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An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST)

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (30 January 2023) | Viewed by 50147

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Prof. Dr. Dragos Catalin Jianu

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Guest Editor

1. Head of the First Division of Neurology, Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, E. Murgu Sq., no.2, 300041 Timisoara, Romania
2. Head of the Centre for Advanced Research titled: “Cognitive Research in Neuropsychiatric Pathology” (Neuro-Psy-Cog), First Division of Neurology, Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300723 Timisoara, Romania
3. Head of the First Department of Neurology, “Pius Branzeu” Clinical Emergency County Hospital, no.156, L. Rebreanu Ave., 300723 Timisoara, Romania
Interests: cerebral vein and dural sinus thrombosis; ischemic stroke and extra and transcranial Doppler sonography (large-artery diseases and small-artery diseases); vascular aphasias; vascular cognitive impairment; neuro-ophthalmology and color Doppler imaging of orbital vessels; Parkinson’s disease
Special Issues, Collections and Topics in MDPI journals

Dr. Jean Claude Sadik

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Guest Editor

Head of the Service de Neuroradiologie Diagnostique, Hôpital Fondation Rothschild, 29 rue Manin, 75019 Paris, France
Interests: stroke; cerebral venous thrombosis; neuro-ophthalmology and color Doppler imaging of cerebral and orbital vessels; noninvasive explorations of large-artery diseases/extra and transcranial Doppler sonography
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Dafin Fior Mureşanu

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Guest Editor

Department of Neurosciences, Iuliu Hațieganu University of Medicine and Pharmacy, No. 8 Victor Babeș Street, 400012 Cluj-Napoca, Romania
Interests: cerebrovascular diseases; neurodegenerative diseases; traumatic brain injury; brain protection and recovery; neurorehabilitation; neuroimmunology; ischemic stroke; neuropharmacology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebral venous thrombosis (CVT) is an uncommon disorder in the general population. At least one risk factor can be identified in 85% of patients with CVT. Because of the high frequency of thrombophilia among patients with CVT, screening for hypercoagulable conditions should be performed. Two pathophysiological mechanisms contribute to their highly variable clinical presentation (the increase of venular and capillary pressure and decrease of cerebrospinal fluid absorption). Four major syndromes have been described: isolated intracranial hypertension, focal neurological abnormalities, seizures, and encephalopathy. Cavernous sinus thrombosis represents the only CVT that produces a characteristic clinical syndrome. Head Computed Tomography is the most frequently performed imaging study, but Magnetic Resonance Imaging of the head, combined with Magnetic Resonance Venography, are the most sensitive studies. Acute phase therapy for CVT focuses on anticoagulation, the management of seizures, increased intracranial pressure, and the prevention of cerebral herniation. The majority of patients have a complete or partial recovery; however, they have an increased incidence of venous thromboembolism. Clinical and imaging follow-ups 3 to 6 months after diagnosis are recommended to assess for recanalization.

This Special Issue of Life (IF=3.817) includes but is not limited to the following topics: the anatomy of dural sinuses and encephalic veins; the epidemiology, the risk factors, and the pathophysiology of CVT; and the clinical presentation, the laboratory testing (including thrombophilia testing), and the imaging of CVT. The management of CVT represents another important aspect, devoted to acute phase therapy, the management after the acute phase, and the prognosis of patients with CVT.

I am pleased to invite you to submit a manuscript covering experimental and clinical research, as well as systematic reviews and meta-analyses.

Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the Special Issue’s website.

Prof. Dr. Dragos Catalin Jianu
Dr. Jean-Claude Sadik
Prof. Dr. Dafin Fior Muresanu
Guest Editors

Keywords

cerebral venous thrombosis
thrombophilia
isolated intracranial hypertension
Magnetic Resonance Imaging of the head
Magnetic Resonance venography
anticoagulation

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Published Papers (10 papers)

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Research

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16 pages, 3800 KiB

Open AccessArticle

Challenges in Cerebral Venous Thrombosis Management—Case Reports and Short Literature Review

by Florentina Cristina Pleșa, Alina Jijie, Gabriela Simona Toma, Aurelian Emilian Ranetti, Aida Mihaela Manole, Ruxandra Rotaru, Ionuț Caloianu, Daniela Anghel and Octaviana Adriana Dulămea

