI related intracranial venous drainage patterns could be found to further support the hypothesis of a direct causal relation between IJVVI and TGA. PMID:15774436

  12. [Clinical, structural-functional and haemodynamic correlates of cerebral venous blood circulation disturbances].

    PubMed

    Todua, F I; Verulashvili, I V; Kortushvili, M G; Gachechiladze, D G

    2006-01-01

    Difficulties of liquor circulation as a result of cerebrospinal fluid absorption and venous drainage of the entire intracranial space, in particular in the presence of venous system abnormalities in the forms of hypoplasia or aplasia of venous sinuses, play an essentiale role in cerebral venous dyscirculation. The symmetric character of hydrocephaly in chronic insufficiency of cerebral blood circulation and strong dependence of chronic cerebrovascular insufficiency on passive congestion suggest that the latter is characteristic of the blood supply system in whole. The MPI analysis of 120 patients revealed signs of cerebral ischemic lesions in 72% of cases, i.e. dilatation of liquor-containing spaces, multiple lacunar infarctions, especially in deep brain regions, diffusive changes of the periventricular white matter etc. Low indices of the blood flow increase during antiorthostatic loading, a trend towards decreasing of PI parameters and difficulty of blood flow in conditional insonation of intracranial veins in cases of "pseudotumorous syndrome" in patients with clinical signs of passive congestion. Venous dilatation of convexital brain areas and intensification of contrasting of direct sinus and vein of Galen were observed in venous infarctions.

  13. 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.

  14. Etiology of venous ulceration.

    PubMed

    Gourdin, F W; Smith, J G

    1993-10-01

    The etiology of venous ulceration is far more complex than Homans' theory of stagnation and hypo-oxygenation. Indeed, studies have shown that flow in lipodermatosclerotic limbs is actually faster than normal. We suggest, therefore, that the terms "stasis dermatitis" and "stasis ulcer" be dropped from medical parlance. The term "lipodermatosclerosis with ulceration" as used by the British, or simply "venous ulcer," would seem more appropriate. Venous hypertension, produced by incompetence of deep and communicating vein valves and thrombosis of segments of the deep system, is closely correlated with the development of venous ulcers. Precisely how this venous hypertension translates into ulceration is unclear. Burnand et al showed that fibrin cuffs are deposited around the capillaries in lipodermatosclerotic limbs. These cuffs may serve as barriers to the diffusion of oxygen, leading to local ischemia and epidermal necrosis. Others suggest that trapped leukocytes in the microcirculation alter capillary permeability by releasing various inflammatory mediators that hasten the flow of fibrinogen across the capillary membrane and promote the formation of fibrin cuffs. Proof of this hypothesis is still lacking, but may eventually come from using radioactive WBC tagging procedures. A synthesis of these two theories may in fact explain the etiology of venous ulceration. PMID:8211332

  15. Sinus thrombosis—do animal models really cover the clinical syndrome?

    PubMed Central

    Yenigün, Mesut; Jünemann, Martin; Gerriets, Tibo

    2015-01-01

    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. PMID:26207231

  16. Pneumocephalus associated with ethmoidal sinus osteoma--case report.

    PubMed

    Nakayama, Y; Tanaka, A; Ueno, Y; Naritomi, K; Yoshinaga, S

    1998-12-01

    A 35-year-old female suffered sudden onset of severe headache upon blowing her nose. No rhinorrhea or signs of meningeal irritation were noted. Computed tomography (CT) with bone windows clearly delineated a bony mass in the right ethmoid sinus, extending into the orbit and intracranially. Conventional CT demonstrated multiple air bubbles in the cisterns and around the mass in the right frontal skull base, suggesting that the mass was associated with entry of the air bubbles into the cranial cavity. T1- and T2-weighted magnetic resonance (MR) imaging showed a low-signal lesion that appeared to be an osteoma but did not show any air bubbles. Through a wide bilateral frontal craniotomy, the cauliflower-like osteoma was found to be protruding intracranially through the skull base and the overlying dura mater. The osteoma was removed, and the dural defect was covered with a fascia graft. Histological examination confirmed that the lesion was an osteoma. The operative procedure resolved the problem of air entry. CT is superior to MR imaging for diagnosing pneumocephalus, by providing a better assessment of bony destruction and better detection of small amounts of intracranial air.

  17. Cavernous Sinus Thrombosis in Children.

    PubMed

    Sweis, Rochelle; Biller, José

    2016-01-01

    Investigators from the Children's Hospital of Philadelphia analyzed the clinical and radiographic findings in 12 cases of cavernous sinus thrombosis (CST) seen between 2000 and 2013, and conducted a literature search and review of the pooled data. PMID:27004138

  18. Sinus Rinsing and Neti Pots

    MedlinePlus

    ... irrigate their sinuses (nose) 3-5 using contaminated tap water. If you are making a solution for irrigating, ... amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a U.S. treated public drinking water system. ...

  19. Transcatheter closure of ruptured sinus of valsalva aneurysm.

    PubMed

    Arora, Ramesh; Trehan, Vijay; Rangasetty, Uma Mahesh C; Mukhopadhyay, Saibal; Thakur, Ashish K; Kalra, G S

    2004-02-01

    Percutaneous transcatheter closure of ruptured sinus of valsalva aneurysm was attempted in eight patients between January 1995 and March 2003 as an alternative strategy to surgery as this technique at present is an accepted therapeutic modality for various intracardiac defects. The age range was 14-35 years, all were male, seven in symptomatic class III and one in class IV on medical treatment. Two-dimensional and color Doppler echocardiography revealed rupture of an aneurysm of right coronary sinus into right ventricle in five and noncoronary sinus into right atrium in three and none had associated ventricular septal defect. The echo estimated size of the defect was 7-12 mm. On cardiac catheterization left ventricular end-diastolic pressure ranged from 20 to 40 mmHg and the calculated Qp/Qs ratio was 2-3.5. In all patients the defect was crossed retrogradely from the aortic side and over an arterio-venous wire loop after balloon sizing, devices were successfully deployed by antegrade venous approach (Rashkind umbrella device in two and Amplatzer occluders in six, which included Amplatzer duct occluder in five and Amplatzer septal occluder in one). One patient who had residual shunt developed hemolysis on the next day and was taken up for reintervention. That patient continued to have intermittent hemolysis and was sent for surgical repair. On follow-up (2-96 months), there was no device embolization, infective endocarditis, and aortic regurgitation. One patient died of progressive congestive heart failure while other six are asymptomatic. These data highlight that transcatheter closure is feasible and effective, especially safe with the available Amplatzer devices. Definitely, it has the advantage of obviating open heart surgery but complete occlusion is mandatory to prevent hemolysis and infective endocarditis. PMID:15009772

  20. [Sinus tarsi syndrome: what hurts?].

    PubMed

    Herrmann, M; Pieper, K-S

    2008-02-01

    Sinus tarsi syndrome, described by O'Connor in 1958 and Brown in 1960, is a clinical finding often seen after an accident, consisting of a painful reaction to pressure on the sinus tarsi. This syndrome has also been described in dancers, volleyball and basketball players, overweight individuals, and patients with foot deformities (flatfoot). We looked for mechanical and functional macroscopic structures in the canalis and sinus tarsi that can be associated with sinus tarsi syndrome in order to deduce therapeutic consequences. We found a complex fibrous layer in the sinus and canalis tarsi that forms slips around the synovial sheats of the extensor tendons under the inferior extensor retinaculum. Both limbs run deep to the base of the sinus and canalis tarsi. The lateral band inserts into the sinus tarsi at the calcaneus, while the medial band inserts at the canalis tarsi at the talus and calcaneus. Instead of the term "interosseous ligaments," we recommend referring to the "fundiform ligament" with one lateral and one medial band. Regarding function, one can assume that the medial band of these fundiform ligaments controls the talus at eversion and inversion together with the well-vasculated and well-innervated interarticular fat pads in the sinus and canalis tarsi. While contracting the long extensor muscles of the toes, the ligament forms a control mechanism for the longitudinal arch of the foot in the moving phase.A question is how variations in vascularization or disorders in innervation will alter the turgor of the pads of fat tissue. That is, such alterations would influence the distribution of synovia in the neighboring joints as well as the tension of the involved ligaments.

  1. Sinus Balloon Dilation as Treatment for Acute Sphenoid Sinusitis with Impaired Vision for a Child.

    PubMed

    Zhao, Yin; Chen, Kangbing; Wang, Zonggui

    2016-01-01

    This paper is about sinus balloon dilatation in treatment of acute left sphenoid sinusitis with left impaired vision in a child. Balloon catheter dilatation (BCD) of the sinus ostia is a new technique. It has been shown to be a minimally invasive technique to manage chronic sinusitis. However, this method is rarely used in the treatment of acute sinusitis. So far, we know of no reported cases of sinus balloon dilatation in treatment of this case, especially for children.

  2. Recurrent psychogenic paresis after dural puncture in a parturient.

    PubMed

    Nguyen, J; Abola, R; Schabel, J

    2013-04-01

    We describe the case of a 29-year-old parturient who, after undergoing elective cesarean delivery, displayed symptoms of lower extremity weakness and sensory deficit. Her past medical history was significant for asymptomatic Arnold Chiari Type I malformation and asthma. She had received spinal anesthesia that failed to achieve an adequate surgical level requiring conversion to general anesthesia. After tracheal extubation, she exhibited bilateral leg weakness that did not resolve over the next 4-6h. An urgent magnetic resonance imaging scan revealed a normal spine with no evidence of hematoma. The lower extremity paresis persisted and a neurologist diagnosed psychogenic paresis, a type of conversion disorder. Interestingly, the patient's postoperative leg paresis was not her first occurrence of neurological dysfunction after dural puncture. At 27 weeks of gestation, she had similar lower extremity symptoms after a lumbar puncture, performed to exclude meningitis for severe headache symptoms. Psychogenic paresis is not commonly reported in the medical literature and we found no reports of psychogenic paresis after spinal anesthesia in a parturient or recurrent psychogenic paresis. We review the various risk factors, etiology, neurological signs and symptoms, types, therapy and future management of a patient with recurrent conversion disorder. PMID:23474280

  3. 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.

  4. 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.

  5. 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. PMID:25361559

  6. 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

    2014-01-01

    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. PMID:25355742

  7. A case of sinus venosus atrial septal defect misdiagnosed as primary pulmonary hypertension.

    PubMed

    Sharma, Awadhesh Kr; Nath, Ranjit Kumar; Pandit, Neeraj

    2016-01-01

    We present a case of sinus venosus atrial septal defect in a patient who was previously diagnosed as having primary pulmonary hypertension in a tertiary care center. Our findings are based on 2-dimensional trans-thoracic echocardiography, chest X-ray and surface electrocardiogram. A 26-year-old man, previously diagnosed as a case of primary pulmonary hypertension, presented to the emergency department (ED) with chest pain and breathlessness on exertion. Cardiac biomarkers were within their normal ranges. Surface electrocardiogram showed right atrial and ventricular overload with right axis deviation. Chest imaging noted enlarged central pulmonary vascularity with bilateral plethoric lung fields. Trans-thoracic echocardiography showed a dilated right atria and ventricle with severe tricuspid regurgitation and severe pulmonary artery hypertension with an intact atrial septum. Surprisingly, the transoesophageal echocardiogram revealed the presence of a sinus venous superior vena cava-type atrial septal defect with the right pulmonary vein draining into the right atria. In this full-text version, we present a more detailed discussion of sinus-venous atrial septal defect associated with partial anomalous pulmonary venous return that was wrongly diagnosed as a case of primary pulmonary hypertension in a tertiary care center. PMID:27445029

  8. Anatomical Variations of Cerebral MR Venography: Is Gender Matter?

    PubMed Central

    Singh, Rambir; Bansal, Nikhil; Paliwal, Vimal Kumar

    2016-01-01

    Purpose Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations. Materials and Methods A retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. Results A total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders. Conclusion Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders. PMID:27621945

  9. Anatomical Variations of Cerebral MR Venography: Is Gender Matter?

    PubMed Central

    Singh, Rambir; Bansal, Nikhil; Paliwal, Vimal Kumar

    2016-01-01

    Purpose Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations. Materials and Methods A retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. Results A total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders. Conclusion Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

  10. Ileofemoral venous thrombectomy.

    PubMed

    Lindhagen, J; Haglund, M; Haglund, U; Holm, J; Scherstén, T

    1978-01-01

    Twentyeight patients with ileofemoral venous thrombosis were treated surgically. Five of the patients had moderate degree of venous congestion, 18 patients had phlegmasia alba dolens and five patients had phlegmasia coerulea dolens. The mean age was 54 years, range 15-80 years, and 15 were men and 13 were women. In all cases the thrombosis was verified by phlebography. Thrombectomy was performed with a Fogarty venous thrombectomy catheter. Peroperative phlebography was used in most cases to guarantee complete extraction of thrombotic material. No operative pulmonary embolism or mortality was encountered. Postoperative continuous heparin infusion in the thrombectomized segment was used for the first week followed by dicumarol treatment. The patients were followed from 6 months to 4 years postoperatively. In two patients thrombectomy was not possible to perform. One of these patients developed a pronounced postthrombotic syndrome, the other developed venous congestion of more moderate degree. Excellent long-term time results were obtained in 82% of the patients and satisfactory in 14%. Thrombectomy is an efficient treatment of ileofemoral venous thrombosis.

  11. Cauda Equina Syndrome Associated with Dural Ectasia in Chronic Anlylosing Spondylitis

    PubMed Central

    Ha, Sang-woo

    2014-01-01

    Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review. PMID:25628815

  12. Bacterial cellulose membranes used as artificial substitutes for dural defection in rabbits.

    PubMed

    Xu, Chen; Ma, Xia; Chen, Shiwen; Tao, Meifeng; Yuan, Lutao; Jing, Yao

    2014-06-16

    To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC) was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR) and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals.

  13. Bacterial Cellulose Membranes Used as Artificial Substitutes for Dural Defection in Rabbits

    PubMed Central

    Xu, Chen; Ma, Xia; Chen, Shiwen; Tao, Meifeng; Yuan, Lutao; Jing, Yao

    2014-01-01

    To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC) was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR) and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals. PMID:24937688

  14. 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

  15. Management of venous trauma.

    PubMed

    Rich, N M

    1988-08-01

    There has been considerable interest in the management of injured extremity veins since the American experience during the Vietnam War. Fortunately, there are an increasing number of reports from civilian experience in the United States that add valuable information. Although the controversy continues, it appears that there is merit in repair of many injured lower-extremity veins, particularly the popliteal vein when it is a single return conduit, assuming that the patient's general condition will permit, in an attempt to prevent acute venous hypertension initially and chronic venous hypertension subsequently. Figure 1 identifies the recovery potential that exists even if the initial venous repair fails. In contrast to thrombosis in the arterial system, recanalization is the rule in venous thrombosis. Patent valves can exist above and below the rather localized area of thrombosis. It appears that recanalization will prevent the problems of chronic venous insufficiency. It is obvious that many patients do well for years; however, the sequelae of acute venous hypertension may be more demonstrable after 10 or 15 years. There has not been similar evidence supporting a more aggressive approach in general in upper-extremity veins. However, it should be appreciated that a return pathway must remain patent, as noted in replantation of extremities. Obviously, there are differences in military and civilian wounds, with the former usually having more extensive soft-tissue destruction and obliteration of collateral veins and lymphatic channels. Unfortunately, many civilian gunshot wounds are being seen in the United States that are similar to the military type. We must not forget the lessons of the past, and we must continue to analyze our experience in the management of injured veins under a variety of conditions.

  16. Chronic venous disease.

    PubMed

    Wolinsky, Claire D; Waldorf, Heidi

    2009-11-01

    Identifying characteristic cutaneous findings is important in determining the appropriate management of certain venous diseases. The health care provider should be familiar with the classic description of patterns and distributions of skin manifestations, such as varicose veins, stasis dermatitis, palpable cord, petechiae, and telangiectasias. In addition to the gross appearance of the skin, a skin biopsy may help elucidate a diagnosis. General treatment and prevention of the underlying venous pathology is essential. Furthermore, specific management of skin findings should include therapy to ameliorate progression of disease and symptomatology when warranted.

  17. Intraoral venous malformation with phleboliths

    PubMed Central

    Mohan, Ravi Prakash S.; Dhillon, Manu; Gill, Navneet

    2011-01-01

    The most common type of vascular malformation is the venous malformation and these are occasionally associated with phleboliths. We report a case of a 45 year old woman with intraoral venous malformation with phleboliths. PMID:24151422

  18. ACTIVATION OF TRPA1 ON DURAL AFFERENTS: A POTENTIAL MECHANISM OF HEADACHE PAIN

    PubMed Central

    Edelmayer, Rebecca M.; Le, Larry N.; Yan, Jin; Wei, Xiaomei; Nassini, Romina; Materazzi, Serena; Preti, Delia; Appendino, Giovanni; Geppetti, Pierangelo; Dodick, David W.; Vanderah, Todd W.; Porreca, Frank; Dussor, Gregory

    2012-01-01

    Activation of transient receptor potential ankyrin-1 (TRPA1) on meningeal nerve endings has been suggested to contribute to environmental irritant-induced headache but this channel may also contribute to other forms of headache such as migraine. The preclinical studies described here examined functional expression of TRPA1 on dural afferents and investigated whether activation of TRPA1 contributes to headache-like behaviors. Whole-cell patch-clamp recordings were performed in vitro using two TRPA1 agonists, mustard oil (MO) and the environmental irritant umbellulone (UMB), on dural-projecting trigeminal ganglion neurons. Application of MO and UMB to dural afferents produced TRPA1-like currents in approximately 42% and 38% of cells, respectively. Using an established in vivo behavioral model of migraine-related allodynia, dural application of MO and UMB produced robust time-related tactile facial and hindpaw allodynia that was attenuated by pretreatment with the TRPA1 antagonist HC-030031. Additionally, MO or UMB were applied to the dura and exploratory activity was monitored for 30 minutes using an automated open-field activity chamber. Dural MO and UMB decreased the number of vertical rearing episodes and the time spent rearing in comparison to vehicle treated animals. This change in activity was prevented in rats pretreated with HC-030031 as well as sumatriptan, a clinically effective anti-migraine agent. These data indicate that TRPA1 is expressed on a substantial fraction of dural afferents and activation of meningeal TRPA1 produces behaviors consistent with those seen in patients during migraine attacks. Further, they suggest that activation of meningeal TRPA1 via endogenous or exogenous mechanisms can lead to afferent signaling and headache. PMID:22809691

  19. Computed tomographic epidurography: an aid to understanding deformation of the lumbar dural sac by epidural injections.

    PubMed

    Fukushige, T; Kano, T; Sano, T; Irie, M

    1999-09-01

    Local anaesthetics injected into the epidural space may deform the dural sac to a variable degree, thereby contributing to variability in the extent of the block. We investigated deformation of the lumbar dural sac after injection into the lumbar epidural space. The subjects were 26 patients with low-back pain who underwent lumbar epidurography and computed tomographic (CT) epidurography, of whom seven also underwent myelography and computed tomographic myelography. The epidural space was entered via the sacral hiatus in 24 patients and through the L5/S1 interspace in two patients. Ten millilitres of local anaesthetic was then injected into the epidural space followed by 20 mL of contrast medium. Computed tomographic epidurography was undertaken approximately 30-min after the epidural injection at the mid-vertebral and mid-discal levels from the first lumbar through to the first sacral vertebrae. The dural sac usually showed an oval or hexagonal shape on the transverse views at the first and second lumbar vertebral levels, and the shape of an inverted triangle below the level of the third lumbar vertebra. A median line of translucency was also observed on the posteroanterior epidurographic view in 25 of the 26 patients. This line was though to be a manifestation of the dural deformation to the inverted triangle. Dural sac deformation usually shows a specific pattern, although there are individual variations. Dural deformability is an important consideration in any analysis of the spread of epidural block or of the changes of epidural pressure after epidural injection of local anaesthetics. PMID:10549463

  20. Sick sinus syndrome: a review.

    PubMed

    Semelka, Michael; Gera, Jerome; Usman, Saif

    2013-05-15

    Sick sinus syndrome refers to a collection of disorders marked by the heart's inability to perform its pacemaking function. Predominantly affecting older adults, sick sinus syndrome comprises various arrhythmias, including bradyarrhythmias with or without accompanying tachyarrhythmias. At least 50 percent of patients with sick sinus syndrome develop alternating bradycardia and tachycardia, also known as tachy-brady syndrome. Sick sinus syndrome results from intrinsic causes, or may be exacerbated or mimicked by extrinsic factors. Intrinsic causes include degenerative fibrosis, ion channel dysfunction, and remodeling of the sinoatrial node. Extrinsic factors can be pharmacologic, metabolic, or autonomic. Signs and symptoms are often subtle early on and become more obvious as the disease progresses. They are commonly related to end-organ hypoperfusion. Cerebral hypoperfusion is most common, with syncope or near-fainting occurring in about one-half of patients. Diagnosis may be challenging, and is ultimately made by electrocardiographic identification of the arrhythmia in conjunction with the presence of symptoms. If electrocardiography does not yield a diagnosis, inpatient telemetry monitoring, outpatient Holter monitoring, event monitoring, or loop monitoring may be used. Electrophysiologic studies also may be used but are not routinely needed. Treatment of sick sinus syndrome includes removing extrinsic factors, when possible, and pacemaker placement. Pacemakers do not reduce mortality, but they can decrease symptoms and improve quality of life.

  1. Diploic venous anatomy studied in-vivo by MRI.

    PubMed

    Jivraj, Khalil; Bhargava, Ravi; Aronyk, Keith; Quateen, Ahmed; Walji, Anil

    2009-04-01

    Calvarial diploic venous anatomy has been studied post-mortem, but few studies have addressed these venous structures in-vivo. Previous work in our laboratory has shown that intraosseous infusion through the skull diploic space near the diploic veins in animals and humans does access the superior sagittal sinus and the systemic venous system. We developed a volumetric method of imaging the diploic veins in-vivo using MRI, intravenous gadolinium, and digital subtraction to provide for three-dimensional depiction and exact localization of these veins. We hypothesized that this technique would allow for an assessment of the probability of existence, distribution, and concentration of diploic veins in the skull. We scanned 31 neurosurgical patients, and were able to create 3D diploic venous maps in 74% of them. These maps were processed using Adobe Photoshop CS2. Mathworks MatLab 6.5, once customized, counted the number of pixels occupied by the diploic veins in the processed image. The probability of veins was highest in the occipital regions (100%). The inferior occipital (4.1%) and posterior parietal (4.1%) regions had the highest concentrations of diploic veins. Digital subtraction venography using a volumetric MRI sequence can demonstrate the diploic veins in-vivo. The inferior occipital region may be the best area for an intraosseous infusion device because it has the greatest likelihood of containing a vein and also has the highest concentration of veins. PMID:19173254

  2. Total venous inflow occlusion in the normothermic dog: a study of haemodynamic, metabolic and neurological consequences.

    PubMed

    Hunt, G B; Malik, R; Bellenger, C R; Pearson, M R

    1992-05-01

    The acute haemodynamic and metabolic repercussions of total venous inflow occlusion were evaluated in six normal dogs, each of which underwent two four minute occlusions and one eight minute occlusion at normothermia. A further three dogs underwent a single eight minute period of occlusion and were allowed to recover from anaesthesia. Total venous inflow occlusion was well tolerated by all animals. They remained in sinus rhythm at the completion of occlusion, and unassisted haemodynamic recovery occurred rapidly. Recovery was quicker after four minutes than after eight minutes. There was no clinically detectable neurological impairment in three dogs which were allowed to recover.

  3. Mesenteric venous thrombosis.

    PubMed

    Singal, Ashwani K; Kamath, Patrick S; Tefferi, Ayalew

    2013-03-01

    The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis.

  4. Venous thrombosis - series (image)

    MedlinePlus

    Venous thrombosis can cause swelling and pain of the leg in which it forms. Large clots can also break free and travel to the heart and lungs, where they can cause cardiac arrest and sometimes death. This is called pulmonary embolism.

  5. Protected Iliofemoral Venous Thrombectomy

    PubMed Central

    Neri, Eugenio; Civeli, Letizia; Benvenuti, Antonio; Toscano, Thomas; Miraldi, Fabio; Capannini, Gianni; Muzzi, Luigi; Sassi, Carlo

    2002-01-01

    Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. Pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity. The cause was determined to be a severe protein S deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy. When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant. (Tex Heart Inst J 2002;29:130–2) PMID:12075871

  6. Sinusitis: Special Considerations for Aging Patients

    MedlinePlus

    ... Nasal crusting Vague facial pressure Decreased sense of smell and taste For the most part, sinusitis symptoms, ... to “sinus trouble”), and a decreased sense of smell and taste. However, it is a mistake to ...

