Objective?To explore the clinical and imaging features of cranial venous sinus thrombosis (CVST). MethodsThe clinical data of 20 patients with CVST treated between January 2008 and December 2012 were retrospectively analyzed, including the clinical manifestations, neuroimaging characters and treatment outcomes. ResultsAmong the 20 patients, there were 10 infected cases; D-dimer was detected positively in only 2 cases; cerebrospinal fluid pressure increased in 13 patients; and red blood cell population of cerebrospinal fluid increased in 12 patients. The common clinical symptoms included headache in 16 cases, eye symptoms in 12 cases, and vomiting in 10 cases. CT showed the direct signs of CVST in 3 cases, and MRI showed the direct signs of CVST in 6 cases. The common disease regions were in left transverse sinus and sigmoid sinus in 5 cases, superior sagittal sinus in 5 cases, and multiple venous sinus in 5 cases. Eighteen patients only received anticoagulation, and 2 received anticoagulation and local thrombolytic treatment. Fourteen cases recovered fully, 6 had dysfunctions. ConclusionThe clinical manifestations of CVST are nonspecific. This disorder predominantly affects childbearing women. Infection is a common cause of CVST. The occlusive venous sinus can be confirmed by enhanced magnetic resonance venography or digital subtraction angiography. Anticoagulation and local thrombolytic therapy are both proved to be safe and effective in the treatment of CVST. The early diagnosis rate of CVST remains to be improved.
Objective To make an evidence-based remedy for a patient with cerebral veins and sinuses thrombosis (CVST), who had an unsatisfactory response to routine treatment. Methods We searched the Cochrane Library (Issue 3, 2005), PubMed (1966 to 2005), CNKI (1979 to 2005) and VIP (1989 to 2005) to identify systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies about efficacy and safety of anticoagulants and thrombolysis therapy for CVST. Results We found 1 systematic review, 3 RCTs and 8 prospective cohort studies about anticoagulation therapy and 2 SRs and 1 CCT about thrombolysis therapy. Routine anticoagulation and thrombolysis for patients with CVST are not recommended due to insufficient evidence. Anticoagulation appeared to be safer and could prevent pulmonary embolism. According to the current evidence, the patient’s status and will, anticoagulants were given. His symptoms relieved and he had no subsequent hemorrhages or pulmonary embolism. Conclusion Patients with CVST should receive anticoagulation treatment with monitoring of de novo hemorrhages and the index of hemostasis and coagulation. Large-sample RCTs comparing the effect and safety of anticoagulant with placebo and RCTs comparing the effect and safety of anticoagulation therapy with that of endovascular thrombolysis therapy in high-risk patients are needed.
In recent years, with the development of neuroimaging and the improvement of people’s awareness, the incidence of cerebral venous sinus thrombosis (CVST) has been increasing year by year. CVST with venous infarction or haemorrhage is severe, accounting for about 60% of CVST, and its clinical manifestations are serious. The current therapies including anticoagulation and intravascular treatment have not significantly improved the prognosis of severe CVST patients. The incidence of long-term poor prognosis (modified Rankin scale score≥2) is up to 56.1%. Recent research indicates that inflammation may be an important factor leading to severe CVST and is significantly associated with poor prognosis. Anti-inflammatory treatment with glucocorticoids may provide a novel method for severe CVST, but further clinical studies are needed to verify it. This paper introduces the relationship between inflammation and severe CVST in order to explore the feasibility of glucocorticoid for severe CVST.
ObjectiveTo explore the features of images by CT,MRI,and MRV for early cranial venous sinus thrombosis (CVST) to provide the diagnostic evidence for choosing an optimal imaging examination. MethodsThe clinical data (imaging features of CT,MRI,and MRV) of 46 patients with CVST diagnosed between January 2009 and January 2013 were retrospectively analyzed. ResultsBrain CT showed the direct signs of CVST in 15 cases (32.6%),and indirect signs of CVST in 8(17.4%).MRI showed the signs of CVST in 17 cases (68.0%);the diagnostic positive rate of MR venography (MRV) combined with MRI was 87.5%,84.6% of which was in line with that of digital subtraction angiography. ConclusionCT can be used as screening tool for those highly suspect CVST cases.MRI combined with MRV show great diagnostic value for CVST.