MyMedR

Cerebral venous sinus thrombosis: review of cases in a single centre in Malaysia

Sim SK, Tan YC, Ghani ARI

Med J Malaysia, 2020 01;75(1):38-42.

PMID: 32008018

INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is a potentially fatal neurological condition. However, due to the non-specific clinical and radiological features of CVST, it can sometimes result in a delay in the diagnosis and subsequent management. The aim of this study was to evaluate the demography, risk factors and one-year outcome of CVST patients treated in Hospital Universiti Sains Malaysia.

METHODS: In this retrospective study, we reviewed the cases diagnosed with CVST admitted to our centre from January 2011 until November 2015.

RESULTS: A total of 15 patients were included in this review. The patterns of imaging findings as well as risk factors for CVST is discussed with a review of the literature and current management practices. One year followed-up showed full recovery (Glasgow Outcome Scale (GOS) of 5) in 10 cases (66.7%), whereas 4 cases (26.7%) with GOS of 4 (three cases with neurological deficits, and 1 case with mild symptom. There was one case of mortality in this study secondary to sepsis during hospitalisation. The presenting symptoms were mainly headache, focal neurology deficits, seizure and altered sensorium. Risk factors identified were oral contraceptive pills usage, chronic sinuses or ear infections, and obesity. Initial computed tomography (CT) scan showed various findings and haemorrhagic infarct was one of the common findings. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) revealed majority of the patients had occlusion at two or more venous sinus sites. No patients had new or recurrent intracranial haemorrhage following initiation of anticoagulation therapy.

CONCLUSION: Thus it is considerable safe to start anticoagulation therapy in CVST patients including those with intracranial haemorrhage. We propose further neuroimaging to avoid missed diagnosis of CVST in patient presented with recent onset headache and CT evidence of unusual cerebral infarction.

Matched MeSH terms: Sinus Thrombosis, Intracranial/diagnosis*; Sinus Thrombosis, Intracranial/drug therapy*; Sinus Thrombosis, Intracranial/etiology

Fulltext Cerebral venous sinus thrombosis in a patient with concomitant Graves' disease and squamous cell carcinoma of the cervix

Chee YC, Abdul Halim S

BMJ Case Rep, 2020 Dec 09;13(12).

PMID: 33298481 DOI: 10.1136/bcr-2020-236730

Cerebral venous sinus thrombosis (CVST) is caused by either acquired or inherited pro-thrombotic states. Hyperthyroidism is a less recognised predisposing factor of CVST, and the causality has been debated. We report a case of a life-threatening CVST in a 40-year-old woman, with uncommon dual risk factors: hyperthyroidism and advanced squamous cell carcinoma of the cervix. CVST should be considered as a differential diagnosis when a patient with hyperthyroidism presents with new-onset headache or other neurological symptoms. Further assessment to elucidate other covert risk factors may need to be continuously carried out, when the causal relationship of one apparent cause has not been well established.

Matched MeSH terms: Sinus Thrombosis, Intracranial/diagnosis; Sinus Thrombosis, Intracranial/etiology*; Sinus Thrombosis, Intracranial/therapy

Fulltext Behcet's syndrome with sagittal sinus and inferior vena caval thrombophlebitis

Segasothy M

Med J Malaysia, 1982 Jun;37(2):132-3.

PMID: 7132832

This report describes a case of Behcet's syndrome in which there was involvement of both the intracranial and systemic veins. The pathogenesis of Behcet's syndrome is discussed.

Matched MeSH terms: Sinus Thrombosis, Intracranial/complications*

Fulltext Cerebral venous sinus thrombosis 2 weeks after the first dose of mRNA SARS-CoV-2 vaccine

Zakaria Z, Sapiai NA, Ghani ARI

Acta Neurochir (Wien), 2021 08;163(8):2359-2362.

PMID: 34101024 DOI: 10.1007/s00701-021-04860-w

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) is a highly transmissible virus and has become pandemic. Part of the prevention of disease spread by the Malaysian government is by getting COVID-19 vaccine. Using the mRNA technology, the Pfizer/BioNTech vaccine is one of the vaccines been approved by the Drug Control Authority in Malaysia. Herein, we report an immediate complication of cerebral VST after the first dose of the Pfizer/BioNTech vaccine.

Matched MeSH terms: Sinus Thrombosis, Intracranial/chemically induced*

Japanese Encephalitis presenting with cerebral venous sinus thrombosis: a case report

Neo RJ

Med J Malaysia, 2019 12;74(6):537-539.

PMID: 31929482

A 17-year-old man from Sarawak presented with acute encephalitis syndrome. Serologic testing revealed raised Japanese Encephalitis (JE) IgM antibody titre in which first serum JE was negative followed by positive second serum JE IgM one week later. Magnetic resonance imaging (MRI) and Magnetic resonance venogram (MRV) showed cerebral venous sinus thrombosis (CVST) which is a rare presentation of JE. Early identification of CVST is important as anticoagulation needs to be started to reduce adverse neurological sequelae and improve prognosis.

Matched MeSH terms: Sinus Thrombosis, Intracranial/diagnosis*; Sinus Thrombosis, Intracranial/etiology

Fulltext Extensive dural sinus thrombosis and bilateral lateral rectus palsy as an uncommon complication of chronic suppurative otitis media

Balasubramanian A, Mohamad I, Sidek D

BMJ Case Rep, 2013;2013.

PMID: 23355565 DOI: 10.1136/bcr-2012-007414

Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.

Matched MeSH terms: Sinus Thrombosis, Intracranial/diagnosis; Sinus Thrombosis, Intracranial/drug therapy; Sinus Thrombosis, Intracranial/etiology*

Fulltext Imaging findings of an isolated deep cerebral venous thrombosis in the absence of superficial sinus thrombosis

Sabrilhakim Sidek, Kartini Rahmat, Norlisah Ramli

Neurology Asia, 2015;20(2):191-195.

MyJurnal

Thrombosis of the deep cerebral venous system in the absence of superficial sinus thrombosis is a very rare disease. The clinical and radiological findings can be diagnostically challenging due to the subtle appearances on computed tomography (CT) scan. Magnetic resonance imaging (MRI) examination is a preferred imaging modality to complement the CT findings for an accurate diagnosis of venous sinus thrombosis. We present a case of this unusual condition which present as unilateral thalamic lesion on CT scan and the role of contrast enhanced MRI with fast spoiled gradient echo (FSPGR) sequence and 3D reconstruction which led to the diagnosis of thrombosis in the deep cerebral venous system.

Matched MeSH terms: Sinus Thrombosis, Intracranial

Intracranial Complications of Chronic Otitis Media: Why Does It Still Occur?

Gendeh HS, Abdullah AB, Goh BS, Hashim ND

Ear Nose Throat J, 2019 Aug;98(7):416-419.

PMID: 31018687 DOI: 10.1177/0145561319840166

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM.

Matched MeSH terms: Sinus Thrombosis, Intracranial

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