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comes established, the tributary surface veins take on a corkscrew appearance that is appreciated on the venous phase of an angiogram 1 Cavernous Sinus Thrombosis As pointed out in 2 Chaps 13 and 14, in cases of anterior cavernous sinus thrombosis there is marked chemosis and 3 proptosis with disorders referable to cranial 4 nerves III, IV, VI, and the ophthalmic division of V (Fig 34-32) Posterior cavernous sinus thrombosis, 5 spreading to the inferior petrosal sinus, may cause 6 palsies of cranial nerves VI, IX, X, and XI without 7 proptosis, and involvement of the superior petrosal sinus may be accompanied by a fth nerve palsy 8 Increased intracranial pressure without ventricular dilatation occurs with thrombosis of the superior sagittal sinus, the main jugular vein, and the lateral sinus or torcula Figure 34-32 Diagram of the cavernous sinus: (1) optic chiasm; (2) oculomotor nerve; (3) Thrombosis of the venous sinuses in neonates cavernous sinus; (4) trochlear nerve; (5) internal carotid artery; (6) ophthalmic nerve; (7) abducens nerve; (8) maxillary nerve (Reproduced by permission from Krayenbuhl and presents special problems in diagnosis In the series Yasargil) of deVeber et al, various perinatal complications, including systemic illness such as severe dehydration or infection, were the common precedents; the outcome was poor In young children the risk factors differed in Nonbacterial Thrombotic (Marantic) that connective tissue and prothrombotic disorders and head and Endocarditis and Cerebral Embolism neck infections were more common Sterile vegetations, referred to also as nonbacterial thrombotic enDeep Cerebral Vein Thrombosis Occlusion of the vein of Galen docarditis, consist of brin and platelets and are loosely attached and of the internal cerebral veins is the rarest and clinically most to the mitral and aortic valves and contiguous endocardium They obscure of the venous syndromes From the few cases that have are a common source of cerebral embolism (almost 10 percent of been studied, a picture of bithalamic infarction emerges, often reall instances of cerebral embolism according to Barron et al, but versible, and consisting mainly of inattention, spatial neglect, and lower in the experience of others) In almost half the patients, the amnesia in the case reported by Benabdeljili and colleagues and of vegetations are associated with a malignant neoplasm; the remainakinetic mutism and apathy in the case of Gladstone and associates der occurs in patients debilitated by other diseases (Biller et al) In most reports of this condition, it is the neuropsychological asExcept for the setting in which it occurs, marantic embolism has pects that are emphasized The MRI is striking, with a large bicirno distinctive clinical features that permit differentiation from cecular region of signal change that encompasses the thalami Much rebral embolism of other types other than that it is often the cause of the signal change probably represents reversible edema and of sequential strokes over days or weeks The apoplectic nature of venous congestion, since substantial clinical improvement may marantic embolism distinguishes it from the usual forms of tumor occur metastases The hazards of using anticoagulants in gravely ill patients with widespread malignant disease probably outweigh the Treatment of Cerebral Venous Thrombosis Anticoagulant bene ts from this treatment, but drugs that prevent platelet aggretherapy beginning with heparin for several days, followed by wargation, while possibly helpful, have not been studied systematically farin, and combined with antibiotics if the venous occlusion is infor this condition fectious (it rarely is in recent times) has been lifesaving in some The lesions of small cerebral arteries formerly observed in cases Nonetheless, the overall mortality rate remains high, with patients with rheumatic heart disease and referred to as rheumatic large hemorrhagic venous infarctions found in 10 to 20 percent of arteritis have not been well characterized clinically or pathologicases The clinical trial conducted by Einhaupl and colleagues has cally The vascular lesions and the microinfarcts that accompany settled the question of therapy in favor of aggressive anticoagulathem are probably manifestations of diffuse cerebral embolism tion There is probably no relationship to the lesion of Sydenham chorea Thrombolytic therapy by local venous or systemic infusion has also been successful in small series of cases, such as the 5 Stroke as a Complication of patients treated with urokinase and heparin by DiRocco and colHematologic Disease leagues However, this approach has not been subjected to a systematic study We have reserved thrombolysis for extreme cases of The brain is involved in the course of many hematologic disorders, dural sinus thrombosis with stupor or coma and greatly raised CSF some of which have already been mentioned A number of the pressure This subject is reviewed by Benamer and Bone, who conbetter-characterized ones are discussed here clude that warfarin anticoagulation should be reserved for patients who deteriorate despite treatment with heparin Most treated paAntiphospholipid Antibody Syndrome This condition, in tients do well, but it may take weeks for the headaches to remit which TIAs, or stroke, migraine, and thrombocytopenia in various Coma and multiple cerebral hemorrhages, on the other hand, are combinations, occurs in young adults, has already been mentioned usually fatal under Strokes in Children and Young Adults The related term. c# pdf Working with PDF files in C# using PdfBox and IKVM - Javi - 博客园
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