Clinic, Etiology and Prognosis in Cerebral Venous Thrombosis

OBJECTIVE: Scientific BACKGROUND: Cerebral venous thrombosis is seen rarely according to arterial stroke and effects every age group. Onset and process is variable and usually a good prognosis occurs. Early development of coma and intracranial hemorrhage are bad prognostic factors. In our study, it is aimed to investigate the neurologic deficits, etiological factors, localization and the prognosis of the patients who are hospitalized with the diagnosis of cerebral venous thrombosis in our in-patient clinic. METHODS: METHOD: Patients were investigated with routine hematologic, biochemical and vasculitic tests and cranial MRI and MR venography RESULTS: RESULTS: Of fifteen patients, 10 were women and 5 were men. Mean age was 47.2 and age interval was 17-80. 5 patients in acute, 6 patients in subacute and 4 patients in chronic stage had admitted to our clinic. Mostly seen complaint was headache (11 patients) and 7 patients had paresis, 6 had epileptic seizures, 6 had visual deficits and 1 had unsteadiness. 9 patients had superior sagittal, 2 had superior sagittal+trasverse, 2 had superior sagittal+rectus+transverse, 1 had rectus+transverse and 1 had transverse sinus thrombosis. 2 patients had subarachnoid hemorrhage, 2 had lobar hematoma, 1 had subdural hematoma and 1 had hemorrhagic infarct. Etiologically 3 cases were in postpartum period and 1 case was pregnant. 1 patient had protein C deficiency, 1 had activated protein C resistancy, 1 had antithrombin III deficiency, 1 had anticardiolipin antibody positivity and 1 had thrombocytosis. There was no etiological resason in 4 of the cases and 1 patient could not be investigated because of the death of the patient in the early period. 9 patients recovered completely, 3 patients recovered partially and 2 patients had permanent visual loss. CONCLUSION: CONCLUSION: Cerebral venous thrombosis needs highly suspection in order to define the clinical signs. As the early treatment prevents exitus and severe disability, early diagnosis is very importan

Heerfordt Syndrome: A Case Report

Heerfordt syndrome is a form of neurosarcoidosis with the combination of fever, enlargement of the parotid gland, anterior uveitis, and facial nerve paralysis. We present a 38-year-old female patient who had a solid and painful swelling behind each ear 20 days after the complaints of redness of both eyes, fatigue, night sweat, and weight loss. Three weeks later, right facial paralysis developed, and the patient was seen in our outpatient clinic. On physical examination, bilateral solid and painful masses were observed on the parotid glands. Neurological examination was normal except for the right facial nerve paralysis. Ophthalmologic examination revealed bilateral anterior uveitis. Cranial magnetic resonance imaging was normal. On parotid gland magnetic resonance imaging, enlargement, lobulation and cystic lesions on both parotid glands with heterogeneous contrast involvement were observed. Parotid biopsy showed non-necrotizing granulomatous sialadenitis. There were multiple nodules on both lungs on mediastinum computerized tomography. Laboratory tests revealed: C-reactive protein 0.75 mg/dL, erythrocyte sedimentation rate 26 mm/hour and angiotensin-converting enzyme 83 U/L (N: 8-52 U/L) Though the patient, diagnosed as Heerfordt syndrome, had phase 1 sarcoidosis, she was treated with 45 mg/day steroid because of the multiple organ involvement. In conclusion, Heerfordt syndrome, a rare manifestation of neurosarcoidosis, must be kept in mind in the differential diagnosis of facial nerve paralysis

Cranial Magnetic Resonance Imaging Findings in Patients with Neuro-Behcet's Syndrome

OBJECTIVE: Behcet’s disease is a multisystemic, vascular-inflammatory disease of unknown origin. Impairment of the central nervous system is rare, and young adults can present with brain stem syndrome or hemiparesis. In this study, we aimed to determine the cranial magnetic resonance imaging (MRI) patterns in patients diagnosed as parenchymal or nonparenchymal neuro-Behcet’s syndrome who did not have headache. METHODS: Thirty-eight patients admitted to the Haydarpasa Numune Training and Research Hospital, Department of 1st Neurology and GATA Haydarpasa Training Hospital Neurology Department, Istanbul between 2003 and 2009 in the acute period and with the diagnosis of neuro-Behcet’s syndrome were investigated. All the patients were examined by routine hematological and biochemical blood tests, vasculitis tests, cranial MRI, and magnetic resonance venography if needed. Patients with headache and those without cranial MRI lesions were excluded. RESULTS: Eighteen patients, with a mean age of 34.6 ± 9.7 and age range of 17-51, were investigated. Eleven of the patients were male and seven were female. In 14 patients, the diagnosis of Behcet’s disease was present for 11.5 years, while four patients were newly diagnosed after admission. The most common complaints were hemiparesis, dysarthria and diplopia due to the cranial nerve involvement. Twelve of the patients were admitted with the first attack, five with the second attack and one with the third attack in the acute period. Sixteen patients with parenchymal neuro-Behcet’s syndrome had a total of 41 lesions, and the brain stem was the most common localization (55.6%). Of the two patients with nonparenchymal neuro-Behcet’s syndrome, thrombosis was observed in the superior sagittal sinus in one and in the transverse sinus in the other. CONCLUSION: Cranial MRI is a sensitive diagnostic technique for neuro-Behcet’s syndrome. MRI is a noninvasive diagnostic tool to confirm the involvement of the central nervous system and has an important role in confirming the stage of the illness in Behcet’s diseas

Cranial Magnetic Resonance Imaging Findings in Patients with Neuro-Behcet's Syndrome

OBJECTIVE: Behcet’s disease is a multisystemic, vascular-inflammatory disease of unknown origin. Impairment of the central nervous system is rare, and young adults can present with brain stem syndrome or hemiparesis. In this study, we aimed to determine the cranial magnetic resonance imaging (MRI) patterns in patients diagnosed as parenchymal or nonparenchymal neuro-Behcet’s syndrome who did not have headache. METHODS: Thirty-eight patients admitted to the Haydarpasa Numune Training and Research Hospital, Department of 1st Neurology and GATA Haydarpasa Training Hospital Neurology Department, Istanbul between 2003 and 2009 in the acute period and with the diagnosis of neuro-Behcet’s syndrome were investigated. All the patients were examined by routine hematological and biochemical blood tests, vasculitis tests, cranial MRI, and magnetic resonance venography if needed. Patients with headache and those without cranial MRI lesions were excluded. RESULTS: Eighteen patients, with a mean age of 34.6 ± 9.7 and age range of 17-51, were investigated. Eleven of the patients were male and seven were female. In 14 patients, the diagnosis of Behcet’s disease was present for 11.5 years, while four patients were newly diagnosed after admission. The most common complaints were hemiparesis, dysarthria and diplopia due to the cranial nerve involvement. Twelve of the patients were admitted with the first attack, five with the second attack and one with the third attack in the acute period. Sixteen patients with parenchymal neuro-Behcet’s syndrome had a total of 41 lesions, and the brain stem was the most common localization (55.6%). Of the two patients with nonparenchymal neuro-Behcet’s syndrome, thrombosis was observed in the superior sagittal sinus in one and in the transverse sinus in the other. CONCLUSION: Cranial MRI is a sensitive diagnostic technique for neuro-Behcet’s syndrome. MRI is a noninvasive diagnostic tool to confirm the involvement of the central nervous system and has an important role in confirming the stage of the illness in Behcet’s disease