Atypical Developmental Venous Anomaly Associated with Single Arteriovenous Fistula and Intracerebral Hemorrhage: a Case Demonstrated by Superselective Angiography

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.     

脑发育性静脉异常的DSA表现

目的　分析脑发育性静脉异常 (DVA)的DSA表现。资料与方法　回顾 8例DVA患者的DSA资料。结果　DVA位于额叶 4例 ,额顶叶 2例 ,小脑半球 1例 ,多发 1例 (位于额、顶、额顶、颞叶 )。共 13支引流静脉 ,其中 5支向表浅引流 ,1支向深部引流 ;多支引流者 1例 ,3支静脉全部向深部引流 ;多发者 1例 ,4支静脉双向引流 (表浅 1支、深部 3支 )。半数病例DSA表现典型 ,其余病例在不同的静脉期期相、投照体位有不同的DSA表现。结论　根据DSA清晰显示DVA及引流静脉数目、引流方向的优越性 ,可将DVA细分为 8个类型。多体位、静脉期连续摄像不致遗漏DVA。     

脑静脉性血管畸形的MRI表现

目的 探讨脑静脉性血管畸形的MRI表现。方法对17例脑静脉性血管畸形病例的临床和MRI资料进行总结、分析。结果所有病例均表现为管状或条带状流空信号,增强扫描病灶明显均匀强化。其中额叶5例,颢叶4例,小脑半球4例,顶叶3例,脑干1例,均为单发,畸形血管向浅部静脉引流。1例合并海绵状血管瘤。结论脑静脉性血管畸形临床症状轻微,常为偶然发现,在MRI上具有特征性表现,可据此做出诊断。     

Venous angioma treated by radiation

Summary A case of cerebral venous angioma which disappeared completely after local irradiation of 3200 cGy is presented. This new method is considered to be beneficial for the treatment of venous angiomas, particularly to prevent rebleeding from them.     

脑静脉窦血栓形成的MRI诊断

目的 :探讨MRI和MR血管成像 (MRA ,MRV)对脑静脉窦血栓形成 (CVST)的诊断价值。方法 :回顾性分析 10例CVST患者的临床和影像资料。全部病例行常规MRI和MRA( 3DTOF)、MRV( 2DTOF)检查 ,其中 9例行增强扫描。结果 :MR常规扫描示脑实质内均出现异常信号 ,仅 1例T2 WI未见异常信号 ,增强扫描 9例全部出现静脉异常强化。有 5例MRA除可见动脉正常显影外 ,还可见受累的静脉和静脉窦显影。MRV示栓塞的静脉窦不显影或显影欠佳。结论 :常规MRI结合MRA、MRV是诊断CVST的无创和有效手段     

Cerebral venous thrombosis after myelography with iopamidol

A young man developed intracranial hypertension immediately after myelography with nonionic water-soluble contrast medium (iopamidol). Cerebral angiography showed extensive cerebral venous thrombosis. The common causes of thrombophlebitis were excluded. A relationship to the contrast medium was strongly suspected, since a similar case has been reported. The rheological properties and haemoconcentration induced by iopamidol could explain this complication.     

重症硬脑膜静脉窦血栓的局部溶栓治疗

目的 研究重症硬脑膜静脉窦血栓的局部溶栓治疗的方法及疗效。方法 总结我院自2000年以来6例重症硬脑膜静脉窦血栓的局部溶栓治疗经验，男4例，女2例，其中4例采用一侧股动脉及对侧股静脉Seldinger穿刺，2例采用股动脉Seldinger穿刺及上矢状窦前1／3穿刺。导管置入一侧颈内动脉及静脉窦血栓处后，于颈内动脉及静脉窦血栓处先后各用尿激酶50万U，以每分钟1万U泵入，再于静脉窦血栓处泵入尿激酶持续溶栓，维持外周血中纤维蛋白原含量1．0～1．5g／L，同时予全身肝素化，维持外周血活化部分凝血活酶时间正常值的2～3倍。结果 本组6例，5例痊愈，颅内压转正常，头痛消失，无神经功能障碍，其中4例数字减影血管造影(DSA)见浅表静脉扩张消失，静脉窦显影正常，1例浅表静脉扩张明显改善，静脉窦显影较前好转；1例好转，颅内压较前降低，头痛好转，DSA见浅表静脉扩张消失，静脉窦显影正常，抗凝治疗1个月后颅内压正常，头痛消失，神经功能恢复正常。结论 重症硬脑膜静脉窦血栓采用动静脉系统联合应用尿激酶局部溶栓治疗是快速、安全、有效的方法，经股静脉途径不易到达静脉窦血栓处者，可以行上矢状窦入路。     

