Spectrum of Intracranial Hemorrhages in Cerebral Venous Thrombosis: A Pictorial Case Series and Review of Pathophysiology and Management.

IF 1.1 4区医学 Q4 CLINICAL NEUROLOGY Neurologist Pub Date : 2025-01-01 DOI:10.1097/NRL.0000000000000604

Shreyashi Jha, Karthik Kulanthaivelu, Pritam Raja, Raghavendra Kenchiah, Subasree Ramakrishnan, Girish Baburao Kulkarni, Ajay Asranna

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Abstract

Objective: We aim to provide a pictorial representation of the broad spectrum of intracranial hemorrhages associated with cerebral venous thrombosis (CVT), emphasizing atypical locations and rare intracerebral hemorrhage (ICH) types. We also hypothesize the pathophysiology leading to atypical locations of the ICH in CVT and the outcomes with anticoagulation therapy.

Background: ICH complicates about 40% of cases with CVT and is known to cause various types of ICH, including subarachnoid hemorrhage (SAH) and subdural hemorrhage (SDH). A combination of hemorrhages is also reported.

Methods: Patients with computed tomography and magnetic resonance imaging findings consistent with CVT examined between January 2011 and June 2014 were included in this retrospective review. Demographic and clinical data and imaging findings were reviewed with particular attention to the type and location of ICH and sinus involvement. Treatment details and 3-month outcomes, assessed using the modified Rankin Scale, were analyzed.

Results: Eleven patients (9 males), ranging in age from 22 years to 58 years, were included. The most common clinical presentations were headache (n = 8) and seizures (n = 7). Intraparenchymal hemorrhages were most common (n = 7), followed by SDH and SAH (n = 4), intraventricular hemorrhage (IVH; n = 3), and juxtacortical hemorrhage (n = 1). All patients who received anticoagulation therapy (n = 11) experienced complete resolution of their symptoms, and the median modified Rankin Scale was 0.

Conclusions: The spectrum of intracranial hemorrhages seen in association with CVT is broad, encompassing atypical locations like basal ganglia, external capsule, and cerebellar hemispheres, and involves multiple intracranial compartments-IVH, SAH, and SDH. While SAH and SDH are seen with superior sagittal sinus thrombosis, ICH is common with lateral sinus thrombosis, and IVH with deep venous thrombosis.

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脑静脉血栓形成颅内出血的频谱：一个图像病例系列和病理生理和治疗的回顾。

目的：我们旨在提供脑静脉血栓形成（CVT）相关颅内出血的广谱图，强调非典型部位和罕见的脑出血（ICH）类型。我们还假设了导致CVT中脑出血不典型位置的病理生理学和抗凝治疗的结果。背景：脑出血合并CVT的病例约占40%，已知脑出血可引起各种类型的脑出血，包括蛛网膜下腔出血（SAH）和硬膜下出血（SDH）。合并出血也有报道。方法：回顾性分析2011年1月至2014年6月期间进行CVT检查的计算机断层扫描和磁共振成像结果一致的患者。回顾了人口统计学和临床数据以及影像学结果，特别注意脑出血和鼻窦累及的类型和位置。采用改良Rankin量表对治疗细节和3个月的结果进行分析。结果：11例患者（男9例），年龄22 ~ 58岁。最常见的临床表现为头痛（n = 8）和癫痫发作（n = 7）。最常见的是肺实质出血（n = 7），其次是SDH和SAH (n = 4)，脑室内出血(IVH；n = 3)，皮质旁出血（n = 1）。所有接受抗凝治疗的患者（n = 11）症状完全缓解，修正Rankin量表中位数为0。结论：与CVT相关的颅内出血范围广泛，包括基底节区、外囊区和小脑半球等非典型部位，并累及多个颅内腔室- ivh、SAH和SDH。SAH和SDH常与上矢状窦血栓形成，ICH常与外侧窦血栓形成，IVH常与深静脉血栓形成。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurologist 医学-临床神经学

CiteScore

1.90

自引率

0.00%

发文量

151

审稿时长

2 months

期刊介绍： The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.