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Michał Paradowski, Joanna Bladowska1,
Bogusław Paradowski
Departments of Neurology and 1Neuroradiology, Medical
University, Wroclaw, Poland
Address for correspondence:
Dr. Michał Paradowski,
Department of Neurology, Medical University, Wroclaw, Poland.
E‑mail: bogusparad@poczta.onet.pl
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix,
tweak, and build upon the work non‑commercially, as long as the author is credited
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Intraventricular vein thrombosis in a patient with
cerebral venous thrombosis
A 35‑year old female patient in her early puerperium presented
with subacute confusional state and benign intracranial
hypertension syndrome. Computed tomography (CT)
scan of the head showed sulcal effacement and an empty
delta sign without parenchymal lesions. The conventional
magnetic resonance imaging (MRI) demonstrated cerebral
venous thrombosis (CVT) of the superficial and deep
venous systems, along with an abnormal finding at the right
ventricular trigone suggestive of intraventricular choroidal
f
e a
b c d
Figure 1: (a) Sagittal T1‑weighted MRI depicting superficial and deep cerebral
venous thrombosis. (b-d) Axial T1‑weighted and FLAIR MRI with hyperintense
signal secondary to enlarged veins and ventricular wall edema in the right occipital
horn. (e and f) Sagittal T1‑weighted MRI and magnified image compatible with
thrombosis of the medial and lateral atrial veins
1442 Neurology India | Volume 65 | Issue 6 | November‑December 2017
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DOI:
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How to cite this article: Paradowski M, Bladowska J, Paradowski B.
MRI in a patient with sporadic Creutzfeldt–Jakob disease with over
72 months survival. Neurol India 2017;65:1441-2.
© 2017 Neurology India, Neurological Society of India | Published by Wolters Kluwer - Medknow
venous thrombosis [Figure 1a‑f]. On MR angiography and
venography, there was no evidence of tangles of blood
vessels, flow voids signals, or hemosiderin compatible with
brain arteriovenous malformation. The patient was placed on
anticoagulants and discharged after 10 days later with a mild
persisting headache. We consider that the involvement of the
intraventricular veins was due to the widespread deep venous
system thrombosis.
CVT is an uncommon cause of stroke with varied clinical
presentations, predisposing factors, and image findings.
Etiological factors can be acquired or genetic. Pregnancy and
puerperium are predisposing factors for CVT, and most events
occur during the third trimester and 6 weeks after delivery.[1‑2]
Here, we describe an uncommon radiological presentation of
CVT  which could also be considered with the wide spectrum
of imaging findings of this entity.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not be
published and due efforts will be made to conceal their identity,
but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB,
Elkind MS. Risk of a thrombotic event after the 6‑week ostpartum
period. N Engl J Med 2014;370:1307‑15.
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2. Dash D, Prasad K, Joseph L. Cerebral venous thrombosis: An Indian
perspective. Neurol India 2015;63:318.
José Luiz Ruiz‑Sandoval1,2,
Juan Didier Parada‑Garza1, Erwin Chiquete3,
Ricardo Marian‑Magaña1,
Gerardo Mauricio Figueroa‑Sánchez4
Servicio de Neurología. Hospital Civil de
1
Guadalajara “Fray Antonio Alcalde”, Guadalajara,
Jalisco, 2Instituto de Neurociencias
Traslacionales, Departamento de
Neurociencias. Centro Universitario
de Ciencias de la Salud. Universidad
de Guadalajara, Guadalajara, Jalisco,
3
Servicio de Neurología,
Instituto Nacional de Ciencias Médicas y
Nutrición “Salvador Zubiran”, Ciudad de México,
4
Servicio de Radiología.
Hospital Civil de Guadalajara “Fray Antonio Alcalde”,
Guadalajara, Jalisco, México
Address for correspondence:
Dr. José Luis Ruiz‑Sandoval,
Servicio de Neurología, Hospital Civil de Guadalajara “Fray
Rachipagus parasitic twin
We present an extremely rare entity of a rachipagus
parasitic twin. A 2‑year old male child presented to our
outpatient services with a heteropagus twin attached to the
dorsolumbar region (rachipagus) of host twin autosite. There
were two rudimentary limbs (right and left arrow) with a
single digit and a depression suggestive of an anal dimple
(diamond arrow, Figure 1). Two primary groups of conjoint
twins have been described – symmetric and asymmetric.
The former has both twins of almost equal proportion
Figure 1: Heteropagus twin attached to the dorsolumbar region (rachipagus) of
host twin autosite. There were two rudimentary limbs (right and left arrow) with a
single digit and a depression suggestive of an anal dimple (diamond arrow)
Neurology India | Volume 65 | Issue 6 | November‑December 2017 1443
Antonio Alcalde”, Calle: Hospital 278, Guadalajara Jalisco México.
E‑mail: jorulej‑1nj@prodigy.net.mx
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix,
tweak, and build upon the work non‑commercially, as long as the author is credited
and the new creations are licensed under the identical terms.
Access this article online
Quick Response Code
Website:
www.neurologyindia.com
DOI:
10.4103/0028-3886.217938
PMID:
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How to cite this article: Ruiz-Sandoval JL, Parada-Garza JD,
Chiquete E, Marian-Magaña R, Figueroa-Sánchez GM. Intraventricular
vein thrombosis in a patient with cerebral venous thrombosis. Neurol
India 2017;65:1442-3.
© 2017 Neurology India, Neurological Society of India | Published by Wolters Kluwer - Medknow
symmetrically disposed and joined by corresponding parts.
The latter, also termed as heteropagus, develops because
of differentially increased placental blood flow to one twin
and the consequent ischemic atrophy of the other twin
resulting in a fetal‑shaped lump, as well as accessory and
differentiated end organs attached to the host twin. This
entity most commonly affects female patients who usually
show the manifestation of a ventral thoracic attachment; the
dorsolumbar site of attachment (rachipagus) in male patients
is extremely rare. Two primary theories of its embryogenesis
exist:  (a) the fission; and,  (b) the fusion theory, with the
latter being more widely accepted.[1,2] The fission theory is
based on an incomplete separation of two monoamniotic
monozygotic twins, subsequent to an in‑utero stimulus at
developmental days 13 or 14. Contrary to that, the fusion
theory is based on the disruption of the ectodermal layer
between two developing monovular embryonic discs,
occupying opposite aspects of a common amniotic cavity,
thereby leading to fusion of two developing neural folds.
Possibility of accompanying malformations such as patent
ductus arteriosus, spinal dysraphism, atrial septal defect,
club foot, gall bladder hypoplasia, syndactyly, rectovaginal
fistula, and horse‑shoe kidney at the autosite of the healthy
twin should also be evaluated.[2] Rachipagus conjoint twins
are extremely rare, but this possibility should be considered in
the cases of well‑developed abnormal tissue on dorsal midline
of the spine. The differential diagnosis of a fetus‑in‑fetus or a
teratoma needs to be ruled out.