Features of dural sinus thrombosis simulating pseudotumor cerebri

To characterize dural sinus thrombosis (DST) patients presenting with a syndrome simulating pseudotumor cerebri (PTC), medical records of patients initially diagnosed as having PTC between 1980 and 1995 were analysed. Inclusion criteria were intracranial hypertension (IH) and a normal initial computed tomography (CT) scan. All patients underwent angiography or magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Patients with IH secondary to a determined disorder were excluded from the study. Forty-six patients were included, 12 patients had MRI/MRV or angiography findings compatible with DST and the remaining 34 patients had no vascular pathology on neuroimaging studies and were considered to have PTC. No clinical or auxiliary findings differed between the two groups except for younger age, which delineated the PTC patients. Two patients with DST died during the study. Both were agitated, had a relatively rapid course of symptom progression, and a CSF pressure of over 40 cm water. We conclude that DST can be identified in 26% of patients presenting with symptoms and signs typical of PTC. It may be impossible to differentiate between patients with and without DST if MRI/MRV or angiography are not performed in this scenario. Copyright Lippincott Williams & Wilkins     

Interobserver agreement in the magnetic resonance location of cerebral vein and dural sinus thrombosis

The interobserver variation in the magnetic resonance (MR) location of cerebral vein and dural sinus thrombosis (CVT) has not been previously reported. Four independent observers rated a convenience sample of 40 MR/MR angiographies to assess whether or not each dural sinus and major cerebral veins were occluded. Interobserver reliability was measured using κ statistics. Interobserver agreement was comparable between the six pairs of raters. Agreement was excellent for thrombosis of the deep cerebral venous system ( κ  = 1.00), cerebellar veins ( κ  = 1.00), superior saggital sinus ( κ range: 0.82–1) and right jugular vein ( κ range: 0.84–0.95); good to excellent for the right transverse/sigmoid sinus ( κ range: 0.75–0.90) and the left jugular vein ( κ range: 0.65–0.85); moderate to excellent for the left lateral sinus ( κ range: 0.59–0.78) and the straight sinus ( κ range: 0.59–0.92); poor to good for the cortical veins ( κ range: 0.02–0.65). Agreement between observers varies with the location of CVT. It is good or excellent for most of the occluded sinus and veins, except for the cortical veins. This study suggests that information on the location of CVT can be reliably collected and used in multicentre studies.     

硬脑膜静脉窦血栓形成的血管内介入治疗

目的 探讨硬脑膜静脉窦血栓形成(DVST)的血管内介入治疗。方法 11例由CT、MRI、DSA确诊的硬脑膜静脉窦血栓形成患者经皮股动、静脉穿刺给予介入治疗；围手术期规范抗凝、抗血小板聚集等综合治疗。结果 2例患者临床症状戏剧性改善，10例患者临床症状消失或好转，1例无变化；术后影像学均有不同程度的改善；1例机械辅助溶栓患者介入治疗时发生导丝断裂；1例机械辅助溶栓后置人支架未成功；术中、术后无其它相关并发症发生。出院时临床痊愈5例，显效3例，好转2例，无效1例。随访9例患者3～6月无复发。结论 多种介入方法联合治疗DVST的方法是可行的且安全有效。是值得在临床推广的治疗DVST的方法，其远期效果尚需观察。     

Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis

PurposeWe aimed to define the possible risk factors for acute and remote seizures in patients with cerebral vein and sinus thrombosis (CVST).MethodNinety-four patients were recruited prospectively at Al-Zahra Hospital, Isfahan, Iran, between April 2007 and April 2012. To identify seizure predictors, we compared demographic, clinical and imaging factors between patients with or without acute and remote seizures.ResultsOf the 94 patients, 32 (34%) experienced at least one seizure after CVST development. Bivariate analysis showed a significant association of remote seizure with loss of consciousness at presentation (P = 0.05, OR: 5.11, 95%CI: 1.07–24.30), supratentorial lesions (P = 0.02, OR: 9.04, 95%CI: 1.04–78.55), lesions in the occipital lobe (P = 0.00, OR: 12.75, 95%CI: 2.28–71.16), lesions in the temporal and parietal lobes, thrombophilia (P = 0.03, OR: 5.87, 95%CI: 1.21–28.39), seizure in the acute phase (P = 0.00, OR: 13.14, 95%CI: 2.54–201.2) and sigmoid sinus thrombosis (P = 0.00, OR: 12.5, 95%CI: 2.23–69.79). Seizures in the acute phase were also more common in patients with paresis (P = 0.00, OR: 4.88, 95%CI: 1.91–12.46), hemorrhagic lesions indicated by imaging (P = 0.02, OR: 2.77, 95%CI: 1.08–7.10), supratentorial lesions, lesions in the frontal (P = 0.01, OR: 3.81, 95%CI: 1.28–11.31) and parietal lobes (P = 0.00, OR: 5.16, 95%CI: 2–13.29), thrombophilia and history of miscarriage (P = 0.03, OR: 2.91, 95%CI: 1.07–7.91). No factor predicted acute or remote seizure in a multiple logistic regression analysis.ConclusionOur results demonstrate that seizure development in the acute phase is the most significant factor for development of remote seizure. Parenchymal lesions in the supratentorial area were also found to be associated with both acute and remote seizures. However, no factor was predictive of acute or remote seizures in a multivariate analysis.     