Life 2023, 13(2), 334; https://doi.org/10.3390/life13020334 - 26 Jan 2023

Cited by 3 | Viewed by 5629

Abstract

Cerebral venous thrombosis (CVT) is a rare type of stroke, with a complex clinical presentation that can make it a diagnostic challenge for the swift initiation of anticoagulation. When a hemorrhagic transformation is added, therapeutic management becomes even more complex. We describe a series of four cases, aged between 23 and 37 years old, with cerebral venous thrombosis. They were admitted to our clinic between 2014 and 2022. All cases presented significant challenges in either diagnostic, therapeutic or etiologic evaluation, at different stages of the disease. Late complications such as epilepsy or depression and other behavioral disorders represent long-term sequelae for the patient. Therefore, through its late complications, CVT is not only an acute disease but a chronic disorder with long-term follow-up requirements. The first case of the series is of a postpartum woman with focal neurological deficit caused by CVT with hemorrhagic transformation that presented multiple thrombotic complications and severe depression. The second case is of a man with extensive cerebral thrombosis who developed bilateral papillary edema under therapeutic anticoagulation treatment. The third case is of a woman with bilateral cavernous sinus thrombosis who later developed depressive disorder and focal seizures. The fourth case is of a pregnant woman in the first trimester presenting with a steep decline in consciousness level secondary to deep cerebral vein thrombosis requiring intensive care and subsequently developing a memory disorder. For a long period of time, due to being underdiagnosed, few things were known about CVT. Nowadays, we have all the tools to diagnose, treat, and follow up cases of CVT. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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12 pages, 583 KiB

Open AccessArticle

The Burden of Cerebral Venous Thrombosis in a Romanian Population across a 5-Year Period

by Adina Stan, Silvina Ilut, Hanna Maria Dragos, Claudia Bota, Patricia Nicoleta Hanghicel, Alexander Cristian, Irina Vlad, Diana Mocanu, Stefan Strilciuc, Paul Stefan Panaitescu, Horatiu Stan and Dafin F. Muresanu

Life 2022, 12(11), 1825; https://doi.org/10.3390/life12111825 - 9 Nov 2022

Cited by 2 | Viewed by 1994

Abstract

Health policies in transitioning health systems are rarely informed by the social burden and the incidence shifts in disease epidemiology. Cerebral venous thrombosis (CVT) is a type of stroke more often affecting younger adults and women, with higher incidences being reported in recent studies. A retrospective, hospital-based population study was conducted at Cluj-Napoca Emergency County Hospital across a 5-year period between 2017 and 2021. The overall incidence and the rates in distinctive gender and age groups were assessed. Length of hospital stay (LHS), modified Rankin score (mRS) and mortality at discharge and at 3 months were calculated. Fifty-three patients were included. The median age was 45 years, and 64.2% were women. In our population of 3,043,998 person-years, 53 CVT cases resulted in an incidence of 1.74 per 100,000 (95% CI 1.30–2.27). CVT incidence was higher in women (2.13 per 100,000, 95% CI 1.47–2.07). There was a statistically significant difference in LHS between patients with different intracranial complications (Kruskal–Wallis, p = 0.008). The discharge mRS correlated with increasing age (r_s = 0.334, p = 0.015), transient risk factors (Fisher’s exact test, p = 0.023) and intracranial complications (Fisher’s exact test, p = 0.022). In addition, the mRS at 3 months was statistically associated with increasing age (r_s = 0.372, p = 0.006) and transient risk factors (Fisher’s exact test, p = 0.012). In-hospital mortality was 5.7%, and mortality at follow up was 7.5%, with higher rates in women (5.9% and 8.8%, respectively). Our findings may provide insight regarding the epidemiological features of certain patient groups more prone to developing CVT and its complications, informing local and central stakeholders’ efforts to improve standards of care. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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Review

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11 pages, 386 KiB

Open AccessReview

Aphasic Syndromes in Cerebral Venous and Dural Sinuses Thrombosis—A Review of the Literature

by Georgiana Munteanu, Andrei Gheorghe Marius Motoc, Traian Flavius Dan, Anca Elena Gogu and Dragos Catalin Jianu

Life 2022, 12(11), 1684; https://doi.org/10.3390/life12111684 - 24 Oct 2022

Cited by 3 | Viewed by 2292

Abstract

Aphasia is an acquired central disorder of language that affects a person’s ability to understand and/or produce spoken and written language, caused by lesions situated usually in the dominant (left) cerebral hemisphere. On one hand aphasia has a prevalence of 25–30% in acute ischemic stroke, especially in arterial infarcts. On the other hand, cerebral venous and dural sinuses thrombosis (CVT) remains a less common and underdiagnosed cause of ischemic stroke (0.5–1% of all strokes). Aphasia has been observed in almost 20% of patients who suffered CVT. The presence of aphasia is considered a negative predictive factor in patients with stroke, severe language disorders corresponding to arduous recovery. Taking into consideration data from the literature, aphasia is also considered a predictive factor for patients with CVT; its absences, together with the absence of worsening after admission, are determinants of complete recovery after CVT. This review has as the principal role of gathering current information from the literature (PubMed database 2012–2022) regarding the clinical features of aphasic syndromes and its incidence in patients with CVT. The main conclusion of this review was that aphasic syndromes are not usually the consequence of isolated thrombosis of dural sinuses or cerebral veins thrombosis. The most frequent form of CVT that determines aphasia is represented by the left transverse sinus thrombosis associated with a posterior left temporal lesion (due to left temporal cortical veins thrombosis), followed by the superior sagittal sinus thrombosis associated with a left frontal lesion (due to left frontal cortical veins thrombosis). Only a few cases are presenting isolated cortical veins thrombosis and left thalamus lesions due to deep cerebral vein thrombosis. We also concluded that the most important demographic factor was the gender of the patients, women being more affected than men, due to their postpartum condition. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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20 pages, 9209 KiB