  7. Sick sinus syndrome: a family study.

    PubMed

    Rogińska, Natalia; Bieganowska, Katarzyna

    2014-02-01

    A case of related individuals affected by sick sinus syndrome is presented in this study. The clinical and electrocardiographic signs of sinus node dysfunction and the most common causes of this disease are presented. Subsequently, the article includes descriptions of sinus node disease in three related children as well as details of the disease in their relatives. A literature review of the genetics of familial sinus node dysfunction concludes the study.

  8. 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.

  9. 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. PMID:26916773

  10. [Sinus node disease and atrio-ventricular disorders in pregnant women. When temporary or permanent pacing is necessary?].

    PubMed

    Kutarski, Andrzej; Polewczyk, Anna

    2015-01-01

    Sinus node disease and atrioventricularis disorders are very rarely observed in women during pregnancy. Bradyarrhythmia in pregnant women is divided into mild bradycardia connected with pressure on venous cava inferior by growing fetus, new detected AV disorders and existing before pregnancy: AV Ill degree block congenital or after surgery, sinus node disease and channelopathies. Management in bradyarrhythmia in pregnancy is very difficult, despite guidelines. Whenever possible problem should be resolved before pregnancy. When symptomatic AV III degree block with wide QRS complex escape rhythm is observed--the permanent pacing should be considered with echocardiography or electro-anatomical system using. Another option is novel temporary, prolonged pacing.

  11. Sudden hemianopsia secondary to ethmoid sinus mucocele.

    PubMed

    Morganti, Ligia; Evangelista, Leandro; Guimaraes, Roberto; Crosara, Paulo

    2014-07-01

    Paranasal sinus mucoceles are benign cystic lesions, filled with mucus, occurring due to an obstruction of involved sinus ostium. They are indolent, locally expansive, and destructive. Surgical treatment must be performed and, when done at the correct time, may prevent sequelae. We present a case of ethmoid sinus mucocele with orbit involvement and permanent optical nerve injury.

  12. Sudden Hemianopsia Secondary to Ethmoid Sinus Mucocele

    PubMed Central

    Morganti, Ligia; Evangelista, Leandro; Guimaraes, Roberto; Crosara, Paulo

    2014-01-01

    Paranasal sinus mucoceles are benign cystic lesions, filled with mucus, occurring due to an obstruction of involved sinus ostium. They are indolent, locally expansive, and destructive. Surgical treatment must be performed and, when done at the correct time, may prevent sequelae. We present a case of ethmoid sinus mucocele with orbit involvement and permanent optical nerve injury. PMID:25992113

  13. Sinus node dysfunction complicating viper bite.

    PubMed

    Agarwal, Ashish; Kumar, Tarun; Ravindranath, Khandenahally S; Bhat, Prabhavathi; Manjunath, Cholenahally N; Agarwal, Neena

    2015-02-01

    Viper venom toxicities comprise mainly bleeding disorders and nephrotoxicity. Cardiotoxicity is a rare manifestation of viper bite. We describe the case of a previously healthy 35-year-old man who developed coagulopathy and sinus node dysfunction following a viper bite. Electrocardiography showed sinus arrest and junctional escape rhythm. This is the first account of sinus node dysfunction caused by a viper bite.

  14. Venous conditions associated with pregnancy.

    PubMed

    Skudder, P A; Farrington, D T

    1993-06-01

    Pregnancy is associated with several changes in venous physiology. These include relaxation of venous wall tone and increased lower extremity venous pressure. As a result of these changes, varicose veins, spider telangiectasias, purpura, and other superficial findings may develop. Treatment of these conditions is conservative during pregnancy. As the changes in venous hemodynamics resolve over several weeks after delivery, partial or complete regression may occur. In cases where persistent abnormality persists well after delivery, more definitive therapy may be considered. Pregnancy is also associated with a mild hypercoagulable state, and there may be trauma to venous endothelium associated with delivery. Coupled with the relative stasis resulting from pelvic venous compression by the uterus and from decreases in venous tone, these changes cause an increased risk of deep vein thrombosis in late pregnancy and the peripartum period. Anticoagulation with heparin is required as coumadin and fibrinolytic agents are considered to be hazardous.

  15. Optic nerve sheath fenestration for the treatment of papilledema secondary to cerebral venous thrombosis.

    PubMed

    Murdock, Jennifer; Tzu, Jonathan H; Schatz, Norman J; Lee, Wendy W

    2014-03-01

    A 16-year-old adolescent girl with multiple risk factors for thrombosis presented with acute onset of headache, decreased vision, and papilledema. Evaluation demonstrated cerebral venous thrombosis (CVT) involving the left transverse and sigmoid sinuses and left internal jugular vein. Following bilateral optic nerve sheath fenestration (ONSF), she experienced improvement in vision and resolution of papilledema. In selected cases, ONSF is an effective surgical option for the treatment of papilledema due to CVT after medical treatment has failed. PMID:24343230

  16. 5-HT7 receptors are involved in neurogenic dural vasodilatation in an experimental model of migraine.

    PubMed

    Wang, Xiaojuan; Fang, Yannan; Liang, Jianbo; Yan, Miansheng; Hu, Rong; Pan, Xiaoping

    2014-01-01

    Neurogenic dural vasodilation has been demonstrated to play an important role in migraine. 5-HT(7) receptors have been found on trigeminal nerve endings and middle meningeal arteries and demonstrated involved in the dilatation of meningeal arteries. The aim of the present study was to demonstrate whether 5-HT(7) receptors are involved in neurogenic dural vasodilation in migraine. The neurogenic dural vasodilation model of migraine was used in this study. Unilateral electrical stimulation of dura mater was performed in anesthetized male Sprague-Dawley rats. Animals were pretreated with selective 5-HT(7) receptor agonist AS19, 5-HT(7) receptor antagonist SB269970, 5-HT1B/1D receptor agonist sumatriptan, or vehicles. Blood flow of the middle meningeal artery (MMA) was measured by a laser Doppler flowmetry. AS19 significantly increased the basal and stimulated blood flows of the middle meningeal artery following electrical stimulation of dura mater, and its effect was dose dependent at the early stage. SB269970 and sumatriptan significantly reduced the basal and stimulated blood flows of middle meningeal artery. The present study demonstrates for the first time that 5-HT(7) receptors are involved in neurogenic dural vasodilation evoked by electrical stimulation of dura mater and maybe of relevance in the pathophysiology and treatment of migraine.

  17. N-Butyl 2-Cyanoacrylate Embolization of Spinal Dural Arteriovenous Fistula

    PubMed Central

    Kwon, B.J.; Kim, T.-K.; Seo, S.I.; Kyung, J.B.; Seol, H.Y.; Han, M.H.

    2005-01-01

    Summary We report an unusual case of spinal dural arteriovenous fistula (SDAVF) presenting with subarachnoid haemorrhage (SAH). Cure was achieved with endovascular treatment with n-butyl 2-cyanoacrylate (NBCA). A review of the literature revealed five cases of cervical SDAVF that presented with SAH. None of these cases were treated with NBCA. PMID:20584439

  18. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules.

    PubMed

    Aspelund, Aleksanteri; Antila, Salli; Proulx, Steven T; Karlsen, Tine Veronica; Karaman, Sinem; Detmar, Michael; Wiig, Helge; Alitalo, Kari

    2015-06-29

    The central nervous system (CNS) is considered an organ devoid of lymphatic vasculature. Yet, part of the cerebrospinal fluid (CSF) drains into the cervical lymph nodes (LNs). The mechanism of CSF entry into the LNs has been unclear. Here we report the surprising finding of a lymphatic vessel network in the dura mater of the mouse brain. We show that dural lymphatic vessels absorb CSF from the adjacent subarachnoid space and brain interstitial fluid (ISF) via the glymphatic system. Dural lymphatic vessels transport fluid into deep cervical LNs (dcLNs) via foramina at the base of the skull. In a transgenic mouse model expressing a VEGF-C/D trap and displaying complete aplasia of the dural lymphatic vessels, macromolecule clearance from the brain was attenuated and transport from the subarachnoid space into dcLNs was abrogated. Surprisingly, brain ISF pressure and water content were unaffected. Overall, these findings indicate that the mechanism of CSF flow into the dcLNs is directly via an adjacent dural lymphatic network, which may be important for the clearance of macromolecules from the brain. Importantly, these results call for a reexamination of the role of the lymphatic system in CNS physiology and disease.

  19. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules

    PubMed Central

    Aspelund, Aleksanteri; Antila, Salli; Proulx, Steven T.; Karlsen, Tine Veronica; Karaman, Sinem; Detmar, Michael; Wiig, Helge

    2015-01-01

    The central nervous system (CNS) is considered an organ devoid of lymphatic vasculature. Yet, part of the cerebrospinal fluid (CSF) drains into the cervical lymph nodes (LNs). The mechanism of CSF entry into the LNs has been unclear. Here we report the surprising finding of a lymphatic vessel network in the dura mater of the mouse brain. We show that dural lymphatic vessels absorb CSF from the adjacent subarachnoid space and brain interstitial fluid (ISF) via the glymphatic system. Dural lymphatic vessels transport fluid into deep cervical LNs (dcLNs) via foramina at the base of the skull. In a transgenic mouse model expressing a VEGF-C/D trap and displaying complete aplasia of the dural lymphatic vessels, macromolecule clearance from the brain was attenuated and transport from the subarachnoid space into dcLNs was abrogated. Surprisingly, brain ISF pressure and water content were unaffected. Overall, these findings indicate that the mechanism of CSF flow into the dcLNs is directly via an adjacent dural lymphatic network, which may be important for the clearance of macromolecules from the brain. Importantly, these results call for a reexamination of the role of the lymphatic system in CNS physiology and disease. PMID:26077718

  20. Dural-Based Cavernoma of the Posterior Cranial Fossa Mimicking a Meningioma: A Case Report

    PubMed Central

    Cruz, Aurora S; Jeyamohan, Shiveindra; Tubbs, R. Shane; Page, Jeni; Chamiraju, Parthasarathi; Tkachenko, Lara; Rostad, Steven; Newell, David W.

    2016-01-01

    Cavernous angiomas usually occur in the parenchyma of both the supra and infratentorial compartments. At times, they can both clinically and radiologically mimic other dural-based lesions. We present a case of a patient with chronic occipital headaches, initially thought to have a meningioma, but proven to be a cavernoma with histological analysis. PMID:27190725

  1. Dural tear and myelomalacia caused by an airgun pellet in a cat

    PubMed Central

    de la Fuente, Cristian; Ródenas, Sergio; Pumarola, Martí; Añor, Sònia

    2013-01-01

    An 8-year-old cat was presented with severe neurological deficits secondary to a traumatic cervical spinal cord injury caused by an airgun pellet. This report describes, for the first time, the myelographic findings of a dural rupture in a cat and also describes a bilateral Horner’s syndrome in a cat. PMID:24155462

  2. Acute cavernous sinus syndrome from metastasis of lung cancer to sphenoid bone.

    PubMed

    Zelenak, Marianna; Doval, Mariana; Gorscak, Jason J; Cuscela, Daniel O

    2012-01-01

    Cavernous sinus syndrome is a rare entity in oncology reported only in occasional case reports. Optimal therapy is thus poorly defined with rapidly progressive disease dominating the picture. Management includes prompt diagnosis, attempts at stabilization of cranial nerve function, and aggressive control of central pain syndrome. Here, we report cavernous sinus syndrome secondary to the original squamous cell carcinoma of the lung. With common presenting causes of this syndrome being infection, thrombosis or tumor, it might seem that metastatic tumor would be expected in a patient with a cancer diagnosis. What was not so expected was the extremely rapid progression from mild headache and mild trigeminal neuralgia with negative-contrast head CT to a massive, destructive lesion involving several skull bones and skull base, only 3 weeks later. In addition, the patient was severely immunosuppressed at the completion of induction chemotherapy. Infectious processes, although unlikely, were considered, as aggressive cancer therapy (including high-dose steroids and radiation therapy) had no impact on this disease. Despite accurate localization, the aggressive nature of this disease with massive bone destruction and dural thickening limited any chance of a durable control. We discuss the process of evaluation, diagnosis and treatment of symptoms and the importance of a team approach to best palliate these unfortunate patients. PMID:22379475

  3. Facial emphysema after sinus lift.

    PubMed

    Sakakibara, Akiko; Suzuki, Hiroaki; Yamashita, Atsuya; Hasegawa, Takumi; Minamikawa, Tsutomu; Furudoi, Shungo; Komori, Takahide

    2015-01-01

    An 80-year-old man with a history of en bloc resection of squamous cell carcinoma of the hard palate (T4aN0M0) was performed a lateral-window sinus lift of the edentulous area of the left maxillary molar region to facilitate future placement of dental implants.Two hours after the surgery, the patient complained of sudden malar swelling. Marked swelling was present from the left infraorbital region to the buccal region. The swelling was associated with air pockets at the alar base and in the angulus oculi medialis region and subcutaneous malar tissue. Emphysema appeared after the patient blew his nose. Therefore, the mucous membrane of the maxillary sinus might have had a small hole, and air might have entered the subcutaneous tissue via the bone window when the air pressure in the maxillary sinus increased with nose blowing. It is important to advise patients to avoid increasing the intraoral pressure after sinus-lift procedure. PMID:26088054

  4. Complicated unroofed coronary sinus syndrome.

    PubMed

    Sarwar, Ghulam; Ahmed, Bilal; Suleman, Naeem; Khan, Ghufranullah

    2005-03-01

    A young boy planned for the surgical closure of atrial septal defect (ASD) and mitral valve regurgitation (MR) was found peroperatively as having a complete unroofed coronary sinus (URCS). Intracardiac re-routing of left superior vena cava (LSVC) and mitral valve replacement (MVR) were performed concomitantly with success. PMID:15808100

  5. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

    Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing. PMID:26076949

  6. A case of cerebral venous thrombosis presenting as acute reversible visual loss: a rarely reported association.

    PubMed

    Ray, Sayantan; Khanra, Dibbendhu; Sonthalia, Nikhil; Saha, Manjari; Talukdar, Arunansu

    2013-07-01

    Cerebral venous sinus thrombosis (CVST) is not an uncommon cause of stroke but very often unrecognized at initial presentation due to lack of clinical suspicion and thus frequently left untreated. CVST is a potentially serious condition which manifests with diverse clinical manifestations, from isolated headache to focal neurological signs and even coma. CVST usually takes place either an inherited thrombophilia or any acquired hyperviscosity state and thus prompting anticoagulation was regimen as is the cornerstone of successful treatment. We describe a 47-year-old woman who presented with recurrent bouts of vomiting in the post-operative period and later developed cortical blindness and asymmetric limb weakness. Magnetic resonance imaging (MRI) showed hyperintensity involving bilateral parieto-occipital corticomedullary junction. MR venography showed signal void in the superior sagittal sinus. She was diagnosed as CVST and achieved complete recovery with anticoagulation therapy. Bilateral occipital infarction as a consequence of cerebral venous thrombosis is a rare cause of visual loss. Thrombosis in the superior sagittal sinus was related to her cortical blindness and weakness. This case illustrates that cerebral venous thrombosis should be considered in cases of occipital vascular lesions leading to acute painless loss of vision prompting anticoagulation therapy which can improve the outcome significantly. Dehydration could be considered as a risk factor for development of CVST in appropriate situations. PMID:25206031

  7. [Prophylaxis of venous thromboembolism].

    PubMed

    Otero Candelera, Remedios; Grau Segura, Enric; Jiménez Castro, David; Uresandi Romero, Fernando; López Villalobos, José Luis; Calderón Sandubete, Enrique; Medrano Ortega, Francisco Javier; Cayuela Domínguez, Aurelio

    2008-03-01

    The recommendations on venous thromboprophylaxis have been updated on the basis of current evidence reviewed by a multidisciplinary team. The problem has been approached with regard to its relevance in both surgical and nonsurgical patients. It should be noted that these recommendations were drawn up for use in Spain and, therefore, should be implemented with the drugs and therapeutic practices authorized and generally accepted in this country.

  8. Doppler ultrasound study and venous mapping in chronic venous insufficiency.

    PubMed

    García Carriazo, M; Gómez de las Heras, C; Mármol Vázquez, P; Ramos Solís, M F

    2016-01-01

    Chronic venous insufficiency of the lower limbs is very prevalent. In recent decades, Doppler ultrasound has become the method of choice to study this condition, and it is considered essential when surgery is indicated. This article aims to establish a method for the examination, including venous mapping and preoperative marking. To this end, we review the venous anatomy of the lower limbs and the pathophysiology of chronic venous insufficiency and explain the basic hemodynamic concepts and the terminology required to elaborate a radiological report that will enable appropriate treatment planning and communication with other specialists. We briefly explain the CHIVA (the acronym for the French term "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire"=conservative hemodynamic treatment for chronic venous insufficiency) strategy, a minimally invasive surgical strategy that aims to restore correct venous hemodynamics without resecting the saphenous vein.

  9. [Odontogenic maxillary sinusitis caused by dental restoration].

    PubMed

    Sato, Kiminori

    2014-06-01

    We report herein on 5 patients with odontogenic maxillary sinusitis caused by a dental restoration (caries cutting, cavity preparation, inlay restoration). Odontogenic maxillary sinusitis was noted following dental restoration. Even though the pulp cavity and dental pulp were intact, the odontogenic maxillary sinusitis occurred caused by an apical lesion. Infection by way of the dentinal tubules was suggested to be a cause of the pathophysiology. Endoscopic sinus surgery was indicated in patients with intractable odontogenic maxillary sinusitis caused by the dental restoration. Cone-beam x-ray CT was useful for the accurate diagnosis of odontogenic maxillary sinusitis caused by a dental restoration. Physicians should thus be aware of the possibility that a tooth, which has undergone dental restoration, may cause odontogenic maxillary sinusitis.

  10. Role of opioid receptors in neurogenic dural vasodilation and sensitization of trigeminal neurones in anaesthetized rats

    PubMed Central

    Williamson, D J; Shepheard, S L; Cook, D A; Hargreaves, R J; Hill, R G; Cumberbatch, M J

    2001-01-01

    Migraine headache is thought to be caused by a distension of meningeal blood vessels, the activation of trigeminal sensory neurones and the the development of a central sensitization within the trigeminal nucleus caudalis (TNC). It has been proposed that clinically effective 5-HT1B/1D agonists act peripherally to inhibit the release of calcitonin gene-related peptide (CGRP) and neurogenic dural vasodilation, and to attenuate nociceptive neurotransmission within the TNC. Since opioids are also effective anti-migraine agents the present studies investigated the role of opioids within the trigemino-vascular system in anaesthetised rats. Electrical stimulation of the dura mater evoked neurogenic dural vasodilation which was significantly inhibited by morphine (1 mg kg−1) the selective μ-opioid agonist DAGO (10 μg kg−1) and the mixed agonist/antagonist butorphanol (1 mg kg−1) but not by the κ- and δ-opioid agonists (±) U50488H (100 μg kg−1) and DPDPE (1 mg kg−1). Morphine had no effect on CGRP-evoked dural vasodilation. In electrophysiological studies morphine (1 – 10 mg kg−1) significantly attenuated brainstem neuronal activity in response to electrical stimulation of the dura by 65% at 10 mg kg−1. Morphine (3 mg kg−1) also inhibited the TNC neuronal sensitization following CGRP-evoked dilation. The present studies have demonstrated that opioids block the nociceptive neurotransmission within the trigeminal nucleus caudalis and in addition inhibit neurogenic dural vasodilation via an action on μ-opioid receptors located on trigeminal sensory fibres innervating dural blood vessels. These peripheral and central actions are similar to those of the ‘triptan' 5-HT1B/1D agonists and could account for the anti-migraine actions of opioids. PMID:11454653

  11. Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease.

    PubMed

    De Maria, Giovanni Luigi; Kassimis, George; Raina, Tushar; Banning, Adrian P

    2016-08-15

    Coronary sinus interventions (CSI) are a class of invasive techniques (surgical and percutaneous) originally proposed in the first half of the 20th century, aiming to treat ischaemic heart disease by acting on the venous coronary system. Three main classes of CSI have been proposed and tested: (1) retroperfusion technique, (2) retroinfusion technique and (3) coronary sinus occlusion techniques. They all share the principle that a controlled increased pressure within the coronary sinus may promote a retrograde perfusion of the ischaemic myocardium with consequent cardioprotection. Development of arterial treatments including coronary aortic bypass grafting and then percutaneous coronary intervention deflected interest from interventions on the coronary venous system. However, CSI may still have a possible niche role today in specific and selected clinical contexts in which existing therapies are insufficient. In this review paper, we aim to revise the rationale for CSI, describing the details and the evidence collected so far about these techniques and to provide insights about the main clinical scenarios in which these strategies may find a contemporary application in combination or as an alternative to existing approaches.

  12. Changes in melatonin synthesis parameters after carbon monoxide concentration increase in the cavernous sinus.

    PubMed

    Romerowicz-Misielak, M; Oren, D A; Sowa-Kucma, M; Tabecka-Lonczynska, A; Gilun, P; Stefanczyk-Krzymowska, S; Koziorowski, M

    2015-08-01

    Previous studies indicate that the gaseous messenger carbon monoxide (CO) is released from the eye into the ophthalmic venous blood depending on the intensity of sunlight. This study was designed to determine whether the increased concentration of CO in ophthalmic venous blood affects the synthesis of melatonin and therefore, whether CO released from the eye under normal lighting conditions can be a carrier of light intensity information. Thirty six mature male wild boar and pig crossbreeds (n = 36) were studied. We measured the difference in the scotophase melatonin pathway response in terms of mean concentration of increased melatonin levels after 48 hours infusion of autologous blood plasma with an experimentally induced approximately 3-fold increase in the concentration of CO into the ophthalmic venous sinus. We demonstrated in this crossbreed a marked variation in the duration and amplitude of nocturnal melatonin peak in response to increased concentration of CO in ophthalmic venous blood. During the winter this treatment limited the nocturnal melatonin rise. During the summer this same experimental treatment enhanced the nocturnal melatonin rise. Changes in melatonin levels were always associated with parallel changes in AANAT protein levels. This work demonstrates that non-physiological changes in CO concentration in ophthalmic venous blood can have an acute impact on the systemic melatonin level. These results support humoral phototransduction as a mechanism for some of bright light's effects in animal chronobiology and treatment of winter seasonal affective disorder. PMID:26348075

  13. Changes in melatonin synthesis parameters after carbon monoxide concentration increase in the cavernous sinus.

    PubMed

    Romerowicz-Misielak, M; Oren, D A; Sowa-Kucma, M; Tabecka-Lonczynska, A; Gilun, P; Stefanczyk-Krzymowska, S; Koziorowski, M

    2015-08-01

    Previous studies indicate that the gaseous messenger carbon monoxide (CO) is released from the eye into the ophthalmic venous blood depending on the intensity of sunlight. This study was designed to determine whether the increased concentration of CO in ophthalmic venous blood affects the synthesis of melatonin and therefore, whether CO released from the eye under normal lighting conditions can be a carrier of light intensity information. Thirty six mature male wild boar and pig crossbreeds (n = 36) were studied. We measured the difference in the scotophase melatonin pathway response in terms of mean concentration of increased melatonin levels after 48 hours infusion of autologous blood plasma with an experimentally induced approximately 3-fold increase in the concentration of CO into the ophthalmic venous sinus. We demonstrated in this crossbreed a marked variation in the duration and amplitude of nocturnal melatonin peak in response to increased concentration of CO in ophthalmic venous blood. During the winter this treatment limited the nocturnal melatonin rise. During the summer this same experimental treatment enhanced the nocturnal melatonin rise. Changes in melatonin levels were always associated with parallel changes in AANAT protein levels. This work demonstrates that non-physiological changes in CO concentration in ophthalmic venous blood can have an acute impact on the systemic melatonin level. These results support humoral phototransduction as a mechanism for some of bright light's effects in animal chronobiology and treatment of winter seasonal affective disorder.

  14. Non-pulsatile subjective tinnitus without hearing loss may be caused by undetectable sounds originating from venous system of the brain.

    PubMed

    Bektas, Devrim; Caylan, Refik

    2008-08-01

    Tinnitus is a common otologic symptom, which can interfere with the daily activities of life. Subjective tinnitus is perception of sound only heard by the patient. The most common type of tinnitus is non-pulsatile subjective tinnitus (NST), which is believed to originate from auditory pathway, mostly from central nervous system. This hypothesis proposes that an important percentage of NST cases are actually misdiagnosed venous type tinnitus cases. Recent studies have demonstrated that dural-jugular system is dominant only in the horizontal body position. Jugular flow is at maximum during this position possibly making any noise generated within the dural-jugular system louder. As body assumes more vertical positions it gradually leaves its function to the extrajugular venous system of the brain. When there is an objective and/or a pulsating sound it is easier to suspect a vascular etiology and diagnose it clinically or radiologically. However, if a vascular pathology causes a non-pulsatile complaint that can not be heard by the examiner or can not be detected clinically or radiologically, it is bound to be misdiagnosed as central tinnitus. Most NST cases experience their symptoms especially at night. Night time usually allows the combination of silent ambience and horizontal body position to take place. We believe that in some NST cases, especially those without hearing loss (HL), the main cause of tinnitus is venous in origin.