Cerebral venous sinus thrombosis presenting with excessive subarachnoid hemorrhage in a 14-year-old boy

Cerebral venous thrombosis presenting with subarachnoid hemorrhage (SAH) is very rare. We report a case of cerebral venous sinus thrombosis as an initial manifestation of SAH. A 14-year-old boy was admitted with progressive headache, nausea, vomiting, diplopia, and gait disturbance. Cerebral computed tomography scan showed a widely SAH in the basal cisterns, bilateral sylvian fissures, and anterior interhemispheric fissure. Cerebral angiography was performed to detect any aneurysm in intracranial vasculature as a cause of SAH; however, the totally thrombosed superior sagittal sinus, galenic vein, and straight sinus were the sole abnormal findings.     

脑静脉窦血栓形成合并脑出血临床分析（附7例报告）

目的：探讨脑静脉窦血栓合并脑出血的临床诊断和治疗。方法：回顾分析2006年6月～2008年10月收治的7例脑静脉窦血栓合并脑出血患者临床资料。结果：7例患者中,3例入院时已经发生脑疝的患者行开颅血肿清除加去骨瓣减压,术后给予脱水、抗炎治疗,1周后其中2例给予抗凝治疗。4例未发生脑疝患者入院后给予脱水、抗炎、低分子肝素抗凝治疗。1例术后未血凝治疗男性患者半月后并发下肢深静脉血栓家人放弃治疗,自动出院,6例女性患者痊愈出院。结论：抗凝治疗可作为当前治疗脑静脉及脑静脉窦血栓的主要方法,即使在合并颅内出血的情况下,也常作为首选方式,但对于急性颅内高压,在脱水药物治疗无效情况下,手术清除血肿及去骨瓣减压也可作为一种治疗手段。     

Postpartum superior sagittal,left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report

Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient''s coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.     

A case report of cerebral venous infarction due to venous sinus thrombosis as complication in a Covid-19 patient

Coronavirus disease of 2019 (COVID-19) is a pandemic disease caused by a new corona virus known as SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) and well known to increase the risk of developing venous thromboembolism; thus, patients with COVID-19 may present with neurological disorders. Venous thromboembolism is an important cause of morbidity and mortality in patients with COVID-19. We report a case of 35 years old woman who presented neurological disorders due to venous infarction and venous sinus thrombosis as complication in COVID-19. Clinicians and medical staff should be aware of neurologic symptoms and neurological deficit in background of COVID-19, which might even be the first presentation of this infection, thus prompting increased attention to disease presentation and early treatment with anticoagulation should be initiated in these settings. *     

The anatomy of collateral venous flow from the brain and its value in aetiological interpretation of intracranial pathology

For more than a century, available data concerning collateral venous outflow from the brain have received insufficient attention, as existing theories did not assign practical importance to them. Ideas concerning arterial blood supply and circulation of cerebrospinal fluid were considered more relevant. But available data afford a schematic model of cerebral venous outflow that does have important pathophysiological consequences. Principal outflow through the internal jugular veins can be substituted completely by the large vertebral plexuses, through communications at the cranial base. Emissary veins of the skull vault are small and few in number. Outflow from the deep venous system through the great vein of Galen can be substituted by choroidal, thalamic and striate anastomoses toward the basal vein. So-called intracerebral venous anastomoses through the centrum semiovale towards the convexity are nonexistent or negligible. Instead, a venous watershed exists separating paraventricular white matter from a layer of subcortical white matter. In most infants, the cavernous sinus is not yet connected to the cerebral veins. Once such communications have been formed, important collateral pathways exist through basal and Sylvian veins via the cavernous sinus to the pterygoid plexuses. Simultaneous hindrance of principal and collateral venous outflow will lead to elevated venous pressure and eventual insufficiency of cerebral blood flow (CBF). This will cause increased intracranial pressure, and ventricular enlargement due to periventricular atrophy. The slow phase of the two-compartment model of CBF coincides with the paraventricular white matter area of the deep venous system. In the neonate CBF was found to be still very low, and in the two compartments CBF increases at a different rate to a maximum in childhood. In hydrocephalus, measurement of CBF in the slow deep compartment, rather than the fast cortical one, will be most informative. Received: 11 July 1995 Accepted: 8 September 1995     

