.: ORİJİNAL ARAŞTIRMA
The Incidence of Cerebral Sinus Venous Thrombosis in Patients Diagnosed with Pseudotumor Cerebri During the COVID-19 Pandemic
COVID-19 Pandemisi Döneminde Psödotümör Serebri Tanısı Alan Hastalarda Serebral Sinüs Venöz Tromboz İnsidansı
Turkiye Klinikleri J Ophthalmol. 2025;34(2):35-9
doi: 10.5336/ophthal.2024-106172
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To emphasize the increasing frequency of cerebral sinus venous thrombosis (CSVT) among the causes of pseudotumor cerebri (PTC) and the necessity of investigating it in patients presenting with papilledema during the COVID-19 pandemic. Material and Methods: Complete ophthalmological examinations, magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance venography (MRV) data of 44 patients diagnosed with PTC in a tertiary neuro-ophthalmology clinic, from the beginning of the COVID-19 pandemic to the present were recorded. Patients without documented increases in intracranial pressure by lumbar puncture, patients with abnormalities in cerebrospinal fluid (CSF) biochemistry and microbiology analysis, and patients with intracranial mass, obstructive hydrocephalus, or meningitis on MRI were excluded. Results: MRI and contrast-enhanced MRV imaging were evaluated together in 36 of the 44 patients with COVID-19 positivity. The mean age of the included patients was 36.9 years (minimum: 9-maximum: 63). Among these 36 patients who underwent combined imaging, 14 (38.8%) showed findings indicative of CSVT: 5 had superior sagittal sinus thrombosis, 5 had transverse sinus thrombosis, 2 had sigmoid sinus thrombosis, 1 had inferior sagittal sinus thrombosis, and 1 had extensive CSVT. Conclusion: While we had a CSVT rate of 9.2% which is compatible with previous studies before the pandemic period; in this retrospective study covering the pandemic period, we detected CSVT in 38.8% of patients with suspected PTC. We think that CSVT should be investigated in all patients who are considered to have increased intracranial pressure with combined MRI-MRV imaging.
Keywords: Pseudotumor cerebri; cerebral sinus venous thrombosis; coronavirus disease-2019; papilledema; magnetic resonance venography
Objective: To emphasize the increasing frequency of cerebral sinus venous thrombosis (CSVT) among the causes of pseudotumor cerebri (PTC) and the necessity of investigating it in patients presenting with papilledema during the COVID-19 pandemic. Material and Methods: Complete ophthalmological examinations, magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance venography (MRV) data of 44 patients diagnosed with PTC in a tertiary neuro-ophthalmology clinic, from the beginning of the COVID-19 pandemic to the present were recorded. Patients without documented increases in intracranial pressure by lumbar puncture, patients with abnormalities in cerebrospinal fluid (CSF) biochemistry and microbiology analysis, and patients with intracranial mass, obstructive hydrocephalus, or meningitis on MRI were excluded. Results: MRI and contrast-enhanced MRV imaging were evaluated together in 36 of the 44 patients with COVID-19 positivity. The mean age of the included patients was 36.9 years (minimum: 9-maximum: 63). Among these 36 patients who underwent combined imaging, 14 (38.8%) showed findings indicative of CSVT: 5 had superior sagittal sinus thrombosis, 5 had transverse sinus thrombosis, 2 had sigmoid sinus thrombosis, 1 had inferior sagittal sinus thrombosis, and 1 had extensive CSVT. Conclusion: While we had a CSVT rate of 9.2% which is compatible with previous studies before the pandemic period; in this retrospective study covering the pandemic period, we detected CSVT in 38.8% of patients with suspected PTC. We think that CSVT should be investigated in all patients who are considered to have increased intracranial pressure with combined MRI-MRV imaging.