Open AccessReview

Imaging of Cerebral Venous Thrombosis

by Jean-Claude Sadik, Dragos Catalin Jianu, Raphaël Sadik, Yvonne Purcell, Natalia Novaes, Edouard Saragoussi, Michaël Obadia, Augustin Lecler and Julien Savatovsky

Life 2022, 12(8), 1215; https://doi.org/10.3390/life12081215 - 10 Aug 2022

Cited by 10 | Viewed by 8360

Abstract

Cerebral venous thrombosis is a rare cause of stroke. Imaging is essential for diagnosis. Although digital subtraction angiography is still considered by many to be the gold standard, it no longer plays a significant role in the diagnosis of cerebral venous thrombosis. MRI, which allows for imaging the parenchyma, vessels and clots, and CT are the reference techniques. CT is useful in case of contraindication to MRI. After presenting the radio-anatomy for MRI, we present the different MRI and CT acquisitions, their pitfalls and their limitations in the diagnosis of cerebral venous thrombosis. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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12 pages, 1742 KiB

Open AccessReview

Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic

by Natalia Novaes, Raphaël Sadik, Jean-Claude Sadik and Michaël Obadia

Life 2022, 12(8), 1105; https://doi.org/10.3390/life12081105 - 22 Jul 2022

Cited by 6 | Viewed by 3839

Abstract

Cerebral venous thrombosis (CVT) is a rare type of stroke that may cause an intracranial hypertension syndrome as well as focal neurological deficits due to venous infarcts. MRI with venography is the method of choice for diagnosis, and treatment with anticoagulants should be promptly started. CVT incidence has increased in COVID-19-infected patients due to a hypercoagulability state and endothelial inflammation. CVT following COVID-19 vaccination could be related to vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but severe complication that should be promptly identified because of its high mortality rate. Platelet count, D-dimer and PF4 antibodies should be dosed. Treatment with non-heparin anticoagulants and immunoglobulin could improve recuperation. Development of headache associated with seizures, impaired consciousness or focal signs should raise immediate suspicion of CVT. In patients who received a COVID-19 adenovirus-vector vaccine presenting thromboembolic events, VITT should be suspected and rapidly treated. Nevertheless, vaccination benefits clearly outweigh risks and should be continued. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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22 pages, 838 KiB

Open AccessReview

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

by Sorin Tuță

Life 2022, 12(6), 854; https://doi.org/10.3390/life12060854 - 8 Jun 2022

Cited by 9 | Viewed by 6668

Abstract

In this review, we provide an update on the pathogenesis, diagnosis, and management of adults with idiopathic intracranial hypertension (IIH) and implications of the cerebral venous system, highlighting the progress made during the past decade with regard to mechanisms of the venous outflow pathway and its connection with the cerebral glymphatic and lymphatic network in genesis of IIH. Early diagnosis and treatment are crucial for favorable visual outcomes and to avoid vision loss, but there is also a risk of overdiagnosis and misdiagnosis in many patients with IIH. We also present details about treatment of intracranial hypertension, which is possible in most cases with a combination of weight loss and drug treatments, but also in selected cases with surgical interventions such as optic nerve sheath fenestration, cerebral spinal fluid (CSF) diversion, or dural venous sinus stenting for some patients with cerebral venous sinus stenosis, after careful analysis of mechanisms of intracranial hypertension, patient clinical profile, and method risks. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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24 pages, 1793 KiB

Open AccessReview

An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review)

by Dragos Catalin Jianu, Silviana Nina Jianu, Traian Flavius Dan, Georgiana Munteanu, Alexandra Copil, Claudiu Dumitru Birdac, Andrei Gheorghe Marius Motoc, Any Docu Axelerad, Ligia Petrica, Sergiu Florin Arnautu, Raphael Sadik, Nicoleta Iacob and Anca Elena Gogu

Life 2022, 12(5), 717; https://doi.org/10.3390/life12050717 - 11 May 2022

Cited by 13 | Viewed by 7242

Abstract

(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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Other

