Use of MLC901 in cerebral venous sinus thrombosis:Three case reports

BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.

Rare cause of cerebral venous sinus thrombosis:Spontaneous intracranial hypotension syndrome:A case report

BACKGROUND Spontaneous intracranial hypotension syndrome is a relatively uncommon neurological disorder of unknown etiology with a good prognosis.Cerebral venous sinus thrombosis is a specific type of cerebrovascular disease caused by multiple etiologies of cerebral venous sinus or vein thrombosis that obstructs cerebral venous return and is associated with impaired cerebrospinal fluid absorption;this entity is rarely seen clinically.Spontaneous intracranial hypotension syndrome is one of the causes of cerebral venous sinus thrombosis,and the probability of their combined occurrence is only 1%-2%.As such,it is easily overlooked clinically,thus increasing the difficulty of diagnosis and treatment.CASE SUMMARY A 29-year-old young woman presented with postural headache.Lumbar puncture suggested a pressure of 50 mmH2O(normal 80 mmH2O-180 mmH2O),and magnetic resonance imaging cerebral venography suggested thrombosis of the supratentorial sinus.These findings were considered indicative of cerebral venous sinus thrombosis due to spontaneous intracranial hypotension syndrome after ruling out immunological causes,tumor,infection,abnormal coagulation mechanism,and hypercoagulable state,etc.She was treated with rehydration and low-molecular heparin anticoagulation for 15 d,and follow-up magnetic resonance imaging cerebral venography suggested resolution of the thrombus.The patient had complete improvement of her headache symptoms.CONCLUSION Spontaneous intracranial hypotension syndrome is one of the rare causes of cerebral venous sinus thrombosis,which is frequently misdiagnosed or missed and deserves consideration by clinicians during differential diagnosis.Dehydration should be avoided in such patients,and early rehydration and anticoagulation therapy are effective treatment options.

Sneddon's syndrome concurrent with cerebral venous sinus thrombosis:A case report

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with Sneddon's syndrome(SS)and cerebral venous sinus thrombosis(CVST).Particular emphasis is placed on the comprehensive elucidation of SS's clinical manifestations,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A 26-year-old woman presented with recurrent episodes of paroxysmal unilateral limb weakness accompanied by skin mottling,seizures,and cognitive impairment.Digital subtraction angiography revealed CVST.Despite negative antiphospholipid antibody results,skin biopsy indicated chronic inflammatory cell infiltration.The patient was treated using anticoagulation,antiepileptic therapy,and supportive care,which resulted in symptom improvement.The coexistence of SS and CVST is rare and the underlying pathophysiology remains uncertain.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of SS with CVST and reviewed the relevant literature to improve the clinical understanding of this rare condition.

An Early Pregnant Chinese Woman with Cerebral Venous Sinus Thrombosis Succeeding in Induction of Labor in the Second Trimester

Cerebral venous sinus thrombosis(CVST)is a rare condition in early pregnancy.A22-year-old Chinese woman at10weeks of pregnancy requested induced abortion and was diagnosed as CVST for a severe headache accompanying with nausea and vomiting.The patient was treated successfully with anticoagulation,followed by amniocentesis,and finally succeeded in induction of labor safely.The diagnosis,treatment and prognosis for this rare condition are discussed in this paper.

Plasmodium vivax cerebral malaria complicated with venous sinus thrombosis in Colombia

Complicated malaria is usually due to Plasmodium falciparum.Nevertheless,Plasmodium vivax is infrequently related with life-threatening complications.Few cases have been reported of severe Plasmodium vivax infection,and most of them from Southeast Asia and India.We report the first case of cerebral malaria due to Plasmodium vivax in Latin America,complicated with sagittal sinus thrombosis and confirmed by a molecular method.

