Cases reported "Venous Thrombosis"

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1/10. Postpartum headache after epidural blood patch: investigation and diagnosis.

    Use of an epidural blood patch to treat spinal headache after accidental dural puncture is well recognized. The high success rate associated with this practice has been questioned and it is not uncommon for patients to suffer recurring headaches after a supposedly successful blood patch. We describe a patient in labour who suffered accidental dural puncture, and whose headache was treated twice with an epidural blood patch. Despite this, the headache persisted. The case highlights the difficulty in the diagnosis of headache in the postnatal period in patients who have had regional analgesia and the importance of considering an alternative pathology, even if epidural blood patching has been successful. In this case, a diagnosis of cortical vein thrombosis was made. The incidence, presentation, aetiology and treatment of this rare condition is described.
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2/10. Changing pattern of headache pointing to cerebral venous thrombosis after lumbar puncture and intravenous high-dose corticosteroids.

    OBJECTIVE: To emphasize the diagnostic importance of change in the headache pattern which pointed to cerebral venous thrombosis in two patients after lumbar puncture and high-dose intravenous methylprednisolone for suspected multiple sclerosis. RESULTS: Both patients had a diagnostic lumbar puncture for suspected multiple sclerosis and were treated with high-dose intravenous methylprednisolone. Both developed a postlumbar puncture headache that was initially postural, typical of low cerebrospinal fluid pressure. Three days later, the headache became constant, lost its postural component, and was associated with bilateral papilledema. magnetic resonance imaging of the brain disclosed superior sagittal and lateral sinuses thrombosis. The diagnostic difficulties of such cases and the potential role of lumbar puncture and corticosteroids as risk factors for cerebral venous thrombosis are discussed. CONCLUSIONS: When a typical postdural puncture headache loses its postural component, investigations should be performed to rule out cerebral venous thrombosis, particularly in the presence of other risk factors.
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3/10. lead insertion by supraclavicular approach of the subclavian vein puncture.

    Total occlusion of the left subclavian vein was diagnosed in a 76-year-old patient, 6 years after implantation of an ICD with VVI pacing backup. Replacement of the ICD included upgrading of the ICD system because of the presence of pacemaker syndrome when the patient was VVI paced. Insertion of an atrial lead through the ipsilateral vein system was made possible by using the supraclavicular approach of the subclavian, enabling puncturing of the left subclavian vein medially to the obstruction.
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4/10. Combined computed tomographic pulmonary angiography and venography for evaluation of pulmonary embolism and lower extremity deep venous thrombosis: report of two cases.

    pulmonary embolism (PE) and deep venous thrombosis (DVT) are major causes of morbidity and mortality, which can be reduced with accurate diagnosis and proper treatment. More than 90% of PEs originate in lower-extremity DVT. Currently, evaluation of PEs and lower-extremity DVT requires 2 separate tests (ventilation-perfusion scan, computed tomographic pulmonary angiography (CTPA), or pulmonary angiography for PE and sonography, computed tomographic venography (CTV), conventional venography, or magnetic resonance venography for DVT). Combined computed tomographic pulmonary angiography and venography (CTPAV) is a new diagnostic technique that combines CTPA and CTV into a single study for the screening of PE and subdiaphragmatic DVT. CTPAV is a modified CTPA study that evaluates the subdiaphragmatic deep vein system at the time of CTPA, without additional venipuncture or contrast medium. It is easy to perform, fairly easy to interpret, readily available, and requires no invasive procedure. We present 2 cases of multiple PE and lower-extremity DVT in which CTPAV was used.
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5/10. Cerebral venous thrombosis in four patients with multiple sclerosis.

