1/25. Traumatic intracerebral venous thrombosis associated with an abnormal golf swing.OBJECTIVES: To describe the occurrence of cerebral venous thrombosis in a 40-year-old man whose cerebral event was induced by a poor golf swing, to review the literature on possible mechanisms producing venous thrombosis, and to compare this case with the literature. BACKGROUND: headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with a headache due to cerebral venous thrombosis are uncommon. The known risk factors for thrombosis include both acquired and genetic factors. When the interaction of these two groups occurs, the magnitude of this interaction is thought to produce a dynamic state that can favor thrombosis. Our case report illustrates that moderate levels of anticardiolipin antibodies together with the mild trauma of a golf swing can induce a cerebral venous thrombosis. This case also suggests that although headache is rarely due to cerebral venous thrombosis, it should be excluded by good medical acumen and testing. RESULTS: Minor trauma induced by a poor golf swing was chronologically related to the development of a progressive cerebral venous thrombosis. The patient had none of the risk factors associated with a predisposition to venous thrombosis: hypercoagulable state, concurrent infection, pregnancy/puerperium, collagen vascular disorder, malignancy, migraine, false-positive VDRL, previous deep vein thrombosis, renal disease, factor v Leiden, or a hematological disorder. There was no anatomical abnormality that would predispose the patient to a cerebral venous thrombosis. The only laboratory abnormality was a moderate anticardiolipin antibody level (25 GPL). The patient was placed on warfarin sodium therapy and is currently without clinical sequela from the venous thrombotic event. CONCLUSIONS: Under certain circumstances, minor trauma can induce cerebral venous thrombosis. A review of the literature indicates that cerebral venous thrombosis in the presence of anticardiolipin antibodies and in the absence of systemic lupus erythematosus is a rare event. Previously, only major traumatic events have been reported to be associated with cerebral venous thromboses. The chronological development of cerebral venous thrombosis after a faulty golf swing strongly indicates that given a background of moderate levels of anticardiolipin antibodies, even minor trauma can induce a venous thrombotic event.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/25. Postpartum postural headache due to superior sagittal sinus thrombosis mistaken for spontaneous intracranial hypotension.PURPOSE: To describe a case of superior sagittal sinus thrombosis in the puerperal period and the difficulties encountered in the diagnosis and management. CLINICAL FEATURES: A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery. Initial presentation suggested spontaneous intracranial hypotension (SIH) since there was no history of epidural or spinal anesthesia, or trauma or surgery to her back or neck. Conservative therapy was initially offered and then a lumbar epidural blood patch (LEBP) was performed, although it failed to relieve the postural headache. A dural leak could not be demonstrated but an MRV (magnetic resonance venography) revealed a superior sagittal sinus thrombosis (SSST). Although anticoagulant therapy was immediately initiated, the neurologist remained convinced that the postural headache was secondary to SIH, and, consequently, a second epidural blood patch was requested. anesthesia was reluctant to perform an LEBP at this point and suggested continuing anticoagulation until a subsequent MRV demonstrated recannalization of the SSST. This advice was followed and the postural headache resolved spontaneously with intravenous anticoagulation. CONCLUSION: The present case illustrates the importance of a multidisciplinary approach to the management of this rare complication of pregnancy. This case also highlights the importance of reviewing the differential diagnosis when considering treatment of a postural headache in the puerperium.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
3/25. Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss.Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
4/25. Spontaneous intracranial hypotension during pregnancy.BACKGROUND: Spontaneous intracranial hypotension is characterized by postural headache associated with low cerebrospinal fluid pressure. CASE: A 37-year-old Japanese woman, gravida 3, para 2, had sudden onset of severe postural headache at 8 weeks' gestation, accompanied by nausea and vomiting. Results of medical and neurologic examinations were normal, and there was no measurable cerebrospinal fluid pressure on lumbar puncture. brain magnetic resonance imaging showed diffuse subdural fluid collection and a narrowing of the ambient cistern, confirming the diagnosis of spontaneous intracranial hypotension. After a month of bed rest and intravenous fluid infusion, all symptoms subsided gradually and did not recur. CONCLUSION: Obstetricians should be aware that spontaneous intracranial hypotension can occur in pregnancy.- - - - - - - - - - ranking = 5.3683718132915keywords = pregnancy, gestation (Clic here for more details about this article) |