Cerebral venous sinus thrombosis following transsphenoidal surgery for craniopharyngioma:A case report

BACKGROUND Cerebral venous sinus thrombosis(CVST)is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.CASE SUMMARY A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery.After admission,head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus,edema at the bilateral parietal lobe,and hemorrhage at the left parietal lobe and right occipital lobe;the venous phase of cerebral angiography revealed CVST.The patient was treated immediately by intravenous thrombolysis,endovascular thrombolysis,and mechanical thrombectomy after the definite diagnosis.However,the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.CONCLUSION For craniopharyngioma undergoing transsphenoidal surgery,it is vital to take an effective strategy to manage the postoperative complications,such as diabetes insipidus,severe electrolyte imbalance,and cerebrospinal fluid leakage.Additionally,the early differential diagnosis of CVST is essential when it develops clinical symptoms,especially in patients following transsphenoidal surgery with a high risk of CVST.Subsequently,the timely and effective treatment of the CVST is critical for preventing neurological deterioration.

Cerebral venous sinus thrombosis in pregnancy: A case report

BACKGROUND Cerebral venous thrombosis(CVT)is a rare but life-threatening disease in pregnant women.Anticoagulation is the first-line therapy for CVT management.However,some patients have poor outcomes despite anticoagulation.Currently,the endovascular treatment of CVT in pregnant women remains controversial.We report a rare case of CVT in a pregnant woman who was successfully treated with two stent retriever devices.CASE SUMMARY The patient was a 29-year-old pregnant woman.She was first diagnosed with hyperemesis gravidarum due to severe nausea and vomiting for one week.As the disease progressed,she developed acute left hemiplegia.Imaging confirmed the diagnosis of superior sagittal sinus,right transverse sinus and sinus sigmoideus thrombosis.As anticoagulant therapy was ineffective,she underwent thrombectomy.After the mechanical thrombectomy,her headache diminished.Three weeks later,the patient was completely independent.At a 3-mo follow-up,no relapse of symptoms was observed.CONCLUSION Mechanical thrombectomy may be an effective alternative therapy for CVT in pregnant women if anticoagulation therapy fails.

Hypereosinophilia with cerebral venous sinus thrombosis and intracerebral hemorrhage:A case report and review of the literature

BACKGROUND Hypereosinophilia(HE)is defined as a peripheral blood eosinophil count of>1.5×109/L and may be associated with tissue damage.The clinical presentations of HE vary;however,myocardial fibrosis and thrombosis can threaten the lives of patients with sustained eosinophilia.Cerebral venous sinus thrombosis(CVST)in the setting of eosinophil-related diseases has seldom been reported.Here,we review the literature on HE with CVST to increase knowledge and encourage early diagnosis.CASE SUMMARY A previously healthy 41-year-old man was admitted to hospital with diarrhea and abdominal pain.He was treated with antibiotics for suspected acute colitis.Three days later,he experienced headache and vomiting.Brain computed tomography(CT)revealed thrombosis of the left jugular vein to the left transverse sinus vein.Platelet(PLT)count decreased to 60×1012/L,and absolute eosinophil count(AEC)increased to 2.41×109/L.He was treated with low-molecular-weight heparin.PLT count progressively decreased to 14×109/L,and we terminated anticoagulation and performed PLT transfusion.Six days after admission,he complained of a worsening headache.Brain CT revealed right temporal lobe and left centrum semiovale intracerebral hemorrhage,and AEC increased to 7.65×109/L.We used prednisolone for HE.The level of consciousness decreased,so emergency hematoma removal and decompressive craniectomy for right cerebral hemorrhage were performed.The patient was alert 2 d after surgery.He was treated with anticoagulation again 2 wk after surgery.Corticosteroids were gradually tapered without any symptomatic recurrence or abnormal laboratory findings.CONCLUSION HE can induce CVST,and we need to focus on eosinophil counts in patients with CVST.

