Purpose: Cerebral vein thrombosis is a rare, life-threatening condition that has now become more commonly diagnosed due to advancements in imaging techniques. Our purpose is to improve understanding of pathogenesis, diagnosis and pregnancy and IVF management in patients with a history of cerebral thrombosis.

Materials and methods: We present an overview of the modern tactics of anticoagulant therapy for cerebral thrombosis with a focus on pregnancy, the use of hormone therapy, and assisted reproductive technologies.

Results: The most common risk factors for cerebral vein thrombosis are pregnancy, the postpartum period, and the use of oral contraceptives, which explains the high incidence of this pathology in women. The development of cerebral thrombosis is a vivid example of the interaction and synergetic effects of persistent factors that cause an increased risk of thrombotic complications, which include thrombophilia and acquired risk factors. Despite the possible risks, pregnancy after previously suffered cerebral thrombosis is not contraindicated provided adequate anticoagulant therapy.

Conclusions: The most common provoking factors for the development of cerebral thrombosis in women are pregnancy and the use of estrogen-containing drugs. The issue of thromboprophylaxis during pregnancy, when using ART methods and the possibility of using hormonal therapy after cerebral vein thrombosis requires further study.

Liquid biopsy represents a noninvasive or minimally invasive diagnostic approach relevant for both the organ-specific changes and systemic health conditions, whereas cell-free DNA (cfDNA) extraction from body liquids has attracted much attention in liquid biopsy, especially. Nowadays, metal-organic frameworks (MOF) such as UiO-66-NH2 has been demonstrated efficient extraction property for DNA molecular, whereas the disadvantages of MOF for solid-phase extraction (SPE) still remain. Herein, one macro-pored MOF hydrogel formation strategy was constructed in this study to achieve superb extraction performance of cfDNAs from body fluids. The MOF crystals were embedded into sodium alginate, which was foamed using laurinol, pre-crosslinked through polyethyleneimine (PEI), and cured by zirconium ion at last. Validation of cfDNA extraction from human gingival crevicular fluid and plasma indicated that hydrogel beads allowed unimpeded flow of body fluids while enabling ultrafast extraction and elution of cfDNAs. Consequently, MOF hydrogel beads, when packed atop the syringe pintle as SPE column, achieved an efficient cfDNA extraction only within 6 min. Our construction strategy of extracting syringe provides an instrument-free purification modality of nucleic acid, which would tremendously simplify and quicken cfDNA extraction procedures for operators.

Cerebral venous thrombosis (CVT) is a less common type of stroke that can occur across all age groups but predominantly affects children and young adults. Diagnosis is often challenging due to the nonspecific and variable clinical presentation. The disease course is heterogeneous, with CVT-related parenchymal lesions developing in approximately 50 to 60% of cases. Despite some advancements, significant gaps persist in understanding the pathophysiology of CVT, including the mechanisms underlying brain injury. Anticoagulation is the cornerstone of CVT treatment, but strategies targeting secondary mechanisms of parenchymal damage are still lacking. Here, the current state of the field is briefly reviewed, with the aim to introduce a wide audience (neuroscientists and clinicians alike) to the disease and inform clinical practice and future research.

Optimal blood flow through a patent cerebral circulation is critical for supply of oxygen and nutrients for brain function. The integrity of vascular elements within arterial vessels of any calibre can be compromised by various disease processes. Pathological changes in the walls of veins and the venous system may also alter the dynamics of cerebral perfusion. The consequences of both systemic vascular and cerebrovascular diseases range from acute focal changes to irreversible chronic restructuring of the brain parenchyma. Cerebral infarcts of different sizes may instigate a cascade of programmed cell death mechanisms including autophagy and mitophagy and processes that range from necroptosis to ferroptosis. Recent advances also emphasise the role of the vascular inflammasome in the pathology of cerebral infarction. Here, we summarise current knowledge on frequencies, epidemiological features and the neuropathology of common cerebrovascular disorders among which cerebral small vessel diseases have become of particular interest. We also highlight the current spectrum of monogenic and polygenic genetic disorders affecting the intracranial vasculature. With the advent of DNA screening technologies, it is now realised that several cerebrovascular disorders exhibit strong genetic traits. Whilst several gene defects and their aberrant products are identified, the precise role or mechanisms of how they influence angiogenesis, vasculogenesis, vessel integrity or the extracellular matrix remain largely unclear. Despite such genetic advances, histopathological examination remains the gold standard for diagnosis and characterisation of most cerebrovascular disorders.

Cerebral venous thrombosis (CVT) is a rare condition in children, and its description remains limited in North Africa. The objective of our study was to describe the clinical, etiological, radiological, therapeutic, and evolutionary characteristics of children with CVT in western Algeria.

This was a retrospective observational study involving children with CVT. The study was conducted at the unit of intensive care of Canastel Children's Hospital and the pediatric intensive care unit (PICU) of Oran Hospital Center (Algeria) from January 2012 to December 2022.

A total of 23 children were included in the study, with an average age of 48±57 months. The most frequent clinical signs were fever (61 %), altered consciousness (61 %), seizures (56.6 %), and headaches (36.8 %). The primary risk factors were head and neck infections (36.8 %). Thrombosis mainly affected the transverse sinus (65.2 %), followed by the superior sagittal sinus (39 %). Associated cerebral complications primarily included hemorrhagic lesions (52 %), hydrocephalus (26 %), and venous ischemic infarction (13 %). Overall, 21 % of children with CVT died while 34 % of our cohort had unfavorable outcomes. Predictors of an unfavorable outcome in multivariate analysis were , parenchymal hemorrhage (aOR: 16.04; 95 % CI: 1.28-201.5), and mechanical ventilation (aOR: 10.50; 95 % CI: 1.02-108.6).

Due to the nonspecific nature of CVT clinical signs and considering the risk factors, it is essential to perform cerebral imaging to confirm the diagnosis and initiate early and effective treatment aimed at reducing potential neurological sequelae and the risk of death.

A non-contrast brain CT Non-contrast computed tomography (NCCT) scan is a valuable and cost-effective way to detect cerebral venous sinus thrombosis (CVST) during its acute phase. The goal of this study was to evaluate how effective this diagnostic approach is, including its various density indices, to enable a more precise and timely diagnosis of this debilitating condition.

This retrospective case-control study was conducted on 88 patients with suspected acute CVST. We analyzed NCCT scans of patients with suspected CVST using a Bayesian regression model with a 95% confidence level. We also conducted ROC analysis in R4.1.0 to determine the optimal cut-off point.