The preoperative venogram in planning extended craniectomies

Summary A technique of extended craniectomy sometimes allows removal of large central or transtentorial mass lesions at a single operative sitting because it affords better exposure and control of normal structures. While seeking to avoid multiple craniotomies, this method requires permanent ligation of the transverse venous sinus. Unless there is adequate collateral venous drainage from the ipsilateral hemisphere, the patient is at risk for venous infarction in the post-craniectomy period. The purpose of this study is to propose a method of establishing the presence of collateral venous drainage preoperatively. Each carotid artery is injected with the head in a neutral position and with the head turned to the side ipsilateral to the carotid artery injection in an attempt to divert the venous flow. Fifty patients were examined using this method; seven were being evaluated for possible craniectomies. The technique identified nine patients with potential venous collaterals (20%). They would otherwise have been considered nonoperable: two of the six patients eventually operated upon (33%) fell into this category. In general, the operative procedure may be safe more often on the left than the right (45%) vs (20%). Particular attention must be given to the pattern of venous drainage from the posterior temporal lobe to avoid isolation of the venous drainage from this area.Presented at the 25th Annual Meeting of the American Society of Neuroradiology, New York, New York, May 13, 1987     

Varix occurring with cerebral venous angioma: a case report and review of the literature

We report a patient in whom a varix occurred with a venous angioma, a rare combination of cerebral vascular malformations. During our review of the 7 previously reported cases, we discovered that all 8 venous angiomas were relatively large and supratentorial, and that the varices involved the veins draining then.     

Findings of magnetic resonance imaging in cerebral venous occlusion: Difference from hemorrhagic infarction

A case of cerebral venous occlusion is reported. X -ray computed tomography showed a high-density lesion mimicking an intracerebral hemorrhage. In contrast, magnetic resonance images taken at the early clinical stage revealed a high-intensity lesion in both T₁- and T₂-weighted images. Follow-up magnetic resonance images at the chronic phase revealed that the intensity of this lesion had changed to low in the T1-weighted image, while still being high in the T₂-weighted image. These findings suggest that the lesion might be due to venous congestion produced by cerebral venous occlusion rather than hemorrhage into the cerebral parenchyma.     

Diagnostic role of 64-slice multidetector row CT scan and CT venogram in cases of cerebral venous thrombosis

Retrospective review of patients with cerebral venous thrombosis (CVT) detected by 64-slice multidetector row computed tomography (MDCT). To evaluate the role of CT scan as the primary modality of imaging in suspected cases of CVT. Between October 2006 and September 2007, 53 patients, suspected to have CVT, underwent CT scan of the brain. Out of these, 33 patients were included in the study, who underwent non-contrast CT (NCCT), CT venous angiogram (MDCTA) and magnetic resonance venogram. Two blinded readers evaluated the NCCT and MDCTA. Final diagnosis was obtained after consensus reading of all the imaging by the two readers. Out of the total 33 patients, 20 patients were detected to have thrombosis of one or more of the cerebral venous sinuses or veins, at the concluding consensus reading. MDCTA together with NCCT could identify thrombosis in all of the 20 patients, i.e., 100% sensitivity and specificity. Sixty-four-slice MDCTA together with NCCT provided 100% sensitivity and specificity for the identification of CVT. It can be considered as a cost-effective and widely available, primary imaging modality in emergency situations.     

