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Early isolated subarachnoid hemorrhage versus hemorrhagic infarction in cerebral venous thrombosis Cover

Early isolated subarachnoid hemorrhage versus hemorrhagic infarction in cerebral venous thrombosis

Radiology and Oncology
Volume 56 (2022): Issue 3 (September 2022)
By: Jan Kobal,  Ksenija Cankar,  Kristijan Ivanusic,  Borna Vudrag and  Katarina Surlan Popovic  
Open Access
|Aug 2022

Figures & Tables

Figure 1

A 23-year old woman with headache followed by seizure and focal neurological deficit MRI on admission showed no focal lesions/oedema (A); contrast material-enhanced (CE) T1 and T2 showed occlusion of the left sigmoid sinus (B) and left transverse (C). Despite immediate anticoagulant treatment (fractioned heparin), the next day the patient became drowsy. CT revealed hemorrhagic infarction; in addition to the transverse sinus (arrow), the Labbe vein was suspected to be occluded due to the infarction territory (D). Decompressive craniotomy failed to prevent progression to irreversible coma (E,F).
A 23-year old woman with headache followed by seizure and focal neurological deficit MRI on admission showed no focal lesions/oedema (A); contrast material-enhanced (CE) T1 and T2 showed occlusion of the left sigmoid sinus (B) and left transverse (C). Despite immediate anticoagulant treatment (fractioned heparin), the next day the patient became drowsy. CT revealed hemorrhagic infarction; in addition to the transverse sinus (arrow), the Labbe vein was suspected to be occluded due to the infarction territory (D). Decompressive craniotomy failed to prevent progression to irreversible coma (E,F).

Figure 2

A 59-year old man was examined after 5 days of headaches and a seizure. CT revealed bilateral cortical subarachnoid hemorrhage (SAH) and moderate diffuse brain edema, but no hemorrhagic infarction was formed (A). An extensive thrombosis of cerebral sinuses/veins including the superior sagittal sinus, transversal sinuses, left sigmoid sinus and jugular bulb was observed. The right transversal sinus was occluded to the point of Labbe vein inflow (B), arrow showing confluence of vein to sinus). Fractured heparin and later warfarin were introduced; the patient scored 0 according modified Rankin Score (mRs) at control examination. Complete recanalization of the occluded sinuses occurred (C).
A 59-year old man was examined after 5 days of headaches and a seizure. CT revealed bilateral cortical subarachnoid hemorrhage (SAH) and moderate diffuse brain edema, but no hemorrhagic infarction was formed (A). An extensive thrombosis of cerebral sinuses/veins including the superior sagittal sinus, transversal sinuses, left sigmoid sinus and jugular bulb was observed. The right transversal sinus was occluded to the point of Labbe vein inflow (B), arrow showing confluence of vein to sinus). Fractured heparin and later warfarin were introduced; the patient scored 0 according modified Rankin Score (mRs) at control examination. Complete recanalization of the occluded sinuses occurred (C).

The basic data and predisposing/precipitating factors in isolated subarachnoid hemorrhage (iSAH) and haemorrhagic infarction groups of patients

iSAH group N = 8Hem. inf. group N = 15
Age (mean ± SD)49.3 ± 16.247.9 ± 16.8
Gender6 M, 2 W4 M, 11 W*
Genetic thrombophilia (%)4 (50.0%)2 (13.3%)
Acquired thrombophilia (%)0 (0%)4 (26.7%)
Autoimmune disorder (%)4 (50.0%)4 (26.7%)
Hypothyroid disorder (%)1 (12.5%)1 (6.7%)
Venous sinuses injury (%)1 (12.5%)0 (0%)
Malignancy (%)1 (12.5%)1 (6.7%)
Pregnancy (%)0 (0%)1 (6.7%)
Glucocorticoid/sex steroid therapy (%)1 (12.5%)6 (40.0%)

Clinical signs on admission in isolated subarachnoid hemorrhage (iSAH) and haemorrhagic infarction groups

iSAH group N = 8Hem. Inf group N = 15
Headache (%)6 (75.0%)9 (60.0%)
Seizure (%)3 (37.5%)8 (53.3%)
Focal signs (%)2 (25.0%)5 (33.3%)
Nausea/vomiting (%)2 (25.0%)3 (20.0%)
Confusion (%)0 (0%)2 (13.3%)
Disturbed consciousness(%)0 (0%)4 (26.7%)

Comparison of thrombosed veins/sinuses (CVS), oedema formation, herniation, sulcal obliteration, modified Rankin Scores (mRs) at discharge and control examination in both groups of patients

iSAH group N = 8Hem. Inf group N = 15
Average No. of thrombosed CVS (median, 25%, 75% percentiles)4 (25% 3.25, 75% 5.75)2 (25% 1, 75% 3)*
Sulcal obliteration0 (0.0%)13 (86.7%)*
Subfalcine/uncal herniation0 (0.0%)4 (26.7%)
Oedema formation2 (25.0%)8 (53.3%)*
Average mRS at discharge (median, 25% , 75% percentiles)1 (25% 0, 75% 1.75)2 (25% 0, 75% 3)
Average mRS at control (median, 25% , 75% percentiles)0 (25% 0, 75% 0)1 (25% 0, 75% 3)*
DOI: https://doi.org/10.2478/raon-2022-0029 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 303 - 310
Submitted on: Feb 25, 2022
Accepted on: Jun 14, 2022
Published on: Aug 14, 2022
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
cerebral venous thrombosis,
subarachnoid hemorrhage,
hemorrhagic brain infarction,
superficial communicating veins
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2022 Jan Kobal, Ksenija Cankar, Kristijan Ivanusic, Borna Vudrag, Katarina Surlan Popovic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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