Keywords: Pseudotumor cerebri; cerebral sinus venous thrombosis; coronavirus disease-2019; papilledema; magnetic resonance venography
ÖZET
Amaç: Psödotümör serebri (PTS) nedenleri arasında serebral sinüs ven trombozunun (SSVT) artan sıklığına ve COVID-19 pandemisi sırasında papilödem ile başvuran hastalarda bunun araştırılmasının gerekliliğine dikkat çekmek. Gereç ve Yöntemler: COVID-19 pandemisinin başlangıcından itibaren üçüncü basamak bir nörooftalmoloji kliniğinde PTS tanısı konan 44 hastanın tam oftalmolojik muayeneleri, manyetik rezonans görüntüleme (MRG) ve kontrastlı manyetik rezonans venografi (MRV) verileri kaydedildi. Lomber ponksiyon ile intrakraniyal basınç artışı belgelenmeyen, beyin omurilik sıvısı biyokimyası ve mikrobiyolojisi analizlerinde anormallikleri olan ve MRG'de intrakraniyal kitle, obstrüktif hidrosefali veya menenjit tespit edilen hastalar çalışma dışı bırakıldı. Bulgular: COVID-19 pozitifliği olan 44 hastanın 36'sında MRG ve kontrastlı MRV görüntülemeleri birlikte değerlendirildi. Çalışmaya dâhil edilen hastaların yaş ortalaması 36,9 idi (minimum: 9-maksimum: 63). Bu 36 hastanın 14'ünde (%38,8) SSVT lehine bulgular saptandı: 5 hastada süperior sagittal sinüs trombozu, 5 hastada transvers sinüs trombozu, 2 hastada sigmoid sinüs trombozu, 1 hastada inferior sagittal sinüs trombozu, 1 hastada yaygın serebral sinüs ven trombozu tespit edildi. Sonuç: Pandemi öncesi dönemde yapılan önceki çalışmalarla uyumlu olarak SSVT oranımız %9,2 iken, pandemi dönemini kapsayan bu retrospektif çalışmada PTS şüphesi olan hastalarda %38,8 oranında SSVT tespit ettik. Artmış intrakraniyal basınç olduğu düşünülen tüm hastalarda kombine MRG-MRV görüntüleme ile SSVT'nin araştırılması gerektiğini düşünüyoruz.
Anahtar Kelimeler: Psödotümör serebri; serebral sinüs venöz trombozu; koronavirüs hastalığı-2019; papilödem; manyetik rezonans venografi
Amaç: Psödotümör serebri (PTS) nedenleri arasında serebral sinüs ven trombozunun (SSVT) artan sıklığına ve COVID-19 pandemisi sırasında papilödem ile başvuran hastalarda bunun araştırılmasının gerekliliğine dikkat çekmek. Gereç ve Yöntemler: COVID-19 pandemisinin başlangıcından itibaren üçüncü basamak bir nörooftalmoloji kliniğinde PTS tanısı konan 44 hastanın tam oftalmolojik muayeneleri, manyetik rezonans görüntüleme (MRG) ve kontrastlı manyetik rezonans venografi (MRV) verileri kaydedildi. Lomber ponksiyon ile intrakraniyal basınç artışı belgelenmeyen, beyin omurilik sıvısı biyokimyası ve mikrobiyolojisi analizlerinde anormallikleri olan ve MRG'de intrakraniyal kitle, obstrüktif hidrosefali veya menenjit tespit edilen hastalar çalışma dışı bırakıldı. Bulgular: COVID-19 pozitifliği olan 44 hastanın 36'sında MRG ve kontrastlı MRV görüntülemeleri birlikte değerlendirildi. Çalışmaya dâhil edilen hastaların yaş ortalaması 36,9 idi (minimum: 9-maksimum: 63). Bu 36 hastanın 14'ünde (%38,8) SSVT lehine bulgular saptandı: 5 hastada süperior sagittal sinüs trombozu, 5 hastada transvers sinüs trombozu, 2 hastada sigmoid sinüs trombozu, 1 hastada inferior sagittal sinüs trombozu, 1 hastada yaygın serebral sinüs ven trombozu tespit edildi. Sonuç: Pandemi öncesi dönemde yapılan önceki çalışmalarla uyumlu olarak SSVT oranımız %9,2 iken, pandemi dönemini kapsayan bu retrospektif çalışmada PTS şüphesi olan hastalarda %38,8 oranında SSVT tespit ettik. Artmış intrakraniyal basınç olduğu düşünülen tüm hastalarda kombine MRG-MRV görüntüleme ile SSVT'nin araştırılması gerektiğini düşünüyoruz.