  15. Medical management of venous ulcers.

    PubMed

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration.

  16. Beyond the sniffer: frontal sinuses in Carnivora.

    PubMed

    Curtis, Abigail A; Van Valkenburgh, Blaire

    2014-11-01

    Paranasal sinuses are some of the most poorly understood features of mammalian cranial anatomy. They are highly variable in presence and form among species, but their function is not well understood. The best-supported explanations for the function of sinuses is that they opportunistically fill mechanically unnecessary space, but that in some cases, sinuses in combination with the configuration of the frontal bone may improve skull performance by increasing skull strength and dissipating stresses more evenly. We used CT technology to investigate patterns in frontal sinus size and shape disparity among three families of carnivores: Canidae, Felidae, and Hyaenidae. We provide some of the first quantitative data on sinus morphology for these three families, and employ a novel method to quantify the relationship between three-dimensional sinus shape and skull shape. As expected, frontal sinus size and shape were more strongly correlated with frontal bone size and shape than with the morphology of the skull as a whole. However, sinus morphology was also related to allometric differences among families that are linked to biomechanical function. Our results support the hypothesis that frontal sinuses most often opportunistically fill space that is mechanically unnecessary, and they can facilitate cranial shape changes that reduce stress during feeding. Moreover, we suggest that the ability to form frontal sinuses allows species to modify skull function without compromising the performance of more functionally constrained regions such as the nasal chamber (heat/water conservation, olfaction), and braincase (housing the brain and sensory structures). PMID:25312364

  17. Beyond the sniffer: frontal sinuses in Carnivora.

    PubMed

    Curtis, Abigail A; Van Valkenburgh, Blaire

    2014-11-01

    Paranasal sinuses are some of the most poorly understood features of mammalian cranial anatomy. They are highly variable in presence and form among species, but their function is not well understood. The best-supported explanations for the function of sinuses is that they opportunistically fill mechanically unnecessary space, but that in some cases, sinuses in combination with the configuration of the frontal bone may improve skull performance by increasing skull strength and dissipating stresses more evenly. We used CT technology to investigate patterns in frontal sinus size and shape disparity among three families of carnivores: Canidae, Felidae, and Hyaenidae. We provide some of the first quantitative data on sinus morphology for these three families, and employ a novel method to quantify the relationship between three-dimensional sinus shape and skull shape. As expected, frontal sinus size and shape were more strongly correlated with frontal bone size and shape than with the morphology of the skull as a whole. However, sinus morphology was also related to allometric differences among families that are linked to biomechanical function. Our results support the hypothesis that frontal sinuses most often opportunistically fill space that is mechanically unnecessary, and they can facilitate cranial shape changes that reduce stress during feeding. Moreover, we suggest that the ability to form frontal sinuses allows species to modify skull function without compromising the performance of more functionally constrained regions such as the nasal chamber (heat/water conservation, olfaction), and braincase (housing the brain and sensory structures).

  18. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas

    SciTech Connect

    Pollock, Bruce E. . E-mail: pollock.bruce@mayo.edu; Stafford, Scott L.

    2005-08-01

    Introduction: The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. Methods: Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). Results: No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. Conclusions: Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit.

  19. Massive superior mesenteric venous aneurysm with portal venous thrombosis.

    PubMed

    Starikov, Anna; Bartolotta, Roger J

    2015-01-01

    Portal venous aneurysm is a rare and sometimes dangerous vascular pathology, which can result in thrombosis or rupture. We present the computed tomography, magnetic resonance, and sonographic imaging of a 27-year-old man with superior mesenteric venous aneurysm and subsequent thrombosis following acute pancreatitis. This multimodality imaging approach can prove useful in the evaluation of these rare aneurysms.

  20. [Big osteoma of ethmoid sinus].

    PubMed

    Peng, Ping

    2014-04-01

    Sinus osteoma is a common nasal and sinus disease, while the clinical cases of osteoma with a diameter greater than 30 millimeter are rarely seen. This paper reports a case of a 39-years-old male patient discovered with one-year long swelling pain in the right eye. The patients' right eye was mildly prominent and he suffered from hypopsia and diplopia. After CT scanned, he have ethmoid osteoma been discovered, besides, the right media rectus compression and orbital apex compression and consequent pathologically were diagnosed. The solid tumor ranged widely from the anterior skull base to the superior and interior orbital walls,and thus deprived the patient's complete surgical resection. As an attempt to prevent complications, most parts of the tumors were sur gically removed.

  1. Pollution: the nose and sinuses

    SciTech Connect

    Leopold, D.A. )

    1992-06-01

    The nose and sinuses are constantly exposed to the huge quantities of gases needed to maintain life. Not only is the human nose well-equipped to warm and humidify this inhaled air, but it is also uniquely able to clean much of it. Any material other than physiologic amounts of oxygen, nitrogen, carbon dioxide, and water that accompanies the airstream can be considered a pollutant, and this pollutant could potentially injure the individual. The following discussion will review the defense mechanisms that allow the nose and sinuses to protect the lower airways. The effects of pollutants on the respiratory mucosa will then be described, including some recent trends in those effects. These trends include specific population consequences of indoor and outdoor air pollution, and changes in risk for individuals in several occupations. Throughout these discussions, specific areas that would benefit from further research will be mentioned.68 references.

  2. Pollution: the nose and sinuses.

    PubMed

    Leopold, D A

    1992-06-01

    The nose and sinuses are constantly exposed to the huge quantities of gases needed to maintain life. Not only is the human nose well-equipped to warm and humidify this inhaled air, but it is also uniquely able to clean much of it. Any material other than physiologic amounts of oxygen, nitrogen, carbon dioxide, and water that accompanies the airstream can be considered a pollutant, and this pollutant could potentially injure the individual. The following discussion will review the defense mechanisms that allow the nose and sinuses to protect the lower airways. The effects of pollutants on the respiratory mucosa will then be described, including some recent trends in those effects. These trends include specific population consequences of indoor and outdoor air pollution, and changes in risk for individuals in several occupations. Throughout these discussions, specific areas that would benefit from further research will be mentioned.

  3. The venous drainage of the heart in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Dinç, G; Ozdemir, D

    2004-08-01

    The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae.

  4. The venous drainage of the heart in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Dinç, G; Ozdemir, D

    2004-08-01

    The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae. PMID:15239815

  5. [Endogenous venous thrombolysis].

    PubMed

    Porembskaya, O Ya; Khmelniker, S M; Shaidakov, E V

    2015-01-01

    Widely incorporated into vascular surgery pharmacological thrombolysis in treatment for deep vain thrombosis is fraught with a series of unsolved problems requiring further consideration. In spite of aggressive nature of treatment in a series of cases pharmacological thrombolysis sometimes turns out ineffective. Along with it, the results of experimental studies suggest a possibility of accelerating resorption of thrombotic masses and inhibiting remodelling of the venous wall by means of influencing effector cells of endogenous thrombolysis. A detailed study of the mechanisms of thrombolysis would make it possible to formulate strict criteria for carrying out pharmacological thrombolysis and to increase its efficacy. PMID:26355926

  6. [Travel and venous thromboembolism].

    PubMed

    Hallundbæk Mikkelsen, Kristian; Knudsen, Stine Ulrik; Nannestad Jørgensen, Lars

    2013-10-28

    A literature study on the association between travel and venous thromboembolism (VTE) is conducted. Studies examining the risk of travel-associated VTE, predisposing factors and prophylactic measures are presented. It is concluded that the absolute risk of travel-associated VTE is low and holds a 2-4 fold increase after travel. The risk increases with duration, presence of other risk factors for VTE and extremes of height. Stockings reduces the risk of asymptomatic VTE. Heparin is presumed to constitute protection whereas there is no evidence of a prophylactic effect of acetylsalicylic acid.

  7. Sinus Node and Atrial Arrhythmias.

    PubMed

    John, Roy M; Kumar, Saurabh

    2016-05-10

    Although sinus node dysfunction (SND) and atrial arrhythmias frequently coexist and interact, the putative mechanism linking the 2 remain unclear. Although SND is accompanied by atrial myocardial structural changes in the right atrium, atrial fibrillation (AF) is a disease of variable interactions between left atrial triggers and substrate most commonly of left atrial origin. Significant advances have been made in our understanding of the genetic and pathophysiologic mechanism underlying the development and progression of SND and AF. Although some patients manifest SND as a result of electric remodeling induced by periods of AF, others develop progressive atrial structural remodeling that gives rise to both conditions together. The treatment strategy will thus vary according to the predominant disease phenotype. Although catheter ablation will benefit patients with predominantly AF and secondary SND, cardiac pacing may be the mainstay of therapy for patients with predominant fibrotic atrial cardiomyopathy. This contemporary review summarizes current knowledge on sinus node pathophysiology with the broader goal of yielding insights into the complex relationship between sinus node disease and atrial arrhythmias.

  8. Venous Drainage Patterns in Carotid Cavernous Fistulas

    PubMed Central

    Aralasmak, Ayse; Karaali, Kamil; Senol, Utku; Ozdemir, Huseyin; Alkan, Alpay

    2014-01-01

    Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. PMID:24967298

  9. Comprehensive review on endonasal endoscopic sinus surgery

    PubMed Central

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  10. New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: an anatomical study.

    PubMed

    Ugur, Hasan Caglar; Dogan, Ihsan; Kahilogullari, Gokmen; Al-Beyati, Eyyub S M; Ozdemir, Mevci; Kayaci, Selim; Comert, Ayhan

    2013-01-01

    Literature defines the landmarks to identify the courses and locations of the transverse and sigmoid sinuses on the outer surface of the skull and inner surface of the scalp. These natural landmarks may only be helpful after skin incision and are inadequate to determine the length and size of the skin incision. Still, there is a need to identify palpable landmarks easily to determine the ideal location to open the initial burr hole before an operation. Twenty-eight dried adult human skulls and 2 cadavers were evaluated. The zygomatic root, the inion, and the mastoid process were identified on the external, and the grooves for sigmoid and transverse sinuses, on the internal surfaces. The distances between the 3 landmarks and the midpoints, and the shortest distances of the midpoints to the border of the groove for sigmoid sinus and groove for transverse sinus were measured. Statistically significant differences were evaluated for both sides. Based on the measurements, the defined "artificial landmarks" can be considered safe points that involve no vascular structures and may be used to perform the initial burr hole during posterolateral approaches. Identification of the midpoints and palpation of the defined landmarks easily before the operation render the study feasible and practical unlike with natural landmarks. To avoid venous injury, the midpoints of mastoid-inion line and zygomatic root-inion line can be used safely in skin incision during posterior fossa approaches and craniotomy.

  11. Peripheral venous contrast echocardiography.

    PubMed

    Seward, J B; Tajik, A J; Hagler, D J; Ritter, D G

    1977-02-01

    Contrast echocardiography is the technique of injecting various echo-producing agents into the bloodstream and, with standard echocardiographic techniques, observing the blood flow patterns as revealed by the resulting cloud of echoes. These techniques have only recently been utilized to evaluate various cardiac defects. Two physical properties of these agents characterize their usefulness: (1) clouds of echoes can be observed downstream as well as at the injection site, and (2) the echo-producing quality of these agents is completely lost with a single transit through either the pulmonary or the systemic capillary bed. Thus, detection of resultant echoes in both the venous and the arterial blood pool is indicative of abnormal shunting. In 60 patients with a spectrum of cardiac defects and a wide range in age of presentation, studies were made of (1) the feasibility of performing contrast echocardiography with superficial peripheral venous injections, and (2) the clinical usefulness of this relatively noninvasive technique in detecting and localizing intracardiac right ot left shunting. Most superficial peripheral veins could be utilized, and the resultant contrast echograms were reproducible and similar in quality to those obtained more central (caval) injections. Right to left shunts could be localized in the atrial, ventricular or intrapulmonary level. Characteristic flow patterns were also recognized for tricuspid atresia and common ventricle.

  12. Venous thrombosis in athletes.

    PubMed

    Grabowski, Gregory; Whiteside, William K; Kanwisher, Michael

    2013-02-01

    Because deep vein thrombosis (DVT) can occur following orthopaedic procedures, knowledge of hereditary and acquired risk factors for DVT is essential. Hereditary forms of thrombophilia include factor V Leiden and prothrombin G20210A mutations, and deficiencies of antithrombin III, protein C, and protein S. Acquired risk factors include but are not limited to trauma, immobilization, and surgical procedures. In general, athletes have a low risk of venous thrombosis; however, this population is exposed to many acquired thrombogenic risk factors, including hemoconcentration, trauma, immobilization, long-distance travel, and the use of oral contraceptives. Thus, orthopaedic surgeons should consider screening athletes for thrombogenic risk factors, including history of venous thrombosis, hypercoagulable disorders, or high altitude exercise, during preparticipation physicals and preoperative examinations. If a patient is determined to be at high risk of DVT, preventive measures such as physical antithrombotic measures and/or low-molecular-weight heparin should be instituted. If an athlete develops a DVT, a risk factor assessment should be conducted along with anticoagulation treatment in accordance with the American College of Chest Physicians guidelines. PMID:23378374

  13. Pathophysiology of chronic venous disease.

    PubMed

    Raffetto, J D; Mannello, F

    2014-06-01

    Chronic venous disease (CVD) is a debilitating condition with a prevalence between 60-70%. The disease pathophysiology is complex and involves genetic susceptibility and environmental factors, with individuals developing visible telengiectasias, reticular veins, and varicose veins. Patient with significant lower extremity symptoms have pain, dermal irritation, swelling, skin changes, and are at risk of developing debilitating venous ulceration. The signature of CVD is an increase in venous pressure referred to as venous hypertension. The various symptoms presenting in CVD and the clinical signs that are observed indicate that there is inflammation, secondary to venous hypertension, and it leads to a number of inflammatory pathways that become activated. The endothelium and glycocalyx via specialized receptors are critical at sensing changes in shear stress, and expression of adhesion molecules allows the activation of leukocytes leading to endothelial attachment, diapedisis, and transmigration into the venous wall/valves resulting in venous wall injury and inflammatory cells in the interstitial tissues. There is a complex of cytokines, chemokines, growth factors, proteases and proteinases, produced by activated leukocytes, that are expressed and unbalanced resulting in an environment of persistent inflammation with the clinical changes that are commonly seen, consisting of varicose veins to more advanced presentations of skin changes and venous ulceration. The structural integrity of protein and the extracellular matrix is altered, enhancing the progressive events of CVD. Work focusing on metabolic changes, miRNA regulation, inflammatory modulation and the glycocalyx will further our knowledge in the pathophysiology of CVD, and provide answers critical to treatment and prevention.

  14. Sphenoid sinus barotrauma after scuba diving.

    PubMed

    Jeong, Jin Hyeok; Kim, Kuk; Cho, Seok Hyun; Kim, Kyung Rae

    2012-01-01

    We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.

  15. Frontal sinus cholesterol granuloma: Case report

    PubMed Central

    Deep, Nicholas L.; Chaaban, Mohamad R.; Chaudhry, Ajaz L.

    2014-01-01

    A case report of a massive cholesterol granuloma (CG) of the frontal sinus in a 15-year-old male subject treated endoscopically is reported. CGs are slowly expanding, cystic lesions that are rarely observed in the frontal sinus. Frontal sinus CGs characteristically present with proptosis, diplopia, and a unilateral painless expanding mass above the orbit. Patients frequently report a history of chronic nasal obstruction or head trauma. Although the pathogenesis is unclear, it is likely multifactorial in etiology. Surgical resection via endoscopic sinus surgery has been gaining popularity because of the minimally invasive approach and lower rates of recurrence. PMID:24612824

  16. Odontogenic maxillary sinusitis obscured by midfacial trauma.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Ryškienė, Silvija; Vaitkus, Saulius

    2015-01-01

    We present a case of odontogenic maxillary sinusitis whose sinonasal symptomatology was thought to be the consequence of a previous midfacial trauma. The patient was admitted to the Clinic of Oral and Maxillofacial Surgery after more than 10 years of exacerbations of sinonasal symptoms, which began to plague soon after a facial contusion. We decided to perform CT of paranasal sinuses, and despite the absence dental symptomatology, the dental origin of sinusitis was discovered. The majority of sinonasal symptoms resolved after appropriate dental treatment, and there was no need for nasal or sinus surgery.

  17. Experimental evaluation of the net "Dallop" covered with collagen as the dural substitute.

    PubMed

    Harat, M; Radek, A; Koktysz, R; Kulig, A

    1989-01-01

    Evaluation of the usefulness of the net "Dallop" produced by Tricomed Lódź covered with collagen to the dural defects reparation was analysed. This new original product of Lódź Technical University was compared with widely used in neurosurgery "Zenoderm" produced by Ethicon and "Duratexol" produced by Czechoslovakia. The trial was conducted on 38 rabbits: 4 as a control group (just an original dura sutured after incision with Mersilk Ethicon sutures), 19 with implanted the net "Dallop" covered with collagen, 11 with the "Zenoderm" and 4 with the "Duratexol". Animals were sacrificed after 3, 14, 30 or 90 days after surgery. There were no significant differences between all analysed groups in clinical, macroscopical and morphological investigations. No negative local reactions in histopathological evaluation of the net "Dallop" covered with collagen were observed. The results of our investigations show that the net "Dallop" covered with collagen seems to be the "Zenoderm" and the "Duratexol" dural substitute.

  18. Nanofibrous Synthetic Dural Patch for Skull Base Defects: Preliminary Experience for Reconstruction after Extended Endonasal Approaches.

    PubMed

    Zenga, Francesco; Tardivo, Valentina; Pacca, Paolo; Garzaro, Massimiliano; Garbossa, Diego; Ducati, Alessandro

    2016-03-01

    Setting One of the consequences of the widespread use of endoscopic endonasal approaches (EEA) to skull base pathologies is the management of complex skull base defects. Nowadays, the gold standard is a multilayer closure that reproduces the physiological tissue barriers. Several techniques have been described in the literature; however, skull base reconstruction after EEA still represents a matter of debate, especially after extended EEA. A watertight closure is paramount to prevent cerebrospinal fluid leak and meningitis. Design Regarding this issue, we present our experience with a new synthetic dural patch, ReDura (Medprin Biotech, La Mirada, California, United States), as a subdural inlay in three patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions. Conclusions ReDura patch showed the same versatility of autologous iliotibial tract. A dural patch that easily adapts to all defects, revealed to be a useful tool for performing watertight closure, possibly in a short operative time, after endoscopic approaches. PMID:26937335

  19. Nanofibrous Synthetic Dural Patch for Skull Base Defects: Preliminary Experience for Reconstruction after Extended Endonasal Approaches

    PubMed Central

    Zenga, Francesco; Tardivo, Valentina; Pacca, Paolo; Garzaro, Massimiliano; Garbossa, Diego; Ducati, Alessandro

    2016-01-01

    Setting One of the consequences of the widespread use of endoscopic endonasal approaches (EEA) to skull base pathologies is the management of complex skull base defects. Nowadays, the gold standard is a multilayer closure that reproduces the physiological tissue barriers. Several techniques have been described in the literature; however, skull base reconstruction after EEA still represents a matter of debate, especially after extended EEA. A watertight closure is paramount to prevent cerebrospinal fluid leak and meningitis. Design Regarding this issue, we present our experience with a new synthetic dural patch, ReDura (Medprin Biotech, La Mirada, California, United States), as a subdural inlay in three patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions. Conclusions ReDura patch showed the same versatility of autologous iliotibial tract. A dural patch that easily adapts to all defects, revealed to be a useful tool for performing watertight closure, possibly in a short operative time, after endoscopic approaches. PMID:26937335

  20. Nanofibrous Synthetic Dural Patch for Skull Base Defects: Preliminary Experience for Reconstruction after Extended Endonasal Approaches.

    PubMed

    Zenga, Francesco; Tardivo, Valentina; Pacca, Paolo; Garzaro, Massimiliano; Garbossa, Diego; Ducati, Alessandro

    2016-03-01

    Setting One of the consequences of the widespread use of endoscopic endonasal approaches (EEA) to skull base pathologies is the management of complex skull base defects. Nowadays, the gold standard is a multilayer closure that reproduces the physiological tissue barriers. Several techniques have been described in the literature; however, skull base reconstruction after EEA still represents a matter of debate, especially after extended EEA. A watertight closure is paramount to prevent cerebrospinal fluid leak and meningitis. Design Regarding this issue, we present our experience with a new synthetic dural patch, ReDura (Medprin Biotech, La Mirada, California, United States), as a subdural inlay in three patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions. Conclusions ReDura patch showed the same versatility of autologous iliotibial tract. A dural patch that easily adapts to all defects, revealed to be a useful tool for performing watertight closure, possibly in a short operative time, after endoscopic approaches.

  1. Primary dural non-hodgkin's lymphoma mimicking meningioma: A case report and review of literature.

    PubMed

    Kudrimoti, Jyoti K; Gaikwad, Manish J; Puranik, Shaila C; Chugh, Ashish P

    2015-01-01

    A 42-year-old immunocompetent female presented with headache, vomiting and diminished unilateral vision. Computed tomography and magnetic resonance imaging were suggestive of high-grade meningioma. Neurological examination and routine hematological parameters were within normal limits. Craniotomy was performed; the tumor was arising from the dura mater, which was completely resected. Hematoxylin and eosin showed lesion comprising a tumor mass with monomorphic population of tumor cells arranged in sheets and small follicles. The tumor cells were immunoreactive for leukocyte common antigen and CD20 and immunonegative for glial fibrillary acid protein, epithelial membrane antigen, cytokeratin, CD3 and CD30. Rest of the body scan was normal. A diagnosis of primary dural non-Hodgkin's lymphoma was made. We report this exceedingly rare case of primary dural non-Hodgkin's lymphoma, which mimicked clinically and radiologically as meningioma. PMID:26458614

  2. Dural Metastases in Advanced Prostate Cancer: A Case Report and Review of the Literature

    PubMed Central

    Weiner, A.B.; Cortes-Mateus, S.; De Luis, E.; Durán, I.

    2014-01-01

    Dural metastases from advanced prostate cancer are considered an uncommon diagnosis. However, autopsy studies show a high association between advanced prostate cancer and metastases to the meninges. Because the overall survival of advanced prostate cancer patients is expected to improve with the advent of new therapies, the incidence of clinically relevant dural metastases from prostate cancer will likely increase. We present a case of a heavily pre-treated castration-resistant prostate cancer patient who developed metastases to the duramater. This entity should be considered in the differential diagnosis of any patient with advanced castration-resistant prostate cancer and neurological symptoms. Clinicians should also be aware of the poor prognosis and survival rates associated with the condition. PMID:24917781

  3. [Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture].

    PubMed

    Castro-Castro, J; Figueiredo-González, O; Río-Gómez, A; Carballo-Loureiro, N; Castro-Bouzas, D

    2014-01-01

    A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy.

  4. A novel equine-derived pericardium membrane for dural repair: A preliminary, short-term investigation

    PubMed Central

    Centonze, Roberto; Agostini, Emiliano; Massaccesi, Samantha; Toninelli, Stefano; Morabito, Letterio

    2016-01-01

    Background: A large variety of biological and artificial materials are employed in dural repair, each of them with major limitations. Autologous grafts have limited availability and require an additional incision and surgical time. Cadaveric preparations and heterologous materials entail the risk of iatrogenic transmission of prions, whereas synthetic substitutes have been reported to cause inflammatory reactions and graft rejection. An equine-derived pericardium membrane has been developed (Heart®, Bioteck, Vicenza, Italy) with mechanical and safety-related features that could make it suitable for neurosurgical application. Aims: This preliminary study aimed to evaluate the short-term safety and efficacy of the Heart® membrane in dural repair procedures following meningioma surgeries. Subjects and Methods: Medical records of patients who were surgically treated for an intracranial meningioma and underwent duraplasty with the Heart® membrane were reviewed retrospectively. The occurrence of any graft-related complications such as cerebrospinal fluid (CSF) leakage, postoperative hematoma, wound infection, meningitis, and neurological symptoms was analyzed. Results: Eight patients were identified as meeting the inclusion criteria. A watertight closure was achieved in all of them. Postoperatively, no patients exhibited CSF leak, cerebral contusion, hemorrhage, or wound infection. The 1-month radiological follow-up revealed no evidence of pseudomeningocele, wound breakdown, or meningitis. Neurologic complications were observed in three patients but not directly imputable to the dural substitute or its application. Conclusions: In all the patients, the pericardium membrane enabled achievement of a watertight dural closure without graft-related adverse events. Further investigations should be performed to assess medium- and long-term clinical outcomes in a larger set of patients. PMID:27366245

  5. Ferumoxytol-enhanced MRI differentiation of meningioma from dural metastases: a pilot study with immunohistochemical observations.