Common Prothrombotic Gene Mutations in Cerebral Venous Sinus Thrombosis in North-West of Iran

Objective: Cerebral venous sinus thrombosis (CVST) is a life-threatening cerebrovascular disease which has high prevalence and mortality rate in Iran. Thrombophilia caused by gene mutation is a common cause of CVST. The present study aimed at assessing the prevalence of thrombophilic gene mutations in Iranian CVST patients and then comparing it with normal population. Materials and methods: In a case-control study, polymerase chain reaction-restriction fragment length polymorphism (PCR_RFLP) and amplification-refractory mutation system (ARMS-PCR) were carried out to detect common thrombophilic mutations in 70 CVST patients. Next, it was compared with 82 sex- and age-matched healthy controls. Results: Factor-V-Leiden, Factor-V-Leiden HR2, Factor prothrombin II, MTHFR (667C/T) and MTHFR (1298A/C) prevalence were significantly high in cases of CVST as compared to the controls (P values: 0.012, 0.019, 0.007 and 0.036, respectively). However, there was no significant difference between the two groups in plasminogen activator inhibitor (PAI), angiotensin-converting enzyme (ACE), beta-fibrinogen (FGB), Factor VIII, Factor XIII, and tissue plasminogen activator (tPA) mutations. Conclusion: The findings of the present study suggest that Factor V-Leiden, Factor-V-Leiden HR2, prothrombin II (G20210A), and MTHFR (667C/T & 1298A/C) mutations are more frequent in CVST. Detection of these mutations may help clinicians to decide on the duration of treatment and referral to genetic counseling for valuable prevention.

Accuracy of Noncontrast CT Brain in Detection of Cerebral Venous Sinus Thrombosis

Background and Purpose: Increasing concern of cerebral venous thrombosis due to treatable and curable causes of stroke. The diagnosis of cerebral venous sinus thrombosis is challenged due to nonspecific clinical symptomatology. Patients may present at an emergency room with a variety of neurological conditions such as severe headache, weakness, seizure, etc. Neuroimaging, particularly noncontrast cranial computed tomography (NCCT), is an investigation of choice in differentiation and triage the patients for further treatment. CT is sensitive in the detection of acute thrombosis or blood clots in all regions of the body. We hypothesize that NCCT might be sensitive to diagnose cerebral venous thrombosis immediately. Materials and Methods: Retrospectively review the electronic database of our patients, there are 27 patients with cerebral sinus venous thrombosis (SVT) and 4 patients with cerebral deep venous thrombosis (DVT). Other 79 patients present with clinically diagnosed cerebral venous thrombosis but the final result can exclude cerebral venous thrombosis. We use MR imaging and CT venography as the gold standard. Independently reviewed by two neuroradiologists for CT direct sign and CT indirect signs that suggest SVT or DVT. CT direct signs for SVT and DVT are the presence of hyperdensity in the sinus venous or deep venous system (cord sign, attenuated vein sign) and CT indirect signs are the changes in brain parenchyma (brain edema, hemorrhagic infarction). Results: Sensitivity and specificity of NCCT in detection attenuated vein sign and diagnosis DVT are 75% and 100% whereas the sensitivity and specificity of NCCT in detection cord sign and diagnosis SVT are 43.8% and 99.7% as respectively. Conclusions: NCCT might not sensitive in detection of SVT without CT direct sign which needs further investigation. However, NCCT might beneficial for emergency conditions such as DVT patients, cortical vein thrombosis and also in SVT patients with the positive CT direct sign.

A Case Report on Atypical Presentation of Cerebral Venous Sinus Thrombosis, a Young Adult with Recurrent Fall: A Clinical Quandary

Cerebral Venous Sinus Thrombosis (CVST) is blood clot in draining veins and venous sinuses of brain, causing hindrance in the blood drainage system in brain, disturbing the internal homeostasis of brain, resulting in local oedema, ischemia, venous haemorrhage, damage to brain parenchyma and blood brain barrier. In our case report, we discussed a rare presentation of CVST, a 16-year-old young boy who presented in emergency with history recurrent fall, weakness, tingling numbness. What makes it challenging to diagnose in his unusual presentation without common symptoms and on examination no positive neurological finding. This case brings focus on the importance of knowledge about CVST among emergency physicians. CSVT is considered more commonly as a differential diagnosis of stroke in young age group owning to genetic predisposition, hot humid climate of the state leading to severe dehydration, dietary factors leading to vitamin B12 deficiency & hyper-homocysteinemia etc. Moreover, present COVID-19, inducing a hypercoagulable state among affected individuals gave CVST a new momentous among emergency physicians. An early diagnosis can be very fruitful as it might prevent long term disability and reduce mortality significantly.

