1. Cerebral Sinus Venous Thrombosis
M.Petrova L.Grozdinski I.Petrov

2. CeRebral Sinus venous thrombosis /CSVT/ symptoms
Introduction
CeRebral Sinus venous thrombosis /CSVT/ symptoms
Progressive headache
Visual defects / blurred vision, diplopia etc./
Difficulty in speaking
Seizures similar to epileptic
Symptoms of stroke/ paresis of upper and lower limbs/

3. Anatomy of Cerebral Venous Sinuses

4. Risk Factors Heritable thrombophilia Chronic inflammation Pregnancy
Oral contraceptives
Autoimmune vascular diseases (lupus, Bechet disease)

5. Mortality rate Risk of death from a venous stroke 10-30%
Often in younger age y

6. Case Report CSVT patient History
44 year old female
Venous stroke march 2013
No significant history of previous diseases
Oral contraceptives – few years
Smoker

7. PRESENT SYMPTOMS Dizziness Weakness in lower limbs “clumsy” right leg
Headache
Speech difficulties

8. Neurological Status Double vision on the left side
Mild intention tremor with right hand
Weakness in right leg
Disturbed coordination- Romberg +
Positive Babinski sign for right side
Hypesthesia for right arm

9. MRT Phlebography
Multiple hypo T1 and hyperintesive T2 and Flair lesions in the grey and white matter
Watershed infarct
Venous infarction as a result of thrombosis of the cerebral veins

10. MRT Phlebography Hypoplastic left jugular vein
Hypoplasia and thrombosis of transversal venous sinus

11. MRT Phlebography
Hypoplasia and thrombosis of the left transversal sinus

12. MRI Phlebography

13. EchoDoppler of jugular veins
Chronic cerebro-spinal venous insufficiency (CCSVI)
Hypoplastic left jugular vein
Severe left side valve stenosis
Moderate valve stenosis of the right jugular vein

14. left

15. right

16. Phlebography
Hypoplastic jugular left jugular vein with severe stenosis
Moderate stenosis of right jugular vein
Severe stenosis of azygos vein

17. Balloon angioplasty of left and right jugular vein and azygos vein
Endovascular therapy
Balloon angioplasty of left and right jugular vein and azygos vein

18. Balloon Angioplasty of both jugular veins
Before
Therapy
Balloon Angioplasty of both jugular veins
Left IJV

19. After
Left IJV

20. Before
Right IJV

21. Right IJV

22. Before
Azygos

23. After
Azygos

24. Discussion We found CCSVI in patient with CSVT
The patient has progressive neurological symptoms similar to multiple sclerosis /MS/ or other neurodegenerative disease
We performed ednovascular therapy on CCSVI due to the obvious connection between cerebral venous pathology and the clinical symptoms
Second case in our practice – combined pathology CSVT and CCSVI

25. Publications Keller, 2012 51 p with CSVT
IJV stenosis /CCSVI/ in 61% of the patients
30 control patients with 0% CCSVI

26. Conclusions We found CCSVI in two patients with CSVT 2 hypothesis:
1. CCSVI of the IJV /hypoplasia, stenosis/ may lead to cerebral sinus thrombosis and venous stroke
2. CCSVI affects IJVs as well as the cerebral venous sinuses.
This inherited anomaly may have a key role for development of neurodegenerative diseases or venous stroke