Cerebral Venous Sinus Thrombosis following Diagnostic Curettage ...
Cerebral Veinous Thrombosis, MESS 2013
-
Upload
surat-tanprawate -
Category
Documents
-
view
141 -
download
0
description
Transcript of Cerebral Veinous Thrombosis, MESS 2013
![Page 1: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/1.jpg)
Cerebral venous thrombosis: A clinical pictureSurat Tanprawate, MD, MSc(Lond.), FRCP(T) the Northern Neuroscience Center in collaboration with Division of Neurology, Department of Medicine Chiang Mai University
MeSS 2013!Chiang Mai University
![Page 2: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/2.jpg)
Case scenario-1A 52 years old man presented with motor seizure on the right side with subsequently mild hemiparesis and headache on the right side
Cerebral cortical vein, sagittal sinus, right lateral and sigmoid sinus thrombosis with brain edema
![Page 3: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/3.jpg)
Cerebral vein thrombosis (CVST)
• CVST is a stroke of (venous site)
• but… the clinical symptoms are not typical as stroke syndrome
• Arterial stroke:
• sudden onset, reach a peak at the onset, typically no seizure, typically no headache
• Venous stroke: ???
![Page 4: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/4.jpg)
Clinical feature of CVST
![Page 5: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/5.jpg)
The onset of symptoms• subacute onset (2 days to 1 month;50-80%)
• can be chronic (more than 2 months) in patient presenting with isolated intracranial hypertension
Bousser MG. Stroke 1985;16:199–213.
![Page 6: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/6.jpg)
Neurological deficit
• can be unilateral or bilateral
• negative symptoms(weakness) +/- positive symptoms (seizure)
• Bilateral cerebral infarct +/- haemorrhage is common
![Page 7: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/7.jpg)
Hemorrhagic venous infarct
Venous infarct
Hemorrhage infarct
![Page 8: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/8.jpg)
Seizure• Seizure: partial or generalize
• Associated location: supratentorial lesion (OR=4.05), cortical vein thrombosis (OR=2.31), sagittal sinus thrombosis (OR=2.18), puerperal CVST (OR=2.06)
Ferro J M, Stroke. 2008;39:1152-1158
![Page 9: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/9.jpg)
Headache : when to suspect CVST?• Headache is the most common symptoms
• Warning sign
• First or worst
• Abrupt onset
• Subacute headache with increasing frequency or severity
• Headache bought by exertion or Valsalva manoeuvre
• Systemic symptoms/signs such fever, vomiting
• Headache associated with neurological symptoms/signs
![Page 10: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/10.jpg)
Case scenario-1
A middle age man with progressive headache
![Page 11: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/11.jpg)
Headache and CVST• 123 patients with CVST/ 17 patients had only
headache
• Headache character:
• 11 progressive
• 3 acute
• 3 thunderclap
Cumurciuc R et al. J Neurol Neurosurg Psychiatry 2005;76:1084-1087
![Page 12: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/12.jpg)
J Headache Pain (2012) 13:487–490
J Headache Pain (2012) 13:487–490
Headache as the sole presentation
![Page 13: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/13.jpg)
Thunderclap headache and CVST
• “Thunderclap”—sudden onset of an excruciating headache (VAS more than 8/10), reaching maximum intensity in less than one minute, and lasting more than 1 hour
• The differential diagnosis of Thunderclap headache
• : SAH, carotid/vertebral artery dissection, CVST, pituitary apoplexy, 3rd ventricular colloid cyst, Call-Fleming syndrome(reversible vasoconstriction syndrome), post-coital headache, primary
![Page 14: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/14.jpg)
Venous infarct with haemorrhage
Primary intracerebral haemorrhage
Intracerebral haemorrhage in HT and CVST
![Page 15: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/15.jpg)
Transverse sinus thrombosis Subarachnoid hemorrhage
Thunderclap headache patient
![Page 16: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/16.jpg)
Bruijin et al. The Lancet 1996, 348: 1623 - 1625
CT brain in 10 patients with CVST presenting with thunderclap headache - 5 normal - 3 SAH - 2 multiple intracerebral haemorrhage
![Page 17: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/17.jpg)
![Page 18: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/18.jpg)
Topographic diagnosis
the location of thrombosis can determine characteristic clinical patterns
![Page 20: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/20.jpg)
Deep cerebral vein thrombosis
From: http://wfffun.info/
Diencephalon hemorrhagic infarct with deep cerebral vein thrombosis in comatose patient
![Page 21: Cerebral Veinous Thrombosis, MESS 2013](https://reader033.fdocuments.net/reader033/viewer/2022051401/55cf9af5550346d033a42b77/html5/thumbnails/21.jpg)
Unusual presentation• Subarachnoid hemorrhage
• Isolated psychiatric symptoms
• Reversible parkinsonism
• Trigeminal neuralgia
• Acute visual loss
• Migraine like phenomena
• Hearing loss
• ocular flutter