XVII. European Stroke Conference
Nice, France

Poster Session: Venous diseases 
 

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Expanding cord infarction over short period due to spinal dural arteriovenous fistula
C.K.Ha    S.H.Kim    E.C.Song                                                    
 
Dept. of Neurology, Inha University Hospital

SOUTH KOREA

Background: Spinal dural arteriovenous fistula(AVF) ia a rare and enigmatic entity. The fistula between radicular arteries and a radicular vein within the dorsal root sleeve leads to congestion of the venous outflow of the spinal cord, and eventually ischemia. Clinical presentation is a progressive myelopathy. Diagnosis of this entity is very difficult in early stage and it mimics various type of myelopathy, so therapeutic intervention may be delayed resulting into catastrophic outcome. We report a case of recurrent expanding ischemic myelopathy over 2 weeks caused by spinal dural AVF, which was missed on the initial MRI study. Case: A 34-year-old man was referred to emergency room because of sudden paresthesia and paraparesis in the both legs. He had been well until a week before admission, when he felt sudden tingling sense in the right leg. The symptom worsened progressively and extended to the left legs, buttock and perianal region over next 2 days. On the day of admission, he noted weakness in the both legs. His neurologic examination was revealed symmetrical paraparesis, hyporeflexia in legs, and hypesthesia below level of T10. Spinal MRI showed intramedullary high signal intensity and swelling at the level of T7-T11 on T2-weighted image. He was treated with 1 gram of methylpredisolone per day for 5 days under the diagnosis of transverse myelitis. However, the neurologic deficits were not changed. A week after treatment, his paraparesis suddenly worsened. Follow-up MRI showed markedly aggravated lesion expanding to the level of T3 with prominent flow voids on the dorsal part of cord. Angiography confirmed spinal dural AVF fed by the left T6 radicular artery. Comment: Ischemic myelopathy caused by spinal dural AVF can be misdiagnosed as transverse myelitis, and extend recurrently over short period. We learn from this case that suspicion of diagnosis is very important and the most significant clue for diagnosis is flow voids on the dorsal area of cord. Also misdiagnosis and delayed management can result into catastrophic outcome.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Markers of essential thrombocythemia in cerebral venous thrombosis
C. Jobin    N. Blais    P. Bourgouin     F.  Moreau     S.  Lanthier                                    
 
Centre hospitalier de l'Université de Montréal and Université de Montréal

CANADA

Background: Essential thrombocythemia (ET) is a myeloproliferative syndrome characterized by thromboembolisms, sustained thrombocytosis otherwise unexplained with blood platelet counts >600 x 109/L, and megakaryocytic proliferation (WHO criteria). ET rarely presents with cerebral venous thrombosis (CVT). Treatment of CVT due to ET consists of chemotherapy in addition to antithrombotic drugs. Diagnosis of ET is therefore crucial but challenging when CVT precede thrombocytosis. Goal: In CVT, to identify markers of ET, including extensiveness at presentation (primary hypothesis). Methods: From a prospective stroke unit database, we identified individuals admitted for CVT between 2000-08 and 2007-12, reviewed medical charts, and used the WHO criteria to diagnose ET. A neuroradiologist blindly reviewed brain imaging studies, attributing one point per thrombosed sinovenous structure (maximum extensiveness score = 10). We compared discrete (Fisher exact test) and continuous variables (student t-test) between groups with (cases) versus without ET (controls). Results: At CVT presentation, 1/2 cases and 2/24 controls had had previous venous thromboembolisms (p=0,222), 1/2 cases and 6/24 controls had altered consciousness (p=0,474), and mean CVT extensiveness scores were 4.50 in cases and 2.83 in controls (p=0,061). Platelet count was normal in all participants at presentation and increased in 2/2 cases within the next 3 and 22 months. 1/2 cases and 0/20 controls had mutant Jak-2 gene. Venous thromboembolism recurred under adequate anticoagulation in 2/2 cases before chemotherapy was initiated, and 0/23 controls (p=0,003). Mean clinical follow-up duration was 52 months in cases and 27 months in controls (p=0,16). Conclusions: ET can present with CVT before blood platelet count increases. In ET, CVT tends to be extensive at presentation and venous thromboembolism recurs despite adequate anticoagulation. In such cases otherwise unexplained, bone marrow aspiration must be considered.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Cerebral venous thrombosis: risk factors associated with in a spanish hospital series.
I. Sanz Gallego    B. Fuentes    P. Martinez     M.A.Ortega-Casarrubios     E. Diez-Tejedor                                    
 
University Hospital "La Paz" Stroke Unit Madrid Spain

SPAIN

Objetive: To study the risk factors associated with cerebral venous thrombosis (CVT) in our environment in an European country to identify the peculiarity over previous worldwide data. Material and methods: Descriptive study with consecutive inclusion of patients with CVT diagnosis admitted in the stroke unit of neurology department between 1999-2006. The presence of following risk factors was studied: (genetic or acquired) thrombophilia, malignancy, hematological condition, vasculitis and other systemic disorders, pregnancy, puerperium, infection, mechanical precipitants, drugs and dehydration. Results: 27 patients were included (18 female; 66,66%) with mean age of 42,62 years. In 15 (55,55%) cases were identified at least one risk factor and in 5 (18,51%) more than one. The most frequent related to CVT risk factor were oral contraceptives (OC) (29,62% of all the patients and in 44,44% the of all the female) and thrombophilia (29,62% of all the patients). The most frequent combination of risk factors were OC with thrombophilia (11,11% of all the patients). Conclusions: The most frequently found risk factors related to CVT in our environment are oral contraceptives and thrombophilia. We have not found association with other risk factors like dehydration, puerperium, pregnancy or infection, which are more frequent in undeveloped and developing countries.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Seven cases of cerebral venous thrombosis in inflammatory bowel disease and review of the litterature
E. COGNAT    I. CRASSARD    K. VAHEDI     M.G.BOUSSER                                            
 
Hopital Lariboisiere

FRANCE

Background : While association between inflammatory bowel diseases (IBD) and thromboembolic events has been pointed out for a long time, cerebral venous thrombosis (CVT) remains rare. Methods :Among 249 patients with CVT admitted in our department (1997-2007), identification of patients with IBD ; Clinical, etiological and evolution data collected for all patients. Review of cases of litterature was performed. Results : 7 patients had IBD either Crohn's Disease (CD) (5 women, 1 man) or ulcerative colitis (1 woman). Ages ranged from 23 to 45 years. All but one complained of headaches, remaining isolated in 3 patients and associated with papilledema in one. Three presented focal neurological signs and two had seizures. CVT occured between 2 months and 17 years after IBD first signs. In one patient having presented intermittent diarrhea for five years, CD was diagnosed during CVT management. Four patients had other favorising factors : contraceptive pills 3, middle ear infection 1, factor V Leiden mutation 1, factor II mutation 1. All patients were treated with heparin. Outcome was good with a complete recovery in 5 patients, 2 patients keeping moderate neurological deficit at discharge. Discussion : Analysis of our data and of cases of the litterature show that CVT in IBD do not differ from CVT due to other causes concerning sex ratio, clinical pictures, and outcome. Associated favorising factors are not rare ; concerning thrombophilia no prevalent abnormality is found in CVT patients in IBD as mentionned in other thromboembolic complications in IBD. Carefull use of heparin (because of possible hemorrhagic complications in IBD and associated iron deficiency anemia) remains the first choice treatment in CVT in combination with specific management of IBD.