颅内静脉窦血栓形成的临床及影像学诊断25例报道

目的 研究颅内静脉窦血栓形成的病因、临床特点、特别是影像学的表现。方法 回顾性分析25例已确诊的静脉窦血栓形成患者（男2例,女23例）的临床资料及影像学特点,包括发病原因、临床表现、实验室检查及影像学头部CT、磁共振成像（MRI）和磁共振血管成像（MRA）的异常表现。结果 25例本病患者除2例男性外,余23例均有明确病因,如妊娠期、产褥期、口服避孕药等,临床表现以亚急性颅压高症状为主;部分头部CT可见条索征及空三征,MRI特征性表现为T1、T2加权像窦内异常高信号,MRA示栓塞的静脉窦未显影。结论 颅内静脉窦血栓形成患者多可找到明确病因,临床表现多样,无特异性,MRI/MRA可帮助确诊。     

Hormonal contraceptives as a risk factor for cerebral venous and sinus thrombosis

This review will focus on recent developments in our understanding of cerebral venous and sinus thrombosis (CVST), as a side effect of combined oral contraceptives (COCs) use. Case-control studies have shown an increased risk of CVST in women who use COCs, especially third-generation contraceptives that contain gestodene or desogestrel. Several studies have indicated that the combination of COCs and thrombophilia greatly increased the risk of CVST, particularly in women with hyperhomocysteinaemia, factor V Leiden and the prothrombin-gene mutation. Women with thrombophilia who developed CVST while taking oral contraceptives should be definitively advised to stop using COCs. These patients should be considered for preventive therapy with low doses of heparin in prothrombotic situations such as bed rest or pregnancy, and the duration of anticoagulation should be considered on a case-by-case basis. Patients may be considered candidates for chronic treatment with antiplatelet agents. The best and most cost-effective screening method for thrombophilia in women who are planning to conceive is selective screening based on the presence of previous personal or family history of either prior extracerebral or cerebral venous thromboembolism events.     

Spontaneous intracranial hypotension followed by dural sinus thrombosis: A case report

SIH is an underdiagnosed condition with variable clinical and radiological presentations that leads to engorged dural sinuses and promotes stasis predisposing for dural sinus thrombosis (DST). We describe a young female patient who presented with clinical and imaging signs of SIH alone followed by a superimposed DST 10 days later. We discuss the pathophysiological mechanisms that may have led to this constellation, and review the literature to-date along with diagnostic and management implications.     

颅内静脉窦血栓形成的诊治(附9例报告)

目的探讨颅内静脉窦血栓形成(CVST)临床表现、诊断及治疗。方法回顾性分析9例经影像学诊断为CVST的患者,行抗凝及血管内介入溶栓治疗。结果9例患者均有颅内压增高表现;3例癫痫发作;2例颅内出血;2例出现意识障碍;1例偏瘫。头部CT、MRI、MRV、DSA为诊断提供依据。8例应用低分子肝素治疗,1例进行血管内介入尿激酶溶栓治疗,同时进行肝素抗凝治疗。治疗后9例患者中7例症状完全缓解,2例症状明显好转。随访6例患者半年至2年,疗效稳定,无1例复发。结论CVST患者多有颅内压增高表现,及时行MRI、MRV及DSA检查,以明确诊断。抗凝治疗为首选治疗方法,血管内介入溶栓治疗协同抗凝治疗可提高疗效。     