We discovered a significant variance in the average sinus attenuation when comparing patients with acute CVST (p < 0.001). By utilizing an optimal cutoff of 61 HU (Hounsfield unit), we achieved sensitivities of 77.1% and specificities of 92.5% for average sinus attenuation. In addition, the optimal cutoff for standardized parameters included the ratios of HU/H (Hematocrit), HU/ICA (internal carotid artery), HU/BA (basilar artery), HU/FRONTAL lobe, HU/TEMPORAL lobe, and HU-BA, which were 1.41, 1.52, 1.63, 1.6, 1.6, and 23, respectively (p < 0.001). Area under the ROC curve for absolute venous Hounsfield was 0.88.

NCCT is a reliable diagnostic approach for acute cerebral venous sinus thrombosis in emergency scenarios. Standardized parameters of absolute Hounsfield unit venous sinus thrombosis increase diagnosis accuracy. It is suggested to use these parameters as a complement to each other for more accurate diagnosis.

This review intends to systematize the diagnostic and treatment approach to cerebral venous thrombosis (CVT), highlighting key studies that have been recently published.

In light of the recent pandemic, new risk factors for CVT have emerged. Contrast-enhanced MRI and susceptibility-weighted imaging have been shown to offer increased sensitivity for detecting cortical vein thrombosis.Dabigatran seems to be as effective and well tolerated as warfarin for long-term anticoagulation. Partial venous recanalization often occurs in patients treated with anticoagulation only, as early as 8 days after treatment onset. For patients with CVT and impending brain herniation, two-thirds of those who undergo decompressive craniectomy survive, with one-third being functionally independent 6 months after diagnosis.

CVT is an unusual type of cerebrovascular disease that mostly affects women of fertile age. Risk factors should be identified and addressed. Diagnosis relies on confirmation of venous sinus and/or vein thrombosis, usually by CT venography or MRI. Anticoagulation is the cornerstone of treatment. Despite the lack of high-quality evidence, endovascular treatment is often considered in severe cases. Special populations require tailored approaches. About 80% achieve mRS 0-1, but residual symptoms often affect quality of life and the ability to return to work.

Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depends on the underlying etiology. This study aims to identify prevalence, risk factors, and recurrent venous thromboembolism (VTE) rates among patients with idiopathic (cryptogenic) CVT and CVT provoked by transient (peripartum, hormonal treatment, infection, trauma) and persistent (cancer, thrombophilia) factors.

We used the ACTION-CVT retrospective database which included consecutive patients who were treated for CVT in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. We compared baseline characteristics and outcomes of patients with cryptogenic, transient provoked (TP) and those with persistent provoked (PP) CVT. Baseline characteristics was compared between the groups using χ2 test, t test, or Mann-Whitney U test as appropriate, followed by multivariable regression. We used Kaplan-Meier survival analysis to assess outcome occurrence. We used interaction analysis and Cox regression to assess the risks of recurrent VTE in patients with CVT.

Among 1,025 included participants with CVT, 510 (49.8%) had no identified risk factor (cryptogenic), 363 (35.4%) had at least one transient provoking factor, and 152 (14.8%) had a persistent provoking factor. Patients with TP CVT were younger (p = 0.003) and more likely to be female patients (p < 0.001). When compared with patients with TP CVT, the risk of recurrent VTE was greater in patients with PP CVT (HR 2.59, 95% CI 1.29-5.22, p = 0.008) and nonsignificantly elevated in patients with cryptogenic CVT (HR 1.85. 95% CI 0.98-3.59, p = 0.059). In the interaction analysis, there was a trend toward higher rate of recurrent VTE in female patients with cryptogenic CVT and male patients with PP CVT.

In this multicenter study, we found that outcomes of CVT differed depending on the underlying etiology. The risk of recurrent VTE in the PP and cryptogenic CVTs may be influenced by sex.

Protein S deficiency is a rare inherited disease. We report the case of a young man who unexpectedly developed isolated cortical vein thrombosis (ICoVT) associated with a novel PROS1 mutation.

Clinical symptoms were recorded, and physical examinations conducted. Comprehensive laboratory tests included routine coagulation function tests, protein C activity, and antithrombin III levels. Advanced imaging techniques, such as magnetic resonance imaging (MRI), magnetic resonance venography (MRV), and computed tomography angiography (CTA) were employed. We also performed genetic analysis on the patient and his parents.

The patient presented with headaches and paroxysmal convulsions without identifiable triggers. Physical examinations and routine coagulation tests were generally normal, except for a markedly reduced protein S activity at 21.2 %. MRI scans revealed right parietal cerebral hemorrhage and thickening of the cortical vein, characterized by high T1-weighted Imaging and low T2-weighted Imaging and Fluid-Attenuated Inversion Recovery signals. CTA and Doppler ultrasound of the lower limbs showed no abnormalities. Family history revealed that his father had suffered from multiple venous thromboses. Genetic testing identified a missense mutation (c.1912G>T p.Gly638Cys) in both the patient and his father, along with a duplication of approximately 403.6 kb on chromosome 3q26.32-33 in the patient.

This case highlights a novel PROS1 missense mutation and its significant role in development of cortical venous thrombosis. It provides a new insight into the genetic basis of autosomal dominant thrombophilia associated with protein S deficiency (THPH5).

Cerebral venous thrombosis (CVT) is a rare and potentially critical cerebrovascular disease involving intracranial dural sinuses and veins. The diagnosis is a stepwise pathway starting from clinical suspicion and employing several neuroradiological techniques, mainly Computed Tomography (CT)-based and Magnetic Resonance Imaging (MRI)-based modalities. The neuroradiological findings, both in the diagnostic phase and in the follow-up phase, may provide some results at risk for misdiagnosis. Non-thrombotic filling defects of intracranial dural sinuses are among them, and the potential sources are artefactual and or anatomical (venous septa and arachnoid granulations). The misdiagnosis of these findings as CVT is potentially linked to dangerous consequences. A potential strategy to avoid this is to increase the knowledge about technical and anatomical reasons for non-thrombotic filling defects of intracranial dural sinuses and their imaging features. The main aim of this review is to address these issues, including the variability of the intracranial venous pathways, providing the solutions for overcoming the above-cited potential misdiagnosis of non-thrombotic filling defects as CVT.

