| Identifier |
Cerebral_Venous_Sinus_Thrombosis |
| Title |
Cerebral Venous Sinus Thrombosis |
| Creator |
Andrew G. Lee, MD; Jae Eun Lee |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JEL) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Subject |
Neuro-Ophthalmology; Venous; Thrombosis; Medical Condition |
| Description |
Dr. Lee lectures medical students on cerebral venous sinus thrombosis. |
| Transcript |
So today we're going to be talking about cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis. But not everything about it, just the neuro-ophthalmology of it. And so you need to know a little bit about the venous sinuses so the superior sagittal sinus the transverse sinus and then the sigmoid sinus down the internal jugular. So when we're dealing with a thrombosis it can be a superior sagittal sinus thrombosis, it can be at this connection point which we call the torcula. It could be a transverse sinus a sigmoid sinus or the internal jugular. So these are the major draining veins that we are dealing with in terms of having a thrombosis- a blockage in the venous sinuses of the cerebral system, and so for neuro-ophthalmology the reason this is important is if you have a blockage in the vein that drains your brain you'll have increased intracranial pressure and so the imaging study of choice for patients who have symptoms or signs of increased intracranial pressure is an MRI with a contrast of MRV and you need this V- venography to find this V- venous sinus thrombosis. So if we just do a an MRI scan you might miss the radiographic feature of venous sinus thrombosis. So it's really important that we have a MRI plus a MRV and basic papilledema. And so when we're looking at patients who might have cerebral venous sinus thrombosis, we're really going to be thinking about what are the symptoms of increased intracranial pressure- headache double vision from a non-localizing sixth nerve palsy and pulse synchronous tinnitus or transient visual obstructions lasting seconds at a time from papilledema. And we're going to be looking for the signs of increased intracranial pressure and in particular sixth nerve palsy non-localizing papilledema and a visual field defect. And on the radiograph, we might just see radiographic signs of increased intracranial pressure- fluid in sheath, flattening the globe, and empty cell lines. But the key feature is going to be on the MRVenogram we're going to see the lack of flow in the venogram, and as opposed to idiopathic intracranial hypertension which causes narrowing of the transverse sinus at the distal junction of the transverse and sigmoid sinus in a thrombosis the flow will travel and then all of a sudden the flow will stop. And so we need to look at both the MRI and the MRVenogram because we can see the hyper intense signal intensity representing the clotted blood and the loss of the flow void in the affected sinus and it can be in the superior transverse, sigmoid, or the jugular. And so we really should be thinking about cerebral venous sinus thrombosis in three circumstances: when it looks like IIH. As you know 95% of patients with idiopathic intracranial hypertension have are obese young females so if it's a thin person, if it's a man, if it's an elderly person, or if they have any risk factor or prior history of a thrombosis including deep venous thrombosis or pulmonary embolism these patients are at particular risks of having a cerebral venous sinus thrombosis. And there's a 3 to 1 risk for women for cerebral venous sinus thrombosis but you really should be thinking about IIH in a man as the person who's the risk factor for pseudotumor. The 3 to 1 gender risk might be hormonal in basis- both the pregnancy and the hypercoagulable state of pregnancy as well as the postpartum period as well as hormonal replacement therapy and of course oral contraceptives all increase your risk of thrombosis in females. So when we're dealing with cerebral venous sinus thrombosis we need to think about it if we have increased intracranial pressure symptoms sign or IIH patients, especially atypical demographics: thin, elderly, man, if they have a history of PE or a DVT, MRI plus MRV, and we're going to admit the person to the hospital because we're going to need anticoagulation therapy. And I usually leave the anticoagulation regimen to the neurology service. Rarely they're interventional type things that could be considered, like thrombectomy, but usually it's a medically treated disease with anticoagulation. The only other thing I'll mention is Diamox which is our normal treatment for pseudotumor cerebri has some theoretical risk for causing dehydration which could cause increased stasis in the Virchow's triad, so you really should talk to neurology about what the risk benefit ratio is going to be for using Diamox and someone who has a venous sinus thrombosis. Of course, if they have an intracranial parenchymal or lobar hemorrhage, they're gonna have symptoms and signs of the hemorrhage, seizure, stroke-like episodes, TIA a or hemiparesis hemisensory loss- the usual things from stroke but on the venous side. But for ophthalmology we really should be worried about our IIH patients and doing an MRVenogram to rule out cerebral venous sinus thrombosis. |
| Date |
2020-05-27 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6vb3p4x |
| Setname |
ehsl_novel_lee |
| ID |
1561501 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6vb3p4x |