    PubMed

    Hamilton, Bronwyn E; Woltjer, Randall L; Prola-Netto, Joao; Nesbit, Gary M; Gahramanov, Seymur; Pham, Thao; Wagner, Jaime; Neuwelt, Edward A

    2016-09-01

    Malignant dural neoplasms are not reliably distinguished from benign dural neoplasms with contrast-enhanced magnetic resonance imaging (MRI). MRI enhancement in central nervous system (CNS) diseases imaged with ferumoxytol has been attributed to intracellular uptake in macrophages rather than vascular leakage. We compared imaging to histopathology and immunohistochemistry in meningiomas and dural metastases having ferumoxytol-enhanced MRI (FeMRI) and gadolinium-enhanced MRI (GdMRI) in order to correlate enhancement patterns to macrophage presence and vascular state. All patients having extraaxial CNS tumors were retrospectively selected from one of two ongoing FeMRI studies. Enhancement was compared between GdMRI and FeMRI. Diagnoses were confirmed histologically and/or by characteristic imaging. Tumor and vascular histology was reviewed. Immunohistochemical staining for CD68 (a macrophage marker), Connexin-43 (Cx43) (a marker of normal gap junctions), and smooth muscle actin (SMA) as a marker of vascularity, was performed in seven study cases with available tissue. Immunohistochemistry was performed on archival material from 33 subjects outside of the current study as controls: 20 WHO grade I cases of meningioma and 13 metastatic tumors. Metastases displayed marked delayed enhancement on FeMRI, similar to GdMRI. Four patients with dural metastases and one patient with meningioma showed similar enhancement on FeMRI and GdMRI. Five meningiomas with typical enhancement on GdMRI lacked enhancement on FeMRI. Enhancement on FeMRI was better associated with decreased Cx43 expression than intralesional macrophages. These pilot data suggest that FeMRI may better differentiate metastatic disease from meningiomas than GdMRI, and that differences in tumor vasculature rather than macrophage presence could underlie differences in contrast enhancement. PMID:27393348

  6. Repair of Inaccessible Ventral Dural Defect in Thoracic Spine: Double Layered Duraplasty

    PubMed Central

    Lee, Dong-Hyun; Park, Jeong-Ill; Park, Ki-Su; Cho, Dae-Chul; Sung, Joo-Kyung

    2016-01-01

    We propose a double layered (intradural and epidural patch) duraplasty that utilizes Lyoplant and Duraseal. We examined a 47-year-old woman after decompression for thoracic ossification of posterior longitudinal ligament was performed in another hospital. On postoperative day 7, she complained of weakness in both legs. Postoperative magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) collection with cord compression. In the operative field, we found 2 large dural defects on the ventral dura mater. We performed a conventional fat graft with fibrin glue. However, the patient exhibited neurologic deterioration, and a postoperative MRI again showed CSF collection. We performed dorsal midline durotomy and inserted a intradural and epidural Lyoplant patch. She immediately experienced diminishing back pain postoperatively. Her visual analog scale and motor power improved markedly. Postoperative MRIs performed at 2 and 16 months showed no spinal cord compression or CSF leakage to the epidural space. We describe a new technique for double layered duraplasty. Although we do not recommend this technique for all dural repairs, double-layered duraplasty may be useful for repairing large inaccessible dural tears in cases of persistent CSF leakage refractory to conventional management. PMID:27437022

  7. Hypoxia facilitates neurogenic dural plasma protein extravasation in mice: a novel animal model for migraine pathophysiology

    PubMed Central

    Hunfeld, Anika; Segelcke, Daniel; Bäcker, Ingo; Mecheri, Badreddine; Hemmer, Kathrin; Dlugosch, Elisabeth; Andriske, Michael; Paris, Frank; Zhu, Xinran; Lübbert, Hermann

    2015-01-01

    Migraine animal models generally mimic the onset of attacks and acute treatment processes. A guinea pig model used the application of meta-chlorophenylpiperazine (mCPP) to trigger immediate dural plasma protein extravasation (PPE) mediated by 5-HT2B receptors. This model has predictive value for antimigraine drugs but cannot explain the delayed onset of efficacy of 5-HT2B receptor antagonists when clinically used for migraine prophylaxis. We found that mCPP failed to induce dural PPE in mice. Considering the role 5-HT2B receptors play in hypoxia-induced pulmonary vessel muscularization, we were encouraged to keep mice under hypoxic conditions and tested whether this treatment will render them susceptible to mCPP-induced dural PPE. Following four-week of hypoxia, PPE, associated with increased transendothelial transport, was induced by mCPP. The effect was blocked by sumatriptan. Chronic application of 5-HT2B receptor or nitric oxide synthase blockers during hypoxia prevented the development of susceptibility. Here we present a migraine model that distinguishes between a migraine-like state (hypoxic mice) and normal, normoxic mice and mimics processes that are related to chronic activation of 5-HT2B receptors under hypoxia. It seems striking, that chronic endogenous activation of 5-HT2B receptors is crucial for the sensitization since 5-HT2B receptor antagonists have strong, albeit delayed migraine prophylactic efficacy. PMID:26644235

  8. Dural repair using autologous fat: Our experience and review of the literature

    PubMed Central

    Di Vitantonio, Hambra; De Paulis, Danilo; Del Maestro, Mattia; Ricci, Alessandro; Dechordi, Soheila Raysi; Marzi, Sara; Millimaggi, Daniele F.; Galzio, Renato J.

    2016-01-01

    Background: Various materials have been proposed to obliterate dead spaces and to reconstruct dural defects during a neurosurgical approach. This study describes our technique of using the abdominal autologous fat graft and evaluates the complications and characteristics related to the use of this tissue during cranial procedures. Methods: Autologous fat grafts were used in 296 patients with basicranial and convexity extraaxial tumors from April 2005 to January 2015. The adipose tissue was removed from the paraumbilical abdominal region and was transformed into a thin foil. When possible, a watertight suture was made between the dural or bone edge with a fat graft. We always used fibrin glue to reinforce the dural closure. Results: Complications occurred between 2 days and 1 year following procedure. Cerebrospinal fluid leaks were found in 11 cases. No case of mortality, pseudomeningoceles, fistula, infections, bacterial meningitides, or lipoid meningitides was reported. No patient required removal of the graft. No adhesion was observed between the brain and the autologous fat. Other fat-related complications observed were 2 cases of fat necrosis in the abdomen and 2 cases of abdominal hemorrhage. Conclusion: The technique of harvesting and applying fat grafts is fairly simple, although it must be performed meticulously to be effective. Our experience has led us to believe that the use of fat grafts presents low morbidity and mortality. However, a neurosurgeon should never forget the possible late or early complications related to the use of fat grafts. PMID:27500007

  9. Watertight dural closure constructed with DuraSeal TM for bypass surgery.

    PubMed

    Nishimura, Kengo; Kimura, Toshikazu; Morita, Akio

    2012-01-01

    Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is a common procedure for the treatment of cerebral ischemia and is useful for cerebral aneurysms and tumors. The STA has to pass through the dura and the dura cannot be sutured tightly around the STA to prevent vessel narrowing, so subcutaneous cerebrospinal fluid (CSF) collection is common. This study analyzed the feasibility of using a synthetic dural sealant in the STA-MCA anastomosis to establish watertight closure. Twenty-four patients underwent STA-MCA anastomosis for cerebral ischemia or cerebral aneurysm. After creation of a standard STA-MCA anastomosis, the dura was reapproximated closely, leaving a small defect around the STA. Then, DuraSeal(TM) was sprayed over the dural defect, and a negative-pressure drain was positioned before closing the skin. Only two patients developed subcutaneous CSF collection, which was managed conservatively. The patency of the anastomosis was proven by magnetic resonance angiography in all cases, and no ischemic complication suggesting chemical spasm of the STA due to the sealant occurred. With DuraSeal(TM), watertight dural closure can be obtained easily and safely in bypass surgery. PMID:22850505

  10. Large capillary hemangioma of the temporal bone with a dural tail sign: A case report.

    PubMed

    Yang, Guang; Li, Chenguang; Chen, Xin; Liu, Yaohua; Han, Dayong; Gao, Xin; Kawamoto, Keiji; Zhao, Shiguang

    2014-07-01

    The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

  11. Repair of Inaccessible Ventral Dural Defect in Thoracic Spine: Double Layered Duraplasty.

    PubMed

    Lee, Dong-Hyun; Kim, Kyoung-Tae; Park, Jeong-Ill; Park, Ki-Su; Cho, Dae-Chul; Sung, Joo-Kyung

    2016-06-01

    We propose a double layered (intradural and epidural patch) duraplasty that utilizes Lyoplant and Duraseal. We examined a 47-year-old woman after decompression for thoracic ossification of posterior longitudinal ligament was performed in another hospital. On postoperative day 7, she complained of weakness in both legs. Postoperative magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) collection with cord compression. In the operative field, we found 2 large dural defects on the ventral dura mater. We performed a conventional fat graft with fibrin glue. However, the patient exhibited neurologic deterioration, and a postoperative MRI again showed CSF collection. We performed dorsal midline durotomy and inserted a intradural and epidural Lyoplant patch. She immediately experienced diminishing back pain postoperatively. Her visual analog scale and motor power improved markedly. Postoperative MRIs performed at 2 and 16 months showed no spinal cord compression or CSF leakage to the epidural space. We describe a new technique for double layered duraplasty. Although we do not recommend this technique for all dural repairs, double-layered duraplasty may be useful for repairing large inaccessible dural tears in cases of persistent CSF leakage refractory to conventional management. PMID:27437022

  12. Junction between the great cerebral vein and the straight sinus: an anatomical, immunohistochemical, and ultrastructural study on 25 human brain cadaveric dissections.

    PubMed

    Dagain, A; Vignes, J R; Dulou, R; Dutertre, G; Delmas, J M; Guerin, J; Liguoro, D

    2008-07-01

    The cerebral venous system is poorly understood, and best appreciated under macroscopic anatomical considerations. We present an anatomical and immunohistochemical studies to better define the morphological characteristics of the junction between the great cerebral vein and the straight sinus. Twenty-five cadaveric specimens from the anatomy laboratory of the University Victor Segalen of Bordeaux were studied. The observation of the venous junctions with the straight sinus was performed under an operating microscope. The smooth muscular actin immunohistochemical staining was performed for 18 veno-sinosal junctions. Five venous junctions were observed using an electron microscope. We observed 3 different anatomic aspects: type 1 was a junction with a small elevation in its floor and a posterior thickening (14 cases); type 2 was a junction with an outgrowth on the floor like a cornice (7 cases); and type 3 was a junction presenting a nodule. Microscopic study of type 1 and 2 junctions showed a positive coloration to orceine attesting the presence of elastic fibers. Immunohistochemistry revealed the presence of smooth muscular actin and S 100 protein attesting the presence of smooth muscular fibers and nervous fibers. We observed in the ultrastructural study, a morphological progression of the endothelium. The venous orifice of the great cerebral vein into the straight sinus could be anatomically assimilated as a true "sphincter." Its function in the regulation of the cerebral blood flow needs further exploration. PMID:18470937

  13. Cross-sectional echocardiographic diagnosis of systemic venous return.

    PubMed Central

    Huhta, J C; Smallhorn, J F; Macartney, F J; Anderson, R H; de Leval, M

    1982-01-01

    To determine the sensitivity and specificity of cross-sectional echocardiography in diagnosing anomalous systemic venous return we used the technique in 800 consecutive children with congenital heart disease and whom the diagnosis was ultimately confirmed by angiography. Cross-sectional echocardiography was performed without prior knowledge of the diagnosis in all but 11 patients, who were recalled because of a known abnormality of atrial situs. The sensitivity of cross-sectional echocardiographic detection of various structures was as follows: right superior vena cava 792/792 (100%); left superior vena cava 46/48 (96%); bilateral superior vena cava 38/40 (95%); bridging innominate vein with bilateral superior vena cava 13/18 (72%); connection of superior caval segment to heart (coronary sinus or either atrium) (100%); absence of suprarenal inferior vena cava 23/23 (100%); azygos continuation of the inferior vena cava 31/33 (91%); downstream connection of azygos continuation, once seen, 21/21 (100%); partial anomalous hepatic venous connection (one hepatic vein not connected to the inferior vena cava) 1/1 (100%); total anomalous hepatic venous connection (invariably associated with left isomerism) 23/23 (100%). The specificity of each above diagnoses was 100% except in one infant with exomphalos in whom absence of the suprarenal inferior vena cava was incorrectly diagnosed. Thus cross-sectional echocardiography is an extremely specific and highly sensitive method of recognizing anomalous systemic venous return. It is therefore of great value of planning both cardiac catheterisation and cannulation for open heart surgery. Images PMID:6751361

  14. Venous Thromboembolism in Cirrhosis

    PubMed Central

    Yang, ZJ; Costa, KA; Novelli, EM; Smith, RE

    2014-01-01

    The cirrhosis population represents a unique subset of patients who are at risk for both bleeding and developing venous thrombotic embolic events (VTE). It has been commonly misunderstood that these patients are naturally protected from thrombosis by deficiencies in coagulation factors. As a result, the cirrhosis population is often falsely perceived to be ‘autoanticoagulated’. However, the concept of ‘autoanticoagulation’ conferring protection from thrombosis is a misnomer. While patients with cirrhosis may have a bleeding predisposition, not uncommonly they also experience thrombotic events. The concern for this increased bleeding risk often makes anticoagulation a difficult choice. Prophylactic and therapeutic management of VTE in patients with cirrhosis is a difficult clinical problem with the lack of clear established guidelines. The elucidation of laboratory and/or clinical predictors of VTE will be useful in this setting. This review serves to examine VTE, and the use of anticoagulation in the cirrhosis population. PMID:23076776

  15. A case of residual inferior sinus venosus defect after ineffective surgical closure

    PubMed Central

    Uga, Sayuri; Hidaka, Takayuki; Takasaki, Taiichi; Kihara, Yasuki

    2014-01-01

    A 38-year-old woman presented with cyanosis and heart failure 34 years after patch closure of an atrial septal defect and partial anomalous pulmonary venous connection. CT and cardiac catheterisation showed a residual defect that caused right-to-left shunting. The patch almost blocked the inferior vena cava from the right atrium, resulting in uncommon drainage of the inferior vena cava into the left atrium. Other anomalies included the coronary-to-pulmonary artery fistula and duplicate inferior vena cava with dilated azygos venous system. A second surgery was performed, and we confirmed an inferior sinus venosus defect, which is rare and can be misdiagnosed. The ineffective patch closure had caused a haemodynamic status that rarely occurs. We describe the diagnostic process and emphasise the importance of correctly understanding the entity. PMID:25281248

  16. Overview of venous thromboembolism.

    PubMed

    Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Rocha, Eduardo

    2010-12-14

    Thrombosis occurs at sites of injury to the vessel wall, by inflammatory processes leading to activation of platelets, platelet adherence to the vessel wall and the formation of a fibrin network. A thrombus that goes on to occlude a blood vessel is known as a thromboembolism. Venous thromboembolism begins with deep vein thrombosis (DVT), which forms in the deep veins of the leg (calf) or pelvis. In some cases, the DVT becomes detached from the vein and is transported to the right-hand side of the heart, and from there to the pulmonary arteries, giving rise to a pulmonary embolism (PE). Certain factors predispose patients toward the development of venous thromboembolism (VTE), including surgery, trauma, hospitalization, immobilization, cancer, long-haul travel, increased age, obesity, major medical illness and previous VTE; in addition, there may also be a genetic component to VTE. VTE is responsible for a substantial number of deaths per annum in Europe. Anticoagulants are the mainstay of both VTE treatment and VTE prevention, and many professional organizations have published guidelines on the appropriate use of anticoagulant therapies for VTE. Treatment of VTE aims to prevent morbidity and mortality associated with the disease, and any long-term complications such as VTE recurrence or post-thrombotic syndrome. Generally, guidelines recommend the use of low molecular weight heparins (LMWH), unfractionated heparin (UFH) or fondaparinux for the pharmacological prevention and treatment of VTE, with the duration of therapy varying according to the baseline characteristics and risk profile of the individual. Despite evidence showing that the use of anticoagulation prevents VTE, the availability of several convenient, effective anticoagulant therapies and the existence of clear guideline recommendations, thromboprophylaxis is underused, particularly in patients not undergoing surgery. Greater adherence to guideline-recommended therapies, such as LMWH, which can be

  17. Hyperhomocysteinaemia and chronic venous ulcers.

    PubMed

    de Franciscis, Stefano; De Sarro, Giovambattista; Longo, Paola; Buffone, Gianluca; Molinari, Vincenzo; Stillitano, Domenico M; Gallelli, Luca; Serra, Raffaele

    2015-02-01

    Chronic venous ulceration (CVU) is the major cause of chronic wounds of lower extremities, and is a part of the complex of chronic venous disease. Previous studies have hypothesised that several thrombophilic factors, such as hyperhomocysteinaemia (HHcy), may be associated with chronic venous ulcers. In this study, we evaluated the prevalence of HHcy in patients with venous leg ulcers and the effect of folic acid therapy on wound healing. Eighty-seven patients with venous leg ulcers were enrolled in this study to calculate the prevalence of HHcy in this population. All patients underwent basic treatment for venous ulcer (compression therapy ± surgical procedures). Patients with HHcy (group A) received basic treatment and administered folic acid (1·2 mg/day for 12 months) and patients without HHcy (group B) received only basic treatment. Healing was assessed by means of computerised planimetry analysis. The prevalence of HHcy among patients with chronic venous ulcer enrolled in this study was 62·06%. Healing rate was significantly higher (P < 0·05) in group A patients (78·75%) compared with group B patients (63·33%). This study suggests a close association, statistically significant, between HHcy and CVU. Homocysteine-lowering therapy with folic acid seems to expedite wound healing. Despite these aspects, the exact molecular mechanisms between homocysteine and CVU have not been clearly defined and further studies are needed.

  18. Hemostasis in Endoscopic Sinus Surgery.

    PubMed

    Pant, Harshita

    2016-06-01

    Intraoperative bleeding during endoscopic sinus surgery poses an additional dimension to an already technically challenging surgical approach because of the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments. Poor visualization is one of the most important factors that increase the risk of intraoperative complications such as inadvertent injury to major vessels and nerves, and incomplete surgery. This article provide a logical approach to improving the surgical field, minimizing risk of inadvertent vascular injury, and managing intraoperative bleeding. PMID:27267017

  19. Thrombophilia and chronic venous ulceration.

    PubMed

    Bradbury, A W; MacKenzie, R K; Burns, P; Fegan, C

    2002-08-01

    It is known that thrombophilia (TP) is a risk factor for deep venous thrombosis (DVT), and that DVT predisposes to chronic venous ulceration (CVU). However, the relationship between TP and CVU has not been well studied. Review of the literature reveals that the prevalence of TP in CVU patients is high--similar to the prevalence found in patients with a history of DVT. This is despite many patients with CVU having no clear history, or duplex evidence of previous DVT. TP may predispose to CVU by leading to macro- or micro-vascular thrombosis. This association raises several issues regarding the investigation, prevention and management of patients with venous disease.

  20. Sinus node dysfunction: recognition and treatment.

    PubMed

    Rusk, Karla; Scordo, Kristine

    2012-12-10

    Sinus node dysfunction (SND) refers to a wide range of abnormalities involving sinus node and atrial impulse generation and propagation. SND occurs at any age and is commonly encountered in clinical practice. Clinicians must be able to accurately diagnose this syndrome, which can present from asymptomatic bradycardia to atrial standstill.

  1. Congenital midline sinus of the upper lip.

    PubMed

    Al-Qattan, M M

    2000-01-01

    A rare case of congenital midline sinus of the upper lip is presented. The patient had recurrent cellulitis with swelling at the base of the medial crus of the right lower lateral cartilage. Excision was performed using the intraoral approach. Theories concerning the etiology of the midline sinus of the upper lip are discussed. PMID:10651370

  2. A Case of Arterial and Venous Tear during Single Lead Extraction.

    PubMed

    Green, Michael S; Wu, Daniel; Patel, Vishal; Tariq, Rayhan

    2016-01-01

    Transcutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extraction of a 6-year-old implantable cardioverter-defibrillator lead due to fracture from insulation break. During the lead extraction, blood pressure fell precipitously and echocardiographic findings were consistent with pericardial effusion. After unsuccessful pericardiocentesis, open chest sternotomy and evacuation of hematoma was performed. Subsequent surgical repair of several injuries was completed including the distal coronary sinus, a large degloving injury of posterior portion of the heart, and first obtuse marginal branch bleed. This case demonstrates that when performing transcutaneous lead extraction (TLE) with laser sheath, a degloving injury can cause arterial rupture with concomitant coronary sinus injury. A multidisciplinary team-based approach can ensure patient safety. Learning Objective. Implantable cardioverter-defibrillator leads will falter over time. With the advancement of new technology for extraction more frequent and serious complications will occur. Active fixation CS leads present unique challenges. In the presence of hemodynamic changes during extraction the occurrence of both an arterial and venous injury must be considered. PMID:27195154

  3. 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.

  4. Inflammation in chronic venous ulcers.

    PubMed

    Raffetto, J D

    2013-03-01

    Chronic venous ulcers (CVUs) occur in approximately 1% of the general population. Risk factors for chronic venous disease (CVD) include heredity, age, female sex and obesity. Although not restricted to the elderly, the prevalence of CVD, especially leg ulcers, increases with age. CVD has a considerable impact on health-care resources. It has been estimated that venous ulcers cause the loss of approximately two million working days and incur treatment costs of approximately $3 billion per year in the USA. Overall, CVD has been estimated to account for 1-3% of the total health-care budgets in countries with developed health-care systems. The pathophysiology of dermal abnormalities in CVU is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in microcirculation, cytokine and matrix metalloproteinase (MMP) activation, resulting in altered cellular function and delayed wound healing.

  5. Venous Thromboembolism and Marathon Athletes

    MedlinePlus

    ... Heart Association Cardiology Patient Page Venous Thromboembolism and Marathon Athletes Claire M. Hull and Julia A. Harris ... general adult population are indisputable. However, for the marathon athlete who trains intensively and for long periods ...

  6. Biologically inert synthetic dural substitutes. Appraisal of a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer.

    PubMed

    Sakas, D E; Charnvises, K; Borges, L F; Zervas, N T

    1990-12-01

    Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.

  7. Understanding Guyton's venous return curves

    PubMed Central

    Feigl, Eric O.

    2011-01-01

    Based on observations that as cardiac output (as determined by an artificial pump) was experimentally increased the right atrial pressure decreased, Arthur Guyton and coworkers proposed an interpretation that right atrial pressure represents a back pressure restricting venous return (equal to cardiac output in steady state). The idea that right atrial pressure is a back pressure limiting cardiac output and the associated idea that “venous recoil” does work to produce flow have confused physiologists and clinicians for decades because Guyton's interpretation interchanges independent and dependent variables. Here Guyton's model and data are reanalyzed to clarify the role of arterial and right atrial pressures and cardiac output and to clearly delineate that cardiac output is the independent (causal) variable in the experiments. Guyton's original mathematical model is used with his data to show that a simultaneous increase in arterial pressure and decrease in right atrial pressure with increasing cardiac output is due to a blood volume shift into the systemic arterial circulation from the systemic venous circulation. This is because Guyton's model assumes a constant blood volume in the systemic circulation. The increase in right atrial pressure observed when cardiac output decreases in a closed circulation with constant resistance and capacitance is due to the redistribution of blood volume and not because right atrial pressure limits venous return. Because Guyton's venous return curves have generated much confusion and little clarity, we suggest that the concept and previous interpretations of venous return be removed from educational materials. PMID:21666119

  8. Sinusitis

    MedlinePlus

    ... Treatments include antibiotics, decongestants, and pain relievers. Using heat pads on the inflamed area, saline nasal sprays, and vaporizers can also help. NIH: National Institute of Allergy and Infectious Diseases

  9. Sinusitis

    MedlinePlus

    ... rhinitis or hay fever Cystic fibrosis Going to day care Diseases that prevent the cilia from working properly Changes in altitude (flying or scuba diving) Large adenoids Smoking Weakened immune system from HIV or chemotherapy

  10. Presentation of Preauricular Sinus and Preauricular Sinus Abscess in Southwest Nigeria

    PubMed Central

    Adegbiji, W. A.; Alabi, B. S.; Olajuyin, O. A.; Nwawolo, C. C.

