Journal Of Cardiovascular, Neurovascular & Stroke

CEREBRAL VENOUS SINUS THROMBOSIS: UNUSUAL CLOT-FORMING PHENOMENON POST HEAD TRAUMA

Khoo Im — 2024-09-30

Introduction/ Background: Cerebral venous sinus thrombosis (CVST) is commonly seen in daily practice, especially in those with predisposing factors. Clinicians might miss the diagnosis if there is a low index of suspicion during clinical assessment of head injury cases, particularly in those without the risk factor.

Case Report: We report a case of a post-traumatic head injury with skull fracture and subarachnoid haemorrhage complicated with delayed, countercoup cerebral venous sinus thrombosis in the context of no predisposing factor for thrombosis. He was started on anticoagulant and achieved clinical improvement within a week.

Discussion: CVST is seen in post head trauma patients regardless of severity of the injury. Presence of neurological deficit post head injury like altered mental status, headache, vomiting or focal neurological signs like hemiparesis raised the suspicious of CVST. Occurrence of CVST can be delayed up to more than 10 days post trauma and it can happen at the opposite site of the trauma.

Conclusion: High suspicion index is needed to diagnose CVST early and subsequently early intervention or treatment could improve clinical outcome and prognosis of the patients.

IATROGENIC SMALL BOWEL HEMORRHAGE TREATED WITH TRANSCATHETER ARTERIAL EMBOLIZATION

dang nguyen — 2024-09-30

Case presentation: A 74 years-old male patient had abdominal pain. He was diagnosed with cholangitis and biliary obstruction due to pacreatic head tumor. He then experienced a Whipple surgery for the pacreatic head and D2 duodenal removal, choledochojujenal anastomosis. Elevent days after the surgery, he had a hypovolemic shock with a hemoperitoneum. There was a suspicious bleeding from the resected arteries at the sutured sites. An abdominal computed tomography angiography (CTA) was performed and the hemorrhagic pseudoaneurysmal artery was identified. He was immediately sent to the angio-suite for the embolization. The bleeding branch of the right gastric artery carrying a pseudoaneurysm was embolized with 2 coils. Check angiogram show complete oclusion of the pseudoaneurysm without any complications. He was doing well after the procedure and was discharged uneventfully after several days.

Conclusion: Transcatheter aterial embolization had shown its effectiveness in the treatment of the postoperative iatrogenic gastrointestinal bleeding. Its technical simplicity makes it more advantageous outweighting a repeat of a surgery especially in the high-risk patients with multiple comorbidities. The development of interventional devices and technology are able to facilitate the procedure, reducing procedure time and could make it be the first-line treatment for the dilematic cases.

Editorial

Prof Dr Khairul Azmi Abd Kadir — 2024-09-30

An address by Prof. Dr. Khairul Azmi Abdul Kadir