脑静脉窦血栓形成的临床与治疗

目的:探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特征、影像特点及治疗。方法:分析34例脑静脉窦血栓形成病因、临床表现、影像特征及治疗。结果:本组病因依次为产褥期(58.8%)、感染(23.5%)、脱水(2.9%)、血液病(2.9%)、外伤(2.9%);头痛、恶心、呕吐为首发症状,查体视乳头水肿89.4%,癫痫发作44.1%,脑膜刺激征阳性35.3%,意识障碍26.5%,轻偏瘫5.9%,眼球突出伴活动障碍5.9%;头MRI、MRV均显示脑静脉窦血栓形成,2例行DSA检查发现双侧横窦血栓形成;本组在应用降颅压、抗感染等药物的同时,应用低分子肝素5000u,12小时一次,疗效显著,治愈25例(73.5%),好转3例,死亡6例。结论:产褥期、感染、脱水是CVST常见原因; CVST患者主要表现为高颅压症状;头MRI和MRV能清楚显示血栓形成部位;抗凝治疗是脑静脉窦血栓形成痊愈的关键。     

Dural sinus thrombosis in spontaneous intracranial hypotension

Dural sinus thrombosis (DST) is rarely associated with spontaneous intracranial hypotension (SIH). Engorgement of the venous system, caused by the CSF loss that occurs in SIH, is considered to favour the thrombosis, although signs of both SIH and DST are usually seen simultaneously at the first diagnostic MRI. We observed two patients with SIH and DST. Changes in pattern of headaches and MRI findings demonstrated that DST followed SIH. In SIH, the velocity of the blood flow in the dural sinuses may be reduced because of dilatation of the venous system which compensates the CSF loss. Other possible mechanisms seem unlikely on the grounds of both clinical presentation and MRI studies. Received in revised form: 6 December 2005     

外伤性脑静脉窦血栓形成

目的 探讨外伤性颅内静脉窦血栓形成（CVST）的特点及治疗策略。方法 对11例外伤所致CVST的诊断、治疗进行回顾性分析。结果 11例CVST患者4例继发于颅骨未骨折的闭合性脑损伤，7例继发于颅骨线形骨折；以头部胀痛、视力下降、癫痫发作为其主要临床表现；头颅MRI及MRV和脑血管造影检查为该病提供确诊依据；11例患者中4例行抗凝治疗，7例行血管内治疗；治疗后6例患者痊愈，4例好转，1例无效，无严重并发症发生。本组中9例病人接受门诊和电话随访6个月至3年，疗效稳定，无一例复发。结论 颅脑损伤后不明原因颅内压增高，尤其是并发颅骨骨折时，应警惕CVST发生，尽早行神经影像学检查以明确诊断，血管内治疗协同抗凝治疗可提高其疗效。     

脑静脉窦血管内治疗脑静脉窦血栓形成临床研究

目的对比静脉肝素抗凝与脑介入治疗脑静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析我院14例脑静脉窦血栓患者,按治疗方法分为介入组(脑静脉窦血管内治疗)和抗凝组(静脉肝素抗凝),每组7例,比较2组平均住院时间、血管完全再通率、mRS及并发症发生率。结果脑静脉窦介入组住院时间较抗凝组短,血管完全再通率高于抗凝组,mRS平均评分低于抗凝组,差异均有统计学意义(P0.05)。2组并发症发生率无显著差异(P0.05)。结论脑静脉窦血管内治疗可改善CVST患者的转归,疗效优于静脉肝素溶栓保守治疗。     

颅内静脉窦血栓形成的抗凝治疗临床分析

目的：探讨颅内静脉窦血栓形成（CVST ）的抗凝治疗效果。方法回顾分析我院2006-01-2013-10收治的124例CVST患者资料,其中病程≤8.5 d者64例,病程＞8.5 d者60例。所有患者接受抗凝治疗,采用普通肝素或低分子肝素0.4 mL （5000 U ）皮下注射,用量2次/d ,q12h;持续3～23 d（平均12 d）。比较治疗前后症状表现、腰穿结果,评估临床疗效,同时比较早期抗凝与晚期抗凝的效果。结果除言语障碍外,出院时患者各项主要症状的发生率均低于病程中发生率,差异均有统计学意义（P＜0.05）。其中37例患者进行腰穿初查及复查,复查时平均颅内压（260.24±64.79）mmH2 O ,低于初次腰穿颅内压（318.75±69.46）mmH2 O ,差异有统计学意义（P＜0.05）。总有效率90.32％,其中中早期抗凝痊愈率（71.88％）高于晚期（23.33％）（P＜0.05）。结论对CVST采用抗凝治疗安全有效,早期抗凝比晚期痊愈率高。     

