Woman with Sickle Cell Disease with Current Sigmoid Sinus Thrombosis and History of Inadequate Warfarin Use during a Past Thrombotic Event

We report a 20-year-old woman with sickle cell disease (SCD) who presented with a severe pulsating headache, nausea, and vomiting. Her history was significant for a past thrombotic event during which she had not used anticoagulation therapy as prescribed. Her mental status was mildly confused. On funduscopic examination, papilledema and retinal hemorrhages were found. Results of a computed tomogram were normal. A lumbar puncture demonstrated increased intracranial pressure (60 cm H2O). Magnetic resonance venography demonstrated a right sigmoid sinus thrombosis. Although SCD has been reported as a cause of thrombotic dural venous sinus events, this case increases the knowledge about neurological complications of SCD. The patient was treated with low molecular weight heparin, blood transfusions, acetazolamide, and methylprednisolone, and her symptoms and signs resolved

Isolated Hand Palsy Due to Small Cortical Infarcts: A Report of Two Cases

The cortical motor hand area is a knob-like structure of the precentral gyrus, with an inverted omega or horizontal epsilon shape. Isolated hand weakness is infrequently observed and is usually due to small cortical infarcts of this hand knob structure. Isolated hand palsy is sometimes restricted to radial-sided fingers or ulnar sided-fingers. Uniform weakness in all fingers may also occur. We present 2 patients with small cortical infarcts of the cortical hand knob due to different etiologies. A 61-year-old male had right hand weakness restricted to his first and second digits. He had a small cortical infarct on the hand knob area due to emboli from ulcerative plaque of the ipsilateral internal carotid artery. The other patient, a 23-year-old female with sickle cell anemia, had uniform left hand weakness due to an epsilon-shaped infarct on the right precentral gyrus. An obstruction of the small cerebral artery supply to the hand knob area due to sickle cell anemia was the likely pathogenic mechanism. It is suggested that isolated hand weakness due to small cortical infarcts may have different etiologies, most commonly homodynamic or embolic processes. Conditions that rarely cause brain infarction, such as sickle cell anemia, deserve clinical attention. Investigations of strokes must include anemia tests. Patients with predominant weakness of the radial group of fingers due to cortical infarct must be checked for embolis

Spontaneous intra cerebral hemorrhage A retrospective study of risk factors and outcome in a Turkish population

BACKGROUND AND PURPOSE: Stroke, which remains the third leading cause of death after heart disease and cancer in developed countries, is a disorder causing permanent neurologic disability. Even though, hemorrhagic strokes are seen less than the ischemic type, they are more fatal. We studied the risk factors for spontaneous intra-cerebral hemorrhage (ICH) to direct the proper preventive treatment modalities and the effects of these factors on mortality as well as applied therapeutic strategies on survival. MATERIALS AND METHODS: The archive records of 106 patients (60 male, 46 female) who were diagnosed with spontaneous ICH in Baskent University Hospital, Ankara, between January 2003 and September 2008, were assessed retrospectively. RESULTS: The mean age was found as 62.5. The most frequent risk factor was hypertension (73.5%); 69.2% of these hypertensive patients had uncontrolled blood pressure levels. The mortality rate was detected as 34.9% and patients were found to die approximately within 9 days after ICH. Older age, increased hemorrhage volume, ventricular extension of hemorrhage, and the presence of midline shift were found to significantly correlate with increased mortality (P < 0.05). Patients who underwent surgical therapy showed a longer survival rate (P = 0.016); however, no association was found between medical and surgical therapy in terms of mortality (P = 0.555). CONCLUSION: The results of this study suggest that effective control of blood pressure is important in the prevention of spontaneous ICH; clinical and radiological findings with treatment modalities influencing mortality should be carefully managed

Topiramate for the Treatment of Hypnic Headache: A Case Report, Including Polysomnography

Hypnic headache is a primary, rare headache disorder of the elderly, which occurs during sleep. Polysomnography (PSG) studies have shown that hypnic headache occurs with much gretaer frequency during REM sleep than during non-REM sleep. We present a 69-year-old male that had been waking from sleep due to headaches that have occurred every night for 10 years and was diagnosed as hypnic headache according to International Headache Society (IHS) criterion. He did not benefit from lithium treatment. After taking topiramate 100 mg/day his headaches disappeared. PSG recordings made while he was taking topiramate showed that he had no headaches. He discontinued topiramate on his own and his headaches returned. Subsequently, three weeks after he stopped taking topiramate, two hypnic attacks were recorded during a second PSG-1 during REM and 1 during non-REM sleep. In two records, both the duration of REM and non-REM sleep were reduced. PSG while the patient was taking topiramate showed a higher proportion of REM sleep and fewer awakenings than did the second PSG. Our findings support the view that hypnic headache attacks arise directly from sleep, not from sleep stages. Changes in sleep physiology in the elderly may contribute to hypnic headache. Topiramate may be an effective alternative treatment for hypnic headache in cases unresponsive to lithium or in those that experience intolerable side-effect

The Importance of Cerebrospinal Fluid Cytology in Leptomeningeal Carcinomatosis Presenting with Intracranial Hypertension

Scientific Background: Leptomeningeal carcinomatosis (LMC) is one of the complications of systemic cancers with the most poor prognosis. Tumor cells in LMC disturb CSF circulation either by spreading into su-baracnoid space or directly infiltrating meninx and occasionaly causes intracranial hypertension (IH). Hydrocephalus can be established by ne-uroimaging methods in the most of patients with IH due to LMC. Me-ningeal contrast enhancements are also present in some patients. CSF cytology must be examined in patients with IH because of not to missing diagnosis of LMC. Material and method: Three patients presented with IH without findings of hydrocephalus in neuroimaging were diagnosed as LMC by CSF cytologic examination. IH and LMC were initial manifestations of breast carcinoma in the first patient. Our second patient was admitted with epileptic seizures and IH two years after the primary diagnosis of breast cancer. However, the fourth cytologic examination of CSF showed LMC by showing malignant cells. The last patient presented with IH was di- agnosed as gastric carcinoma one and a half month ago and LMC was diagnosed by both CSF cytology and cranial magnetic resonance imaging studies. Conclusions: LMC should be suspected in IH patients even in the absence of hydrocephaly and/or meningeal contrast enhancement in ne-uroimaging and CSF cytology must examined even if there is no history of cance

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.WOS:0005375741000192-s2.0-85083703251PubMed: 3235381

Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study

PubMed: 33130674Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. Materials and Methods: in the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. the number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. in the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ?3 in 23.1% of the patients in the CH group. Discussion and Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome. © 2020 S. Karger AG, Basel. All rights reserved