Brain lesions due to cerebral venous thrombosis do not correlate with sinus involvement

Cerebral venous thrombosis may be well tolerated or lead to a brain lesion; availability of collateral venous pathways may explain the great variability of the lesions. This collateral circulation involves mainly medullary and cortical veins. These are difficult to assess neuroradiologically, particularly if thrombosed. Cerebral venous thrombosis is diagnosed usually based on thrombosis of dural sinuses and of the deep venous system. We tried to correlate the site and extent of dural sinus thrombosis with the location and the size of brain lesions in 26 consecutive patients with cerebral venous thrombosis, to investigate whether a simple causal relationship exists. No significant correlation between the extent and site of thrombosis in dural sinuses and the extent and location of brain lesions was found. In some cases a clear relationship between thrombosis of cortical and medullary veins and the lesions was evident. These data suggest that sinus thrombosis alone may be well tolerated in many cases, while involvement of cortical and medullary veins leads to a worse clinical situation. Accepted: 26 November 1998     

CT血管造影在颅内静脉畸形诊断中的应用

目的 评价CT血管造影在诊断颅内静脉畸形中的价值与限度。材料与方法 5例经DSA证实的颅内静脉畸形病例,幕上1例,幕下4例。分别在动脉期（CTA）和静脉期（CTV）扫描采样,运用SSD和MIP进行重建。结果 CTA显示所有病灶,但没有显示颅内静脉畸形的“海蛇头”即引流静脉影像特征,而CTV不仅显示病灶,而且还显示了引流静脉“海蛇头”影像特征。结论 静脉期的CT血管造影（CTV）是诊断和随访颅内静脉畸形的有效方法,优于动脉期的CT血管造影（CTA）。     

Dysgenesis of the deep venous system as a diagnostic criterion for holoprosencephaly

Summary The angiographic features of three cases with holoprosencephaly are reported. In all of them, the galenic venous system seemed to be deficient and the basal ganglia were drained by peculiar veins which coursed laterally and drained directly into the lateral sinus. These peculiar veins are considered to be remnants of the embryonic diencephalic viens, suggesting that these patients retain their early embryonic pattern of venous drainage. The diagnosis of alobar holoprosencephaly is established by the demonstration of the azygos anterior cerebral artery coursing along the frontal bone with excessive undulations. But with lobar holoprosencephaly, this characteristic feature is not present, and dysgenesis of the deep venous system is important for the diagnosis of holoprosencephaly.     

瘀血性脑血管病的脑血流灌注改变:初步经验

目的:探讨瘀血性脑血管病(CCVD)的脑血流灌注变化特点。方法:收集2006年~2009年间在我院经MR增强扫描和临床其他检查确诊的CCVD病例13例,其中颅内静脉窦血栓形成(DVT)8例,有脑水肿并发症的脑发育性静脉异常(DVA)5例,伴有静脉性脑梗死6例(均为DVT病例)。脑血流灌注成像采用磁共振动态磁敏感对比增强灌注加权成像(DSC-PWI),原始数据传送至GE AW4.3工作站做图像后处理,得到平均通过时间(MTE)、负性增强积分(NEI)、达谷时间(TTM)和最大下降斜率(MSD)伪彩图。将脑病变分为两组,即静脉性梗死(VI)组和脑水肿(BE)组,比较两种不同病灶的血流灌注参数的异同。收集同期急性动脉性脑梗死(AI)病例9例,用同样方法比较AI与VI病灶血流灌注变化的异同。结果:在CCVD,VI和BE灶的MTE和TTM均增大,两组间差别无显著意义;但NEI和MSD两组间存在显著差异,在VI灶两参数均显著降低,而BE灶则有的升高,有的降低,改变不一致。在VI和AI的对比中,各灌注参数的变化趋势是一致的,虽然AI的MTE延长和NEI降低幅度更大,但统计学上差别无显著意义。结论:在CCVD,VI和BE灶的血流灌注值有显著差异,NEI和MSD的显著降低可能是脑血流灌注失代偿的反映。无论是VI还是AI,其血流灌注参数呈相同的变化趋势,提示脑血流灌注失代偿期的相同结果。