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13 pages, 9988 KiB

Open AccessCase Report

Diagnosis and Management of Cerebral Venous Thrombosis Due to Polycythemia Vera and Genetic Thrombophilia: Case Report and Literature Review

by Dragos Catalin Jianu, Silviana Nina Jianu, Nicoleta Iacob, Traian Flavius Dan, Georgiana Munteanu, Anca Elena Gogu, Raphael Sadik, Andrei Gheorghe Marius Motoc, Any Axelerad, Carmen Adella Sirbu, Ligia Petrica and Ioana Ionita

Life 2023, 13(5), 1074; https://doi.org/10.3390/life13051074 - 24 Apr 2023

Cited by 1 | Viewed by 3301

Abstract

(1) Background: Cerebral venous and dural sinus thrombosis (CVT) rarely appears in the adult population. It is difficult to diagnosis because of its variable clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. (2) Case presentation: A 41-year-old male patient presented with an acute isolated intracranial hypertension syndrome. The diagnosis of acute thrombosis of the left lateral sinus (both transverse and sigmoid portions), the torcular Herophili, and the bulb of the left internal jugular vein was established by neuroimaging data from head-computed tomography, magnetic resonance imaging (including Contrast-enhanced 3D T1-MPRAGE sequence), and magnetic resonance venography (2D-TOF MR venography). We detected different risk factors (polycythemia vera-PV with JAK2 V617F mutation and inherited low-risk thrombophilia). He was successfully treated with low-molecular-weight heparin, followed by oral anticoagulation. (3) Conclusions: In the case of our patient, polycythemia vera represented a predisposing risk factor for CVT, and the identification of JAK2 V617F mutation was mandatory for the etiology of the disease. Contrast-enhanced 3D T1-MPRAGE sequence proved superior to 2D-TOF MR venography and to conventional SE MR imaging in the diagnosis of acute intracranial dural sinus thrombosis. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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8 pages, 1568 KiB

Open AccessCase Report

Cerebral Venous Sinus Thrombosis Following an mRNA COVID-19 Vaccination and Recent Oral Contraceptive Use

by Timothy C. Frommeyer, Tongfan Wu, Michael M. Gilbert, Garrett V. Brittain and Stephen P. Fuqua

Life 2023, 13(2), 464; https://doi.org/10.3390/life13020464 - 7 Feb 2023

Viewed by 5510

Abstract

Rising concerns of cerebral venous sinus thrombosis (CVST) and other forms of venous thromboembolism have been associated with the SARS-CoV-2 vaccinations. Adverse effects with vector-based vaccines are well documented in the literature, while less is known about the mRNA vaccines. This report documents a case of CVST in a 32-year-old female patient who received her second Pfizer mRNA COVID-19 vaccination 16 days prior to hospital admission and had started oral combined contraceptives approximately 4 months beforehand. Clinicians should be cognizant of the possibility that mRNA vaccines, when combined with other risk factors like oral contraceptive pill use, may enhance one’s hypercoagulable status. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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14 pages, 2586 KiB

Open AccessCase Report

Case Reports of Pregnancy-Related Cerebral Venous Thrombosis in the Neurology Department of the Emergency Clinical Hospital in Constanta

by Any Docu Axelerad, Lavinia Alexandra Zlotea, Carmen Adella Sirbu, Alina Zorina Stroe, Silviu Docu Axelerad, Simona Claudia Cambrea and Lavinia Florenta Muja

Life 2022, 12(1), 90; https://doi.org/10.3390/life12010090 - 9 Jan 2022

Cited by 3 | Viewed by 3433

Abstract

Cerebral venous thrombosis accounts for 0.5–1% of all cerebrovascular events and is one type of stroke that affects the veins and cerebral sinuses. Females are more affected than males, as they may have risk factors, such as pregnancy, first period after pregnancy, treatment with oral contraceptives treatment with hormonal replacement, or hereditary thrombophilia. This neurological pathology may endanger a patient’s life. However, it must be suspected in its acute phase, when it presents with variable clinical characteristics, so that special treatment can be initiated to achieve a favorable outcome with partial or complete functional recovery. The case study describes the data and the treatment of two patients with confirmed cerebral venous thrombosis with various localizations and associated risk factors, who were admitted to the neurology department of the Sf. Apostol Andrei Emergency Hospital in Constanta. The first patient was 40 years old and affected by sigmoid sinus and right lateral sinus thrombosis, inferior sagittal sinus, and right sinus thrombosis, associated with right temporal subacute cortical and subcortical hemorrhage, which appeared following a voluntary abortion. The second case was a patient aged 25 who was affected by left parietal cortical vein thrombosis, associated with ipsilateral superior parietal subcortical venous infarction, which appeared following labor. The data are strictly observational and offer a perspective on clinical manifestations and clinical and paraclinical investigations, including the treatment of young patients who had been diagnosed with cerebral venous thrombosis and admitted to the neurology department. Full article

(This article belongs to the Special Issue An Integrated Approach on Cerebral Venous Sinus Thrombosis (CVST))

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