    2013-01-01

    BACKGROUND AND AIM: Preauricular sinus abscess is a common congenital external ear disease. This abscess is usually misdiagnosed because it is commonly overlooked during physical examination. In Nigeria, the prevalence was 9.3% in Ilorin, north central Nigeria This study is to determine the distribution and clinical presentation of the preauricular sinus abscess in Ekiti, south west Nigeria. MATERIALS AND METHODS: This is a prospective hospital based study of all patients with diagnosis of preauricular sinus abscess seen in our clinic carried out between April 2008 to March 2010. Detailed clinical history, administered interviewer’s assisted questionnaires full examination and. Data obtained were collated and analysed. RESULTS: Preauricular sinus were noticed in 184 (4.4%) out of 4170 patients seen during the study period. Preauricular sinus abscess were noticed in 21 (11.4%) of the preauricular sinuses especially in children. Unilateral preauricular sinus abscess accounted for 90.5%. Common presenting complaints were preauricular swelling (81.0%), 90.5% with recurrent earaches, 76.2% with ear discharges. All patients had antibiotic / analgesic while 17 out of 21 (81.0%) had surgical excisions. CONCLUSION: Preauricular sinus abscess were noticed among 11.4% of the preauricular sinuses especially in children, unilateral preauricular sinus abscess accounted for 90.5%. Common complaints were otorrhoea, earaches, and swelling and they were mostly managed surgically. PMID:24711764

  11. Transcrestal sinus lift and implant placement using the sinus balloon technique

    PubMed Central

    Galán-Gil, Sónnica; Carrillo-García, Celia; Peñarrocha-Diago, David; Peñarrocha-Diago, Miguel

    2012-01-01

    Objective: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Material and method: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. Results: One patient was excluded due to Schneider’s membrane perforation as confirmed by endoscopy. Trans-crestal sinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100%. Conclusions: Transcrestal sinus lift using the sinus balloon technique is a minimally invasive procedure. In 5 patients the bone height gained proved sufficient to allow implant placement even in the presence of 3 mm of residual bone. Key words: Sinus lift, balloon, sinus complications. PMID:22157670

  12. [Frontal sinus osteomas: neuro-ophthalmological complications].

    PubMed

    Bourgeois, P; Fichten, A; Louis, E; Vincent, C; Pertuzon, B; Assaker, R

    2002-05-01

    Osteomas are the most frequent benign tumors of the paranasal sinuses. They often grow in the frontal sinus near the nasofrontal duct. They remain frequently asymptomatic and they tend to be an incidental finding on radiographic studies. Rarely, they extend out of the sinus limits. Two cases with neuro-ophthalmological complications are reported and discussed. A 19-year-old female presented with a progressive left visual impairment and orbital bone deformity. A CT-scan revealed a large calcified mass in both frontal sinuses, with left intraorbital and frontobasal extension. A 21-year-old man suffered from acute frontoethmoidal sinusitis. Radiological exams revealed a right frontal sinus osteoma with bilateral nasofrontal ducts obstruction. The frontal sinus cavities were filled with a large mucocele with intracranial extension. Both patients were successfully treated using frontobasal craniotomy with complete osteoma and mucocele removal and cranio facial bone reconstruction. Neuro-ophthalmological or intrasinusal complications of osteomas lead to radical treatment. CT-scan and MRI analysis for surgical purpose and strategy are emphased.

  13. In situ precise electrospinning of medical glue fibers as nonsuture dural repair with high sealing capability and flexibility

    PubMed Central

    Lv, Fu-Yan; Dong, Rui-Hua; Li, Zhao-Jian; Qin, Chong-Chong; Yan, Xu; He, Xiao-Xiao; Zhou, Yu; Yan, Shi-Ying; Long, Yun-Ze

    2016-01-01

    Purpose In this work, we propose an in situ precise electrospinning of medical glue fibers onto dural wound for improving sealing capability, avoiding tissue adhesion, and saving time in dural repair. Methods N-octyl-2-cyanoacrylate, a commercial tissue adhesive (medical glue), can be electrospun into ultrathin fibrous film with precise and homogeneous deposition by a gas-assisted electrospinning device. Results The self-assembled N-octyl-2-cyanoacrylate film shows high compactness and flexibility owing to its fibrous structure. Simulation experiments on egg membranes and goat meninges demonstrated that this technology can repair small membrane defects quickly and efficiently. Conclusion This method may have potential application in dural repair, for example, working as an effective supplementary technique for conventional dura suture.

  14. In situ precise electrospinning of medical glue fibers as nonsuture dural repair with high sealing capability and flexibility

    PubMed Central

    Lv, Fu-Yan; Dong, Rui-Hua; Li, Zhao-Jian; Qin, Chong-Chong; Yan, Xu; He, Xiao-Xiao; Zhou, Yu; Yan, Shi-Ying; Long, Yun-Ze

    2016-01-01

    Purpose In this work, we propose an in situ precise electrospinning of medical glue fibers onto dural wound for improving sealing capability, avoiding tissue adhesion, and saving time in dural repair. Methods N-octyl-2-cyanoacrylate, a commercial tissue adhesive (medical glue), can be electrospun into ultrathin fibrous film with precise and homogeneous deposition by a gas-assisted electrospinning device. Results The self-assembled N-octyl-2-cyanoacrylate film shows high compactness and flexibility owing to its fibrous structure. Simulation experiments on egg membranes and goat meninges demonstrated that this technology can repair small membrane defects quickly and efficiently. Conclusion This method may have potential application in dural repair, for example, working as an effective supplementary technique for conventional dura suture. PMID:27621616

  15. Mucoceles of the maxillary sinus.

    PubMed

    Gardner, D G; Gullane, P J

    1986-11-01

    Antral mucoceles are a separate entity that must be distinguished from the common, dome-shaped lesions of the floor of the sinus that are also often, although inaccurately, referred to as mucoceles. The latter lesions are known by a variety of names, including pseudocysts, and are innocuous. True antral mucoceles are potentially destructive lesions that are often secondary to trauma, especially the Caldwell-Luc procedure. This article describes in some detail the clinical, radiologic, and histopathologic features of true antral mucoceles. One type of antral mucocele, commonly seen in Japan, is referred to as a postoperative maxillary cyst and is identical to the surgical ciliated cyst of the maxilla originally reported by Gregory and Shafer.

  16. Sinus histiocytosis with massive lymphadenopathy.

    PubMed

    Foucar, E; Rosai, J; Dorfman, R F

    1978-12-01

    Sinus histiocytosis with massive lymphadenopathy (SHML) is a newly recognized, distinct, pseudolymphomatous benign entity with very characteristic microscopic features. Most patients are children or young adults with massive painless cervical adenopathy, although other node groups and extranodal sites often are involved. Sixteen patients with SHML involving the upper respiratory tract and/ or salivary gland are presented. Nine of the patients had ear, nose, and throat (ENT) manifestations at the time of presentation. In most cases the ENT involvement resulted in prominent clinical symptoms. Treatment included surgery, antibiotics, irradiation, chemotherapy, and steroids, frequently in combination, but no consistent pattern of response emerged from the study. These 16 patients were very similar clinically to patients with SHML who did not have ENT disease, indicating that extranodal involvement is not associated with more aggressive disease.

  17. Anomalies of cardiac venous drainage associated with abnormalities of cardiac conduction system.

    PubMed

    Morgan, D R; Hanratty, C G; Dixon, L J; Trimble, M; O'Keeffe, D B

    2002-07-01

    The embryological development of the superior vena cava (SVC) is complex. If the left common cardinal vein fails to occlude it can, along with the left duct of Cuvier form a left SVC, which frequently drains into the coronary sinus. This may result in abnormalities in the anatomy of this structure. A persistent left SVC occurs in 0.5% of the normal population, and 3% to 4.3% of patients with congenital heart anomalies. The pacemaking tissue of the heart is derived from two sites near the progenitors of the superior vena cava. The right-sided site forms the sinoatrial node, the left-sided site is normally carried down to an area near the coronary sinus. Out of 300 patients with cardiac rhythm abnormalities, who have undergone electrophysiological studies (EPS), or permanent pacemaker insertion (PPI), we identified 12 patients with cardiac conduction abnormalities and anomalies of venous drainage. Anomalies of the coronary sinus may be associated with abnormalities of the conduction system of the heart. This may be due to the close proximity of the coronary sinus to the final position of the left-sided primitive pacemaking tissue. In our series of 300 patients, 4% had an associated left SVC, a similar incidence to that found in previous studies of congenital heart disease.

  18. Isolated sphenoid sinus lesion: A diagnostic dilemma

    PubMed Central

    Alazzawi, Sarmad; Shahrizal, Tengku; Prepageran, Narayanan; Pailoor, Jayalakshmi

    2014-01-01

    Isolated sphenoid sinus lesions are an uncommon entity and present with non-specific symptoms. In this case report, the patient presented with a history of headaches for a duration of one month without sinonasal symptoms. A computed tomography scan showed a soft tissue mass occupying the sphenoid sinus. An endoscopic biopsy revealed fungal infection. Endoscopic wide sphenoidotomy with excision of the sphenoid sinus lesion was then performed however, the microbiological examination post-surgery did not show any fungal elements. Instead, Citrobacter species was implicated to be the cause of infection. PMID:25320694

  19. [Aggressive fibromatosis of the frontal sinus].

    PubMed

    Jensen, Søren Gade; Krogdahl, Annelise; Godballe, Christian

    2009-01-26

    Aggressive fibromatosis (AF) is a benign tumour with expansive and locally invasive growth. It is very rarely seen in the head and neck area. We present a 52-year-old female patient with AF localized to the left frontal sinus. The condition was initially mistaken for chronic sinusitis however computed tomography indicated tumour. A biopsy showed AF and the patient received surgical treatment. Symptoms, signs and treatment are discussed. It is concluded that AF in the sino-nasal tract is a rare, but potentially life threatening condition which might be mistaken for a simple sinusitis. PMID:19176167

  20. Coronary Sinus to Left Atrial Communication

    PubMed Central

    Scheller, Vandhana; Mazur, Wojciech; Kong, James; Chung, Eugene S.

    2009-01-01

    Congenital coronary sinus anomalies are rare in clinical practice, partly due to the lack of symptoms. We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia. In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation. In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA). PMID:19730747

  1. Management of the entered frontal sinus.

    PubMed

    Caroli, Emanuela; Rocchi, Giovanni; D'Andrea, Giancarlo; Delfini, Roberto

    2004-10-01

    The opening of the frontal sinus is a common occurrence in surgical practice. It may involve many surgical disciplines. The complications that may derive from incorrect treatment of an opened frontal sinus are potentially fatal. Unfortunately, the treatment of patients with injured frontal sinus is not uniform and standardized. Here, we describe our technique of treatment. We propose our treatment modality on the basis of our personal experience, which has been excellent in the past 20 years, that is from the time of the technique's introduction and routine application.

  2. Effects of anesthesia with isoflurane on plasma concentrations of adrenocorticotropic hormone in samples obtained from the cavernous sinus and jugular vein of horses.

    PubMed

    Carmalt, James L; Duke-Novakovski, Tanya; Schott, Harold C; van der Kolk, Johannes H

    2016-07-01

    OBJECTIVE To determine effects of anesthesia on plasma concentrations and pulsatility of ACTH in samples obtained from the cavernous sinus and jugular vein of horses. ANIMALS 6 clinically normal adult horses. PROCEDURES Catheters were placed in a jugular vein and into the cavernous sinus via a superficial facial vein. The following morning (day 1), cavernous sinus blood samples were collected every 5 minutes for 1 hour (collection of first sample = time 0) and jugular venous blood samples were collected at 0, 30, and 60 minutes. On day 2, horses were sedated with xylazine hydrochloride and anesthesia was induced with propofol mixed with ketamine hydrochloride. Horses were positioned in dorsal recumbency. Anesthesia was maintained with isoflurane in oxygen and a continuous rate infusion of butorphanol tartrate. One hour after anesthesia was induced, the blood sample protocol was repeated. Plasma ACTH concentrations were quantified by use of a commercially available sandwich assay. Generalized estimating equations that controlled for horse and an expressly automated deconvolution algorithm were used to determine effects of anesthesia on plasma ACTH concentrations and pulsatility, respectively. RESULTS Anesthesia significantly reduced the plasma ACTH concentration in blood samples collected from the cavernous sinus. CONCLUSIONS AND CLINICAL RELEVANCE Mean plasma ACTH concentrations in samples collected from the cavernous sinus of anesthetized horses were reduced. Determining the success of partial ablation of the pituitary gland in situ for treatment of pituitary pars intermedia dysfunction may require that effects of anesthesia be included in interpretation of plasma ACTH concentrations in cavernous sinus blood. PMID:27347826

  3. Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note.

    PubMed

    Oyama, Kenichi; Fukuhara, Noriaki; Taguchi, Manabu; Takeshita, Akira; Takeuchi, Yasuhiro; Yamada, Shozo

    2014-04-01

    A less invasive transsphenoidal approach with a keyhole dural opening for intrasellar arachnoid cysts is described. This approach was used to address seven sellar cystic lesions with suprasellar extension; they were six intrasellar arachnoid cysts (IACs) and one Rathke's cleft cyst (RCC). In all cases, preoperative MRI revealed cerebrospinal fluid (CSF) intensity on both T1- and T2-weighted images. On preoperative contrast-enhanced MRI, five of the six IACs manifested posterior displacement of the flattened pituitary gland toward the dorsum sellae; one of the six IACs and the RCC exhibited a flattened pituitary gland on the anterior surface of the cyst. Wide cyst cisternostomy through a keyhole dural opening was carried out safely using a microscope with the support of a thin angled endoscope (30° and/or 70°, diameter 2.7 mm). As we aimed to avoid iatrogenic injury of the pituitary function, we found it difficult to obtain a sufficiently wide and precise opening of the cyst wall when the pituitary gland was located on the anterior surface of the cyst wall. Our approach facilitates safe cyst cisternostomy as wide as that obtainable by transcranial manipulation. In addition, CSF leakage is prevented by dural plasty using the fascia lata and stitching with 6-0 monofilament sutures. This technique can be adapted to address various sellar cystic lesions. However, as the posterior or anterior displacement of the normal pituitary gland in the presence of IACs or RCCs, respectively, affects the width of the cyst opening, our technique is more suitable for IACs than RCCs.

  4. Dural neurogenic inflammation induced by neuropathic pain is specific to cranial region.

    PubMed

    Filipović, B; Matak, I; Lacković, Z

    2014-05-01

    Up to now, dural neurogenic inflammation (DNI) has been studied primarily as a part of migraine pain pathophysiology. A recent study from our laboratory demonstrated the occurrence of DNI in response to peripheral trigeminal nerve injury. In this report, we characterize the occurrence of DNI after different peripheral nerve injuries in and outside of the trigeminal region. We have used the infraorbital nerve constriction injury model (IoNC) as a model of trigeminal neuropathic pain. Greater occipital nerve constriction injury (GoNC), partial transection of the sciatic nerve (ScNT) and sciatic nerve constriction injury (SCI) were employed to characterize the occurrence of DNI in response to nerve injury outside of the trigeminal region. DNI was measured as colorimetric absorbance of Evans blue plasma protein complexes. In addition, cellular inflammatory response in dural tissue was histologically examined in IoNC and SCI models. In comparison to the strong DNI evoked by IoNC, a smaller but significant DNI has been observed following the GoNC. However, DNI has not been observed either in cranial or in lumbar dura following ScNT and SCI. Histological evidence has demonstrated a dural proinflammatory cell infiltration in the IoNC model, which is in contrast to the SCI model. Inflammatory cell types (lymphocytes, plasma cells, and monocytes) have indicated the presence of sterile cellular inflammatory response in the IoNC model. To our knowledge, this is the first observation that the DNI evoked by peripheral neuropathic pain is specific to the trigeminal area and the adjacent occipital area. DNI after peripheral nerve injury consists of both plasma protein extravasation and proinflammatory cell infiltration.

  5. Neurological consequences of scuba diving with chronic sinusitis.

    PubMed

    Parell, G J; Becker, G D

    2000-08-01

    Sinus barotrauma from scuba diving is relatively common, usually self-limiting, and often the result of transient nasal pathology. We describe serious neurological sequelae occurring in two scuba divers who had chronic sinusitis We suggest guidelines for evaluating and treating divers who have chronic sinusitis. Divers with nasal or sinus pathology should be aware of the potentially serious consequences associated with scuba diving even after endoscopic sinus surgery to correct this condition.

  6. Is Prolactin Measurement of Value during Inferior Petrosal Sinus Sampling in Patients with ACTH-dependent Cushing’s Syndrome?

    PubMed Central

    Sharma, S. T.; Nieman, L. K.

    2014-01-01

    Inferior petrosal sinus sampling (IPSS) is considered the gold standard test to distinguish between Cushing’s disease (CD) and ectopic ACTH syndrome (EAS). Anomalous venous drainage, abnormal venous anatomy and lack of expertise can lead to false-negative IPSS results and thereby misclassification of patients with ACTH-dependent Cushing’s syndrome. Prolactin measurement during IPSS can improve diagnostic accuracy and decrease false negative results. A baseline prolactin inferior petrosal sinus to peripheral (IPS/P) ratio (ipsilateral to the dominant post-CRH ACTH IPS/P ratio) of 1.8 or more suggests successful catheterization during IPSS. Prolactin-normalized ACTH IPS/P ratios can then be used to differentiate between a pituitary and ectopic source of ACTH. Values ≤ 0.7 are suggestive of EAS and those ≥ 1.3 are indicative of CD but the implication of values between 0.7 and 1.3 remains unclear and needs further investigation. Larger prospective studies are also needed for further evaluation of the role of contralateral prolactin IPS/P ratios, post-CRH prolactin values and prolactin-adjusted ACTH inter-sinus ratios for tumor localization in CD. PMID:23887034

  7. Persistent left superior vena cava, absence of the innominate vein, and upper sinus venosus defect : a rare anomaly detected using bubbles.

    PubMed

    Akpinar, I; Sayin, M R; Karabag, T; Dogan, S M; Sen, S T; Gudul, N E; Aydin, M

    2013-05-01

    Superior vena cava anomalies are rare malformations that are typically seen with other congenital cardiac defects. Although a persistent left superior vena cava is the most common anomaly of the systemic venous return in the thorax, its combination with an upper sinus venosus defect and absence of the innominate vein is extremely rare. Here, we report a patient diagnosed with these anomalies based on a bubble study and confirmed with magnetic resonance imaging.

  8. Globe ptosis secondary to maxillary sinus mucocele.

    PubMed

    Garber, P F; Abramson, A L; Stallman, P T; Wasserman, P G

    1995-12-01

    Six patients were treated for gradual onset of enophthalmos, a deep superior sulcus and globe ptosis. There was no history of orbital trauma or sinusitis. CT scan showed an opacified shrunken maxillary sinus with dehiscence and depression of the orbital floor and downward displacement of the orbital contents. Pathological review of the surgical specimens showed a respiratory mucosal lining with thick mucoid secretions, new bone formation, but no purulence. The etiology is thought to be maxillary sinus mucocele. Surgical treatment with an otolaryngologist consisted of a Caldwell-Luc procedure to evacuate the maxillary sinus with nasal antrostomy and an orbital floor exploration with insertion of a methylmethacrylate implant molded at the time of surgery to reform the orbital floor and reposition the globe. Follow-up of 2 1/2-4 years shows excellent functional and cosmetic results.

  9. Intraparenchymal pneumocephalus caused by ethmoid sinus osteoma.

    PubMed

    Kamide, Tomoya; Nakada, Mitsutoshi; Hayashi, Yutaka; Hayashi, Yasuhiko; Uchiyama, Naoyuki; Hamada, Jun-Ichiro

    2009-11-01

    We report a 57-year-old man with intraparenchymal pneumocephalus caused by ethmoid sinus osteoma. He had a history of severe allergic rhinitis, which caused him to frequently blow his nose, and he was referred to our hospital with headache and mild left hemiparesis. CT scans revealed a large volume of intraparenchymal air entrapped in the right frontal lobe related to an osteoma in the ethmoid sinus. The osteoma eroded the upper wall of the sinus and extended into the anterior cranial fossa. At operation, we observed that the osteoma had protruded intracranially through the skull base, disrupted the dura and extended into the frontal lobe. To our knowledge, this is the first report of a patient with intraparenchymal pneumocephalus caused by an ethmoid sinus osteoma.

  10. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  11. Maxillary sinus manifestations of methamphetamine abuse.

    PubMed

    Faucett, Erynne A; Marsh, Katherine M; Farshad, Kayven; Erman, Audrey B; Chiu, Alexander G

    2015-01-01

    Methamphetamines are the second most commonly used illicit drug worldwide and cost the United States health-care system ∼$23.4 billion annually. Use of this drug affects multiple organ systems and causes a variety of clinical manifestations. Although there are commonly known sequelae of methamphetamine abuse such as "meth mouth," there is limited evidence regarding maxillary sinus manifestations. The following cases highlight the initial evaluation and management of two methamphetamine abusers with loculated purulent collections within the maxillary sinus as a result of methamphetamine abuse. Our aim was to delineate the otolaryngologic symptoms associated with the patients' methamphetamine abuse. Computed tomography and magnetic resonance imaging studies revealed loculated purulent collections within the maxillary sinus of probable odontogenic origin in both patients. Methamphetamine abuse leading to rampant caries and poor oral hygiene may predispose individuals for craniofacial infections and fluid collections. These cases illustrate the development of maxillary sinusitis and maxilla mucoceles that have been associated with methamphetamine use.

  12. Major orbital complications of endoscopic sinus surgery

    PubMed Central

    Rene, C; Rose, G; Lenthall, R; Moseley, I

    2001-01-01

    BACKGROUND—The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss.
METHODS—A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery.
RESULTS—All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply.
CONCLUSION—Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed. 

 PMID:11316724

  13. Echocardiographic and color flow Doppler assessment of systemic and pulmonary venous connection and drainage in the neonate with congenital heart disease.

    PubMed

    Seliem, M A

    1991-07-01

    Systemic and pulmonary venous anomalies are frequently encountered either as isolated lesions or as a significant component of a more complex lesion in the newborn infant with congenital heart disease. Two-dimensional echocardiography and Doppler techniques (conventional and color flow) have become the primary diagnostic imaging modality in this setting. Precise pre-operative definition of these variable venous connection and drainage patterns is critical as the required surgical procedure may solely be based on exact understanding of the veins' anatomy and physiology. On the systemic venous site, anomalies of superior and inferior venae cavae, innominate vein, and coronary sinus can be equally well imaged with either echocardiography or angiography. However, on the pulmonary venous site, echocardiography and Doppler techniques including color flow mapping are superior to angiography for precise definition of the connection and drainage sites of the individual pulmonary veins.

  14. Systemic venous drainage: can we help Newton?

    PubMed

    Corno, Antonio F

    2007-06-01

    In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton.

  15. Cavernous sinus thrombosis progression from trismus.

    PubMed

    Cho, Jin Yong; Kim, Hyeon Min; Ryu, Jae Young

    2015-02-01

    In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature. PMID:25741468

  16. Anatomic Considerations in Frontal Sinus Surgery.

    PubMed

    Folbe, Adam J; Svider, Peter F; Eloy, Jean Anderson

    2016-08-01

    Comprehension of the complex anatomic variants comprising the frontal sinus outflow tract is essential for successful surgical intervention. Deviation from sound technique increases the potential for a variety of deleterious sequelae, including recurrent disease as well as catastrophic intracranial and orbital injury. Furthermore, incomplete removal of elements occluding the frontal recess can result in severe stenosis that can increase the difficulty of further interventions. This review covers anatomic considerations that should be kept in mind when performing frontal sinus surgery. PMID:27329978

  17. Endoscopic sinus surgery: evolution and technical innovations.

    PubMed

    Govindaraj, S; Adappa, N D; Kennedy, D W

    2010-03-01

    Prior to the introduction of functional endoscopic sinus surgery, several surgeons had begun to use telescopes to perform surgical procedures in the nose and sinuses. However, the central concepts of functional endoscopic sinus surgery evolved primarily from Messerklinger's endoscopic study of mucociliary clearance and endoscopic detailing of intranasal pathology. The popularity of a combination of endoscopic ethmoidectomy plus opening of secondarily involved sinuses grew rapidly during the latter part of the twentieth century, and endoscopic intranasal techniques began to expand to deal with pathology other than inflammation. We present a review of the evolution of knowledge regarding the pathogenesis of inflammatory sinus disease since that point in time, and of the impact that this has had on the management of inflammatory sinus disease. We also detail the technological advances that have allowed endoscopic intranasal techniques to expand and successfully treat other pathology, including skull base and orbital disease. In addition, we describe evolving technologies which may further influence development within this field. PMID:19930748

  18. Spine fusion cross-link causing delayed dural erosion and CSF leak: case report.

    PubMed

    Rahmathulla, Gazanfar; Deen, H Gordon

    2015-04-01

    The past 2 decades have seen a considerable increase in the number of lumbar spinal fusion surgeries. To enhance spinal stabilization and fusion, make the construct resistant to or stiffer for axial stress loading, lateral bending, and torsional stresses, cross-links and connectors were designed and included in a rod-screw construct. The authors present the case of a 49-year-old woman who presented 11 years after undergoing an L4-5 decompression and fusion in which a pedicle screw-rod construct with an integrated cross-link was designed to attach onto the pedicle screws. The patient's response at the time to the initial surgery was excellent; however, at the time of presentation 11 years later, she had significant postural headaches, severe neurogenic claudication, and radiculopathy. Imaging revealed canal compression across the instrumented levels and a possible thickened adherent filum terminale. Reexploration of the level revealed a large erosive dural defect with a CSF leak, spinal canal compression, and a thickened filum at the level of the cross-link. To the author's knowledge, such complications have not been reported in literature. The authors discuss this rare complication of spinal fusion and the need to avoid dural compression when cross-links are used. PMID:25635637

  19. Pharmacological prophylaxis of venous thrombo-embolism.

    PubMed

    Flute, P T

    1976-02-01

    The pathogenesis of venous thrombosis is briefly discussed as a basis for the understanding of preventive measures used in this condition. Prophylaxis in venous thrombosis is then reviewed with emphasis on pharmacological treatment, and more particularly on heparin.

