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Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
CVT presents with headaches, seizures, stroke-like symptoms, or mental status changes. Peak incidence is in immediate postpartum period though its occurrence during pregnancy is also known. CVT may lead to ischemic infarction or to intraparenchymal hemorrhage. MRI usually shows hemorrhagic infarcts and magnetic resonance venography may show thrombus in major sinuses or cerebral veins. Conditions that may present with similar symptoms like eclampsia, meningitis, or cerebral mass should be excluded.
Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The venous drainage of the brain is important because thromboses can give rise to many clinical syndromes. The cerebral hemispheres are drained by the superficial and deep cerebral veins. They lack valves.
Thrombosis in Children
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Eric F. Grabowski, Margaret W. Hilgartner
Venous thrombosis in various organs may give rise to specific findings. Acute respiratory distress and/or chest pain may suggest pulmonary embolism. Renal or hepatic vein thrombosis may cause functional impairment and renal or hepatic swelling. The latter is frequently more easy to palpate in the very young. Cerebral vein/venous sinus thrombosis can present as headache, vomiting, and mental impairment.
Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy
Published in Neurological Research, 2023
Hongmin Li, Suliman Khan, Rabeea Siddique, Qian Bai, Yang Liu, Ruiyi Zhang, Yan Zhang, V. Wee Yong, Mengzhou Xue
Haematological disorders are a rare but important cause of ischaemic stroke [23]. They are commonly caused by clotting in the cerebral veins, termed cerebral venous thrombosis. Essential thrombocytosis (via increased platelet count), polycythaemia vera (via increased red blood cell count and blood viscosity), and antiphospholipid syndrome (via a procoagulant state) are three of the common haematological conditions that predispose to thrombus formation. Stroke can be the presenting feature of these disorders. In addition, sickle cell anemia can cause stroke and is an important cause of pediatric stroke in individuals of African descent [24]. When an intracranial artery is occluded, alternative blood flow pathways (called collaterals) can sustain viability in the penumbral brain regions for a period of time. The extent of collateral flow varies substantially between individuals and probably has both genetic and environmental determinants. In addition, the extent of collateral flow can vary over time within the same individual [25]. The circle of Willis is one potential source of collateral flow, but it is often incomplete, and occlusions are common downstream, limiting its capacity for compensatory flow. The most clinically relevant source of collateral blood flow in most patients is via leptomeningeal anastomoses (Figure 1) [26]. Poor collateral blood flow leads to rapid progression of infarction and limited response to reperfusion therapies [25].
Exploring the pathways of inflammation and coagulopathy in COVID-19: A narrative tour into a viral rabbit hole
Published in International Reviews of Immunology, 2022
Nitsan Landau, Yehuda Shoenfeld, Liat Negru, Gad Segal
Anti-PF4 antibodies may also play a role in the natural pathophysiology of the disease. These antibodies, traditionally associated with heparin-induced thrombocytopenia (HIT) were reported in a high percentage of COVID-19 patients, clinically suspected of having HIT, with high titer anti-PF4/heparin antibodies. However, when functional tests were performed, many of them had a negative result [62]. Entering the new era of the pandemic, vaccines are becoming widely available. Recent reports describe a PF4-dependent syndrome that is unrelated to the use of heparin therapy and can occur after the vaccination. Healthy individuals presented with acute atypical thrombosis, primarily of the cerebral veins, and concurrent thrombocytopenia. All of the patients had d-dimer levels at presentation that were much higher than would be expected in patients with acute venous thromboembolism [63, 64].
Stroke mimics: incidence, aetiology, clinical features and treatment
Published in Annals of Medicine, 2021
Brian H. Buck, Naveed Akhtar, Anas Alrohimi, Khurshid Khan, Ashfaq Shuaib
Stroke is one of the most common diseases affecting one in four people during their lifetime [1]. Most strokes are due to reduction or interruption of blood flow to the brain (ischaemic stroke). A small minority may result from thrombosis in medium or large cerebral veins. Approximately, 20–30% of strokes are haemorrhages and results from damage to small or medium-size vessels [1]. Stroke is a medical emergency and presents with focal neurological deficits. Immediate evaluation, confirmation of diagnosis and treatment to re-establish blood flow leads to improvement in symptoms and prevention of brain damage [2]. The diagnosis of acute ischaemic stroke is however not always straightforward. Similar symptoms may develop in a number of medical conditions commonly referred to as “stroke mimics” (see Table 1). It is essential to entertain stroke mimics in the differential diagnosis when treating an acute suspected stroke to avoid the inappropriate use of expensive and potentially harmful medications. This becomes particularly important with telestroke and in hospitals with limited acute stroke experience [3].