17 March 2021>: Articles
Chronic Headache and Cerebral Venous Sinus Thrombosis Due to Varicella Zoster Virus Infection: A Case Report and Review of the Literature
Unusual clinical course
Laith Alamlih A* , Mohammad Abdulgayoom A , Suresh N. Menik Arachchige A , Mohammed Hamza Shah B , Muhammad Zahid ADOI: 10.12659/AJCR.927699
Am J Case Rep 2021; 22:e927699
Table 2. Patients with cerebral venous sinus thrombosis complicating varicella zoster primary infection.
Khan 2019 [15] | Mehta 2018 [16] | Imam 2017 [17] | Shrivastava 2016 [23] | Paul 2016 [18].2 | |
---|---|---|---|---|---|
26 | 20 | 39 | 18 | 37 | |
Male | Male | Male | Male | Male | |
2 weeks prior to presentation | 2 weeks prior to presentation | 7 days prior to presentation | 2 weeks prior to presentation | 3 weeks prior to presentation | |
Non | Non | ||||
No meningeal sign | Nuchal rigidity | Slight neck stiffness | Not mentioned | No meningeal signs | |
Not mentioned | Normal on the beginning then developed papilledema | Not mentioned | Bilateral papilledema | Not mentioned | |
Dural sinus thrombosis, involving left transverse, sigmoid sinuses, and internal jugular vein (IJV) | Extensive cerebral venous sinus thrombosis | Superior sagittal sinus, left transverse and sigmoid sinuses | Superior sagittal, right transverse and sigmoid sinus | ||
Hemorrhage and Brain edema | MRV T2 fluid attenuated inversion recovery (FLAIR) hyperintense area in the left tempo-parieto-occipital area, suggestive of subacute infarct (left MCA and posterior cerebral artery territory) with effacement of cortical sulci seen on the left side, suggestive of edema | Not mentioned | CT: Hyper density in Superior sagittal sinus. MRV: Thrombosis of superior sagittal sinus, left transverse and sigmoid sinuses | Right frontoparietal venous infarction | |
Normal | CSF was clear and the opening pressure was normal. CSF report showed normal leukocyte count of 5 cells/mm, all lymphocytes with mildly raised CSF protein (62.1 mg/dL) and with normal sugar (79 mg/dl). CSF IgM for VZV was positive | Not mentioned | Pleocytosis with 40 cells/mm, mildly raised protein 60 mg% and normal glucose | Not mentioned | |
Positive IgM | Mentioned to be positive | Not mentioned | Not mentioned | Not mentioned | |
Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | |
Pulmonary embolism | no | no | No | Right atrium thrombosis, Pulmonary embolism, left femoral and distal popliteal vein | |
No | Coagulation profile normal and homocysteine normal | No | Yes | Yes | |
Improved | Complete recovery | Complete recovery. | Complete recovery | He gradually improved. and day 12 total recovery | |
Paul 2016 [18].1 | Gayathri 2016 [19] | Sardana 2014 [20] | Mathew 2013 [13] | ||
30 | 23 | 30 | 33 | ||
Male | Male | Male | Female | ||
3 weeks prior to presentation | 2 weeks prior to presentation | 2 weeks prior to presentation | 16 days prior to presentation. | ||
None | |||||
Not mentioned | Nuchal rigidity (+ve Kernig sign) | Nuchal rigidity | Not mentioned | ||
Bilateral papilledema | Bilateral papilledema. | Normal | Bilateral papilledema | ||
Transverse sinus and sigmoid sinus on the right side | Superior sagittal, bilateral transverse and right sigmoid sinuses which extends into the straight sinus | Left transverse and sigmoid sinus | Right transverse, sigmoid and straight sinuses | ||
Hemorrhagic infarct in the right temporoparietal lobe with edema and mass effect | Venous hemorrhagic infarcts were seen in right frontoparietal cerebral parenchyma (largest 4 cm in length) and in right thalamus. Multiple lacunar infarcts in bilateral frontoparietal white matter | CT scan showed a hemorrhagic infarct in the left temporo-parietal lobe with edema and mass effect over the ipsilateral lateral ventricle. MRV with gadolinium hemorrhagic infarct with significant perilesional edema and adjacent meningeal enhancement in left tempo-parietal region with mass effect. Venography showed loss of normal signal intensity in transverse sinus and sigmoid sinus on left side | Magnetic resonance imaging and venography revealed thrombosis of right transverse, sigmoid, and straight sinuses without venous infarcts or hemorrhages | ||
Not mentioned | Pleocytosis with 20 cells/mm, mildly raised protein 60 mg%, and normal glucose (40 mg%).CSF VZV DNA by PCR was positive | Cell counts: 3 cells/mm; protein 46 mg%, and glucose 54 mg% | Not mentioned | ||
Not mentioned | Positive for IgG | Not mentioned. | Not mentioned | ||
Not mentioned | Positive IgG with reduced serum/CSF ratios of VZV IgG | Positive IgG Reduced serum/CSF ration of VZV IgG | Not mentioned | ||
No | No | No | No | ||
Low protein s | Yes | Yes | No | ||
Iv heparin followed with oral anticoagulation | |||||
He gradually improved over 3 weeks. | Improved | Headache and language function gradually improved over few days. Hemiparesis gradually improved over 4 weeks | Complete recovery | ||
Menon 2012 [14] | Sada 2012 [21] | Siddiqi 2012 [22].2 | Siddiqi 2012 [22].1 | ||
20 | 30 | 15 | 20 | ||
Female | Male | Male | Male | ||
Unclear | 15 days prior Presentation | 3 weeks prior to presentation | 1-week prior to presentation | ||
Non | |||||
Nuchal rigidity | Not mentioned. | Not mentioned. | No meningeal signs. | ||
Normal | Bilateral papilledema. | Not mentioned | Normal | ||
Superior sagittal and right transverse sinuses | Central venous sinus thrombosis | Central venous sinus thrombosis | |||
Hemorrhagic infarct in the left temporal lobe with edema and mass effect over the ipsilateral lateral ventricle. | CT: brain showed diffuse cerebral edema and hyper dense superior sagittal and right transverse sinuses. MRV: showed thrombosis of superior sagittal and right transverse sinuses | MRI revealed extensive CVST MRA showed focal area of narrowing in the left distal middle cerebral artery just before trifurcation with a relative paucity of the left Sylvian branches, suggesting vasculitis | Widespread CVST | ||
Pleocytosis with 40 cells/mm, mildly raised protein 60 mg%, and normal glucose | Not specifically mentioned | Normal | Normal | ||
Not mentioned | Positive IgG | Not mentioned | Not mentioned | ||
Not mentioned | Positive IgG with Reduced serum/CSF ratios of VZV IgG | Not mentioned | Not mentioned | ||
No | No | No | No | ||
Yes | yes | Yes | yes | ||
Total recovery | Complete recovery | Complete recovery | Complete recovery |