Trombosis de senos venosos cerebrales con afectación parcial de la tórcula de Herófilo en el sexto día de puerperio

Thrombosis of the cerebral venous sinuses is rare during pregnancy and the puerperium, even though pregnancy-specially in the last trimester and puerperium-together with prothrombotic states, head trauma and oral contraceptive use are risk factors for this common condition. Thrombosis of the cerebral venous sinuses occurs in 12 out of every 100,000 births. We report a case of venous thrombosis of the sigmoid and left transverse sinuses with partial involvement of torcular Herophili in a 25-year-old patient on the sixth day of the puerperium.     

Trombosis de los senos venosos cerebrales en una gestante en el primer trimestre de embarazo

Cerebral venous thrombosis is an uncommon disease during pregnancy. In 25-40% of cases, the etiology is unknown. Risk factors are infectious diseases, pregnancy, puerperium, dehydration, oral contraception use, hypercoagulative states, tumors,and traumatism.     

Bubbles in the brain veins as a complication of daily management of a scalp vein catheter

Recently, it has been suspected that venous dural sinus air embolisms could occur as a result of scalp vein infusion. The possible mechanism for this complication has not been documented to date, and procedures to avoid venous dural sinus air embolism have not been presented. We report a preterm neonate who demonstrated venous dural sinus air embolism following daily management of a scalp vein catheter. The air embolism disappeared in a few days without complications. Clinicians should avoid injecting air into a scalp vein catheter and leaving it open to air. Following careful examination and review of the infant's case, we were able to conclude that positioning the infant in either supine or Trendelenburg position during daily management of scalp venous infusions and using an air-occlusive dressing once the catheter is removed could limit the risk of venous dural sinus air embolisms caused by scalp vein infusions.     

Sinus venous thrombosis: a differential diagnosis of postpartum headache

In this report, we describe a patient who developed severe headache following epidural analgesia for labor and delivery. Although the epidural puncture had been reported to be uneventful, headache was initially suspected to result from an accidental dural puncture. After the headache worsened, a sinus venous thrombosis was suspected and subsequently confirmed by magnetic resonance imaging. This case highlights the difficulty of differential diagnosis of headache in the postnatal period in patients after EDA and stresses the necessity of considering alternative pathologies.     

Dural arteriovenous malformation of the transverse sinus with sinus occlusion: report of a case.

We report a case of dural arteriovenous malformation (AVM) of the transverse sinus with sinus occlusion. This 49-year-old man developed right parietal lobe dysfunction with acute onset. Computed tomography and magnetic resonance imaging (MRI) showed a non-hemorrhagic venous infarct in the subcortical white matter of the right parietal lobe, and diffusely dilated subcortical veins. Thrombosis of the right internal jugular bulb was also revealed on MRI. Cerebral angiography showed a dural AVM in the posterior fossa with occlusion of the right transverse sinus and retrograde venous drainage into the superior sagittal sinus, causing diffuse engorgement of the superficial cortical and the deep intramedullary veins. The focal neurologic deficits in this case were due to a non-hemorrhagic venous infarct in the subcortical white matter of the right parietal lobe secondary to retrograde cortical venous drainage.     

Study of serum lipid and blood fibrinolytic activity in cases of cerebral venous-venous sinus thrombosis during the puerperium

Serum lipid and blood fibrinolytic activity has been studied in 17 cases of cerebral venous/venous sinus thrombosis occurring during puerperium and also in 25 nonpregnant, 25 healthy pregnant, and in 25 women in first week of normal puerperium. A statistically significant rise in serum triglycerides, phospholipids, free fatty acids and fall in blood fibrinolytic activity were found in cases of cerebral venous/venous sinus thrombosis during the puerperium as compared to normal cases. These factors may be playing a role in the etiology of cerebral venous/venous sinus thrombosis during the puerperium.     

Central Venous Sinus Thrombosis in a Young Woman Taking Norethindrone Acetate for Dysfunctional Uterine Bleeding: Case Report and Review of Literature

BackgroundThe association between the progestin-only pill used for treatment of menstrual disorders and central venous sinus thrombosis (CVST) has rarely been reported in the literature. This report describes a case of central venous sinus thrombosis following intake of norethindrone acetate for dysfunctional uterine bleeding secondary to polycystic ovary syndrome in a young woman with undiagnosed underlying hyperhomocysteinemia.CaseA 23-year-old woman presented with severe headache, followed by hemiparesis, seizures, and altered sensorium. She had been prescribed norethindrone acetate for the management of dysfunctional uterine bleeding secondary to polycystic ovary syndrome. Investigations revealed acquired hyperhomocysteinemia, presumably due to nutritional deficiencies, and evidence of CVST on MRI and magnetic resonance venography. Investigations showed no evidence of inherited thrombophilia. The patient was treated with low molecular weight heparin, followed by warfarin, vitamin B₁₂, vitamin B₆, and folic acid, and recovered successfully.ConclusionAlthough venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen-only pills for gynaecological disorders may develop thrombosis, especially if they have predisposing metabolic disorders.     

