MR angiographic diagnosis of cerebral venous sinus thrombosis following allogeneic bone marrow transplantation

Abstract

Summary:Allogeneic bone marrow transplantation is frequently associated with neurological complications, particularly intracerebral bleeds and infections. Cerebral venous sinus thrombosis has only rarely been reported following allogeneic transplants. We report three cases of cortical venous thrombosis following allografting for acute lymphoblastic leukaemia. Two patients received marrow from HLA-identical siblings and one from an unrelated donor. Two of the patients presented with grand mal seizures and one presented with a headache. No neurological abnormalities were found upon clinical examination and lumbar puncture was normal in all three cases. In two of the patients computed tomography (CT) of the brain was normal and in the third showed non-specific abnormalities. Magnetic resonance imaging (MRI) with MR angiography (MRA) demonstrated cerebral venous sinus thrombosis in all three patients. In conclusion, cerebral venous sinus thrombosis should be considered in the differential diagnosis when neurological symptoms occur following allogeneic bone marrow transplantation. We therefore advocate the use of MRA for unexplained neurological symptoms post-allograft since without it cerebral venous sinus thrombosis may easily be missed. Bone Marrow Transplantation (2000) 25, 791-795.

Cerebral venous sinus thrombosis after allogeneic stem cell transplantation

“…Only a few cases were reported about thrombocytopenia complicated with CVST, and it has been described that thrombocytopenia in this setting may be influenced by not only CVST but also SCT [4]. However, CVST may be a main cause of thrombocytopenia in our case because recovery of the platelet count occurred after anticoagulant therapy.…”

“…MR angiography was also useful for diagnosing this complication following allogeneic HSCT in previous reports [3,4]. The consensus treatment for CVST is administration of either intravenous heparin or subcutaneous low molecular weight heparin during the acute phase and an oral vitamin K antagonist (warfarin) during the chronic phase to prevent recurrence [5,6].…”

“…There was no sinusitis/mastoiditis, oral contraceptive use, or systemic infection in the present patient. The occurrence of CVST following allogeneic HSCT is rare and only six such patients have been described [3,4]. CsA was used in the previous patients as GVHD prophylaxis and was continued after the diagnosis of CVST for a median of 43.5 days (range 25-208 days).…”

“…Complications that affect the central nervous system (CNS) can include infection in immunocompromised hosts, cerebrovascular events such as subdural hematoma or stroke, calcineurin-induced CNS neuropathy, and leukoencephalopathy resulting from intrathecal chemotherapy or cranial irradiation [2]. Cerebral venous sinus thrombosis (CVST) is a relatively rare complication after allogeneic HSCT [3,4] and its pathogenesis is still unclear. Here, we describe a patient who developed CVST during immunosuppressive therapy for chronic graft-versus-host disease (GVHD) after allogeneic HCST.…”

Cerebral venous sinus thrombosis after allogeneic stem cell transplantation

“…Only a few cases were reported about thrombocytopenia complicated with CVST, and it has been described that thrombocytopenia in this setting may be influenced by not only CVST but also SCT [4]. However, CVST may be a main cause of thrombocytopenia in our case because recovery of the platelet count occurred after anticoagulant therapy.…”

“…MR angiography was also useful for diagnosing this complication following allogeneic HSCT in previous reports [3,4]. The consensus treatment for CVST is administration of either intravenous heparin or subcutaneous low molecular weight heparin during the acute phase and an oral vitamin K antagonist (warfarin) during the chronic phase to prevent recurrence [5,6].…”

“…There was no sinusitis/mastoiditis, oral contraceptive use, or systemic infection in the present patient. The occurrence of CVST following allogeneic HSCT is rare and only six such patients have been described [3,4]. CsA was used in the previous patients as GVHD prophylaxis and was continued after the diagnosis of CVST for a median of 43.5 days (range 25-208 days).…”

“…Complications that affect the central nervous system (CNS) can include infection in immunocompromised hosts, cerebrovascular events such as subdural hematoma or stroke, calcineurin-induced CNS neuropathy, and leukoencephalopathy resulting from intrathecal chemotherapy or cranial irradiation [2]. Cerebral venous sinus thrombosis (CVST) is a relatively rare complication after allogeneic HSCT [3,4] and its pathogenesis is still unclear. Here, we describe a patient who developed CVST during immunosuppressive therapy for chronic graft-versus-host disease (GVHD) after allogeneic HCST.…”