Hematologic diseases are considered important contributors to cerebral venous sinus thrombosis (CVST) cases. This retrospective study aims to compare the difference of the clinical and radiological characters between CVST patients with and without hematologic diseases. Consecutive hospitalized CVST patients with hematologic disorders constituted the hematologic disorder group, while that without identifiable risk factors comprised the control group in this study. We systematically documented the various types of hematologic diseases associated with CVST, along with laboratory tests. Clinical manifestations, imaging findings, as well as treatment and prognosis, were recorded. A comparative analysis was conducted between the hematologic disorder group and the control group based on the aforementioned parameters. The final analysis included 97 CVST cases associated with hematologic diseases and 65 cases without any identified risk factors. The spectrum of hematologic diseases in our study ranged from iron-deficiency anemia to acute leukemia. Patients with hematologic disorder showed higher admission mRS, greater thrombotic burden, and higher incidence of stroke and cerebral hemorrhage (p < 0.05). The use of batroxobin significantly improved the prognosis of CVST caused by hematologic diseases, without causing major bleeding or death during the follow-up period. Patients with hematologic disorders who develop CVST tend to present with more severe conditions compared to those without identifiable risk factors. It is essential to conduct timely screening for CVST in patients with hematologic diseases who present with risk factors of thrombosis.

Cerebral venous thrombosis (CVT) is a rare but critical condition, particularly in young women, often linked to oral contraceptive use. It can lead to complications like subdural hematoma (SH), which are challenging to diagnose and manage. We report the case of a 39-year-old woman who presented with severe headaches and neurological symptoms, leading to a diagnosis of chronic SH and CVT, associated with long-term oral contraceptive use. This case is unique as it documents the first known instance of chronic SH associated with CVT induced by oral contraceptives. Our objective was to explore this association using the Bradford Hill criteria and to review the diagnostic and therapeutic challenges of CVT and SH in this population.

We conducted a systematic literature review adhering to PRISMA guidelines, focusing on SH cases linked to CVT in women using oral contraceptives.

Including our case, four cases of SH associated with CVT secondary to oral contraceptive use were identified. Common symptoms included severe headache and neurological deficits. All patients received anticoagulation therapy, with surgical intervention required in severe cases. Prognosis was generally favorable with appropriate management.

This case emphasizes the importance of considering CVT in women presenting with spontaneous SH, particularly those on oral contraceptives. Early diagnosis, careful clinical and radiological monitoring, and timely surgical intervention are crucial for optimal outcomes.

Cerebral venous sinus thrombosis (CVST) is an uncommon form of cerebrovascular disease. Although our understanding of CVST has improved significantly over the past decades, there has been no bibliometric analysis of CVST until now. We aimed to examine and visualize the hotspots and trends of the research related to CVST using a bibliometric analysis based on Citespace and provide new insights for scholars in their future researches in this area.

The literature on CVST was collected from the Web of Science Core Collection database. Bibliometric analysis was performed using CiteSpace (6.2.R3) Advanced software.

A total of 2396 articles were included in the analysis. Publications regarding CVST have increased over time. U.S.A. contributed the most articles. Ferro JM had the highest number of published papers. Stroke was the journal with the most publications and the most commonly cited journal. Nine out of the top 10 cited journals belong to Q1. The risk factors for CVST, emerging and current treatment of CVST, and CVST related to COVID-19 and COVID-19 vaccines are the major potential research hot spots and trends.

CVST is a rapidly expanding research area and has received increasing attention by the researchers. Our study can provide researchers valuable information on the current status and trends in this area and guide for future studies.

The postpartum period is a well-defined risk factor for cerebral venous sinus thrombosis (CVST). However, it is unclear which patients are at risk for CVST in the postpartum period. Thus, determining some CVST risk factors in postpartum patients may be useful for preventing the disorder in this population. Previous studies have shown that preeclampsia (PE) is a risk factor for pulmonary thromboembolism and deep vein thrombosis, but whether it is related to postpartum CVST has not yet been evaluated. This study aimed to determine if this relationship exists. This study was a case-control study of retrospectively screened patients diagnosed with CVST between 2018 and 2023 at the Uludağ University Faculty of Medicine Department of Neurology, the Eskişehir Osmangazi University Faculty of Medicine and the Bursa City Hospital Health Sciences University Department of Neurology. All of the women who delivered between 2018 and 2023 at the Uludağ University Faculty of Medicine Department of Obstetrics and Gynaecology were included in the control group. In total, 57 out of 322 cases and 4299 out of 4452 controls were included in this study. A nonsignificant relationship was found between CVST and spinal anesthesia, but a significant relationship was found between PE and stillbirth. Women with PE who had recently delivered were found to be at increased risk of developing CVST. The primary limitation of this study is that it was retrospective, and the control group was hospital-based. We recommend that these findings be confirmed by multicenter prospective international studies.

Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease with increased intracranial pressure from impaired cerebral venous drainage and absorption of cerebrospinal fluid. There is a lack of evidence to prove the benefits and risks of thrombolytic and anticoagulant therapies. We conducted a retrospective analysis of the therapeutic effect of carotid artery puncture injections of urokinase combined with warfarin in patients with CVST.

Thirty-six patients with CVST who received a carotid artery puncture injection of urokinase combined with warfarin were retrospectively analyzed in the urokinase group, while 30 patients with CVST received subcutaneous low-molecular-weight heparin (LMWH) and warfarin, as the control group. Clinical parameters, imaging data, laboratory test data, treatment plans, and follow-up information were collected and compared.

At discharge, the GCS score was higher in the urokinase group than that in the control group. In the urokinase group, no patient died. Recanalization of the venous sinus trunk was observed in 32 patients. While two patients died in the control group, recanalization of the venous sinus trunk was achieved in 20 patients. A follow-up examination showed that recovery in the urokinase group was also better than that in the control group.

This study suggests that carotid artery puncture injection of urokinase combined with warfarin is a safe and effective option for CVST, can reduce CVST recurrence. However, this was a retrospective study with a relatively small sample size, and future studies are needed to confirm the procedure's feasibility.

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke. COVID-19 infection and vaccination have been associated with CVT. Fibrinolysis and mechanical thrombectomy may play an emerging role in management. We conducted a literature review summarizing current evidence on use of antiplatelets, anticoagulants, thrombolysis, and mechanical thrombectomy for the management of CVT and COVID-19 related CVT. This was achieved through a review of MEDLINE, PubMed, and Cochrane Reviews databases, performed using the search terms CVT AND "antiplatelets' aspirin", "ticagrelor", "clopidogrel", "eptifibatide", "Low-molecular-weight-heparin (LMWH)", "Unfractionated heparin (UH)", "warfarin", "DOACs", "rivaroxaban", "apixaban", "dabigatran", "fibrinolysis", "intra-sinus thrombolysis", "mechanical thrombectomy", and "craniectomy". We found that LMWH and UH are safe and effective for the management of acute CVT and should be considered first line. Warfarin may be used in the sub-acute phase for secondary prevention but has weak evidence. DOACs are potentially a safe warfarin alternative, but only warfarin is currently recommended in international guidelines. Antiplatelets show little evidence for the prevention or management of CVT, but studies are currently limited. COVID-19 related CVT is treated similarly to non-COVID-19 CVT; however, vaccine-related CVT is a newly recognised disease with a different pathophysiology and is treated with a combination of non-heparin anticoagulants, immunotherapy, and steroids. Decompressive craniectomy may be used to reduce intracranial pressure in life-threatening cases. There is a small body of evidence for endovascular therapy in complex cases but should be reserved for complex cases in specialist centres. This paper is of relevance to clinical practice since the safe and effective management of CVT is important to reduce the risk of disability.