  20. [Automatic regulator of venous pressure and venous outflow in the perfusion system].

    PubMed

    Smirnov, L M; Levinskiĭ, M M; Kharnas, S Sh; Cherniak, V A

    1976-01-01

    A scheme for automatic regulation of the venous pressure and venous blood outflow during extracorporeal circulation is proposed. The system consists of a photoelectric sensor placed on a tube led out of the major venous trunkline, a converter and an electromechanical eccentric clamp that compresses the venous trunkline, all of which secures stabilization of the controlled values.

  1. A Literature Review Revisiting Phenytoin-Induced Sinus Arrest.

    PubMed

    Parsai, Shireen; Hariri, Imad; Taleb, Mohammad; Yoon, Youngsook

    2016-01-01

    Classically, phenytoin (PTN) infusion for the treatment of status epilepticus has been proven to be associated with cardiovascular toxicity, including dysrhythmias, hypotension, and cardiovascular collapse. Subsequently, fosphenytoin (FOS) was introduced on the market in 1997 with claims of having less cardiac toxicity. However, since then, many accounts of cardiac events have been reported undermining these claims. FOS gained popularity due to its water solubility, which allows 3 times faster infusion in comparison with PTN with less venous irritation and local toxicity. FOS is the phosphate ester prodrug of PTN and is rapidly converted to PTN independent of the dose and rate of administration. Intravenous FOS and PTN are bioequivalent. Adverse cardiac effects of both intravenous FOS and PTN have been correlated to the rate of infusion, concentration of the agent, known risk factors, or pre-existing hypersensitivity, and most cases have been identified after infusing a loading dose of these medications. This case report is unique, in that, the patient developed sinus arrest while concurrently receiving oral PTN and intravenous FOS. Clinicians should be more cognizant of the association of FOS and PTN with adverse cardiac events. Baseline electrocardiogram should be obtained on all patients prescribed FOS or PTN to identify underlying cardiac problems that may place the patient in a higher risk category. Telemetry should be performed on all patients receiving PTN in an inpatient setting.

  2. [Influence of beta block and autonomic nerve block on the recovery time of the sinus node in sick sinus syndrome and carotid sinus syndrome].

    PubMed

    Brignole, M; Sartore, B; Barra, M; Menozzi, C; Monducci, I; Bertulla, A

    1984-10-01

    In order to evaluate the relative role of the automatic nervus system and of the intrinsic electrophysiologic properties on the sinus node function, we measured the corrected sinus node recovery time before and after autonomic nervous system blockade in 24 patients. Fourteen had a sick sinus syndrome, five had a carotid sinus syncope, two had syncope of unknown origin associated with bradycardia. Beta blockade was obtained by infusing metoprolol intravenously at a dosage of 0.2 mg/kg; complete automatic blockade was achieved by further i.v. administration of atropine at a dosage of 0.04 mg/kg. After beta blockade, the corrected sinus node recovery time increased in patients with sick sinus syndrome and intrinsic slow heart rate, whereas it decreased in patients with carotid sinus syncope or with syncope and bradycardia. In patients with sick sinus syndrome and normal intrinsic heart rate the response was variable. A positive direct correlation was found between the changes of the corrected sinus node recovery time induced by beta blockade and those induced by autonomic blockade; that is, both either prolonged or shortened the corrected sinus node recovery time. The changes of the corrected sinus node recovery time after beta blockade alone were inversely correlated with the intrinsic heart rate. We conclude that patients with intrinsic depression of the sinus node have an increased sympathetic tone.

  3. [Sinus lift and dental implantation after endosurgical treatment of odontogenic maxillary sinusitis].

    PubMed

    Sysoliatin, S P; Sysoliatin, P G; Palkina, M O; Solop, M V

    2013-01-01

    The long-term results of dental implant placement in patients with the history of odontogenic maxillary sinusitis are assessed in retrospective study. Maxillary sinusotomy and endoscopic surgery procedures are compared in regard to complications risks after subsequent sinus lift and dental implantation, the latter proving to be method of choice in such cases.

  4. Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis

    SciTech Connect

    Bardin, P.G.; Van Heerden, B.B.; Joubert, J.R. )

    1990-07-01

    The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways.

  5. The Venous Lymph Node Flap: Concepts, Experimental Evidence, and Potential Clinical Implications.

    PubMed

    Visconti, Giuseppe; Constantinescu, Thomas; Chen, Pei Yu; Salgarello, Marzia; Franceschini, Gianluca; Masetti, Riccardo; Chen, Hung-Chi

    2016-10-01

    Background Traditionally, lymph node flaps (LNF) have been designed as arteriovenous flaps, with little attention given to the functional anatomy of lymphatic system included in the flap. Based on the anatomical and physiological features of lymphatic system, we believe that a new concept of LNF, the venous LNF, should be investigated. In this article, we report the concepts and findings of venous LNF, and help gauge its potential clinical application in the treatment of lymphedema. Methods Eight healthy Wistar rats underwent cervical LNF harvesting along the right external jugular vein, right inguinal node clearance, and venous LNF transfer in a flow-through fashion along the femoral vein. At 45 postoperative days, the restoration of lymphatic continuity with surrounding tissue was verified with intradermal injection of 0.1% of methylene blue. The flaps were then excised and sent for histologic evaluation. Results All rats survived uneventfully in the postoperative period and no postoperative complications were experienced. The venous anastomosis was proven to be patent clinically. In all rats we found reestablishment of lymphatic continuity with surrounding tissues. Histologically, the nodes showed the following main histoarchitectural changes: drastic reduction of the stromal compartment and preservation of the lymphatic/sinus and vascular compartments. Conclusions The novel venous LNF flap is able to restore lymphatic continuity with surrounding tissue. As healing occurs, the lymph nodes undergo major histoarchitectural changes. The venous LNF has unique theoretical advantages over arteriovenous LNFs. Further investigations would be beneficial to understand its potential in the surgical treatment of lymphedema. PMID:27326800

  6. Combined transcatheter device closure of ruptured sinus of valsalva and a post-surgical residual ventricular septal defect.

    PubMed

    Mahimarangariah, Jayaranganath; Kikkeri H, Srinivasa; Rai K, Maneesh; Nanjappa, Manjunath Cholenhally

    2013-11-15

    Sinus of Valsalva aneurysms are commonly associated with ventricular septal defects (VSDs). We describe a 14-year-old boy who presented with rupture of right sinus of Valsalva (RSOV) into the right ventricular outflow tract (through two openings) along with a residual VSD, four years after surgical closure of the VSD. Both antegrade and retrograde approaches were used to close the RSOV defects. The larger defect was closed from the venous side using an Amplatzer Duct Occluder (ADO-I) device while the smaller defect was closed from the arterial end using and ADO-II device. The residual VSD was also closed percutaneously using a ADO-I device. Successful transcatheter closure of all defects was possible thereby preventing the morbidity and mortality associated with a repeat surgery. PMID:23436333

  7. Normal Sinus Rhythm-Sinus Bradycardia is Common in Young Children Post-extracardiac Fontan.

    PubMed

    Evans, William N; Acherman, Ruben J; Restrepo, Humberto

    2016-10-01

    We hypothesized that normal sinus rhythm-sinus bradycardia is common in young children following extracardiac Fontan. After excluding patients with sinus pauses, junctional rhythm, tachy-brady syndrome, frequent ectopics, or ectopic atrial rhythm, we found an ambulatory 24-h Holter monitor average heart rate of 78 ± 12 beats per minute (bpm) in 33 post-extracardiac Fontan children with a median age of 6 years (5-10). A 24-h average heart rate of 78 ± 12 bpm is statistically significantly lower than a 24-h average heart rate value of 90 ± 10 bpm derived from a similarly aged control population (p < 0.01). We conclude that after excluding those with significant arrhythmias, normal sinus rhythm-sinus bradycardia is common in children post-extracardiac Fontan.

  8. [Non-puncture treatment of sinusitis in nasal septal defects].

    PubMed

    Shilenkova, V V; Markov, G I; Shilenkov, A A

    1994-01-01

    The [symbol: see text] sinus-catheter was used to treat purulent sinusitis with septal perforation or defective septum of the sinuses. The procedure described implies simultaneous introduction of two sinus-catheters the functioning channels of which unite into one output by means of T-joint. The method has been successfully tried in the treatment of exudative and aggravated chronic purulent hemisinusitis (6 cases). The authors hold that communication between nasal sinuses is not a contraindication for sinus-catheter application. This fact widely extends potentialities of its use.

  9. Air travel and venous thromboembolism.

    PubMed Central

    Mendis, Shanthi; Yach, Derek; Alwan, Ala

    2002-01-01

    There has recently been increased publicity on the risk of venous thrombosis after long-haul flights. This paper reviews the evidence base related to the association between air travel and venous thromboembolism. The evidence consists only of case reports, clinical case-control studies and observational studies involving the use of intermediate end-points, or expert opinion. Some studies have suggested that there is no clear association, whereas others have indicated a strong relationship. On the whole it appears that there is probably a link between air travel and venous thrombosis. However, the link is likely to be weak, mainly affecting passengers with additional risk factors for venous thromboembolism. The available evidence is not adequate to allow quantification of the risk. There are insufficient scientific data on which to base specific recommendations for prevention, other than that leg exercise should be taken during travel. Further studies are urgently needed in order to identify prospectively the incidence of the condition and those at risk. PMID:12077617

  10. Venous ulceration, fibrinogen and fibrinolysis.

    PubMed Central

    Leach, R. D.

    1984-01-01

    The effect of long and short-term venous hypertension upon lymph fibrinogen concentrations was studied in an attempt to explain the peri-capillary deposition of fibrin reported in patients with post-phlebitic syndromes. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of rats and human volunteers was also studied. Both long- and short-term venous hypertension were found to increase fibrinogen transport across the interstitial space by more than 600%. Not only was there evidence of fibrinolytic activity in the lymph but after long-term venous hypertension alpha 2 antiplasmin activity was also detectable. Skin biopsies from the venous hypertensive ankles showed deposition of interstitial fibrin. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of the rat was found to be delayed if the rats were given epsilon amino caproic acid but it could not be increased with stanozolol. In human subjects it was found that patients with lipodermatosclerosis had delayed clot clearance and retarded blood fibrinolytic activity when compared with normal volunteers and patients with uncomplicated varicose veins. The principle cause why tall men are more subject to ulcers than short men, Dr Young conceived to be then length of the column of blood in their veins; which by its pressure, renders the legs less able to recover when hurt by any violence. Images Fig. 1 Fig. 2 Fig. 5 PMID:6742738

  11. [THERAPEUTIC GUIDE IN VENOUS ULCERS].

    PubMed

    López Herranz, Marta; Bas Caro, Pedro; García Jábega, Rosa Ma; García Carmona, Francisco Javier; Villalta García, Pedro; Postigo Mota, Salvador

    2014-11-01

    The treatment of venous ulcers and wounds in general, is a complex and important public health problem, with personal effects, family and health, without addressing the economic impact includes assistance, care of patients with ulcerative lesions. The increase in life expectancy, driven by improved socio-sanitary conditions that this aging population, facilitates the emergence of chronic diseases may be complicated by the presence of skin ulcers. There is no doubt that the best way to treat a skin ulcer is avoiding to occur, hence the importance of early diagnosis and risk factors act alone them. In relation to venous ulcers is crucial, provide local treatment, act on the cause, because if not, relapse is the norm in this type of injury. Currently, the moist wound healing, is an important step in solving earlier of these chronic wounds. This has meant that the pharmaceutical industry has been involved in researching and creating different types of dressings, having specific activity at different stages of venous ulcer healing, ie inflammatory phase, proliferative and remodeling. The proliferation of these products has been increasing over the years, not surprisingly, are described therapeutic 12 families that are applied in the management, care of these injuries. The fact of existing therapeutic options highlights the ineffectiveness of these products individually. Therefore, the nurse will not forget that the optimal treatment of venous ulcers, necessarily involves choosing the right product for every type and stage of the lesion. In this decision process, strongly influenced by the specific characteristics of each patient and injury, the nurse will take into account a lot of factors when choosing the product, not forgetting that an ulcer is not cured with a single therapeutic element, several products being used throughout the process to evolutionary venous ulcer until complete resolution.

  12. Dural metastases from disseminated prostate cancer clinically mimicking a benign reactive condition of the dura: case report and review of the literature.

    PubMed

    Gunia, S; Ecke, T; Wohlfarth, B; Koch, S; Erbersdobler, A

    2011-01-01

    Dural spread from prostate cancer (PC) is exceedingly uncommon. We report on a 62-year-old man suffering from disseminated PC with osseous metastases who presented with a parietal skull metastasis along with a circumscribed nodular thickening of the adjacent dura. Magnetic resonance imaging findings suggested a benign reactive condition of the dura which, however, histologically turned out to be a dural metastasis. Therefore, the present case report stresses the notion that very rarely, disseminated PC might present with clinically unsuspected dural metastases radiologically mimicking a benign condition.

  13. A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery

    PubMed Central

    Epstein, Nancy E.

    2013-01-01

    Background: In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated. Methods: During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Other etiologies of CSF fistulas/DTs include; epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired. Results: DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle; the larger suture occludes the dural puncture site. Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted. Conclusion: DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction. PMID:24163783

  14. Symptomatic sick sinus syndrome requiring permanent pacemaker implantation in a patient uwith mirror image dextrocardia with situs inversus and infertility.

    PubMed

    Kahali, Dhiman; Mandal, Saroj; Mandal, Debasmita; Ghose, Arijit; Kanjilal, Souvik

    2013-01-01

    Situs inversus with dextrocardia is a congenital condition in which the heart is a mirror image of the anatomically normal heart on the right side. A patient presented with the sick sinus syndrome accompanying mirror image dextrocardia which was associated with double superior vena cava and a left sided inferior vena cava A permanent transvenous demand pacemaker was inserted because of repeated episodes of dizziness and a single episode of syncope with ECG showing bradycardia with junctional escape rhythm. Precise knowledge of the venous system and the location of the apex of the right ventricle were necessary prior to permanent pacemaker implantation. Without such knowledge pacing may be technically challenging.

  15. Onyx extrusion through the scalp after embolization of dural arteriovenous fistula.

    PubMed

    Singla, Amit; Fargen, Kyle Michael; Hoh, Brian

    2016-09-01

    A man in his sixties referred with symptoms of episodic left lip numbness and left arm weakness was diagnosed with a Borden type 3 dural arteriovenous fistula (DAVF) on DSA. Successful Onyx embolization of the DAVF was performed via the distal left occipital artery using an ev3 Apollo detachable tip microcatheter. He underwent surgical obliteration for the residual DAVF 3 days later. Three months later during a routine postoperative clinic visit, the patient produced a plastic bag containing multiple small pieces of Onyx cast and the detached tip of the Apollo microcatheter that had extruded out from his scalp through small spontaneous holes about 5 weeks after the embolization procedure. This spontaneous extrusion of Onyx can be alarming to the patient not expecting it; however, prior knowledge and discussion can lessen the anxiety of both the treating physician and the patient dealing with such a situation.

  16. Onyx extrusion through the scalp after embolization of dural arteriovenous fistula.

    PubMed

    Singla, Amit; Fargen, Kyle Michael; Hoh, Brian

    2015-01-01

    A man in his sixties referred with symptoms of episodic left lip numbness and left arm weakness was diagnosed with a Borden type 3 dural arteriovenous fistula (DAVF) on DSA. Successful Onyx embolization of the DAVF was performed via the distal left occipital artery using an ev3 Apollo detachable tip microcatheter. He underwent surgical obliteration for the residual DAVF 3 days later. Three months later during a routine postoperative clinic visit, the patient produced a plastic bag containing multiple small pieces of Onyx cast and the detached tip of the Apollo microcatheter that had extruded out from his scalp through small spontaneous holes about 5 weeks after the embolization procedure. This spontaneous extrusion of Onyx can be alarming to the patient not expecting it; however, prior knowledge and discussion can lessen the anxiety of both the treating physician and the patient dealing with such a situation.

  17. [Accidental dural puncture during epidural injection of corticosteroids: a different approach?].

    PubMed

    Galindo Palazuelos, M; González Fernández, I; Fernández Abascal, A; Díaz Setién, N; Manso Marín, F J; Castro Ugalde, A

    2006-04-01

    We report 6 cases diagnosed with accidental dural puncture after epidural injection of corticosteroids for low back pain. All the patients reported postdural puncture headache during their stay in the postanesthetic recovery unit. For 3 patients, pain resolved with treatment given in the recovery unit. Two other patients also required mild analgesics for 1 week. In the last patient, a blood patch was used to treat incapacitating headache 22 days after the epidural procedure and mild analgesics were needed for 4 more weeks. It is important to establish a protocol for treating postdural puncture headache in pain clinics to facilitate decision making. Good physician-patient communication is necessary to avoid refusals for permission for other epidural techniques and to facilitate management of symptoms.

  18. Evolution of the paranasal sinuses' anatomy through the ages

    PubMed Central

    Mavrodi, Alexandra

    2013-01-01

    Previously, anatomists considered paranasal sinuses as a mysterious region of the human skull. Historically, paranasal sinuses were first identified by ancient Egyptians and later, by Greek physicians. After a long period of no remarkable improvement in the understanding of anatomy during the Middle Ages, anatomists of the Renaissance period-Leonardo da Vinci and Vesalius-made their own contribution. Nathaniel Highmore's name is also associated with the anatomy of paranasal sinuses as he was first to describe the maxillary sinus. PMID:24386595

  19. Evolution of the paranasal sinuses' anatomy through the ages.

    PubMed

    Mavrodi, Alexandra; Paraskevas, George

    2013-12-01

    Previously, anatomists considered paranasal sinuses as a mysterious region of the human skull. Historically, paranasal sinuses were first identified by ancient Egyptians and later, by Greek physicians. After a long period of no remarkable improvement in the understanding of anatomy during the Middle Ages, anatomists of the Renaissance period-Leonardo da Vinci and Vesalius-made their own contribution. Nathaniel Highmore's name is also associated with the anatomy of paranasal sinuses as he was first to describe the maxillary sinus. PMID:24386595

  20. Spatiotemporal complexity of the aortic sinus vortex

    NASA Astrophysics Data System (ADS)

    Moore, Brandon; Dasi, Lakshmi Prasad

    2014-07-01

    The aortic sinus vortex is a classical flow structure of significant importance to aortic valve dynamics and the initiation and progression of calcific aortic valve disease. We characterize the spatiotemporal characteristics of aortic sinus vortex dynamics in relation to the viscosity of blood analog solution as well as heart rate. High-resolution time-resolved (2 kHz) particle image velocimetry was conducted to capture 2D particle streak videos and 2D instantaneous velocity and streamlines along the sinus midplane using a physiological but rigid aorta model fitted with a porcine bioprosthetic heart valve. Blood analog fluids used include a water-glycerin mixture and saline to elucidate the sensitivity of vortex dynamics to viscosity. Experiments were conducted to record 10 heart beats for each combination of blood analog and heart rate condition. Results show that the topological characteristics of the velocity field vary in timescales as revealed using time bin-averaged vectors and corresponding instantaneous streamlines. There exist small timescale vortices and a large timescale main vortex. A key flow structure observed is the counter vortex at the upstream end of the sinus adjacent to the base (lower half) of the leaflet. The spatiotemporal complexity of vortex dynamics is shown to be profoundly influenced by strong leaflet flutter during systole with a peak frequency of 200 Hz and peak amplitude of 4 mm observed in the saline case. While fluid viscosity influences the length and timescales as well as the introduction of leaflet flutter, heart rate influences the formation of counter vortex at the upstream end of the sinus. Higher heart rates are shown to reduce the strength of the counter vortex that can greatly influence the directionality and strength of shear stresses along the base of the leaflet. This study demonstrates the impact of heart rate and blood analog viscosity on aortic sinus hemodynamics.

  1. Sumatriptan inhibition of N-type calcium channel mediated signaling in dural CGRP terminal fibres

    PubMed Central

    Baillie, Landon D.; Ahn, Andrew H.; Mulligan, Sean J.

    2012-01-01

    The selective 5-HT1 receptor agonist sumatriptan is an effective therapeutic for migraine pain yet the antimigraine mechanisms of action remain controversial. Pain-responsive fibres containing calcitonin gene-related peptide (CGRP) densely innervating the cranial dura mater are widely believed to be an essential anatomical substrate for the development of migraine pain. 5HT1 receptors in the dura colocalize with CGRP fibres in high density and thus provide a possible peripheral site of action for sumatriptan. In the present study, we used high-resolution optical imaging selectively within individual mouse dural CGRP nociceptive fibre terminations and found that application of sumatriptan caused a rapid, reversible dose-dependent inhibition in the amplitude of single action potential evoked Ca2+ transients. Pre-application of the 5-HT1 antagonist GR127935 or the selective 5-HT1D antagonist BRL 15572 prevented inhibition while the selective 5-HT1B antagonist SB 224289 did not, suggesting this effect was mediated selectively through the 5-HT1D receptor subtype. Sumatriptan inhibition of the action potential evoked Ca2+ signaling was mediated selectively through N-type Ca2+ channels. Although the T-type Ca2+ channel accounted for a greater proportion of the Ca2+ signal it did not mediate any of the sumatriptan inhibition. Our findings support a peripheral site of action for sumatriptan in inhibiting the activity of dural pain fibres selectively through a single Ca2+ channel subtype. This finding adds to our understanding of the mechanisms that underlie the clinical effectiveness of 5HT1 receptor agonists such as sumatriptan and may provide insight for the development of novel peripherally targeted therapeutics for mitigating the pain of migraine. PMID:22691374

  2. Prevention of post-dural puncture headache in parturients: a systematic review and meta-analysis.

    PubMed

    Bradbury, C L; Singh, S I; Badder, S R; Wakely, L J; Jones, P M

    2013-04-01

    Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions to reduce PDPH following ADP. Multiple electronic databases were searched for randomised clinical trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, and the incidence of at least one of these was recorded. Forty RCTs (n = 11,536 epidural insertions) were included, studying combined spinal-epidurals (CSEs), loss of resistance medium, prophylactic epidural blood patches, needle bevel orientation, ultrasound-guided insertion, epidural morphine, Special Sprotte needles, acoustic-guided insertion, administration of cosyntropin, and continuous spinal analgesia. The RCTs for CSE, loss of resistance medium, and prophylactic epidural blood patches were meta-analysed. Five methods reduced PDPH: prophylactic epidural blood patch {four trials, median quality score = 2, risk difference = -0.48 [95% confidence interval (CI): -0.88 to -0.086]}, lateral positioning of the epidural needle bevel upon insertion (one trial, quality score = 1), Special Sprotte needles [one trial, quality score = 5, risk difference = -0.44 (95% CI: -0.67 to -0.21)], epidural morphine [one trial, quality score = 4, risk difference = -0.36 (95% CI -0.59 to -0.13)], and cosyntropin [one trial, quality score = 5, risk difference = -0.36 (95% CI -0.55 to -0.16)]. Several methods potentially reduce PDPH. Special Sprotte needles, epidural morphine, and cosyntropin are thus far each supported by a single, albeit good quality trial. Prophylactic blood patches are supported by three trials, but these had flawed methodology. Mostly, trials were of limited quality, and further well-conducted, large studies are needed.

  3. Superior sinus of the pericardium: CT appearance

    SciTech Connect

    Aronberg, D.J.; Peterson, R.R.; Glazer, H.S.; Sagel, S.S.

    1984-11-01

    On computed tomography, a mass-like density is often observed, just posterior to the ascending aorta, that occasionally has been mistaken for mediastinal lymph node enlargement. Cadaver studies confirmed this retroaortic structure to be an extension of the periocardial cavity, the superior sinus. Anatomic studies revealed the presence of a superior sinus in all of the 28 cadavers studied. Retrospective review of 116 consecutive adult chest computed tomographic examinations disclosed its presence in 49%. This normal variant has a characteristic location, shape, and attenuation value by CT that should allow recognition and prevent misinterpretation.