Brain MR imaging abnormalities in pediatric patients after allogeneic bone marrow transplantation

“…Cerebral venous sinus thrombosis should be considered in the differential diagnosis when neurological symptoms occur following BMT (17). In our study 1 case (3.03%) complained of headache on day 5 post transplant, and MRV showed thrombosis of the superior sagittal sinus, which recanalized in the follow up studies.…”

Cerebral venous sinus thrombosis after allogeneic stem cell transplantation

“…Only a few cases were reported about thrombocytopenia complicated with CVST, and it has been described that thrombocytopenia in this setting may be influenced by not only CVST but also SCT [4]. However, CVST may be a main cause of thrombocytopenia in our case because recovery of the platelet count occurred after anticoagulant therapy.…”

“…MR angiography was also useful for diagnosing this complication following allogeneic HSCT in previous reports [3,4]. The consensus treatment for CVST is administration of either intravenous heparin or subcutaneous low molecular weight heparin during the acute phase and an oral vitamin K antagonist (warfarin) during the chronic phase to prevent recurrence [5,6].…”

“…There was no sinusitis/mastoiditis, oral contraceptive use, or systemic infection in the present patient. The occurrence of CVST following allogeneic HSCT is rare and only six such patients have been described [3,4]. CsA was used in the previous patients as GVHD prophylaxis and was continued after the diagnosis of CVST for a median of 43.5 days (range 25-208 days).…”

“…Complications that affect the central nervous system (CNS) can include infection in immunocompromised hosts, cerebrovascular events such as subdural hematoma or stroke, calcineurin-induced CNS neuropathy, and leukoencephalopathy resulting from intrathecal chemotherapy or cranial irradiation [2]. Cerebral venous sinus thrombosis (CVST) is a relatively rare complication after allogeneic HSCT [3,4] and its pathogenesis is still unclear. Here, we describe a patient who developed CVST during immunosuppressive therapy for chronic graft-versus-host disease (GVHD) after allogeneic HCST.…”

Brain MR imaging abnormalities in pediatric patients after allogeneic bone marrow transplantation

“…Cerebral venous sinus thrombosis should be considered in the differential diagnosis when neurological symptoms occur following BMT (17). In our study 1 case (3.03%) complained of headache on day 5 post transplant, and MRV showed thrombosis of the superior sagittal sinus, which recanalized in the follow up studies.…”

Cerebral venous sinus thrombosis after allogeneic stem cell transplantation

“…Only a few cases were reported about thrombocytopenia complicated with CVST, and it has been described that thrombocytopenia in this setting may be influenced by not only CVST but also SCT [4]. However, CVST may be a main cause of thrombocytopenia in our case because recovery of the platelet count occurred after anticoagulant therapy.…”

“…MR angiography was also useful for diagnosing this complication following allogeneic HSCT in previous reports [3,4]. The consensus treatment for CVST is administration of either intravenous heparin or subcutaneous low molecular weight heparin during the acute phase and an oral vitamin K antagonist (warfarin) during the chronic phase to prevent recurrence [5,6].…”

“…There was no sinusitis/mastoiditis, oral contraceptive use, or systemic infection in the present patient. The occurrence of CVST following allogeneic HSCT is rare and only six such patients have been described [3,4]. CsA was used in the previous patients as GVHD prophylaxis and was continued after the diagnosis of CVST for a median of 43.5 days (range 25-208 days).…”

“…Complications that affect the central nervous system (CNS) can include infection in immunocompromised hosts, cerebrovascular events such as subdural hematoma or stroke, calcineurin-induced CNS neuropathy, and leukoencephalopathy resulting from intrathecal chemotherapy or cranial irradiation [2]. Cerebral venous sinus thrombosis (CVST) is a relatively rare complication after allogeneic HSCT [3,4] and its pathogenesis is still unclear. Here, we describe a patient who developed CVST during immunosuppressive therapy for chronic graft-versus-host disease (GVHD) after allogeneic HCST.…”

Brain MR imaging abnormalities in pediatric patients after allogeneic bone marrow transplantation

“…Cerebral venous sinus thrombosis should be considered in the differential diagnosis when neurological symptoms occur following BMT (17). In our study 1 case (3.03%) complained of headache on day 5 post transplant, and MRV showed thrombosis of the superior sagittal sinus, which recanalized in the follow up studies.…”