5/25. Management of a ruptured basilar artery aneurysm during pregnancy.A 36 year old woman who ruptured a basilar artery aneurysm at 38 weeks gestation in her second pregnancy was managed successfully by endovascular embolisation 36 hours after an emergency Caesarean section. The timing of treatment along with the obstetric, neurosurgical and anaesthetic aspects of this complex problem are discussed along with a review of the current literature on the subject.- - - - - - - - - - ranking = 5.3683718132915keywords = pregnancy, gestation (Clic here for more details about this article) |
6/25. Cerebellar hemangioblastoma in pregnancy. A case report.BACKGROUND: The incidence of symptomatic hemangioblastoma of the posterior fossa during pregnancy is extremely low. Previous reports have noted that pregnancy seems to aggravate the clinical course of intracranial tumors, but little is known about the possible reasons. Various theories have been proposed to explain the rapid neurologic deterioration of hemangioblastoma patients during pregnancy; however, the pathophysiologic behavior and histogenesis of this vascular tumor are still not well understood. CASE: A case of cerebellar hemangioblastoma was diagnosed during pregnancy. Urgent surgery was required due to rapid development of obstructive hydrocephalus and brainstem compression. CONCLUSION: Obstetricians and neurosurgeons should be aware of the rare clinic entity of hemangioblastoma during pregnancy. Surgery might be indicated as soon as the tumor becomes symptomatic.- - - - - - - - - - ranking = 9keywords = pregnancy (Clic here for more details about this article) |
7/25. Reversible cortical blindness in preeclampsia.PURPOSE: To report the clinical course and magnetic resonance imaging (MRI) findings in a 28-year-old woman with preeclampsia and reversible cortical blindness. DESIGN: Interventional case report. methods: The patient presented at the 37th week of pregnancy with headache and hypertension. The next day, her visual acuity decreased to light perception in both eyes. After emergent cesarean section, examination revealed reactive pupils and normal fundi. RESULTS: magnetic resonance imaging of the brain showed areas of increased signal in both occipital lobes. One month later, at which time the patient's visual acuity had returned to 20/20, follow-up MRI showed complete resolution of radiologic abnormalities. CONCLUSIONS: Cortical blindness is a rare complication of preeclampsia. In this case, cortical blindness was reversible and most likely due to vasogenic edema rather than vasospasm.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
8/25. Non-aneurysmal primary subarachnoid hemorrhage in pregnancy-induced hypertension and eclampsia.Clinical as well as neuroimaging studies of women with eclampsia or pregnancy-induced hypertension (PIH) have described a variety of neurologic manifestations, including intraparenchymal brain hemorrhage. autopsy studies have described pia-arachnoid hemorrhage in women who died of eclampsia, but radiographic studies have found only intraparenchymal hemorrhage. The author describes clinical and radiographic features in three women with subarachnoid hemorrhage associated with PIH.- - - - - - - - - - ranking = 5keywords = pregnancy (Clic here for more details about this article) |
9/25. hemolysis, hemorrhage, headache, and hidden abortion: imaging findings in antiphospholipid syndrome.Antiphospholipid antibodies are associated with arterial and venous thromboses, recurrent pregnancy loss, and organ infarction. Any vascular region can be affected. We present a 20-year-old woman suffering from secondary antiphospholipid syndrome with a unique combination of multifocal venous thromboses, pulmonary embolism, spontaneous abortion, and splenic infarction. Diversity of clinical symptoms and diagnostic imaging modalities are discussed with emphasis on cross-sectional imaging. The syndrome should be suspected in patients with thromboses and organ infarctions of otherwise undetermined etiology.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
10/25. Acute subdural haematoma after accidental dural puncture during epidural anaesthesia.A case is reported of acute intracranial subdural haematoma following accidental dural puncture during epidural anaesthesia. A 36-year-old primigravida with a gestation of 37 weeks and 3 days underwent caesarean section for which epidural anaesthesia was initially planned. An 18-gauge Tuohy needle was inserted into the L3-4 interspace but accidental dural puncture occurred. The needle was removed and general anaesthesia was initiated for surgery. On the second day post partum, the patient described a headache in both occipital area and neck that was relieved by lying down. On the seventh post-partum day she suffered tonic-clonic convulsions and underwent computerised tomography (CT). Despite different analgesic treatments and a normal CT, the patient suffered severe headaches in the following days. magnetic resonance imaging revealed a 4-mm subdural hematoma in the right frontal area. The persisting headache decreased on day 12 and disappeared on day 14. The patient was discharged from hospital on day 15. The presence of post dural puncture headache complicated by atypical neurological deterioration following epidural anaesthesia should prompt the anaesthetist to consider the existence of intracranial complications and to seek immediate clinical and radiological diagnosis.- - - - - - - - - - ranking = 0.36837181329146keywords = gestation (Clic here for more details about this article) |
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