  4. Epidemiology and definition of inappropriate sinus tachycardia.

    PubMed

    Pellegrini, Cara N; Scheinman, Melvin M

    2016-06-01

    Inappropriate sinus tachycardia (IST) is a clinical syndrome lacking formal diagnostic criteria. It is generally defined as an elevated resting heart rate (HR; >90-100 bpm) with an exaggerated response to physical or emotional stress and a clearly sinus mechanism. Clinical manifestations are broad from a complete lack of symptoms to incapacitating incessant tachycardia. Now understood to be relatively prevalent, it is observed to have a generally benign prognosis, though symptoms may persist for years. Whether IST is a single discrete entity or a heterogeneous condition with overlap to other syndromes such as postural orthostatic tachycardia syndrome remains a matter of debate. PMID:26310298

  5. Rhinoplasty and Functional Endoscopic Sinus Surgery

    PubMed Central

    Murrell, George L.

    2011-01-01

    An increasing number of patients are opting for combining sinus surgery and cosmetic rhinoplasty. The author has been performing rhinoplasty with FESS since April of 1990. The technique and equipment used in early cases is much different than that used in more recent surgeries. Specific advances include high definition monitor, intraoperative navigation system, and powered dissecting instruments. The benefits of these advances are illustrated by a review of the more recent cases performed by the author. Combined rhinoplasty and FESS can be performed with good results (functional and cosmetic) and minimal complications. Advances in sinus surgery technique and equipment have made the procedure safer, faster, more precise, and more comfortable. PMID:22567242

  6. [Anorexia with sinus bradycardia: a case report].

    PubMed

    Wang, Fang-fang; Xu, Ling; Chen, Bao-xia; Cui, Ming; Zhang, Yuan

    2016-02-18

    As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus

  7. [Pleomorphic adenoma of the maxillary sinus].

    PubMed

    Leunig, A; Grevers, G

    1994-11-01

    Pleomorphic adenoma is the most common benign tumour of the salivary glands, especially the parotid gland. In the present paper we introduce the rare case of a pleomorphic adenoma of the maxillary sinus in a 82-year-old man who was referred to our outpatient clinic with nasal obstruction and occasional events of nose bleeding. Thorough investigation, using endoscopy and computed tomography, revealed a mass extending from the left maxillary sinus to the nasal cavity; the tumour was removed surgically; pathological examination showed a pleomorphic adenoma with no signs of malignancy.

  8. [Anorexia with sinus bradycardia: a case report].

    PubMed

    Wang, Fang-fang; Xu, Ling; Chen, Bao-xia; Cui, Ming; Zhang, Yuan

    2016-02-18

    As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus

  9. Evaluation of anterior third of superior sagittal sinus in normal population: Identifying the subgroup with dominant drainage

    PubMed Central

    Sahoo, Sushanta K.; Ghuman, Mandeep S.; Salunke, Pravin; Vyas, Sameer; Bhar, Rahat; Khandelwal, N. K.

    2016-01-01

    Background/Object: The ligation and transection of anterior third of superior sagittal sinus (AT-SSS) is an important step to approach anterior skull base lesions. Some clinical studies have shown frontal lobe venous infarct following such surgical procedures questioning the safety of its ligation. We have studied the variations in venous drainage patterns to AT-SSS in the normal population using postcontrast magnetic resonance venogram (MRV). A novel scoring system to recognize the subgroup with dominant venous drainage from frontal lobes has been described. Materials and Methods: In this study, 60 three-dimensional contrast-enhanced (CE) MRVs were obtained from those cases being evaluated for a headache not harboring any intracranial mass lesion. The AT-SSS with all its draining veins was studied in detail. Morphology of individual veins such as length, caliber, tributaries, and angulation with AT-SSS was studied, and a numerical value of 0 or 1 was assigned for each of the above parameters. Summing up these scores derived from the individual cortical veins quantified the drainage of AT-SSS. Results: There are 3–4 veins on either side draining to AT-SSS. Barely, 3% of the veins had > 3 tributaries. Only 6.6% of veins had a caliber >3 mm, and 16.5% drained at acute angles to AT-SSS. About 26% of the veins did cross at least half of the lateral frontal lobe. We found in 26 individuals the AT-SSS score was 0–2, in 22 it was 3–5 and, in only in 12 (20%) the score was 6 or more (dominant drainage). Conclusion: There are anatomical variations in venous drainage of frontal lobes into AT-SSS. Those with dominant drainage are likely to develop venous congestion and complications if sacrificed. It is possible to identify these individuals on the basis of venous drainage pattern as shown in CE-MRV. PMID:27114658

  10. [Severe and prolonged post-dural puncture headache: from pathological basis to therapeutic role and correct timing for epidural blood patch].

    PubMed

    Wetzl, R G; Taglione, G; Ceresa, F; D'Agostino, R; Foresta, S; Guarnerio, C; Ladiana, N; Megaro, F; Zanesi, R; De Vietro, A; Pavani, M

    2001-09-01

    Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.

  11. Relationship of optic neuritis to disease of the paranasal sinuses.

    PubMed

    Rothstein, J; Maisel, R H; Berlinger, N T; Wirtschafter, J D

    1984-11-01

    The relationship of paranasal sinusitis to optic neuritis remains an intriguing curiosity to both the otolaryngologist and the ophthalmologist. The literature is replete with anecdotal case reports of patients whose sinusitis appears to have caused optic neuritis. There is much speculation about the pathophysiological mechanisms which relate these two distinct disease entities. Five new cases are described which highlight distinct pathophysiologic routes through which paranasal sinus disease has caused optic neuritis. These include compressive optic neuropathy secondary to mucoceles and/or pyoceles; direct extension of sinus infection to the optic nerve from suppurative paranasal sinusitis; and, in one case, from osteomyelitis of the ethmoid and sphenoid sinuses. The usefulness of computerized axial tomography of the orbits and paranasal sinuses to evaluate optic neuritis and to elucidate in detail the pathophysiology of its relationship to disease of the paranasal sinuses is emphasized. Currently, optic neuritis is felt to be a rare complication of paranasal sinusitis. Paranasal sinus surgery is advocated in those cases where sinus suppuration is suspected, or when a compressive optic neuropathy is caused by a sinus mucocele or pyocele. Since in most cases, however, optic neuritis is self-limited, it is difficult to evaluate the results of surgery in circumstances other than those mentioned already. Continued careful evaluation, management, and documentation of this group of patients is necessary to help better define the relationship between these two disease entities.

  12. [Odontogenic maxillary sinusitis in elderly and old age].

    PubMed

    Nikitenko, V V; Iordanishvili, A K; Ryzhak, G A

    2013-01-01

    On the basis of a detailed analysis of the clinical picture of odontogenic maxillary sinusitis the peculiarities of its flow in elderly and senile patients are demonstrated. The causes of odontogenic inflammation of the maxillary sinuses, the clinical features of inflammation of the maxillary sinus in older age groups, including those with oroantral communication are shown.

  13. [Age associated clinical features of odontogenic maxillary sinusitis].

    PubMed

    Iordanishvili, A K; Nikitenko, V V; Balin, D V

    2013-01-01

    Detailed analysis of odontogenic maxillary sinusitis clinical course allowed identifying clinical features of the disease specific for elderly and senile patients. The paper describes the peculiarities of odontogenic maxillary sinusitis in elderly and senile patients including those having oroantral sinus tract.

  14. Structural characteristic of splenic sinuses in idiopathic portal hypertension.

    PubMed

    Maesawa, C; Sakuma, T; Sato, T; Masuda, T; Muro-oka, G; Satodate, R

    1995-09-01

    Splenic sinuses in idiopathic portal hypertension (IPH; 8 patients), liver cirrhosis (LC; 14 patients) and in regenerating autotransplanted spleens from 25 rats were compared with each other by scanning electron microscopy (SEM) and immunohistochemistry using antibodies against proliferating cell nuclear antigen (PCNA). Spleens obtained from six patients with gastric carcinoma and from five untreated adult rats were examined as controls. SEM of the sinuses showed that in IPH endothelial cells became irregular in shape, and the interendothelial slits of sinuses were irregularly enlarged. Sinus endothelial processes traversing the sinusal lumen were also found. The same changes were observed in the proliferating sinuses during regeneration of splenic tissue after autotransplantation in rats, but disappeared when the regeneration was completed. Irregular endothelial cells were few in LC. PCNA-positive sinus endothelial cells were increased in number in IPH as compared with those in LC; the mean number of PCNA-positive ones per cm2 was 45.4 in IPH and 8.2 in LC. It was suggested that, from SEM observation of sinus endothelial cells and counting PCNA-positive sinus endothelial cells, the sinuses of the spleen in IPH consist of proliferating endothelial cells or are in the state of increased proliferation. In conclusion, splenomegaly in IPH was presumed to be caused by proliferation of sinus endothelial cells, and by the increased splenic blood flow in the irregularly widened interendothelial slits of the sinuses.

  15. [Clinical analysis of acute invasive fungal sinusitis with orbital infection].

    PubMed

    Chen, Feifei; Hu, Haiwen; Li, Jin

    2014-10-01

    The clinical manifestation of acute invasive fungal sinusitis was associated with facial pain,altered sense of smell, blindness and headache. Physical examinations show that dark brown nasal secretions with bone resorption in paranasal sinus. Radiographi parameters showed uneven density in paranasal sinus and intraorbital extension. Fungus smears and pathological examination can make a definitive diagnosis.

  16. Sepsis, venous return, and teleology.

    PubMed

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  17. Hydrocephalus in cerebral venous thrombosis.

    PubMed

    Zuurbier, Susanna M; van den Berg, René; Troost, Dirk; Majoie, Charles B; Stam, Jan; Coutinho, Jonathan M

    2015-01-01

    Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and 2010 (prospectively since July 2006). Hydrocephalus was defined as a bicaudate index larger than the 95th percentile for age, and/or a radial width of the temporal horn of ≥ 5 mm. We excluded patients in whom hydrocephalus was caused by a disease other than CVT or if it was iatrogenic. 20 out of 99 patients with CVT had hydrocephalus. 6 patients with hydrocephalus were excluded from the analysis. Patients with hydrocephalus more often had focal neurological deficits (86 vs. 49%, p = 0.02) and were more frequently comatose (43 vs. 16%, p = 0.06), as compared to patients without hydrocephalus. Deep cerebral venous thrombosis (64 vs. 9%, p < 0.001) and edema of the basal ganglia and thalami (64 vs. 4%, p < 0.001) were more common in patients with hydrocephalus. Intraventricular hemorrhage was present in 1 patient with hydrocephalus, compared to none among patients without hydrocephalus (7 vs. 0%, p = 0.15). Outcome at follow-up was worse in patients with hydrocephalus (mRS 0-1, 36 vs. 68%, p = 0.02; mortality 29 vs. 9%, p = 0.07). Hydrocephalus occurs more frequently in cerebral venous thrombosis than previously believed, especially in patients with deep cerebral venous thrombosis and edema of the basal ganglia. The presence of hydrocephalus is associated with a worse clinical outcome, but a direct causal relation is unlikely. Routine shunting procedures are not advisable.

  18. 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

  19. CT maxillary sinus evaluation-A retrospective cohort study

    PubMed Central

    Vaz, Paula; Faria-Almeida, Ricardo; Braga, Ana-Cristina; Felino, António

    2015-01-01

    Background Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population. Material and Methods Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature. Results 32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus. Conclusions Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis. Key words: Maxillary sinusitis/etiology, odontogenic, computed tomography, maxillary sinus. PMID:25858084

  20. Magnetic Resonance Angiography in the Diagnosis of Cerebral Arteriovenous Malformation and Dural Arteriovenous Fistulas: Comparison of Time-Resolved Magnetic Resonance Angiography and Three Dimensional Time-of-Flight Magnetic Resonance Angiography

    PubMed Central

    Cheng, Yu-Ching; Chen, Hung-Chieh; Wu, Chen-Hao; Wu, Yi-Ying; Sun, Ming-His; Chen, Wen-Hsien; Chai, Jyh-Wen; Chi-Chang Chen, Clayton

    2016-01-01

    Background Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF). Objectives The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA. Patients and Methods A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test. Results Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P < 0.0001) between 4D-TRAK MRA and 3D TOF MRA. The results indicate that 4D-TRAK MRA is superior to 3D TOF MRA in the assessment of lesions. Conclusion Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF.

  1. Magnetic Resonance Angiography in the Diagnosis of Cerebral Arteriovenous Malformation and Dural Arteriovenous Fistulas: Comparison of Time-Resolved Magnetic Resonance Angiography and Three Dimensional Time-of-Flight Magnetic Resonance Angiography

    PubMed Central

    Cheng, Yu-Ching; Chen, Hung-Chieh; Wu, Chen-Hao; Wu, Yi-Ying; Sun, Ming-His; Chen, Wen-Hsien; Chai, Jyh-Wen; Chi-Chang Chen, Clayton

    2016-01-01

    Background Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF). Objectives The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA. Patients and Methods A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test. Results Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P < 0.0001) between 4D-TRAK MRA and 3D TOF MRA. The results indicate that 4D-TRAK MRA is superior to 3D TOF MRA in the assessment of lesions. Conclusion Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF. PMID:27679690

  2. Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses

    PubMed Central

    Cho, Kwang Ho; Jin, Zhe Wu; Abe, Hiroshi; Shibata, Shunichi; Murakami, Gen; Rodríguez-Vázquez, Jose Francisco

    2016-01-01

    Epidural blocks have been used extensively in infants. However, little histological information is available on the immature neural-dural transition. The neural-dural transition was histologically investigated in 12 late-stage (28–30 weeks) fetuses. The dural sheath of the spinal cord was observed to always continue along the nerve roots with varying thicknesses between specimens and segments, while the dorsal root ganglion sheath was usually very thin or unclear. Immature neural-dural transitions were associated with effective anesthesia. The posterior radicular artery was near the dorsal root ganglion and/or embedded in the nerve root, whereas the anterior radicular artery was separated from the nearest nerve root. The anterior radicular artery was not associated with the dural sheath but with thin mesenchymal tissue. The numbers of radicular arteries tended to become smaller in larger specimens. Likewise, larger specimens of the upper thoracic and lower lumbar segments did not show the artery. Therefore, elimination of the radicular arteries to form a single artery of Adamkiewicz was occurring in late-stage fetuses. The epidural space was filled with veins, and the loose tissue space extended ventrolaterally to the subpleural tissue between the ribs. Consequently, epidural blocks in infants require special attention although immature neural-dural transitions seemed to increase the effect. PMID:27069926

  3. 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.

  4. Evaluation and Decision Making in Frontal Sinus Surgery.

    PubMed

    Saini, Alok T; Govindaraj, Satish

    2016-08-01

    Management of frontal sinusitis can be challenging for even the most experienced otolaryngologists. A thorough understanding of the anatomy and pathophysiology of the frontal sinus is essential to properly manage disease affecting the frontal sinus. Being able to distinguish acute viral from acute bacterial and acute from chronic sinusitis is crucial because these distinctions guide appropriate management. Nasal endoscopy can confirm diagnosis, and radiologic imaging, including computed tomography and MRI, is often a necessary adjunct that aids in determining appropriate therapeutic decisions. One must be aware of the many procedures used in the surgical treatment of frontal sinusitis. PMID:27450615

  5. Outer table craniotomy for frontal sinus mucocele.

    PubMed

    Wang, Kuo-Wei; Hsu, Huan-Chen; Lu, Kang; Chen, Han-Jung; Liang, Cheng-Loong

    2004-09-01

    Variants of the external osteoplastic flap procedure or endoscopy have been used to approach the frontal sinus mucocele. The authors introduce a modified external approach for radical resection of the mucocele. Using the bicoronal skin incision, the skin flap exposed the right upper orbital rim. The outer table craniotomy was then performed to expose the frontal sinus cavity while carefully preserving the inner table, with radical removal of the mucocele mucosa. The sinus cavity was irrigated with hyper-oxide solution to ensure adequate destruction of possible residual mucosa. The fascia of the frontalis muscle was split, with one part placed into the mucocele cavity to plug the nasofrontal duct. The advantages of the procedures for mucocele removal include clear visualization of the frontal sinus for radical resection of the mucosa, preservation of the inner table avoiding dura manipulation, prevention of central nervous system infection, possibly lower rates of recurrence, prevention of mucosal ingrowth by plugging of the nasofrontal ducts with fascia, and favorable cosmetic outcome. The disadvantages are more intensive surgery comparable to the endoscopic approaches and execution difficulties when the frontal mucocele is small. Additional clinical studies are needed to evaluate the efficiency and safety of this procedure.

  6. Double mucocele of the paranasal sinuses.

    PubMed

    Weissman, J L; Curtin, H D; Eibling, D E

    1994-08-01

    We have observed two contiguous mucoceles in one patient. Based on the mucoceles' signal intensities on MR imaging, as well as their anatomic location as delineated by CT and MR, we hypothesize that the "downstream" mucocele obstructed the "upstream" sinus, leading to formation of a secondary mucocele.

  7. Sinus node recovery time in the elderly.

    PubMed

    Kulbertus, H E; Leval-Rutten, F; Mary, L; Casters, P

    1975-04-01

    Measurement of the sinus node recovery time has been proposed as a diagnostic tool for recognition of the sick sinus syndrome. The latter is most frequently encountered in elderly patients with hypertension, coronary heart disease, and atherosclerosis. In order to provide normal values for the sinus node recovery time in this particular population group, atrial pacing studies were carried out in 30 subjects over 50 years of age, all with peripheral vascular disease and some with angina pectoris (10), residua of infarction (6), or hypertension (7). On stimulation, 7 patients maintained a I:I atrioventricular conduction up to the rate of 180/min. Second degree atrioventricular block developed in all other cases. On six occasions, Wenckebach's periods appeared at the relatively slow pacing rate of 120/min. The maximum postoverdrive pause ranged from 680 to 1600 ms with an average of 1100 ms plus or minus 190 (10). For each pacing speed, a correlation was found between the duration of the pause and the control intrinsic cardiac rate, longer pauses being associated with longer resting PP intervals. Beyond 120/min, the duration of the pause was seen to shorten progressively as the driving rate was increased. Finally, the behavior of the sinus node pacemaker following interruption of pacing showed individual variations. After pacing at relatively slow rates, a prompt return to near control values was consistently observed, whereas, after fast rates of driving, a phase of secondary depression developed in about one-half of the studied cases.

  8. Genetics Home Reference: sick sinus syndrome

    MedlinePlus

    ... 65. The incidence of this condition increases with age. Related Information What information about a genetic condition can statistics ... adults, sick sinus syndrome is often associated with age-related changes in the heart. Over time, the SA node may ... Related Information What is a gene? What is a gene ...

  9. Stent hypersensitivity and infection in sinus cavities

    PubMed Central

    Soufras, George D.; Hahalis, George

    2013-01-01

    Persistent mucosal inflammation, granulation tissue formation, hypersensitivity, and multifactorial infection are newly described complications of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. In an important report published in Allergy and Rhinology, a 45-year-old male patient suffering from recalcitrant chronic rhinosinusitis underwent functional endoscopic sinus surgery and was found, for the first time, to have steroid-eluting catheters that were inadvertently left in the ethmoid and frontal sinuses. The retained catheters had caused persistent mucosal inflammation and formation of granulation tissue denoting hypersensitivity reaction. These consequences had induced perpetuation of symptoms of chronic rhinosinusitis. Meticulous removal of the retained stents with the nitinol wings from inflamed tissues of the frontal, ethmoidal, and sphenoethmoidal recesses in which they were completely imbedded was successfully performed without polypoid regrowth. Cultures of specimens taken from both left and right stents showed heavy growth of Stenotrophomonas maltophilia and moderate growth of Klebsiella oxytoca, coagulase negative Staphylococcus, and beta-hemolytic Streptococcus anginosus. Fungal infection was not detected. The current knowledge and experience regarding stent hypersensitivity and infection in relation with the use of stents in sinus cavities is reviewed. PMID:24498522

  10. Acute otitis media and acute bacterial sinusitis.

    PubMed

    Wald, Ellen R

    2011-05-01

    Acute otitis media and acute bacterial sinusitis are 2 of the most common indications for antimicrobial agents in children. Together, they are responsible for billions of dollars of health care expenditures. The pathogenesis of the 2 conditions is identical. In the majority of children with each condition, a preceding viral upper respiratory tract infection predisposes to the development of the acute bacterial complication. It has been shown that viral upper respiratory tract infection predisposes to the development of acute otitis media in 37% of cases. Currently, precise microbiologic diagnosis of acute otitis media and acute bacterial sinusitis requires performance of tympanocentesis in the former and sinus aspiration in the latter. The identification of a virus from the nasopharynx in either case does not obviate the need for antimicrobial therapy. Furthermore, nasal and nasopharyngeal swabs are not useful in predicting the results of culture of the middle ear or paranasal sinus. However, it is possible that a combination of information regarding nasopharyngeal colonization with bacteria and infection with specific viruses may inform treatment decisions in the future.

  11. Sinus node function after autonomic blockade in normals and in sick sinus syndrome.

    PubMed

    Sethi, K K; Jaishankar, S; Balachander, J; Bahl, V K; Gupta, M P

    1984-06-01

    Electrophysiologic studies were performed in 10 normals and 33 patients with sick sinus syndrome before and after total autonomic blockade with propranolol and atropine. In normals both corrected sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) decreased significantly after autonomic blockade. In patients with sick sinus syndrome the corrected SNRT was abnormal (greater than 450 msec) in 16 (48.5%) cases before and 25 (76%) cases (greater than 285 msec) after autonomic ablation (P less than 0.02). Thirteen of 21 patients (62%) with normal intrinsic heart rate and all 12 cases with abnormally low intrinsic rate after autonomic blockade had abnormal corrected SNRT (greater than 285 msec). Mean SACT measured in 19 patients also shortened significantly following pharmacologic denervation. During control it was prolonged (greater than 226 msec) in 8 patients (44%). After autonomic blockade 2 of 13 patients with normal intrinsic heart rate and 3 of 6 with low intrinsic rate showed abnormal SACT (greater than 151 msec). The data suggest that the majority (76%) of patients with sick sinus syndrome have intrinsic abnormality of sinus node automaticity while in a minority (24%) disturbed autonomic regulation is the pathogenetic mechanism. Patients with normal intrinsic heart rate usually have normal intrinsic SACT, while a significant proportion of those with low intrinsic rate have abnormal perinodal conduction. Subjects with abnormal intrinsic heart rate have more severe disturbances of sinus node function than those with normal intrinsic rate.

  12. [Sinus-node recovery time in the sick-sinus syndrome (author's transl)].

    PubMed

    Delius, W; Wirtzfeld, A; Sebening, H; Blömer, H

    1975-11-01

    Sinus-node recovery times were measured, before and after atropine administration, in 21 patients with the clinical diagnosis of sick-sinus syndrome. The results were compared with those reported by other workers. It is concluded that sinus-node recovery times of more than 1 400 ms are most likely due to sinus-node damage (sick-sinus syndrome); normal recovery times are rare in such patients. The diagnosis of the syndrome is strengthened if the recovery time remains abnormally long even after atropine. Further useful diagnostic information can be obtained from the total stimulation phase (duration until restoration of the basic rhythm), this being overall longer in patients with the syndrome than in normal subjects. The increased incidence of A-V nodal rhythms before restoration of the basic rhythm is another indication of organic damage to the sinus node, especially if it also occurs after atropine. The significance of a recovery time which is prolonged before but normal after atropine is less clear: a raised sensitivity to vagotonic influences may be the determining factor here.

  13. Acute electrophysiological effects of dipyridamole on sinus node function in patients with sick sinus syndrome.

    PubMed

    Yeşil, M; Bayata, S; Postaci, N; Aydin, C

    1997-12-01

    One of the most widely used tests for evaluation of sinus node function is sinus node recovery time (SNRT), which requires right heart catheterization. On the other hand SNRT has high specificity but only moderate sensitivity in the diagnosis of sick sinus syndrome (SSS). The authors studied acute electrophysiologic effects of dipyridamole (0.40 mg/kg IV) in 16 patients with clinical SSS. All of them had normal SNRT and had undergone permanent DDD pacemaker implantation. By the aid of temporary pacing inhibition, the authors noninvasively measured the corrected sinus node recovery time (SNRTc) and sinus cycle length (SCL) before and after dipyridamole administration. SCL was slightly decreased from a mean basal value of 1025 +/-323 to 913+/-213 msec after dipyridamole administration (mean -10%), but this was not statistically significant. SNRTc was increased from a mean basal value of 344+/-91 to 606+/-156 msec after dipyridamole administration (+76% P< or =0.004). These results suggest that dipyridamole must be used cautiously in patients with SSS. Intravenous dipyridamole may be a useful test to assess sinus node function. SNRT measurement after intravenous dipyridamole may increase sensitivity of this test in patients with suspected SSS and normal SNRT.