Trombosis de vena ovárica y vena cava inferior asociada a endometritis en el puerperio

Ovarian vein thrombosis is a rare and severe puerperal complication that usually manifests as fever and abdominal pain in the puerperal period and is more frequent in women who have undergone cesarean section. There is an associated high risk of pulmonary embolism and thus early diagnosis and treatment are required. We report the case of a 30-year-old woman with pelvic pain and fever in the puerperal period. Computed tomography scan revealed ovarian vein thrombosis extending to the inferior vena cava. Endometritis was also diagnosed. The patient received dalteparin and antibiotics. Ovarian vein thrombosis should be included in the differential diagnosis of fever in the postpartum period.     

Prenatal demonstration of afferent vessels and progressive thrombosis in a torcular malformation

OBJECTIVES: To elucidate a part of the prenatal natural history of dural sinus malformation of the posterior fossa. METHODS: Ultrasound and magnetic resonance imaging were performed from 31 to 32 weeks' gestation. RESULTS: We observed the progressive development of a thrombus that was visible as an expanding hyperechoic round area within a cystic mass of the posterior fossa. It was characterized, as expected for a vascular malformation, by the presence of blood flow into the aneurismal cavity. Color doppler identified superior sagittal and straight sinuses, and distinguished that their flow continued into the dilated torcular. Prenatal magnetic resonance imaging confirmed an arteriovenous malformation involving the dural sinus. CONCLUSION: The vascular malformation had a fixed volume and preceded the thrombosis, which formed within several days. The present case is the first report with all the prenatal sonographic features of this condition.     

Painful fourth cranial nerve palsy caused by posteriorly-draining dural carotid-cavernous sinus fistula.

A 65-year-old man with a dural carotid-cavernous fistula (DCCF) presented with sudden onset of painful trochlear nerve paresis. Typical signs of DCCF including conjunctival arterialization, chemosis, and proptosis did not become manifest until 4 months later. This unusual presentation of DCCF was caused by drainage of the fistula posteriorly into the inferior petrosal sinus with low flow. With this condition, patients may present with trochlear nerve palsy without a red eye. Although rare, DCCF must be considered in patients presenting with isolated painful trochlear palsy.     

Trombosis fetal extensa de vena cava inferior y vena renal derecha

Thrombosis of the inferior vena cava in a fetus is an extremely rare event.     

Thrombectomy of acute iliofemoral venous thrombosis during pregnancy

Acute iliofemoral venous thrombosis is six times more frequent among pregnant than nonpregnant women. The disease is serious because of the risk of pulmonary embolism. The treatment of choice with regard to prevention of post-thrombotic disorders is controversial. Pregnant women represent a therapeutic problem because thrombolysis is hazardous to the fetus. We have performed thrombectomy and temporary arteriovenous fistula in combination with anticoagulant treatment upon all pregnant or recently pregnant women coming to our department with acute iliofemoral venous thrombosis from August 1985 to March 1987. In this period, eight pregnant women and one woman 12 days after cesarean section were admitted. This is an incidence of 0.83 per 1,000 deliveries. All of the women were evaluated with a mean follow-up time of 15 months. Six of nine patients were clinically asymptomatic. Six had a normal ambulatory strain gauge volumetry and seven, a normal occlusion strain gauge plethysmography. Two women delivered by cesarean section, one woman had an induced abortion because of the disease, two women delivered after partus provocatus and four delivered spontaneously. We conclude that thrombectomy and temporary arteriovenous fistula together with heparin is a safe treatment of acute iliofemoral venous thrombosis during pregnancy. There is no need to interrupt the pregnancies except for obstetric reasons.     

Prenatal MR imaging of dural sinus malformation: a case report

OBJECTIVE: To describe prenatal magnetic resonance imaging (MRI) findings of dural sinus malformation (DSM), a very rare, congenital form of dural arteriovenous shunt (DAVS), typically affecting newborns. METHODS: Ultrasound (US) and MRI were performed at 34 weeks' gestation, and the findings of these examinations were compared with postnatal MRI studies performed at 2 days and 1 month. RESULTS: US showed an anechoic, midline posterior fossa collection with irregular internal echodensities. Color Doppler showed prominent arterial vascularity at the lesion margins. The prenatal MRI showed a large, profoundly hypointense, midline retrocerebellar mass. Postnatal MRI, complemented with magnetic resonance (MR) angiography, showed the lesion to be a giant dural venous pouch fed by multiple mural arteriovenous shunts. Follow-up MRI at 1 month suggested latent venous hypertension and prompted endovascular treatment. CONCLUSION: Prenatal MR imaging is useful to establish the diagnosis, to assess complications such as hydrocephalus and tonsillar prolapse, and to help plan perinatal management, postnatal follow-up, and treatment decision-making.     