Cerebral venous sinus thrombosis (CVST) is a rare but serious manifestation of venous thrombosis in patients with antiphospholipid syndrome (APS). This study investigated the risk factors, clinical characteristics and prognosis of CVST in APS patients.

This retrospective cohort study included all thrombotic APS (tAPS) patients from Peking Union Medical College Hospital (PUMCH) from April 2005 to August 2023. Demographic characteristics, laboratory data and thrombotic risk factors were compared between tAPS-CVST group and tAPS-non-CVST group. Kaplan-Meier survival analysis was utilized to compare the recanalization rate and the recurrence rate.

A total of 453 APS patients were enrolled, and 40 (8.8%) APS patients were with CVST. The median age of the APS-CVST patients was 27 (21.25, 32.75) years, and 72.5% were females. In 50% of these patients, CVST was the initial symptom of APS, with headache being the most prevalent clinical symptom (95%). Involvement of more than two venous sinuses were observed in 79.5% of patients, with the transverse sinus (79.5%) and sigmoid sinus (74.4%) being the most commonly affected sites. Oral contraceptives, intracranial infections and malignancy were identified as risk factors of APS-CVST. There were no statistically significant differences in baseline characteristics or the distribution of antiphospholipid antibodies profiles between the two groups. After a median follow-up of 24 (12, 52) months, 21 patients (52.5%) experienced recanalization, and 13 patients (32.5%) had a thrombotic recurrence. Survival analysis indicated that adequate anticoagulant therapy significantly contributed to recanalization (HR 6.27, 95% CI 2.616-15.02, P = 0.003), while continuous anticoagulant therapy was highly effective in reducing the recurrence of thrombotic events (HR 0.14, 95% CI 0.0447-0.4328, P = 0.0007).

CVST should be considered in APS patients who experience sudden onset headaches, particularly those with thrombotic risk factors, such as the use of oral contraceptives, intracranial infections and malignancy. Continuous and adequate anticoagulant therapy is pivotal and beneficial for achieving recanalization and prevention of recurrence. Key Points • The prevalence of CVST in patients with APS may be underestimated. • APS-CVST is associated with special risk factors, including pregnancy, intracranial infection, oral contraceptives and tumors. • Long-term and adequate anticoagulation therapy can increase the vascular recanalization rate and reduce thrombosis recurrence.

Cerebral venous thrombosis (CVT) is a rare and complex form of stroke, representing a small percentage of all stroke cases. The disease's clinical presentation is highly variable, involving a wide range of medical specialists due to its diverse manifestations. Over the past decade, significant advancements in understanding CVT have been made, particularly in light of the COVID-19 pandemic and subsequent vaccination efforts. Current classification systems of CVT, which categorize the disease as acute, subacute, or chronic based on symptom onset, vary significantly in their criteria and practical relevance. Key challenges include aligning these time-based classifications with real-world delays in diagnosis and treatment, as well as understanding the timing and nature of complications such as raised intracranial pressure and the need for decompressive procedures. Radiological studies of clot morphology provide additional insights, suggesting that clot characteristics may indicate the recanalization potential and influence treatment strategies. However, the relationship between clot recanalization and clinical outcomes remains debated. A comprehensive classification that integrates clinical, radiological, and prognostic parameters could aid in better managing CVT and improving patient outcomes.

Cerebral venous sinus thrombosis (CVST) is a rare, serious, and complex cerebrovascular disease. The prothrombin G20210A mutation is the second most common inherited thrombophilia and is considered to be one of the etiologies of CVST. The optimal heparinoid medication for treatment remains a topic of debate.

This case report describes a young woman with CVST who did not respond to low-molecular-weight heparin (LMWH). The patient was initially treated with LMWH; however, her symptoms and clot burden in the sagittal sinus worsened, and coagulation studies showed no evidence of therapeutic anticoagulation despite good compliance. Unfractionated heparin was then initiated, and the patient's symptoms improved dramatically within 24 hours, along with the recanalization of the cerebral venous sinuses. Genetic testing revealed a heterozygous mutation in the prothrombin gene (G20210A). This mutation is a known risk factor for CVST. However, it is unclear why the patient did not respond to LMWH but responded appropriately to unfractionated heparin.

This case report highlights the potential for LMWH resistance in patients with CVST and prothrombin gene mutations. These findings also emphasize the importance of close monitoring of coagulation parameters and clinical response in patients with CVST receiving LMWH.

Neurobrucellosis occurs when Brucella affects the nervous system and it has several presentations. One of its rarest complications is cerebral venous sinus thrombosis (CVST).

A 16-year-old male patient complaining of a sudden onset of bilateral pulsatile headache accompanied by fever, dizziness, nausea, vomiting, and blurred vision. On neurological examination the patient had neck stiffness and a bilateral 2nd degree papilledema. Brain computed tomography did not reveal any space-occupying lesions. Lumbar puncture showed an elevated lymphocyte count in the CSF and the Brucella PCR was positive. MRI with contrast and magnetic resonance venography revealed a left transverse sinus thrombosis and a diagnosis of neurobrucellosis complicated with CVST was made.

CVST is a rare but serious complication of neurobrucellosis, it has been described in only a handful of cases. The diagnosis mainly consists of establishing the presence of neurobrucellosis using the CSF analysis and the Brucella PCR, and proving the existence of CVST using the brain MRI. Although, the management of this complication remains a controversy, the use of an antibiotic combination and anticoagulation therapy may improve the symptoms greatly.

Although Brucella seldom affects the nervous system, with CVST being an extremely rare complication. Physicians should consider brucella as the cause of CVST, in endemic areas. Usually, it is treated with a combination of antibiotics. However, anticoagulation should be considered in some cases and future studies must be conducted to assess the role of anticoagulation treatment.

The appearance of cerebral venous sinus thrombosis (CVST) in childhood acute lymphocytic leukemia (ALL) is a rare life-threatening disease that can cause significant morbidity, neurological sequelae, and potentially poor outcomes.

