patients with recurrent varicose veins have both a higher prevalence and a greater number of incompetent perforating veins than patients with primary varicose veins.
Young stroke should alert clinicians to investigate for unusual causes.A previously well 43-year-old Caucasian female presented with 2 days of punctuated left sided weakness and sensory inattention. MRI demonstrated multiple territory infarcts, predominantly on the right side. With no vascular risk factors, high dose steroids were commenced assuming primary angiitis of the CNS (PACNS). Blood tests including ESR, HIV, an autoimmune and thrombotic screen and blood cultures were negative. A 24-hour ECG and TOE failed to identify an embolic source, though interval MRIs plus CT angi- ography revealed evolving cerebral and splenic infarcts. A DOAC was added. Retinal angiography did not support PACNS, nor did PET-CT though it did show an avid uptake large pelvic mass. Tumour markers CA 125 and CA 19–9 were markedly raised. Urgent gynaecological review was sought but the patient developed florid aortic regurgitation and further cerebral infarcts despite heparinisation. Repeat echocar- diography this time showed a dysplastic aortic valve. Pelvic mass excision confirmed adenocarcinoma.Non-bacterial thrombotic (marantic) endocarditis (NBTE) is a rare cause of embolic stroke. Systemic wasting from associated malignancy is hinted at in the etymology (Greek.marantikos= to waste away). Our patient remained ‘well’ and only the valve wasted away. Friable valve lesions in NBTE are prone to embolization and removal of the pro-coagulant tumour is the most effective treatment.sarah.cook18@nhs.net
AimTo present a case of cerebral venous sinus thrombosis (CVST) with an unusual aetiology.CaseA 56 year old female was referred from her optician with bilateral papilloedema. In the preceding 2 weeks she had developed a gradual onset severe occipital headache and blurred vision. She was also under investigation for an enlarging right sided neck lump. Examination confirmed the mass deep to the sternocleidomastoid muscle, bilateral papilloedema, reduced visual acuity and right cranial nerve VI palsy. MRI demonstrated external compression of the right internal jugular vein with associated thrombosis in the internal jugular vein and transverse sinus. LP showed raised intra-cranial pressure and provided some symptomatic benefit, although significant neurology remained. A diagnosis of non-metastatic squamous cell carcinoma of the tonsil was eventually achieved and therapeutic heparin commenced whilst the patient awaited definitive treatment.ConclusionCVST is an uncommon condition with a wide range of aetiologies. Predisposing factors can co-exist in one patient: along with a neoplastic state, here, the growing tumour caused external compression of the jugular venous system, leading to venous stasis and the eventual development of a CVST.
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