Cerebral sinus thrombosis in patients with inflammatory bowel disease: A case report

Inflammatory bowel disease (IBD) is an idiopathic inflammatory disease of the gastrointestinal tract. The pathophysiology of IBD is probably the result of the complex interaction of genetic susceptibility and environmental influences. There is a well-known risk of thrombosis in patients with IBD. We present the case of a 53-year-old man with ulcerative colitis, who spontaneously developed intracranial sinus thrombosis that was treated with low molecular weight heparin. Literature was searched to assess the frequency and characteristics of cerebral sinus thrombosis in IBD and the role of certain etiopathological factors in such thrombotic patients.

Cerebral venous thrombosis presenting with headache only and misdiagnosed as subarachnoid hemorrhage

INTRODUCTION Patients with headache constitute up to 4.5%of emergency department(ED)visits.[1]Cerebral venous thrombosis(CVT)is an important cause of the headache that is more common than once suspected.The diagnosis of CVT is often missed or delayed because of non-

Antithrombin gene Arg197Stop mutation-associated venous sinus thrombosis in a Chinese family

This study sought to elucidate the genetic correlation of cerebral venous sinus thrombosis caused by a hereditary antithrombin deficiency in a Chinese family, at the genetic and protein levels. A nonsense mutation from C to T on locus 6431 in exon 3B of the antithrombin gene was observed, leading to an arginine （CGA） to stop codon （TGA） change in the protein. This is the first report of this mutation in China. Ineffective heparin therapy in the propositus patient is associated with a lack of heparin binding sites after antithrombin gene mutation. Characteristic low intracranial pressure in the acute phase might be specific to this patient with cerebral venous sinus thrombosis.

Two cases of venous sinus thrombosis in women taking the oral contraceptive pill, Yaz (dropirenone/ ethinyl estradiol), and review of the literature

Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke and the clinical presentation is variable, thus mimicking other neurologic pathologies. One of the more common acquired risk factors of venous sinus thrombosis is oral contraceptive medications such as Yaz. While the prognosis for CVT is favorable, it is important to identify and treat early to prevent neurologic deficits. We report two cases of young female patients who presented with sinus thrombosis and review the current literature on this topic. CVT accounts for 0.5% of strokes and most commonly presents with headaches and in many cases focal neurologic deficits. Diagnosis is confirmed with neuroimaging including CT angiography or MR angiography. Treatment consists of anticoagulation and in some cases, thrombolytic therapy is beneficial. The overall prognosis of CVT is favorable but, further research is needed to outline optimal treatment options including the duration of anticoagulation therapy and the role of thrombolytic therapy to prevent serious neurologic deficits.

Cerebral venous thrombosis and heparin-induced thrombocytopenia in an 18-year old male with severe ulcerative colitis

The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. Furthermore, its treatment can be complex and is not without complications. We describe a case of an adolescent boy who developed a cerebral sinus venous thrombosis during a relapse of his ulcerative colitis and who, while on treatment with heparin, developed heparin-induced thrombocytopenia (HIT). The treatment was then switched to fondaparinux, a synthetic and selective inhibitor of activated factor .

Dabigatran in the Treatment of Extensive Cerebral Venous Thrombosis:A Case Report

Background: Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease associated with a 15% rate of death or function dependence. The mainstay of treatment for CVT is systemic anticoagulation, despite venous hemorrhagic infarction. Vitamin K antagonists have long been the only available option for anticoagulation;however, the past few years have brought the development of many new target-specific drugs, collectively called non-vitamin K antagonist oral anticoagulants (NOACs). Although emerging evidence suggests NOACs have an acceptable safety and tolerability profile in CVT, there are limited data available and no randomized controlled trials have been performed to date. Case Presentation: This describes the case of a patient with CVT occurring during an infection who was successfully treated with a NOAC, dabigatran, after a difficult time on warfarin. Conclusions: A case of extensive and deep CVT was identified. Dabigatran 150 mg treatment twice daily in this patient resulted in no additional damage to the brain. This case study illustrates that the use of NOACs such as dabigatran can be safe and effective in patients with CVT.

