Subarachnoid Hemorrhage as the Initial Presentation of Cerebral Venous Thrombosis

Kato, Yukio; Takeda, Hidetaka; Furuya, Daisuke; Nagoya, Harumitsu; Deguchi, Ichiro; Fukuoka, Tatsunari; Tanahashi, Norio

doi:10.2169/internalmedicine.49.2789

Cited by 33 publications

(35 citation statements)

References 12 publications

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“…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: 91%

“…One possibility is rupture of venous parenchymal hemorrhagic infarcts into the subarachnoid space. 6,7,12,16) However, none of our 4 patients had findings of hemorrhagic venous infarction on MR imaging or CT. Similarly, intraparenchymal findings of venous hemorrhagic infarction were observed in only one of ten patients with cortical SAH due to CVT.…”

Section: Discussionmentioning

confidence: 86%

“…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%

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Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Oda

Shimoda

Hoshikawa

et al. 2011

Neurol. Med. Chir.(Tokyo)

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Oda

Shimoda

Hoshikawa

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…6 The exact mechanism of cortical SAH caused by CVT is unknown. One possibility is the rupture of venous parenchymal hemorrhagic infarcts into the subarachnoid space, 15,16 although signs of hemorrhagic venous infarction were not found in our patient. Another possible mechanism is venous hypertension and subsequent rupture of dilated, valueless, thin-walled, bridging subarachnoid cortical veins devoid of smooth muscle fibers.…”

Section: Discussioncontrasting

confidence: 54%

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: a Case Report

Arévalo-Lorido¹,

Carretero-Gómez²

2014

Clinical Medicine & Research

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Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present the case of a man with CVT of the right transverse sinus who presented with a SAH in the right parietal sinus. In this case, we describe a hyper-homocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance of identifying possible causes that could be reversed with an appropriate treatment, and the controversy about the timing for starting anticoagulation therapy in such cases.

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“…VST; baş ağrısı, nöbet, fokal nörolojik defisit, konfüzyon ve komaya kadar değişen çok çeşitli bulgularla ortaya çıkabilmektedir (1)(2)(3)(4). VST'nda venöz enfarkta bağlı parankimal hemoraji görülebilmekle beraber, venöz enfarkt olmaksızın SAK'ya oldukça nadir rastlanır (1,2,4).…”

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