We present the case of a 13-year-old boy with ALL who developed CVST and intrinsic hemorrhage approximately 30 days after receiving chemotherapy with vincristine, dexamethasone, daunorubicin, and pegylated-asparaginase (PEG-Asp). He complained of a severe headache and then developed a generalized seizure at night. T1- and T2-weighted magnetic resonance imaging (MRI) and cerebral magnetic resonance venography sequences revealed superior sagittal sinus thrombosis and intrinsic hemorrhagic changes in the bilateral frontoparietal lobes. He received nadroparin calcium as the anticoagulant treatment and was switched to Erwinia asparaginase (Erwinia Asp) rather than PEG-Asp. Oxcarbazepine and clonazepam were started with good seizure control. Intrathecal treatment was delayed until 1 month later. Anticoagulation treatment was stopped for 24 h before and 6 h after lumbar puncture. Platelet transfusion was administered to ensure the platelet count remained at >50 × 109/L. Oral acetazolamide (500-1,000 mg, daily) was administered to relieve headache and reduce intracranial pressure. Three months later, brain MRI showed a complete resolution of or significant improvement in the filling defect. Nadroparin calcium was administered for 1 week after switching to Erwinia Asp to prevent clot recurrence. He completed the 6-month chemotherapy and is doing well with no neurological sequelae and no recurrence of bleeding or thrombosis.

Nadroparin calcium therapy appears to be safe and effective for pediatric CVST with ALL. The reintroduction of Erwinia Asp should be accompanied by anticoagulant therapy with nadroparin calcium.

Herpes encephalitis is caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). One of the infrequent complications of herpes encephalitis is cerebral venous thrombosis (CVT) because of the inflammation in the brain parenchyma. We report a unique and challenging case of a 14-year-old female patient presenting with confusion, headache, and fever. On examination, there was no neck rigidity and a negative Kernig's sign with no focal neurological deficits. Systemic examination was done to rule out other systems as a cause for her symptoms, and she was empirically treated as a case of encephalitis. An initial computed tomography (CT) scan of the brain without contrast was normal except for a subtle hypoattenuating area involving the right thalamus. Cerebrospinal fluid (CSF) analysis revealed viral infection while we awaited the results of CSF polymerase chain reaction (PCR) and culture analysis for specific microorganisms. Her Glasgow Coma Scale (GCS) deteriorated following an episode of generalized tonic-clonic seizure, and she was subsequently catheterized and an enteral feeding tube (nasogastric tube) was passed. CSF PCR detected HSV-1. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain with contrast revealed encephalitis with superior sagittal sinus, transverse sinus, straight sinus, and vein of Galen thrombosis yielding a diagnosis of HSV encephalitis with concurrent cerebral venous thrombosis. Hence, this required a very specialized and cautious approach to her treatment. She was started on intravenous acyclovir and subcutaneous enoxaparin, and she recovered over the next few days. She did, however, develop acyclovir-induced renal toxicity in the absence of another offending agent, and the dose of the acyclovir was adjusted accordingly. A diagnosis of CVT, although rarely described, should be systematically suspected in patients with HSV encephalitis presenting with sudden deterioration or unexpected neurological findings in the early phase of treatment or inadequate response to treatment for better management and outcomes.

Cerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT).

The 2016-2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT. Patients with a currently active diagnosis of malignancy (CA-CVT) were then identified. Demographics and comorbidities were compared between CA-CVT and CVT patients. Subgroup analyses explored patients with hematopoietic cancer and non-hematopoietic cancers. Stroke severity and treatment were explored. Inpatient outcomes studied were discharge disposition, length of stay, and mortality.

Between 2016 and 2019, 6,140 patients had a primary diagnosis code of CVT, and 370 (6.0%) patients had a coexisting malignancy. The most common malignancy was hematopoietic (n=195, 52.7%), followed by central nervous system (n=40, 10.8%), respiratory (n=40, 10.8%), and breast (n=40, 10.8%). These patients tended to be older than non-CA-CVT and were more likely to have coexisting comorbidities. CA-CVT patients had higher severity scores on the International Study of Cerebral Vein and Dural Sinus Thrombosis Risk Score (ISCVT-RS) and increased complications. In a propensity-score matched cohort, there were no differences in inpatient outcomes.

Malignancy occurs in 6% of patients presenting with CVT and should be considered a potential comorbidity in instances where clear causes of hypercoagulabilty have not been identified. Malignancy was linked to higher mortality rates. Nonetheless, after adjusting for the severity of CVT, the outcomes for inpatients with cancer-associated CVT were comparable to those without cancer, indicating that the increased mortality associated with malignancy is probably due to more severe CVT conditions.

Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalize obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy can be an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction.

Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular event in which the thrombosis occurs in a vein of the cerebral venous system. The diagnosis could be challenging due to the great clinical variability, but the outcome is favourable in most cases, especially in the case of early diagnosis. Anticoagulant therapy is the core of CVT management and currently consists of heparin in the acute phase followed by vitamin K antagonists (VKAs) in the long term. The ideal duration of anticoagulant therapy is still unclear, and the same criteria for the treatment of extracerebral venous thromboembolism currently apply. In this paper, we reviewed the literature regarding the use of direct oral anticoagulants (DOACs) in CVT since in recent years a considerable number of studies have been published on the use of these drugs in this specific setting. DOACs have already been shown to be equally effective with VKAs in the treatment of venous thromboembolism. In addition to efficacy, DOACs appear to have the same safety profile, being, on the other hand, more manageable, as they do not require close monitoring with continuous personalised dose adjustments. In addition, a further advantage of DOACs over VKAs is the possibility of anticoagulant prophylaxis using a reduced dosage of the drug. In conclusion, although the use of DOACs appears from preliminary studies to be effective and safe in the treatment of CVT, additional studies are needed to include these drugs in the treatment of CVT.

The proportion of cerebral venous sinus thrombosis involving the straight sinus (StS) is low, and the prognosis is poor. We report a case of multiple sinus thrombosis involving StS in which the patient underwent mechanical thrombectomy (MT) using a stent retriever and an aspiration catheter (combined MT) with a good postoperative course. A 15-year-old girl was admitted to our hospital with rapid loss of consciousness. Magnetic resonance imaging (MRI) revealed thrombosis of the bilateral internal cerebral veins, vein of Galen, StS, torcular herophili (TH), and right transverse sinus (TS), as well as edema mainly in the left thalamus, basal ganglia, and corpus callosum. Systemic heparinization was initiated, and combined MT was performed. Although complete recanalization of the TH and right TS via the left internal jugular vein was achieved, the microwire could not be advanced to the StS. Hence, the approach route was changed to remove the thrombus from the superior sagittal sinus and successfully reach the StS via the right TS. Partial recanalization of the StS was achieved, and venous congestion was improved. Two months after MT, the patient returned to school without neurological deficits. MRI performed 3 months after MT revealed disappearance of the edema and complete recanalization of the StS. In this case, StS catheterization via the left TS was not possible. However, we could reach the right TS, which were recanalized first. Partial recanalization of the StS can be expected a good prognosis under the patency of the TH and TS.

Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT.

Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol.

Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8 days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up.     Conclusion: DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.

Septic cerebral venous sinus thrombosis is a rare but often fatal complication caused by bacterial meningitis and paranasal sinusitis.We report a particular case of the sudden and unexpected death of a six-day-old infant from unrecognised acute meningitis that caused a thrombotic occlusion of the venous sinuses (with the particular involvement of the torcular Herophili at the confluence of sinuses) resulting in subdural haemorrhage.This case report alerts paediatricians and neonatologists to the importance of promptly considering a possible diagnosis of meningitis without delay to avoid the fatal complications described here. As in all cases of sudden infant death our case study underlines the need for a thorough autopsy, accompanied by histological analysis, in order to identify the causes of the underlying pathological mechanisms causing death and to ensure an adequate differential diagnosis.

Objective and aim Cerebral venous thrombosis (CVT) is a rare condition with significant morbidity and mortality risk involving the thrombosis of cerebral veins and dural sinuses. Its symptoms vary widely, ranging from headaches to focal neurological deficits, posing significant challenges to its diagnosis. Various contributing factors are involved in its etiology, some of which are gender specific. The clinical presentation varies widely and differs based on geographic distribution. This diversity makes CSVT challenging to diagnose, as it manifests in different ways and requires keen medical observation. Early detection is crucial for prognosis, as addressing the underlying cause can prevent further complications. This study aims to identify various causative factors and clinical presentations observed in individuals diagnosed with cerebral venous sinus thrombosis (CVST). Material and methods This prospective observational study was conducted at the Department of Neurology for a year, involving 55 patients admitted to the Neurology OPD/ER. Sample selection was done using non-probability convenience sampling. Patients aged 18 years or older presenting with symptoms indicative of CVST, confirmed by neuroimaging, were included in the study. Patients with arterial stroke, space-occupying lesions, and CVST related to pregnancy or puerperium were excluded. A detailed and structured medical history was obtained, and relevant blood investigations were conducted to find the underlying etiology. Results The study population had a mean age of 33 ± 2.04 years. The gender distribution is inclined towards 78.1% males due to the exclusion of pregnancy- or puerperium-related CVST to identify other predominant risk factors. 87.2% of the patients presented acutely, primarily with headaches (94.54%), and 67.2% had seizures within a week of admission. Prothrombotic conditions (45.4%) were the prevalent risk factor in the study group. Second, infections accounted for 21.8%. Alcoholism was seen in 52.7% of the study population, but its correlation with CVST remains unclear. The superior sagittal sinus (34.5%) and transverse sinus (20%) were commonly involved in neuroimaging, with multiple sinus involvement observed in some cases. Conclusion Cerebral venous sinus thrombosis (CVST) presents with a wide range of symptoms, making diagnosis challenging. However, with modern imaging and lab tests, we can detect and treat it effectively, often with positive outcomes and minimal long-term effects. This study seeks to understand the risk factors associated with CVST, contributing to its diagnosis and management.

Cerebral venous sinus thrombosis (CVST) is a challenging condition to diagnose and treat due to its diverse range of clinical presentations. The incidence of CVST is increasing, and although diagnostic techniques have improved, the mainstay of treatment is heparin followed by vitamin K antagonist (VKA), warfarin has remained largely unchanged for the past three decades. However, new direct oral anticoagulants (NOACs) like dabigatran have been developed to address the limitations of VKA therapy. Magnetic resonance imaging (MRI) with magnetic resonance venography (MRV) is the current preferred diagnostic method for CVST due to its exceptional sensitivity and specificity. This prospective observational study was set out to investigate the efficacy and safety of dabigatran in treating cerebral venous sinus thrombosis. The study included 30 patients who reported regular intake of 150 mg dabigatran etexilate twice a day. Among the participants, headache was the most commonly reported symptom. The study found that patients treated with dabigatran experienced favorable outcomes, with all patients achieving re-canalization and reporting no major complications. These promising results suggest that dabigatran could be an effective treatment option for CVST cases. However, the study emphasizes the need for larger, multi-center studies to further validate these findings and improve the overall understanding of the condition and its treatment options.

Extracorporeal membrane oxygenation (ECMO) plays a crucial role in managing heart and respiratory failure. However, it is associated with complications such as bleeding, acute renal failure, neurological issues, and thrombosis. Cerebral venous sinuses thrombosis (CVST) is a rare condition that primarily affects young females, especially those of childbearing age. CVST can result from multiple factors, both congenital and acquired, such as pregnancy, dehydration, oral contraceptives, and the postpartum period. The most common and nonspecific symptom is headache. Notably, the occurrence of CVST during ECMO has not been documented in adult patients. In this case report, we present the case of a 29-year-old lactating mother who was admitted to our hospital with complaints and clinical features indicative of community-acquired pneumonia. Despite conventional treatment, her oxygen requirement increased; therefore, she was placed on veno-venous ECMO (VV ECMO). Her condition gradually improved, and she was extubated while still on ECMO support (Awake ECMO). However, a day later of successful weaning from ECMO, she reported blurred vision and proptosis. Magnetic resonance imaging (MRI) and MR venography (MRV) of the brain showed features suggestive of CVST. She was promptly treated with anticoagulation and later discharged with minimal residual complications. This paper emphasizes the importance of early clinical recognition and treatment with anticoagulants in cases of CVST during ECMO for improved outcomes.

Due to the rarity of cerebral venous thrombosis (CVT), performing high-quality scientific research in this field is challenging. Providing answers to unresolved research questions will improve prevention, diagnosis, and treatment, and ultimately translate to a better outcome of patients with CVT. We present an international research agenda, in which the most important research questions in the field of CVT are prioritized.

This research agenda has three distinct goals: (1) to provide inspiration and focus to research on CVT for the coming years, (2) to reinforce international collaboration, and (3) to facilitate the acquisition of research funding.

This international research agenda is the result of a research summit organized by the International Cerebral Venous Thrombosis Consortium in Amsterdam, the Netherlands, in June 2023. The summit brought together 45 participants from 15 countries including clinical researchers from various disciplines, patients who previously suffered from CVT, and delegates from industry and non-profit funding organizations. The research agenda is categorized into six pre-specified themes: (1) epidemiology and clinical features, (2) life after CVT, (3) neuroimaging and diagnosis, (4) pathophysiology, (5) medical treatment, and (6) endovascular treatment. For each theme, we present two to four research questions, followed by a brief substantiation per question. The research questions were prioritized by the participants of the summit through consensus discussion.

This international research agenda provides an overview of the most burning research questions on CVT. Answering these questions will advance our understanding and management of CVT, which will ultimately lead to improved outcomes for CVT patients worldwide.