Patients with SERPINC1 rs2227589 polymorphism found to have multiple cerebral venous sinus thromboses despite a normal antithrombin level:A case report

BACKGROUND The hereditary antithrombin(AT)deficiency caused by SERPINC1 gene mutation is an autosomal dominant thrombotic disorder.An increasing number of studies have shown that mutations in the SERPINC1 rs2227589 polymorphic site are correlated with a risk of venous thromboembolism(VTE)at common sites,such as lower extremity deep venous thrombosis and pulmonary thromboembolism.Currently,there are no reports of cerebral venous sinus thrombosis(CVST),a VTE site with a low incidence rate and rs2227589 polymorphism.CASE SUMMARY Here,we report a Chinese CVST case with a mutation of the SERPINC1 rs2227589 polymorphic site,which did not cause significant AT deficiency.In a 50-year-old male patient presenting with multiple cerebral venous sinus thromboses no predisposing factors were detected,although a relative had a history of lower extremity deep venous thrombosis.We performed sequencing of the SERPINC1 gene for the patient and his daughter,which revealed the same heterozygous mutation at the rs2227589 polymorphic site:c.41+141G>A.CONCLUSION The results showed that more studies should be conducted to assess the correlation between rs2227589 polymorphism and CVST.

Retinopathy Revealing Cerebral Venous Thrombosis in Sickle Cell Disease in Niger

Cerebral venous thrombosis (CVT) in sickle cell disease has been rarely described in the literature. Some authors consider sickle cell disease as a risk factor for CVT. We report the case of a 20-year-old boy, known as sickle cell, followed at the National Reference Center for Sickle Cell Disease in Niger. Admitted in consultation for a decrease of acuity with the right eye with perception of a black spot evolving since about three (3) days, ophthalmological examination revealed sickle cell retinopathy associated with cerebral venous thrombosis on MRI. The rest of the balance showed normochromic anemia, ionic disturbance and a D-dimer at 1500 μg/l. Rehydration, strict rest, antibiotic therapy and analgesics were started with an internal medicine opinion for further treatment. There was an improvement in visual acuity of 6/10 in 48 hours with disappearance of black spot perception, after three weeks, an ad integrum recovery of retinal lesions to control imaging. Despite the ocular complications of sickle cell disease involving visual prognosis, cerebral venous thrombosis is another complication to be investigated in any sickle cell retinopathy.

Cerebral Venous Thrombosis: A Rare Complication of Spinal Anesthesia

Introduction: Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs by isolated headache, following post spinal puncture headache (PSPH). We report a case of cerebral venous thrombosis complicating PSPH, following a spinal anesthesia. Observation: A 23-year-old man was admitted to the emergency room for PSPH appeared 6 hours after a spinal aesthesia for removal of osteosynthesis equipment from the right tibial plateau. The headache was fronto-occipital, relieved by lying down. Six days later, headache became permanent, not relieved by morphine, associated with vomiting. The neurological examination was normal. Brain magnetic resonance Magnetic venography showed superior sagittal sinus and right transverse sinus thrombosis. After administration of low molecular weight heparin at curative dose, and warfarin under INR control, the evolution was marked by a rapid regression of headaches on the same day. After a 1-year setback, the patient was asymptomatic. Conclusion: CVT is a rare complication of spinal anesthesia and potentially severe if diagnosed lately. Urgent brain imaging must be performed for any atypical headache or the onset of neurological disorders so as not to misunderstand cerebral vein thrombosis. Controlling the spine anesthesia would reduce the inadvertent perforation of the dura-mother that would lead to CVT complicating post spinal puncture headaches.