Cerebral venous sinus thrombosis in a neonate with homozygous prothrombin G20210A genotype.

We describe a 7-day-old infant who presented with extensive cerebral venous sinus thrombosis (CVST) and was found to be homozygous for the prothrombin G20210A gene mutation. No other known risk factors for thrombosis were identified.     

Fetal magnetic resonance imaging of an intracranial venous thrombosis. Case report

OBJECTIVE: To describe the magnetic resonance imaging findings of an antenatal intracranial venous thrombosis. METHODS: Prenatal ultrasound (US) at 22 weeks' gestational age (GA) in a 27-year-old patient (G2 P1) revealed a nonspecific avascular echogenic mass above the cerebellum evaluated with MRI at 23 weeks' GA. RESULTS: With MRI an enlarged occipital pericerebral space with a layered ovoid mass at the torcular herophili was demonstrated and MRI characteristics suggested a subacute cloth. In follow-up, an important enlargement of the mass was noticed on US examinations. After multidisciplinary consult and parental consent, a prostaglandin induction was performed at 25 weeks' GA. The baby died immediately after birth. Pathology confirmed the diagnosis of a venous thrombosis at the torcular herophili with extension into the superior sagittal sinus. CONCLUSION: In our case, MRI findings were helpful in diagnosing an intracranial fetal venous thrombosis.     

Diagnostic imaging in puerperal febrile morbidity

This retrospective study was conducted to assess the value of imaging in patients with refractory puerperal febrile morbidity. During a 36-month period, 31 patients were referred for ultrasound and/or computed tomography or magnetic resonance imaging because of postpartum fever unresponsive to broad-spectrum antibiotic therapy of at least 72 hours' duration. Hematomas were identified in 11 women. Abscesses were diagnosed in seven patients, ovarian venous thrombosis in two, vesicouterine fistula in one, small-bowel obstruction in one, and a subcutaneous seroma in one. Twenty-one women had endomyometritis, 13 of whom also had other extrauterine abnormalities (abscess in six, hematoma in four, and ovarian venous thrombosis, vesicouterine fistula, and small-bowel obstruction in one each). Retained placental tissue was found in two women with endomyometritis. Only two subjects had negative imaging studies. In most patients, imaging led to definitive diagnosis and specific therapeutic measures resulting in resolution of the febrile morbidity. Our experience suggests that these imaging techniques may be helpful in evaluating puerperal fever.     

Cerebral Venous Sinus Thrombosis in a Woman Using the Etonogestrel-Ethinyl Estradiol Vaginal Contraceptive Ring: A Case Report

BackgroundThe vaginal contraceptive ring is a hormonal contraceptive that releases etonogestrel and ethinyl estradiol. Cerebral venous sinus thrombosis (CVST) is a rare but serious complication of hormonal contraceptive use.CaseWe present a case of CVST in a 33-year-old nulligravid woman who was using a vaginal contraceptive ring. At the time of presentation, she had been using the ring for 18 months, having previously used oral contraceptives for 13 years. She had no additional risk factors for thrombosis apart from cigarette smoking. Despite vigorous management, the patient died from the effects of the CVST.ConclusionThe serious adverse effects of the vaginal contraceptive ring are not well known, although deep vein thrombosis, pulmonary embolism, and aortic thrombosis in association with use of the ring have been reported to Health Canada. Continuing post-market surveillance of thrombotic risk in users of the vaginal contraceptive ring is critical.     

孕产妇脑静脉及静脉窦血栓形成的诊治

孕产妇脑静脉及静脉窦血栓形成（cerebral venous and sinus thrombosis,CVST）是妊娠与分娩相关的神经急症事件的主要内容之一,处在这一特殊生理期的人群CVST发生率数倍于正常人群。如能准确把握对这一特殊群体患者CVST的早期认知,及时精准诊断和治疗将会显著降低孕产妇CVST患者的病死率和致残率。     

Upper body venous thrombosis associated with ovarian stimulation: case report and review of the literature

Thromboembolic events are a serious complication of assisted conception treatment. Thrombosis may be either arterial or venous but the latter is far more common. This phenomenon is more frequent in the lower limb, but several cases of upper extremity thrombosis have been described in the literature. Although the aetiology of these thromboembolic disorders is not fully understood, the mechanism is thought to be due to a hypercoagulable state associated with haemostasis and thrombophilia. Predisposing factors seem to be hyperoestrogenism, ovarian hyperstimulation syndrome, a hereditary hypercoagulable state and multifoetal pregnancy. We report a case of superior sagittal sinus thrombosis that developed in a patient following successful assisted conception in the absence of evident risk factors. In the current literature, the site of thrombosis, possible predisposing factors, oestrogen levels, number of foetuses, maternal and foetal outcomes, and management of thrombosis were analysed.