Hypereosinophilia is a rare condition, defined as a persistent elevation of absolute eosinophil count greater than 1.5x109/L and/or tissue eosinophilia. This condition can be caused by numerous different etiologies, both hematological (clonal) and non-hematological (reactive). Reactive hypereosinophilia encompasses all disorders, including infections. Patients with hypereosinophilia may experience a spectrum of clinical consequences due to multiple organ damage, including neurologic and thrombotic complications, associated with organ dysfunction and potentially life-threatening sequelae. Cerebral venous thrombosis (CVT) is the term used to describe thrombotic occlusion of veins and/or venous sinuses in the brain. This condition can occur at all ages and CVT related to hypereosinophilia is a rare disease. Diagnosis of the disease must be done quickly because thrombosis causes blockage of cerebral drainage, venous congestion, disruption of cerebrospinal fluid reabsorption, ischemic neuronal damage, cerebral edema, and hemorrhage, leading to severe neurological complications. Management of intracranial hemorrhage from CVT due to hypereosinophilia is a challenging task for clinicians, based on anticoagulation therapy, systemic corticosteroid, management of elevated intracranial pressure, and potentially progressive hemorrhage due to anticoagulant. The outcome of the patient generally relies on early detection, prompt, and appropriate treatment. In this case report, we discuss a rare case of CVT with hypereosinophilia and positive dengue serology in a child, in the context of intracranial hemorrhage, enlightening the importance of considering a personalized strategy in the management of this complex scenario.

The high incidence of wasp stings have been causing a variety of injuries in China, but systemic complications are rarely reported.

A 59-year-old man was severely attacked by wasps. He developed an acute onset of right hemiplegia and chest distress and was admitted to our emergency department 13 hours after being attacked. Various abnormal signals were found by biochemical tests. Magnetic resonance venography of head demonstrated that the superior sagittal sinus was not visible, indicating cerebral venous sinus thrombosis. Magnetic resonance imaging showed abnormal signals in the left frontal lobe, parietal lobe, and thalamus, indicating venous cerebral infarction and hemorrhage, coupled with subarachnoid hemorrhage. The patient was diagnosed with a rare combination of cerebral venous sinus thrombosis, cerebral venous infarction, and multi-organ dysfunction following hornet stings. After undergoing systematic treatment including blood perfusion, blood dialysis, anti-inflammatory hormone therapy, antiallergic medication, antibiotic use, and anticoagulation treatment, the patient showed significant improvement in limb muscle strength and dizziness symptoms. However, the patient developed irreversible kidney damage and is currently dependent on renal replacement therapy.

This case highlights the serious systemic consequences that can occur following multiple wasp stings, including rare complications such as venous sinus thrombosis leading to cerebral infarction and renal failure. Early intervention with blood perfusion, hemodialysis, and plasmapheresis, in addition to general treatment, may help prevent permanent organ damage in patients with a large number of wasp stings.

 Atypical sites for thrombosis include deep vein thrombosis (DVT) of the upper extremity (UE-DVT), splanchnic vein thrombosis (SVT), and cerebral venous sinus thrombosis (CVST). In addition to specific pathogenic factors, their underlying mechanisms share similarities with typical venous thromboembolism (VTE), namely, DVT of the lower extremity and/or pulmonary embolism, but are less understood.

 Records of unselected patients with a history of typical VTE (n = 2,011), UE-DVT (n = 117), SVT (n = 83), and CVST (n = 82), who were referred to the Institute in Bonn for ambulatory thrombophilia testing, were retrospectively analyzed. Acquired and hereditary thrombosis risk factors were comparatively assessed.

 UE-DVT was characterized by a high rate (50.4%) of site-specific acquired risk factors. Compared with typical VTE, SVT was more frequently associated with systemic inflammation, infection, or malignancy (2.2 vs. 12.0%, p = 3·10-8) and the JAK2 V617F mutation was present in 16.9%. In CVST compared with typical VTE, demographics and higher rates of oral contraception (43.2 vs. 57.6%, p = 0.011) and pregnancy (4.2 vs. 10.9%, p = 0.012) suggest a significant hormonal influence on etiology. While the prevalence of inhibitor deficiencies and factor V Leiden mutation did not differ between cohorts, the prevalence of F2 20210G > A was higher in SVT (15.7%, p = 0.003) and CVST (15.9%, p = 0.003) than in typical VTE (7.0%).

 The cohorts with thrombosis in atypical sites showed distinctive patterns of acquired risk factors. Further studies are warranted to provide additional mechanistic insight into the role of hormonal influence in CVST and the contribution of F2 20210G > A to the development of SVT and CVST.

Although rare, cerebral venous sinus thrombosis (CVT) can result in significant neurological complications, particularly after childbirth. Early diagnosis poses a challenge due to symptom overlap with other conditions. Limited publications and underdiagnosis of CVT are prevalent in developing nations, notably in Ethiopia.

A 29-year-old mother, having given birth four times, presented to the emergency department in her second month postpartum with complaints of persistent headaches and blurred vision over three weeks. Additionally, she reported sudden weakness on her right side for one day. Despite previous treatments for migraine headaches, she was diagnosed with CVT after magnetic resonance imaging/venography revealed blockage in the right anastomotic vein and the posterior segment of the superior sagittal sinus. Treatment commenced with the anticoagulant enoxaparin. During hospitalization, she experienced one episode of generalized seizures, leading to transfer to the intensive care unit where phenytoin was added. Subsequent diagnosis of papilledema occurred. After a 16-day hospital stay, she was discharged with warfarin, phenytoin, and acetazolamide. Oral anticoagulation and other medications ceased after six months of treatment, considering the postpartum period as a temporary risk factor for CVT. The patient currently maintains good health and has resumed normal activities.

Maintaining a high index of suspicion for CVT during the postpartum period and promptly conducting imaging scans are crucial for early diagnosis. This approach can halt neurological decline and facilitate immediate recovery through early therapeutic interventions.

Venous sinus thromboses (VSTs) are rare complications of neurosurgical procedures in the proximity of the dural sinuses. Surgery of the posterior cranial fossa (PCF) and particularly of the cerebellopontine angle (CPA) shows increased risk of VST. VST management is challenging because anticoagulant therapy must be balanced with the risk of postoperative bleeding. We performed a systematic review and meta-analysis to summarize the most important neuroradiologic and clinical aspects of VST after PCF/CPA surgery.

We performed a comprehensive literature search to identify articles reporting data on VST after PCF/CPA surgery. We selected only comparative studies providing adequate neuroimaging assessing VST and a control group.