  14. Surgical treatment of the high jugular bulb by compressing sinus sigmoideus: two cases.

    PubMed

    Oztürkcan, Sedat; Katilmiş, Hüseyin; Ozkul, Yilmaz; Erdoğan, Nezahat; Başoğlu, Sinan; Tayfun, Mehmet Ali

    2008-08-01

    If the jugular bulb normally surrounded by a bony layer in jugular fossa is anatomically over the inferior surface of the bony annulus, in the middle ear or over the basal turn of cochlea, it is then named as high jugular bulb (HJB). It may be dehiscent or aberrant. It is reported to occur in 5% of the temporal bone specimens. In accordance with the literature jugular bulb compression, jugular vein ligation and embolization are suggested in such cases. In both of the presented cases, there was bleeding from jugular bulb during surgery and jugular bulb was compressed with bone wax and Surgicel, but sigmoid sinus has been compressed after failure to stop bleeding through jugular bulb compression. Venous MR angiographies showed no flow in postoperative controls. Although it is very rarely seen clinically, we present two HJB cases and different treatment perspectives accompanied by literature. PMID:18046566

  15. [Sinus histiocytosis with massive lymphadenopathy with complete occlusion of the superior and inferior vena cava].

    PubMed

    Runde, J; Ebbecke, H; Kurlemann, G; Frosch, M; Schuierer, G

    1997-01-01

    Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disease of the lymph nodes, still of unknown origin. We are reporting the case of a 16 year old boy with SHML which occurred in 1983. Investigations showed a massive lymphadenopathy of the mediastinal and abdominal nodes, causing displacement and compression of surrounding tissue. The patient further developed a blockage of the vena cava superior and inferior, leading to numerous collateral circulation routes in the upper and lower extremities. The etiology of the venous blockage is still disputed. It is possible that they are the result of compression of the major veins. Alternatively, the cause could lie in the disruption of the coagulation system. Finally and more likely, the problem could be the result of fibrosis developing through the healing process.

  16. Starling curves and central venous pressure.

    PubMed

    Berlin, David A; Bakker, Jan

    2015-01-01

    Recent studies challenge the utility of central venous pressure monitoring as a surrogate for cardiac preload. Starting with Starling's original studies on the regulation of cardiac output, this review traces the history of the experiments that elucidated the role of central venous pressure in circulatory physiology. Central venous pressure is an important physiologic parameter, but it is not an independent variable that determines cardiac output. PMID:25880040

  17. Repeated loss of frontal sinuses in arctoid carnivorans.

    PubMed

    Curtis, Abigail A; Lai, George; Wei, Fuwen; Van Valkenburgh, Blaire

    2015-01-01

    Many mammal skulls contain air spaces inside the bones surrounding the nasal chamber including the frontal, maxilla, ethmoid, and sphenoid, all of which are called paranasal sinuses. Within the Carnivora, frontal sinuses are usually present, but vary widely in size and shape. The causes of this variation are unclear, although there are some functional associations, such as a correlation between expanded frontal sinuses and a durophagous diet in some species (e.g., hyenas) or between absent sinuses and semiaquatic lifestyle (e.g., pinnipeds). To better understand disparity in frontal sinus morphology within Carnivora, we quantified frontal sinus size in relationship to skull size and shape in 23 species within Arctoidea, a clade that is ecologically diverse including three independent invasions of aquatic habitats, by bears, otters, and pinnipeds, respectively. Our sampled species range in behavior from terrestrial (rarely or never forage in water), to semiterrestrial (forage in water and on land), to semiaquatic (forage only in water). Results show that sinuses are either lost or reduced in both semiterrestrial and semiaquatic species, and that sinus size is related to skull size and shape. Among terrestrial species, frontal sinus size was positively allometric overall, but several terrestrial species completely lacked sinuses, including two fossorial badgers, the kinkajou (a nocturnal, arboreal frugivore), and several species with small body size, indicating that factors other than aquatic habits, such as space limitations due to constraints on skull size and shape, can limit sinus size and presence. PMID:25069818

  18. Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

    PubMed Central

    Ji, Gyu Yeul; Oh, Chang Hyun; Moon, Bongju; Choi, Seung Hyun; Yoon, Young Sul; Kim, Keung Nyun

    2015-01-01

    Purpose Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. Materials and Methods This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. Results The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. Conclusion PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area. PMID:25837174

  19. Inferior sinus venosus defects: anatomic features and echocardiographic correlates.

    PubMed

    Plymale, Jennifer; Kolinski, Kellen; Frommelt, Peter; Bartz, Peter; Tweddell, James; Earing, Michael G

    2013-02-01

    Inferior sinus venosus defects (SVDs) are rare imperfections located in the inferior portion of the atrial septum, leading to an overriding inferior vena cava (IVC) and an interatrial connection. These defects have increased risk of anomalous pulmonary venous return (PAPVR) and often are confused with secundum atrial septal defects (ASDs) with inferior extension. The authors sought to review their experience with inferior SVDs and to establish at their institution an echocardiographic definition that differentiates inferior SVDs from secundum ASDs with inferior extension. The study identified 161 patients 1.5 to 32 years of age who had undergone repair of a secundum ASD with inferior extension or inferior SVD over the preceding 10 years. All surgical notes, preoperative transthoracic echocardiograms (TTEs), and preoperative transesophageal echocardiograms (TEEs) were reviewed. Based on the surgical notes, 147 patients were classified as having a secundum ASD (147/161, 91 %) and 14 patients (9 %) as having an inferior SVD. The study identified PAPVR in 7 % (1/14) of the patients with inferior SVDs and 3.5 % (5/14) of the patients with secundum ASDs. Surgical diagnosis and preoperative TTE correlated for 143 (89 %) of the 161 patients. Using a strict anatomic and echocardiographic definition with a blinded observer, the majority of the defects (14/18, 78 %) were reclassified correctly after review of their TTE images, and 100 % of the defects were correctly reclassified after TEE image review. Accurate diagnosis of inferior SVDs remains challenging. The data from this study demonstrate that use of a strict anatomic and echocardiographic definition (a defect that originates in the mouth of the IVC and continues into the inferoposterior border of the left atrium, leaving no residual atrial septal tissue at the inferior margin) allows for accurate differentiation between secundum ASDs with inferior extension and inferior SVDs. This differentiation is extremely important

  20. Histological analysis of the repair of dural lesions with silicone mesh in rats subjected to experimental lesions

    PubMed Central

    da Rosa, Fernando William Figueiredo; Pohl, Pedro Henrique Isoldi; Mader, Ana Maria Amaral Antônio; de Paiva, Carla Peluso; dos Santos, Aline Amaro; Bianco, Bianca; Rodrigues, Luciano Miller Reis

    2015-01-01

    ABSTRACT Objective To evaluate inflammatory reaction, fibrosis and neovascularization in dural repairs in Wistar rats using four techniques: simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Methods Thirty Wistar rats were randomized in five groups: the first was the control group, submitted to dural tear only. The others underwent durotomy and simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Animals were euthanized and the spine was submitted to histological evaluation with a score system (ranging from zero to 3) for inflammation, neovascularization and fibrosis. Results Fibrosis was significantly different between simple suture and silicon mesh (p=0.005) and between simple suture and mesh with suture (p=0.015), showing that fibrosis is more intense when a foreign body is used in the repair. Bovine membrane was significantly different from mesh plus suture (p=0.011) regarding vascularization. Inflammation was significantly different between simple suture and bovine collagen membrane. Conclusion Silicon mesh, compared to other commercial products available, is a possible alternative for dural repair. More studies are necessary to confirm these findings. PMID:26761555

  1. Postextrasystolic sinoatrial exit block in human sick sinus syndrome: demonstration by direct recording of sinus node electrograms.

    PubMed

    Asseman, P; Berzin, B; Desry, D; Bauchart, J J; Reade, R; Leroy, O; Poncelet, P; Lekieffre, J; Thery, C

    1991-12-01

    Ten patients with sick sinus syndrome having repetitive sinus node electrograms during long postpacing pauses were studied during programmed atrial stimulation. Sinus node activity was recorded using a percutaneous catheter electrode. A sinus node electrogram was recorded before the return atrial beat in seven patients; it was similar to the sinus node electrogram observed during postpacing pauses and is clearly identified because sinoatrial conduction time was markedly prolonged following the atrial extra beat. Complete sinoatrial exit block occurred in four patients. (1) Sinus node electrograms were thus validated both during postpacing pauses and during programmed atrial stimulation in most patients with sick sinus syndrome. (2) Sinoatrial conduction time was markedly prolonged after one extrasystole, accounting for supracompensatory atrial return cycles. (3) If it were cumulative following multiple extrasystoles, this effect could constitute the electrophysiologic link between an abnormal response during programmed atrial stimulation and the complete sinoatrial block recorded during the pauses that follow rapid atrial pacing.

  2. The Role of Hyperthyroidism as the Predisposing Factor for Superior Sagittal Sinus Thrombosis

    PubMed Central

    Hwang, Jong-Uk; Hur, Jin-Woo; Lee, Jong-Won; Lee, Hyun-Koo

    2012-01-01

    Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism. PMID:23210057

  3. The role of hyperthyroidism as the predisposing factor for superior sagittal sinus thrombosis.

    PubMed

    Hwang, Jong-Uk; Kwon, Ki-Young; Hur, Jin-Woo; Lee, Jong-Won; Lee, Hyun-Koo

    2012-09-01

    Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism. PMID:23210057

  4. Timing of neuraxial pain interventions following blood patch for post dural puncture headache.

    PubMed

    Shaparin, Naum; Gritsenko, Karina; Shapiro, David; Kosharskyy, Boleslav; Kaye, Alan D; Smith, Howard S

    2014-01-01

    Post dural puncture headache (PDPH) is a common complication of interventional neuraxial procedures. Larger needle gauge, younger patients, low body mass index, women (especially pregnant women), and "traumatic" needle types are all associated with a higher incidence of PDPH. Currently, an epidural blood patch is the gold-standard treatment for this complication. However, despite the high PDPH cure rate through the use of this therapy, little is known about the physiology behind the success of the epidural blood patch, specifically, the time course of patch formation within the epidural space or how long it takes for the blood patch volume to be resorbed by the body. Of the many unanswered and debated topics related to PDPH and epidural blood patches, one additional specific question that may alter clinical management is when it is safe for patients who have experienced a disruption of the thecal space and have undergone this procedure to have a subsequent epidural or spinal procedure, such as a neuraxial anesthetic (i.e. a spinal anesthetic for an elective outpatient procedure) or an interventional pain procedure for chronic pain management. This question becomes more unclear if the new procedure includes a steroid medication. As an example, an older patient presents with a history of lumbar disc disease and during lumbar epidural steroid injection, an inadvertent wet tap occurs leading to PDPH. Following management with fluids, caffeine, medications, and a successful epidural blood patch, it remains unclear as to when would be the best time frame to consider a second lumbar epidural steroid injection. We identified the 3 main risk factors of subsequent interventional neuraxial procedures as (1) disruption of the epidural blood patch and ongoing reparative processes, (2) epidural procedure failure, and (3) infection. We looked at the literature, and summarized the existing literature in order to enable health care professionals to understand the time course of

  5. Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access

    SciTech Connect

    Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio

    2011-12-15

    Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.

  6. Cerebral venous thrombosis associated with thyrotoxicosis, the use of desmopressin and elevated factor VIII/von Willebrand factor.

    PubMed

    Waheed, Waqar; Aljerdi, Salman; Decker, Barbara; Cushman, Mary; Hamill, Robert W

    2016-01-01

    Cerebral venous thrombosis (CVT) is an uncommon disorder associated with diverse processes. We report a patient who, while receiving desmopressin and contraceptive pills (OCP), developed straight sinus thrombosis. Clinical assessment and laboratory investigations revealed untreated hyperthyroidism and a hypercoagulable state, characterised by high levels of von Willebrand factor, factor VIII coagulant activity and IgM cardiolipin antibody. The clinical picture improved with anticoagulation, treatment of hyperthyroidism and discontinuation of OCP and desmopressin. To the best of our knowledge, the association between the use of oral desmopressin and CVT has not been described. The multiple risk factors present in our case were probably additive in increasing the risk of CVT. Although this case represents a rare occurrence, practitioners should be alerted to the possible associations of desmopressin, oral contraceptives and Graves' disease with venous thrombosis. PMID:27503942

  7. Lateral cervical sinus: specific sonographic findings in two pediatric cases.

    PubMed

    Hosokawa, Takahiro; Yamada, Yoshitake; Sato, Yumiko; Tanami, Yutaka; Amano, Hizuru; Fujiogi, Michimasa; Kawashima, Hiroshi; Oguma, Eiji

    2015-10-01

    A lateral cervical sinus, also known as a second pharyngeal or branchial cleft fistula/sinus, occurs when the second pharyngeal arch fails to grow caudally over the third and fourth arches, leaving remnants of the second branchial clefts in contact with the surface of the neck via a narrow canal. This type of sinus is detected on the lateral aspect of the neck directly anterior to the sternocleidomastoid muscle. We report two pediatric cases with lateral cervical sinus, and pathognomonic sonographic findings to confirm the diagnosis. The first case involved a 3-month-old boy with a sinus on the lateral neck and occasional drainage from a cervical sinus opening. Sonography revealed that the sinus tract extended between the external and internal carotid arteries. In case two, a 1-month-old girl presented with a sinus on the lateral neck and signs of acute infection at the site of a pinpoint opening. Sonography revealed an oval-shaped cystic lesion and sinus tract extending between the external and internal carotid arteries. Sonography does not require radiation or sedation for children. The best choice for the first examination for lateral cervical sinus is sonography, rather than CT, MRI, or contrast fistulograms. PMID:26576989

  8. Klotho protein lowered in senile patients with brady sinus arrhythmia

    PubMed Central

    Wang, Ying; Yang, Wei; Zheng, Ernv; Zhang, Wei; Su, Xianming

    2015-01-01

    Objective: To explore the correlationship between brady sinus arrhythmia and the levels of serum klotho protein in aged. Methods: 104 patients over 75 years old with brady sinus arrhythmia (experiment group) were enrolled, including 34 cases of sinus arrest, 43 cases of sinus bradycardia and 25 cases of atrioventricular block. 109 patients over 75 years old without brady sinus arrhymia were chosen as control group. All subjects were monitored by Holter. The levels of serum klotho protein were detected and compared among three groups. The correlation between the frequency of sinus arrest and the levels of serum klotho protein was analyzed simultaneously. Results: The levels of serum klotho protein in experiment group were lower than that in control group (P<0.01); the sinus arrest frequency was negatively correlated with the levels of serum klotho protien. The levels of serum klotho protein in patients with sinus arrest were lower than that with sinus bradycardia and atrioventricularblock (P<0.05). But there was no significant difference between sinus bradycardia group and atrioventricular block group. Conclusion: The levels of serum klotho protein may reflect the function of sinoatrial node and could be used as an index to estimate the function of sinoatrial node. PMID:26550342

  9. Acroangiodermatitis secondary to chronic venous insufficiency.

    PubMed

    Palmer, Benjamin; Xia, Yang; Cho, Sunghun; Lewis, Felisa S; Lewis, Felicia S

    2010-11-01

    Acroangiodermatitis (AAD) is a benign uncommon vasoproliferative disorder that affects the lower extremities. It appears to be a reactive phenomenon related to severe chronic Venous insufficiency and stasis of the lower extremities. The clinical presentation of this condition often is similar to Kaposi sarcoma. We report a case of AAD in a patient with severe hypertension and chronic venous insufficiency. PMID:21214123

  10. 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

  11. Stent Placement on Fresh Venous Thrombosis

    SciTech Connect

    Vorwerk, Dierk; Guenther, Rolf W.; Schuermann, Karl

    1997-09-15

    Purpose: To report on the efficacy of fixing fresh venous thrombus to the venous wall by stent placement. Methods: Seven patients underwent stenting to treat acute venous thrombosis. In two patients, the hemodialysis fistula was thrombosed with the thrombus extending into the brachial veins. In three patients, the hemodialysis fistula was patent but massive swelling of the ipsilateral arm was caused by proximal venous thrombosis. Two patients presented with iliac venous thrombosis within stented pelvic veins. Stent placement was preceded by other mechanical thrombectomy methods in all cases. Results: Attachment of thrombus to the venous wall was successful in all cases treated. Acute rethrombosis did not occur. Follow-up patency in dialysis patients was 7.2 {+-} 2.1 months. One patient had rethrombosis of the dialysis graft 3 months after primary treatment. Three patients developed restenosis within a mean period of 7.7 months. One shunt remained patent for 10 months with no event of reobstruction during follow-up. In both patients with iliac stent placement, the vein remained patent over a follow-up period of 8 and 12 months respectively. Conclusion: Stenting fresh venous thrombus can achieve immediate venous patency. It may be used as an alternative approach when all other percutaneous methods fail. Frequent restenosis within stented veins limits its use to very selected cases.

  12. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  13. Venous Thromboembolism in Patients with Membranous Nephropathy

    PubMed Central

    Lionaki, Sophia; Derebail, Vimal K.; Hogan, Susan L.; Barbour, Sean; Lee, Taewoo; Hladunewich, Michelle; Greenwald, Allen; Hu, Yichun; Jennette, Caroline E.; Jennette, J. Charles; Falk, Ronald J.; Cattran, Daniel C.; Nachman, Patrick H.; Reich, Heather N.

    2012-01-01

    Summary Background and objectives The aims of this study were to determine the frequency of venous thromboembolic events in a large cohort of patients with idiopathic membranous nephropathy and to identify predisposing risk factors. Design, setting, participants, & measurements We studied patients with biopsy-proven membranous nephropathy from the Glomerular Disease Collaborative Network (n=412) and the Toronto Glomerulonephritis Registry (n=486) inception cohorts. The cohorts were pooled after establishing similar baseline characteristics (total n=898). Clinically apparent and radiologically confirmed venous thromboembolic events were identified. Potential risk factors were evaluated using multivariable logistic regression models. Results Sixty-five (7.2%) subjects had at least one venous thromboembolic event, and this rate did not differ significantly between registries. Most venous thromboembolic events occurred within 2 years of first clinical assessment (median time to VTE = 3.8 months). After adjusting for age, sex, proteinuria, and immunosuppressive therapy, hypoalbuminemia at diagnosis was the only independent predictor of a venous thromboembolic event. Each 1.0 g/dl reduction in serum albumin was associated with a 2.13-fold increased risk of VTE. An albumin level <2.8 g/dl was the threshold below which risk for a venous thromboembolic event was greatest. Conclusions We conclude that clinically apparent venous thromboembolic events occur in about 7% of patients with membranous nephropathy. Hypoalbuminemia, particularly <2.8 g/dl, is the most significant independent predictor of venous thrombotic risk. PMID:22076873

  14. The reflex cardiovascular depression caused by occlusion of the coronary sinus in the dog

    PubMed Central

    Muers, M. F.; Sleight, P.

    1972-01-01

    1. Brief occlusions of the outflow from the cannulated coronary sinus in the open chest anaesthetized dog caused a rise in coronary venous pressure, bradycardia, and systemic hypotension. 2. The bradycardia and hypotension were directly proportional to the peak systolic coronary venous pressures above a threshold value of about 50 mm Hg. 3. The bradycardia, but not the systemic hypotension, was abolished by intravenous atropine. Both responses were abolished by cutting the cervical vagi, and reversibly abolished by cooling them to less than 7° C. 4. During occlusions, there was inhibition of activity in single and small multi-fibre preparations of sympathetic efferent nerves in the ansae subclaviae and the cervical sympathetic. 5. On the right side, nearly all afferent fibres ran in the recurrent cardiac nerve. There was no concentration of afferents in one cardiac nerve on the left side. 6. It was concluded that the cardiovascular depression was reflex, and was caused by the stimulation of nerves or nerve endings in the ventricles of the heart. PMID:5020978

  15. Venous pressure in man during weightlessness

    NASA Technical Reports Server (NTRS)

    Kirsch, K. A.; Roecker, L.; Gauer, O. H.; Krause, R.; Wicke, H. J.; Leach, C.; Landry, R.

    1984-01-01

    To determine whether the body fluid shift from the lower limbs toward the head that occurs during spaceflight leads to lasting increases of venous pressure in the upper body, venous pressure and hematocrit measurements were made on four astronauts before flight and 1 and 12 hours after recovery and compared with measurements in space. During the mission the hematocrit was elevated and the venous pressure lowered by 1 to 8 centimeters of water as compared with the preflight data. One hour after landing the hematocrit decreased, indicating a hemodilution, venous pressures were unexpectedly high, and a body weight loss of 4 to 5 percent was observed. Twelve hours later the venous pressures were the lowest recorded during the study. The fluid shift apparently takes place during the first several hours of spaceflight. Thereafter, the pressure in the peripheral veins and the central circulation is lower than that measured before flight.

  16. Septic Cavernous Sinus Thrombosis: A Case Report

    PubMed Central

    Arian, Mahdieh; Kamali, Azadeh; Tabatabaeichehr, Mahbubeh; Arashnia, Parisa

    2016-01-01

    Introduction Septic cavernous sinus thrombosis (CST) is a rare condition that can result in high mortality and morbidity rates if not treated immediately. CST may be aseptic or septic. Less common primary sites of infection include the tonsils, soft palate, middle ear, and orbit. Reported cases of middle ear infection are very rare, and response to treatment is poor. Case Presentation The present study is a case report of acute otitis media which led to septic cavernous sinus thrombosis in a 56-year-old woman in Bojnord city, North Khorasan, Iran. Conclusions Findings of laboratory tests and magnetic resonance imaging (MRI) confirmed the clinical diagnosis. Clinical-based medical care led to successful management of the patient with broad spectrum intravenous antibiotics that prevented serious complications. PMID:27781123

  17. Sinus Pause in Association with Lyme Carditis

    PubMed Central

    Dibs, Samer R.; Friedman, Harvey

    2015-01-01

    Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement of the atrioventricular node. On rare occasions, Lyme carditis patients present with other conduction system disorders such as bundle branch block, intraventricular conduction delay, and supraventricular or ventricular tachycardia. We report the unusual case of a 59-year-old man who presented with new-onset symptomatic sinus pauses one month after hiking in upstate New York. To our knowledge, this is the first case report from North America that describes the relationship between symptomatic sinus pause and Lyme carditis. PMID:26175640

  18. Lymphoma of the nose and paranasal sinuses.

    PubMed

    Wilder, W H; Harner, S G; Banks, P M

    1983-05-01

    The records of 37 patients with lymphoma of the nose and paranasal sinuses in an 18-year period were studied. The symptoms were divided into three categories: (1) local symptoms: obstruction, bleeding, and rhinorrhea; (2) symptoms of invasion of adjacent structures: facial pain and ear fullness; and (3) systemic symptoms: fever, weight loss, and nocturnal sweating. The presence of an intranasal mass was the most common physical finding. Conventional tomography and computed tomography were helpful for diagnosis. Abnormalities were usually disclosed on biopsy specimens from the nose or mouth. As a rule, several sites in the nose and sinuses were involved. An early diagnosis of sinonasal lymphoma and other malignant neoplasms generally allows effective treatment; therefore, the otorhinolaryngologist should be alert for such disease and, if the clinical picture warrants, should add tomography to the diagnostic workup. PMID:6847482

  19. Sinus pause in association with Lyme carditis.

    PubMed

    Oktay, A Afsin; Dibs, Samer R; Friedman, Harvey

    2015-06-01

    Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement of the atrioventricular node. On rare occasions, Lyme carditis patients present with other conduction system disorders such as bundle branch block, intraventricular conduction delay, and supraventricular or ventricular tachycardia. We report the unusual case of a 59-year-old man who presented with new-onset symptomatic sinus pauses one month after hiking in upstate New York. To our knowledge, this is the first case report from North America that describes the relationship between symptomatic sinus pause and Lyme carditis.

  20. Cavernous sinus syndrome: need for early diagnosis.

    PubMed

    Toro, Jaime; Burbano, Lisseth Estefania; Reyes, Saúl; Barreras, Paula

    2015-01-01

    Cavernous sinus syndrome (CSS) is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and Horner's syndrome. These signs and symptoms result from the involvement of the cranial nerves passing through the cavernous sinus. We report the case of a 53-year-old man with a history of daily stabbing headache associated with dizziness, progressive blurred vision, right ocular pain, ptosis and ophthalmoplegia. After working up the patient, a meningioma was identified as the cause of the CSS. Despite advances in neuroimaging techniques, in some cases, the aetiology of CSS remains difficult to determine. We highlight the clinical and radiological features of a meningioma, one of the causes of CSS. Early diagnosis and treatment of CSS play a key role in a better prognosis. PMID:25819816