Тромбоза на супериорен сагитален синус кај дете- приказ на случај

Cerebral venous sinus thrombosis (CVST) is presence of a blood clot in the dural venous sinuses. This is a rare, but dangerous condition. CSVT is characterized by a highly variable clinical spectrum, difficult diagnosis, variable etiologies and prognosis. The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) determined the frequency of the sites of SCVT. The aim of this case study was to show the clinical presentation, the examination we made, the therapy that was ordinated and the outcome of the treatment. Case study: A 14-year-old male teenager was admitted to the University Clinic for Neurosurgery in Skopje with GCS 10, accompanied with tonic-clonic epileptic seizures. CT examinations by systems were made, and during the time of recording the patient was given Dormicum 2mg overall dose. CT scan of the brain showed hyperdense zones formation around superior sagittal sinus (SSS), the rest of the medical finding was normal. We ran laboratorytests and the test for hemostasisshowed deviation from the normal range. With the ordinated therapy the clinical condition of the patient drastically improved. He was discharged home 12 days after the admission. He was given a recommendation for further check-ups by a transfusiologist and regular visits to our clinic. Occlusion of the cerebral veins and dural venous sinuses may occur on the basis of local trauma, neoplasm or infection. Primary aseptic thrombosis may involve either cerebral veins or dural venous sinuses, or both in combination. The clinical picture and the prognosis of intracranial venous thrombosis probably depend largely on the location, extent, and rapidity of development of the venous occlusion. Conclusion: Superior sagittal sinus thrombosis is a condition that can be manifested with diverse and many symptoms and signs, which often can start unexpectedly and can be life-threatening.Тромбоза на церебрален венски синус (CVST) е присуство на тромб во дуралните венски синуси. Ова е ретка, но опасна состојба. CSVT се карактеризира со високо променлив клинички спектар, тешка дијагноза, променлива етиологија и прогноза. Меѓународната студија за церебрална вена и тромбоза на дурален синус (ISCVT) ја утврди фреквенцијата на местата на CVST. Целта на овој приказ на случај беше да ја прикажеме клиничката слика кај наш пациент, испитувањата кои ги одбравме, а нè доведоа до конечната дијагноза, терапијата која ја ординиравме и крајниот исход од лекувањето. Приказ на случај: 14-годишен машки тинејџер беше примен на Универзитетската клиника за неврохирургија во Скопје со GCS 10, придружуван од тонично-клонични епилептични напади. Беа направени КТ прегледи по системи и за време на снимањето на пациентот му била дадена Дормикум 2 мг вкупна доза. Од КТ скенот на мозокот се забележани хипердензирани зони околу супериорниот синус сагиталис, а остатокот од КТ скенот бил нормален. Направивме лабораториски тестови, а тестот за хемостаза покажа отстапување од нормалниот опсег. Со ординираната терапија клиничката состојба на пациентот драстично се подобри. Тој беше отпуштен дома 12 дена по приемот. Тој доби препорака за понатамошни прегледи од трансфузиологот и на нашата клиника. Оклузија на церебрални вени и дурални венски синуси може да се појави врз основа на локална траума, неоплазма или инфекција. Примарната асептична тромбоза може да вклучува или церебрални вени или дурални венски синуси, или обете во комбинација. Клиничката слика и прогнозата на интракранијална венска тромбоза веројатно во голема мерка зависи од локацијата, степенот и брзината на развој на венската оклузија. Заклучок: Тромбоза на сагиталниот синус е состојба што може да се манифестира со разновидни  симптоми и знаци, кои честопати можат да започнат неочекувано и да бидат опасни по живот

Selective and superselective angiography of pediatric moyamoya disease angioarchitecture: the anterior circulation

The angioarchitecture of the so-called moyamoya vessels in children has not been explicitly analyzed. We aimed to investigate the precise anatomy of the vascular anastomotic networks in patients with childhood moyamoya disease. Six children diagnosed with moyamoya disease for the first time underwent an angiographic investigation with selective and superselective injections. We recorded the arterial branches feeding the moyamoya anastomotic networks, their connections and the recipient vessels. Depending on the level of the steno-occlusive lesion, the feeding vessels included the medial striate arteries, the perforators of the choroidal segment of the carotid, the uncal artery, the medial and lateral branches of the intraventricular segment of the anterior choroidal artery, perforators of the communicating segment, the superior hypophyseal arteries, the prechiasmal branches of the ophthalmic artery, the ethmoidal arteries and the dural branches of the cavernous carotid. Through connections, which are described, the recipient vessels were the lateral striate arteries and the middle cerebral, the medial striate arteries and the anterior cerebral, medullary arteries around the ventricular system, anterior temporal branches of the middle cerebral, orbitofrontal and frontopolar branches of the anterior cerebral, as well as other cortical branches of the anterior and middle cerebral territories. The use of high quality selective and superselective angiography enabled us to clearly demonstrate for the first time aspects of the microangiographic anatomy of the moyamoya anastomotic network previously only vaguely or incompletely described

Selective and superselective angiography of pediatric moyamoya disease angioarchitecture in the posterior circulation

The anastomotic network of the posterior circulation in children with moyamoya disease has not been analyzed. We aimed to investigate the angiographic anatomy of this unique vascular network in patients with childhood moyamoya disease. Selective and superselective injections of the posterior circulation were performed in six children with newly diagnosed moyamoya disease. The arterial branches feeding the moyamoya anastomotic network, their connections and the recipient vessels were demonstrated. Depending on the level of the steno-occlusive lesion, the feeding vessels were the thalamoperforators, the posterior choroidals, the splenic artery, parietoccipital artery, other cortical posterior cerebral artery (PCA) branches, the dural branch of the PCA, the premamillary artery and other posterior communicating artery perforators. Through connections, which are described, the recipient vessels were the striate and medullary arteries, other thalamic arteries with or without medullary extensions, the pericallosal artery, medial parietoccipital cortical branches of the PCA and the anterior choroidal artery. High quality selective and superselective angiography helped in demonstrating the angiographic anatomy of the moyamoya posterior anastomotic network previously either vaguely or incompletely described, as well as connections within the posterior circulation but also its relevance as a collateral to the anterior circulation

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care