We included 13 articles reporting 1855 patients. VST occurred in 251/1855 cases (estimated incidence, 17.3%; 95% confidence interval [CI], 12.4%-22.2%). Only presigmoid approach (odds ratio [OR], 2.505; 95% CI, 1.161-5.404; P = 0.019) and intraoperative sinus injury (OR, 8.95; 95% CI, 3.43-23.34; P < 0.001) showed a significant association with VST. VST-related symptoms were reported in 12/251 patients with VST (pooled incidence, 3.1%; 95% CI, 1%-5.2%). In particular, we found a significantly increased OR of cerebrospinal fluid leak (OR, 3.197; 95% CI, 1.899-5.382; P < 0.001) and cerebrospinal fluid dynamic alterations in general (OR, 3.625; 95% CI, 2.370-5.543; P < 0.001). Indications for VST treatment were heterogeneous: 58/251 patients underwent antithrombotics, with 6 treatment-related bleedings. Recanalization overall occurred in 56.4% (95% CI, 40.6%-72.2%), with no significant difference between treated and untreated patients. However, untreated patients had a favorable outcome.

VST is a relatively frequent complication after PCF/CPA surgery and a presigmoid approach and intraoperative sinus injury represent the most significant risk factors. However, the clinical course is generally benign, with no advantage of antithrombotic therapy.

Using ferric chloride (FeCl3) to induce experimental superior sagittal sinus (SSS) thrombosis might interfere with magnetic resonance imaging (MRI)-assisted visualization and evaluation of the thrombus, the brain parenchyma, and the quality of the occlusion. The aim of this study was to investigate whether aluminum chloride (AlCl3)-induced thrombosis of the SSS has comparable properties to those of FeCl3 without causing artifacts in MRI. SSS thrombosis was induced in 14 male Wistar rats by exposure of the SSS and subsequent topical application of a filter paper strip soaked in AlCl3 (n = 7) or FeCl3 (n = 7) over a period of 15 min. The animals with AlCl3-induced SSS thrombosis showed a constant and complete occlusion with in histological analysis large thrombi. Blood flow measurements indicated a significant reduction on the first and seventh postoperative day compared to preoperative measurements. MRI enabled visualization and subsequent evaluation of the thrombus and the surrounding parenchyma. In comparison, FeCl3-induced SSS thrombosis could not be evaluated by MRI due to artifacts caused by the paramagnetic properties and increased susceptibility of FeCl3. The occluded sinus and the surrounding area appeared hypointense. The quality of SSS occlusion by AlCl3 was comparable to that of FeCl3. AlCl3 therefore represents a significant alternative substance in experimental SSS thrombosis ideally suited for studies using MRI.

Cerebral venous thrombosis (CVT) is an uncommon but potentially fatal condition which presents with a wide range of symptoms. Some of these presenting features are vague thus contributing to the delay in diagnosis. A prompt diagnosis and initiation of appropriate therapy are therefore of paramount importance. In this pictorial, we have tried to illustrate the direct and indirect imaging features of CVT in detail on multiple imaging modalities, along with the potential pitfalls of imaging.

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic) syndrome is a newly described hemato-inflammatory acquired monogenic entity that presents in adulthood. One of the main features of VEXAS syndrome is a high venous thromboembolism (VTE) burden, with approximately 30-40% experiencing lower extremity deep vein thrombosis and a lower incidence of pulmonary embolism at approximately 10%. To date, VEXAS syndrome has not been associated with rarer forms of VTE such as cerebral sinus vein thrombosis (CSVT) and Budd-Chiari syndrome, which are well-recognized vascular manifestations in Behcet's disease, another autoinflammatory vasculitic disease. Herein, we describe a case of acute severe extensive and fatal CSVT in a patient with VEXAS syndrome. The event occurred during a period of apparently quiescent inflammatory status, while the patient was receiving tocilizumab and a low dose of glucocorticoids. Despite treatment with anticoagulation, high-dose glucocorticoids, endovascular thrombectomy, and intracranial pressure-lowering agents, the patient suffered severe neurologic damage and ultimately succumbed to the condition 3 weeks after the onset of CSVT. To the best of our knowledge, this is the first reported case of CVST in a patient with VEXAS syndrome.

In managing cerebral venous sinus thrombosis (CVT), the standard approach has been administering parenteral anticoagulation for at least five days, despite limited supporting evidence. This study aimed to determine the optimal duration of parenteral anticoagulation for CVT patients and its potential impact on their functional outcomes upon discharge. This retrospective observational cohort study was conducted across multiple healthcare centers and included adult CVT patients who received varying durations of parenteral anticoagulation: less than 5 days (n = 25) or 5 days or more (n = 16). The primary focus was on the duration of acute anticoagulation treatment, with secondary endpoints including hospital stay length and functional outcomes. The study found that a shorter duration of anticoagulation treatment (< 5 days) was linked to more favorable outcomes, as measured by the modified Rankin Scale (mRS) (68% vs. 25%, RR = 0.37, CI 0.15-0.90, p = 0.007). However, regression analysis showed non statistically significant associations for all variables except gender. Female patients were significantly more likely to receive a shorter duration of anticoagulation (Odds Ratio: 2.6, 95% CI: 2.2-3.1, P-Value: <0.001). These findings suggest a potential connection between shorter anticoagulation duration (< 5 days) and improved CVT patient outcomes, as indicated by their mRS scores at discharge. The observed relationship between female gender and shorter anticoagulation duration warrants further exploration. Nevertheless, caution is necessary when interpreting these findings due to the small sample size and specific patient characteristics. Further research in a larger and more diverse cohort is essential to validate these results and understand their implications fully.

To explore the relationship between asymmetric deep cerebral venous (ADCV) filling and poor outcomes after endovascular treatment (EVT) in patients with acute basilar artery occlusion (ABAO).

ABAO patients were selected from a prospectively collected data at our center. The DCV filling was evaluated using computed tomography perfusion (CTP)-derived reconstructed 4D-DSA or mean venous map. ADCV filling was defined as the internal cerebral vein (ICV), thalamostriate vein (TSV), or basal vein of Rosenthal (BVR) presence of ipsilateral filling defects or delayed opacification compared to the contralateral side. Poor prognosis was defined as a modified Rankin scale score >3 at the 90-day follow-up.

A total of 90 patients were enrolled in the study, with a median Glasgow Coma Scale of 6, 46 (51.1%) showed ADCV filling, 59 (65.6%) had a poor prognosis, and 27 (30.7%) had malignant cerebellar edema (MCE). Multivariate adjusted analysis revealed significant associations between asymmetric TSV and poor prognosis (odds ratio, 9.091, p = 0.006); asymmetric BVR (OR, 9.232, p = 0.001) and asymmetric ICV (OR, 4.028, p = 0.041) were significantly associated with MCE.

Preoperative ADCV filling is an independent influencing factor for the poor outcome after EVT in ABAO patients.