Anahtar Kelimeler: Psödotümör serebri; serebral sinüs venöz trombozu; koronavirüs hastalığı-2019; papilödem; manyetik rezonans venografi
REFERANSLAR:
- Dandy WE. Intracranial pressure without brain tumor: diagnosis and treatment. Ann Surg. 1937;106(4):492-513. [Crossref] [PubMed] [PMC]
- Tezel TH, Günalp İ, Tezel G. İdiopatik intrakranial hipertansiyon. Türkiye Klinikleri J Ophthalmol. 1992;1(2):152-63. [Link]
- Thurtell MJ, Wall M. Idiopathic intracranial hypertension (pseudotumor cerebri): recognition, treatment, and ongoing management. Curr Treat Options Neurol. 2013;15(1):1-12. [Crossref] [PubMed] [PMC]
- Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002;59(10):1492-5. [Crossref] [PubMed]
- Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81(13):1159-65. [Crossref] [PubMed]
- Friedman DI. Papilledema and idiopathic intracranial hypertension. Continuum (Minneap Minn). 2014;20(4 Neuro-ophthalmology):857-76. [Crossref] [PubMed] [PMC]
- Sørensen PS, Krogsaa B, Gjerris F. Clinical course and prognosis of pseudotumor cerebri. A prospective study of 24 patients. Acta Neurol Scand. 1988;77(2):164-72. [Crossref] [PubMed]
- Masuhr F, Mehraein S, Einhäupl K. Cerebral venous and sinus thrombosis. J Neurol. 2004;251(1):11-23. [Crossref] [PubMed]
- Ropper AH, Klein JP. Cerebral venous thrombosis. N Engl J Med. 2021;385(1):59-64. [Crossref] [PubMed]
- Lin A, Foroozan R, Danesh-Meyer HV, De Salvo G, Savino PJ, Sergott RC. Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension. Ophthalmology. 2006;113(12):2281-4. [Crossref] [PubMed]
- Gómez-Mesa JE, Galindo-Coral S, Montes MC, Muñoz Martin AJ. Thrombosis and coagulopathy in COVID-19. Curr Probl Cardiol. 2021;46(3):100742. [Crossref] [PubMed] [PMC]
- Sriuoginys S, Margareta S, Jon Hersir E. De novo presentation of idiopathic intracranial hypertension (IIH) associated with COVID-19 infection. Neurohospitalist. 2022;12(4):691-2. [Crossref] [PubMed] [PMC]
- Rajabi MT, Rafizadeh SM, Aghajani AH, Pirzadeh M. Idiopathic intracranial hypertension as a neurological manifestation of COVID-19: a case report. J Fr Ophtalmol. 2022;45(7):e303-e305. [Crossref] [PubMed] [PMC]
- Mukharesh L, Bouffard MA, Fortin E, Brann DH, Datta SR, Prasad S, et al. Pseudotumor cerebri syndrome with COVID-19: a case series. J Neuroophthalmol. 2022;42(3):e545-e547. [Crossref] [PubMed]
- Elnahry AG, Elnahry GA. Management of idiopathic intracranial hypertension during the COVID-19 pandemic. Rev Recent Clin Trials. 2021;16(2):122-5. [Crossref] [PubMed]
- Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664-70. [Crossref] [PubMed]
- Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007;6(2):162-70. [Crossref] [PubMed]
- Sachdeva V, Nalawade R, Kannam M, Kapoor R, Chattannavar G, Kale SB, et al. Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis. Indian J Ophthalmol. 2021;69(12):3598-606. [Crossref] [PubMed] [PMC]
- Zhao T, Wang G, Dai J, Liu Y, Wang Y, Li S. Cases of visual impairment caused by cerebral venous sinus occlusion-induced intracranial hypertension in the absence of headache. BMC Neurol. 2018;18(1):159. [Crossref] [PubMed] [PMC]
- Silva MTT, Lima MA, Torezani G, Soares CN, Dantas C, Brandão CO, et al. Isolated intracranial hypertension associated with COVID-19. Cephalalgia. 2020;40(13):1452-8. [Crossref] [PubMed] [PMC]
- Agarwal P, Kumar M, Arora V. Clinical profile of cerebral venous sinus thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol. 2010;58(2):153-5. [Crossref] [PubMed] [PMC]
- Fink JN, McAuley DL. Cerebral venous sinus thrombosis: a diagnostic challenge. Intern Med J. 2001;31(7):384-90. [Crossref] [PubMed]
- Purvin VA, Trobe JD, Kosmorsky G. Neuro-ophthalmic features of cerebral venous obstruction. Arch Neurol. 1995;52(9):880-5. [Crossref] [PubMed]
- Barnes C, Newall F, Furmedge J, Mackay M, Monagle P. Cerebral sinus venous thrombosis in children. J Paediatr Child Health. 2004;40(1-2):53-5. [Crossref] [PubMed]
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