Localized convexity subarachnoid haemorrhage – a sign of early cerebral venous sinus thrombosis

Panda, Sibasish; Prashantha, D.K.; Sk, Shankar; Nagaraja, D

doi:10.1111/j.1468-1331.2010.03001.x

Cited by 47 publications

(45 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another possible mechanism is venous hypertension and subsequent rupture of dilated, valveless, thin-walled, bridging subarachnoid cortical veins devoid of smooth muscle fibers. 6,7,12,16,17) This mechanism is consistent with previous reports, 17,20) and our study showed that cortical SAH usually occurs in the region adjacent to thrombosed veins or sinuses.…”

Section: Discussionsupporting

confidence: 92%

“…Similarly, intraparenchymal findings of venous hemorrhagic infarction were observed in only one of ten patients with cortical SAH due to CVT. 17) However, selection of SAH patients is likely to exclude patients with venous hemorrhagic infarction associated with secondary SAH, who would be classified as having intracerebral hemorrhage, not SAH. Another possible mechanism is venous hypertension and subsequent rupture of dilated, valveless, thin-walled, bridging subarachnoid cortical veins devoid of smooth muscle fibers.…”

Section: Discussionmentioning

confidence: 99%

“…20) The reason may be the lack of blood in the basal cistern or posterior fossa, the low volume of blood, or lowpressure non-arterial bleeding along the cortical surface. 17,20) Focal deficits related to the location of the SAH, such as seizures, are more likely to occur in patients with cortical SAH caused by CVT, especially in the convexity including the motor cortex, than in patients with aneurysmal SAH. 20) However, in our study, no patient presented with focal neurological deficits, including seizures, because the cortical SAH was confined to a small area and a few clots, without involving the eloquent cortex.…”

Section: Discussionmentioning

confidence: 99%

“…6,20) Acute-stage cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. 1,4,12,16,18) Ten of 233 patients with CVT had evidence of cortical SAH, 17) indicating that the presence of cortical SAH without involvement of the basal cisterns may provide an early sign of underlying CVT. 17) CVT is a potentially serious but treatable condition, and the outcome depends on early diagnosis and management.…”

Section: Introductionmentioning

confidence: 99%

“…1,4,12,16,18) Ten of 233 patients with CVT had evidence of cortical SAH, 17) indicating that the presence of cortical SAH without involvement of the basal cisterns may provide an early sign of underlying CVT. 17) CVT is a potentially serious but treatable condition, and the outcome depends on early diagnosis and management. Accordingly, CVT must be excluded in the diagnosis of patients with cortical SAH, because immediate selection of treatment strategy is necessary, and anticoagulant and antifibrinolytic therapy are contradicted for CVT.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Oda

Shimoda

Hoshikawa

et al. 2011

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Patients with non-traumatic, non-aneurysmal, and non-perimesencephalic subarachnoid hemorrhage (SAH) tend to have clots circumscribed along the cortical convexity, a condition referred to as acute cortical SAH. Cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. The study tried to establish the diagnosis and management of cortical SAH caused by CVT. Retrospective review of 145 patients with non-traumatic SAH identified 15 patients with no ruptured aneurysm. Clinical features were investigated with a specific focus on patients with SAH caused by CVT. Eight of the 15 patients had perimesencephalic SAH, and 7 had cortical SAH. SAH caused by CVT was diagnosed in 4 of the 7 patients with cortical SAH. The cortical SAH involved the unilateral convexity or sylvian cistern and spared the basal cistern on computed tomography in all 4 patients. CVT occurred in the transverse sinus and cortical vein (1 patient), insular vein (1 patient), and cortical vein (2 patients). Identification of thrombosed veins or sinuses was established directly by T 2 *-weighted and diffusion-weighted magnetic resonance (MR) imaging in the acute stage and diffusion-weighted and T 1 -weighted MR imaging in the subacute stage. All patients had cortical swelling without findings of venous hemorrhagic infarction on T 2 *-weighted MR imaging. None of the 4 patients received active treatment, and all had favorable outcomes. CVT in patients with non-traumatic cortical SAH should be first excluded as a potential hemorrhagic cause by MR imaging for thrombosed veins or sinuses before initiating antifibrinolytic therapy.

show abstract