    We report four new cases of cerebral venous thrombosis (CVT) occurring in patients with multiple sclerosis (MS). Each patient had undergone lumbar puncture at varying times prior to clinical presentation (4 days to over 1 year). Only two of the patients had received intravenous (i.v.) methylprednisolone 48 h prior to CVT and were under oral contraception, a risk factor for cerebral thrombophlebitis. The other two patients had not undergone recent lumbar puncture, were not taking corticosteroids and did not present vascular risk factors. The patients all had normal routine blood work-ups and none had thrombophilia. All patients dramatically improved with full systemic heparinization. Minor sequelae were noticed in two patients. The pathogenesis underlying the occurrence of CVT in MS patients remains unclear and we discuss the relationship between lumbar puncture, steroid treatment and CVT.
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6/10. Translumbar high inferior vena cava access placement in patients with thrombosed inferior vena cava filters.

    Venous access is a dire necessity in some patients such as those with end-stage renal disease or short gut syndrome. The right internal jugular vein is the preferred entry site for tunneled central venous catheters. Alternatively, the left internal jugular is considered next, with the external jugular and subclavian veins being considered later. Catheter-related venous stenosis approaches 40% in certain sites, resulting in loss of access sites. As sites are lost, insertion of functional long-term central venous catheters becomes challenging. Translumbar inferior vena cava (IVC) access created in two patients with limited venous access sites who had thrombosed IVCs containing IVC filters is described. Because of the higher IVC punctures in these cases, procedural planning with cross-sectional imaging is crucial to avoid puncturing the right renal artery as it passes posterior to the IVC.
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7/10. Upper-extremity deep venous thrombosis complicating whole-blood donation.

    BACKGROUND: Up to 36 percent of blood donors may experience a donation-related complication. fatigue, bruises, hematomas, and vasovagal reactions comprise the great majority of donor reactions and injuries. Serious complications are rare. CASE REPORT: A 20-year-old female taking the third-generation oral contraceptive desogestrel/ethinyl estradiol and ethinyl estradiol (Mircette) developed bruising and increased pain and swelling of her right arm over a 5-day period after whole-blood donation. She was a first-time donor and the venipuncture was reported as being mildly traumatic. There was no personal or family history of thrombosis. RESULTS: Ultrasound examination of her upper extremity revealed the presence of a deep venous thrombosis that required treatment with enoxaparin sodium for 5 days and warfarin for 6 months. Evaluation for thrombophilia was negative. The only risk factor for thrombosis was use of oral contraceptives. CONCLUSION: Although serious complications from whole-blood donation are rare, they may occur. Deep venous thrombosis should be considered in a donor presenting with increasing pain and swelling after blood donation.
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8/10. Deep vein thrombosis in the arm following transradial cardiac catheterization: an unusual complication related to hemostatic technique.

    Transradial cardiac catheterization is an increasingly popular technique mainly because of the low vascular complication rate. We report a case of arm deep vein thrombosis that may be related to a common puncture site hemostasis technique. This complication supports the use of specific unilateral compression hemostatic systems following transradial procedures.
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9/10. Cerebral venous thrombosis and demyelinating diseases: report of a case in a clinically isolated syndrome suggestive of multiple sclerosis onset and review of the literature.

    Cerebral venous thrombosis (CVT) has been described in several cases of clinically definite multiple sclerosis (MS). In the majority of these, lumbar puncture followed by intravenous corticosteroid treatment was suspected as the cause. We report what is, to our knowledge, the first case of a patient with a multifocal clinically isolated syndrome suggestive of MS onset, who developed multiple CVT after lumbar puncture and during high-dose i.v. corticosteroid treatment We conclude that the sequence 'lumbar puncture followed by corticosteroid treatment' may be a contributory risk factor for the development of CVT when associated with other risk factors.
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10/10. A false aneurysm mistaken for a DVT after hip surgery.

    False or pseudoaneurysm formation usually occurs after traumatic, iatrogenic or infective injury to the arterial wall. Despite the high incidence of pseudoaneurysm formation secondary to puncture injury to the common femoral artery false aneurysm formation of the profunda femoris artery (PFA) is a rare complication and has not been previously reported as a complication of orthopaedic surgery. We present a patient who developed a false aneurysm of the PFA secondary to arterial damage caused by a bone fragment dislodged during orthopaedic surgery for fracture of the femur.
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