|Year : 2017 | Volume
| Issue : 2 | Page : 116-118
A case report on communicating hydrocephalus due to cerebral venous sinus thrombosis: A rare scenario
Khandaker Abu Talha, Mohammad Sulaiman, Sameh Hamed, Moez Khemakhem
Department of Neurosurgery, King Faisal Hospital, Taif, Kingdom of Saudi Arabia
|Date of Web Publication||15-Sep-2017|
Khandaker Abu Talha
King Faisal Hospital, Taif
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
There are different causes of hydrocephalus. Lack of cerebrospinal fluid (CSF) absorption due to cerebral venous sinus thrombosis is one of the rare causes of hydrocephalus. We present a 47-year-old gentleman who had complaint of headache for 2 months. He was diagnosed as communicating hydrocephalus due to right transverse sinus and anterior part of superior sagittal sinus thrombosis. The patient was treated by CSF diversion procedure. There are only few cases have been published on hydrocephalus due to the same etiology.
Keywords: Cerebral venous sinus thrombosis, cerebrospinal fluid, communicating hydrocephalus
|How to cite this article:|
Talha KA, Sulaiman M, Hamed S, Khemakhem M. A case report on communicating hydrocephalus due to cerebral venous sinus thrombosis: A rare scenario. Saudi J Health Sci 2017;6:116-8
|How to cite this URL:|
Talha KA, Sulaiman M, Hamed S, Khemakhem M. A case report on communicating hydrocephalus due to cerebral venous sinus thrombosis: A rare scenario. Saudi J Health Sci [serial online] 2017 [cited 2021 Jan 28];6:116-8. Available from: https://www.saudijhealthsci.org/text.asp?2017/6/2/116/214851
| Introduction|| |
Cerebral venous thrombosis (CVT) is one of the rare types of strokes. This incidence of CVT is 1.3/100,000 adults. CVT causes impairment of cerebrospinal fluid (CSF) drainage, leads to raised intracranial pressure with the clinical features of headache, vomiting, papilledema, and sixth cranial nerve palsy. However, hydrocephalus due to cerebral venous sinus thrombosis is very rare, incidences between 0.2% and 6.6% only. Hydrocephalus is common in children although it can occur in older adults also. The most common etiology of hydrocephalus is postinfectious hydrocephalus. The common classifications of hydrocephalus are according to its etiology and status of CSF flow. They are arrested hydrocephalus, congenital hydrocephalus, external hydrocephalus, idiopathic normal pressure hydrocephalus, chronic hydrocephalus, communicating hydrocephalus, internal hydrocephalus, and obstructive hydrocephalus. Hydrocephalus could be postinfectious, postoperative, posthemorrhagic, trapped fourth ventricle, and after myelomeningocele. Congenital hydrocephalus, most commonly involving stenosis of aqueduct, has been linked to genes which regulate brain development and growth. Newborn infant hydrocephalus usually present with germinal matrix hemorrhage.
The pathological explanation of hydrocephalus as the result of obstruction to the bulk flow of CSF is evolving to models that incorporate brain compliance, dysfunctional cerebral pulsations, and newly characterized water-transport mechanisms.
We are reporting the adult case of communicating hydrocephalus caused by cerebral venous sinus thrombosis as a rare etiology.
| Case Report|| |
This 47-year-old nondiabetic, normotensive gentleman was admitted into the Intensive Care Unit of our tertiary hospital with the complaint of cough and shortness of breathing. He was diagnosed as bilateral pneumonia and was treated with antibiotics. He also had complaint of chronic headache for 2 months. There was no complaint of vomiting, convulsion, or loss of consciousness but he had bilateral papilledema. Computed tomography (CT) scan of the brain was done to evaluate headache. CT brain revealed huge communicating hydrocephalus with ballooning of all ventricles [Figure 1]. CT angiogram was reported as partial occlusion of anterior part of the superior sagittal sinus and near total occlusion of the left transverse sinus [Figure 2]. The patient denied any history of meningitis or head trauma in the past. All the biochemical parameters including international normalized ratio, protein C, protein S, antithrombin 3, and platelet count were in normal limit. There was no history of steroid use or acute dehydration.
|Figure 2: Magnetic resonance venogram shows thrombosis of right transverse and anterior part of superior sagittal sinus|
Click here to view
The patient was scheduled for external ventricular drainage (EVD). After cannulating the frontal horn of right ventricle the opening CSF pressure was found high (25 mm of mercury). CSF was clear. The biochemistry and culture sensitivity report did not show any evidence of infection. After EVD, the patient was clinically improved and the headache was subsided. Bilateral papilledema was improved. EVD was removed on 5th day and right-sided ventriculo peritoneal (VP) shunt was performed. The postoperative recovery was uneventful.
