391/441. iron deficiency: a cause of stroke in infants and children. iron deficiency is a common pediatric problem affecting 20%-25% of the world's infants. Most commonly causing anemia, iron deficiency is also implicated in such neurologic sequelae as irritability, lethargy, headaches, developmental delay, and infrequently papilledema, pseudotumor cerebri, and cranial nerve abnormalities. Rarely has iron deficiency been recognized as a significant cause of stroke in the adult or pediatric populations. We report a series of 6 children, 6 to 18 months of age, who presented with an ischemic stroke or venous thrombosis after a viral prodrome. All patients had iron deficiency as a consistent finding among the group, and other known etiologies of childhood stroke were excluded. These patients provide evidence of a strong association between iron deficiency and ischemic events in children between 6 and 18 months of age. ( info) |
392/441. Two thrombotic complications in a patient with active ulcerative colitis. A 30-year-old woman is described with both a cerebral venous thrombosis and a deep vein thrombosis of her leg in association with an exacerbation of her ulcerative colitis. Laboratory investigations revealed a transient functional APC resistance, without factor v mutation, and a mild hyperhomocysteinaemia. After colectomy the APC ratio was normal. These findings may form a partial explanation of the thrombophilia seen in some patients with active ulcerative colitis. ( info) |
| Intracranial complications of sinusitis are infrequent since the advent of antibiotics, and furthermore the prognosis is improved by medical therapy. We have seen a patient with an intracranial complication of sinus infection that had a history of frontal bone trauma five years ago. Then following an upper respiratory tract infection, headache, bilateral periorbital pain and swelling, spiking fever, neck stiffness, bilateral chemosis and ophthalmoplegy developed. cavernous sinus thrombosis was diagnosed clinically and high doses of I.V. antibiotics were started promptly. The patient's condition improved in the first week of her admission. She was discharged three weeks later, without any surgical intervention. Two-year follow up showed no cranial nerve palsies or any neurologic deficiencies. A good result has been achieved by immediate medical measures. ( info) |
394/441. Endovascular thrombolysis in deep cerebral venous thrombosis. We present two cases of acute thrombosis of the internal cerebral veins, vein of Galen, and straight sinus without sagittal sinus involvement. Both patients had hydrocephalus and severe edema of the basal ganglia and thalami, one with hemorrhagic infarction of the thalamus. Because both patients rapidly deteriorated to a comatose state, endovascular thrombolysis was performed with urokinase infusion of the deep venous structures. Thrombolysis was continued until a patent channel with brisk flow in the venous structures was achieved. Both patients survived with minimal neurologic deficits. ( info) |
395/441. Unusual neck masses secondary to jugular venous abnormalities: case report and discussion. Thrombosis of the lateral sinus/proximal jugular vein and jugular venous ectasia are infrequent but not uncommon neck masses. lateral sinus thrombosis was well described in the preantibiotic era, but modern-day surgeons may not be familiar with this entity. Failure to diagnose a neck mass due to jugular vein thrombosis may have deadly consequences. Jugular vein ectasia, which is innocuous, has been mistaken for laryngocele, cystic hygroma, as well as other vascular lesions. However, the management of jugular vein ectasia, which is thought to be caused by incompetence of the bicuspid jugular venous valve, is conservative. We present a case illustrating a neck mass arising from the internal jugular vein with a discussion of jugular venous pathology. ( info) |
396/441. Nonseptic lateral sinus thrombosis: the otolaryngologic perspective. Nonseptic lateral sinus thrombosis (NSLST) differs from septic lateral thrombosis (SLST) in that it is not associated with ear or sinus infection, it usually occurs in the adult population, and it has an ambiguous clinical presentation. The otolaryngologist is often consulted about diagnostic findings associated with lateral sinus thrombosis. We report three cases of NSLST that required otolaryngologic assessment. The patients were women, ages 23 to 31 years. Presenting symptoms were headaches in all three patients; one also had concomitant ear pain. Two patients had negative head computed tomography scans; only magnetic resonance imaging was diagnostic. Treatment of NSLST consists of anticoagulation and elimination of predisposing factors. Familiarity with this condition is fundamental for early diagnosis and initiation of appropriate therapy. We discuss the origins and causes of NSLST, clinical presentation, preferred diagnostic strategy, and treatment alternatives. ( info) |
397/441. Intracranial complications of sinusitis. Intracranial suppurative complications of sinusitis remain a challenging and contemporary topic. To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995. There were 203 patients with 212 suppurative intracranial infections. Sinogenic sources were identified in 12 patients with 19 infections. Most patients had ethmoid or frontal sinusitis. We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases. The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses. The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae. ( info) |
| PURPOSE: To report a case of ocular neuromyotonia occurring after cavernous sinus thrombosis secondary to mucormycosis. methods: Case report. We performed serial comprehensive neuro-ophthalmologic examinations. RESULTS: Fifteen months after initial total ophthalmoplegia of the right eye and complete right upper eyelid ptosis, isolated ocular neuromyotonia, characterized by episodic upward jerking movements of the right upper eyelid, was noted. CONCLUSION: Ocular neuromyotonia, which usually manifests in patients with a history of intracranial tumors and cranial radiation, may also be secondary to infectious cavernous sinus thrombosis. ( info) |
| We present a case of isolated inferior sagittal sinus thrombosis shown on CT, MRI and angiography. This condition has not, to our knowledge, been described previously. ( info) |
400/441. neuroblastoma and venous sinus thrombosis in an adult patient. A 35-year-old woman developed symptoms consistent with intracranial venous sinus occlusions that were demonstrated by MR angiography. After a few weeks of anticoagulant therapy, she became paraplegic due to haemorrhages in the caudal spinal canal. A decompressive laminectomy did not improve her neurological deficits. Up to this point, we assumed her condition to be caused solely by the intracranial venous thrombosis and complications of the treatment. A tumour diagnosis had so far not been considered. A few months later she became tetraplegic. MRI revealed fresh bleeding in the upper spinal cord and a dissemination of tumour along the entire craniospinal axis. biopsy specimens obtained from the spinal canal contained tumour cells with the characteristics of neuroblastoma. ( info) |