Theoretically, sinus thrombosis is one of the causes of hydrocephalus due to lack of reabsorption of CSF, but practically it is one of the rare scenarios. Only few cases have been reported as hydrocephalus due to occlusion of intracranial venous sinus.
| Discussion|| |
There are few international case reports on the same title.
Mullen et al. published their report on a 49-year-old patient who was presented with headache, vomiting with gradual neurological deterioration which led him to coma. Images confirmed the diagnosis of hydrocephalus with extensive cerebral venous sinus thrombosis. He was treated by anticoagulation therapy along with endovascular thrombolysis. She was recovered from the condition and survived without any deficit without having any EVD done. In this report, the patient was from similar age group and with similar complaints. However, treatment modality was different.
Zuurbier et al. performed their cohort study on 99 cerebral venous sinus thrombosis patients. Twenty of the total patients presented with hydrocephalus. The most common sinus involved was straight sinus. Superior sagittal sinus thrombosis was thrombosed less frequently. Most of the patients were treated by CSF diversion procedures either by VP shunt or EVD. The cerebral sinus mostly affected in this report was transverse sinus. This case was markedly improved by the EVD too.
Leblebisatan et al. treated a 4-year-old male who was presented with a day history of vomiting and headache. He did not have any lateralizing sign but had bilateral papilledema. Magnetic resonance imaging confirmed obstructive hydrocephalus and intracerebral venography revealed right transverse sinus thrombosis. The male was treated by anticoagulation therapy successfully. The patient of this case report was an adult in contrast to the report of Leblebisatan et al., but the thrombosed sinus was the same in both the cases.
Chakor et al. presented a 40-year-old communicating hydrocephalus patient who had a complaint of severe headache for 6 months and gradual visual loss for 2 months. Magnetic resonance venogram (MRV) showed the right transverse and sigmoid sinus thrombosis. Initially, he was treated by repeated CSF drain by lumbar puncture and thecoperitoneal shunt which did not relieve the complaint. Finally, ventriculo peritoneal shunt was done to reduce the hydrocephalus. Age group and affected venous sinus had similarity with the presented case. This case was also improved by VP shunt.
Weidauer et al. published their report on an adult hydrocephalus patient due to its rare etiology. Diagnosis of hydrocephalus was confirmed by CT scan. MRV revealed superior sinus thrombosis. The patient was treated by EVD.
Only few cases have been reported on hydrocephalus due to cerebral sinus thrombosis. When we compared the etiology, presentation and management, we found a great similarity among all the cases.
We are grateful to Dr. Deepak Joshi and Dr. Haitham Osman for their inspiration and support for this case report. Their efforts made our work smooth and comfortable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: A cross-sectional study. Stroke 2012;43:3375-7.
Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT Investigators, et al.
Prognosis of cerebral vein and dural sinus thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004;35:664-70.
Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005;352:1791-8.
Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol 2007;6:162-70.
Mullen MT, Sansing LH, Hurst RW, Weigele JB, Polasani RS, Messé SR, et al.
Obstructive hydrocephalus from venous sinus thrombosis. Neurocrit Care 2009;10:359-62.
Zuurbier SM, van den Berg R, Troost D, Majoie CB, Stam J, Coutinho JM, et al.
Hydrocephalus in cerebral venous thrombosis. J Neurol 2015;262:931-7.
Leblebisatan G, Yiş U, Doğan M, Derundere U. Obstructive hydrocephalus resulting from cerebral venous thrombosis. J Pediatr Neurosci 2011;6:129-30. [Full text]
Chakor RT, Jakhere S, Gavai BY, Santhosh NS. Communicating hydrocephalus due to cerebral venous sinus thrombosis treated with ventriculoperitoneal shunt. Ann Indian Acad Neurol 2012;15:326-8.
] [Full text]
Weidauer S, Marquardt G, Seifert V, Zanella FE. Hydrocephalus due to superior sagittal sinus thrombosis. Acta Neurochir (Wien) 2005;147:427-30.
[Figure 1], [Figure 2]