脑静脉窦血栓形成伴颅内出血的治疗分析

目的 对比单纯抗凝和机械取栓联合局部溶栓治疗颅内静脉窦血栓形成(CVST)伴颅内出血患者的效果。方法 回顾性分析2014年6月-2018年6月武汉大学中南医院神经内科收治的28例CVST伴颅内出血患者的病例资料,根据其治疗方式分为单纯抗凝组(12例)和机械取栓组(机械取栓+局部溶栓+抗凝组16例),比较2组患者临床疗效、再通情况及预后。结果 机械取栓组的临床疗效、血管再通情况及预后均优于单纯抗凝组(P均<0.05),单纯抗凝组治疗后均未发现新发出血灶,机械取栓组仅有1例术后出现阴道出血。结论 对于合并有颅内出血的CVST患者,机械取栓联合局部溶栓治疗能有效促进静脉血流的恢复,缓解临床症状和改善预后。     

侧窦区硬脑膜动静脉瘘的血管内介入治疗

目的本文报道我科对连续收治的10例侧窦区(横窦和乙状窦)硬脑膜动静脉瘘(DAVF)行超选择性动脉内栓塞的初步经验。方法所有病人先进行脑血管造影,确诊为侧窦区DAVF后立即对供血动脉行超选择性造影术并用NBCA胶或PVA颗粒进行栓塞。结果10位病人进行16次栓塞治疗(有6例行2次),共对23根供血动脉进行了栓塞。其中8例采用NBCA胶,另2例采用PVA颗粒进行栓塞。8例栓塞后获得解剖学和临床治愈,另2例虽获临床治愈,但造影中仍可见少量病灶残留。4例伴有搏动性耳鸣和杂音者在首次栓塞后其症状和体征消失,其中1例搏动性耳鸣在第一次部分栓塞后2个月复发,但在第二次栓塞后消失。无一例病人在栓塞后出现并发症。结论超选择性动脉内栓塞治疗对于某些类型的侧窦区DAVF是一个安全、有效和微侵袭的治疗方法。     

矢状窦切开置管抗凝治疗颅内静脉窦血栓形成

颅内静脉窦通常因大脑的血液循环血流较快,不易造成血栓形成,但在外伤及一些高凝状态等情况下也可发生颅内静脉窦血栓形成(cranial venous sinUS thrombosis,CYST).     

矢状窦切开置管抗凝治疗颅内静脉窦血栓形成

颅内静脉窦通常因大脑的血液循环血流较快,不易造成血栓形成,但在外伤及一些高凝状态等情况下也可发生颅内静脉窦血栓形成(cranial venous sinUS thrombosis,CYST).     

矢状窦切开置管抗凝治疗颅内静脉窦血栓形成

颅内静脉窦通常因大脑的血液循环血流较快,不易造成血栓形成,但在外伤及一些高凝状态等情况下也可发生颅内静脉窦血栓形成(cranial venous sinUS thrombosis,CYST).     

Establishment of an animal model of dural venous sinus embolism*★

BACKGROUND： The pathological mechanism of secondary brain lesion following an embolism remains unclear. The establishment of an animal model that imitates the clinical pathophysiological processes is crucial to better study this disease during a certain time window. OBJECTIVE： To establish a new animal model of dural venous sinus embolism that is simple, has a high success rate, and emulates the pathophysiological course of clinical disease. DESIGN, TIME AND SETTING： A randomized block design trial was performed at the Department of Anatomy, Ningxia Medical College between March and December 2007. MATERIALS： Fifty-eight healthy, adult, Sprague Dawley rats were used in the present study. Plastic emboli, with a total length of 0.4 cm, were self-made. Each plastic embolus had a conical anterior segment; the largest diameter being 0.12 cm. The posterior segment became gradually thin and flat, with a width of 0.2 cm and length of 0.1 cm. METHODS： The fifty-eight rats were randomly divided into three groups： control （n = 6）, embolism （n = 26）, and sham-embolism （n = 26） groups. In the embolism group, a solid embolus was slowly inserted and fixed into the posterior part of the superior sagittal sinus against the flow of blood. The posterior segment was detained outside the superior sagittal sinus for fixing. In the sham-embolism group, rats were subjected only to sinus sagittalis superior exposure. In the control group, rats received no treatments. In both the embolism and the sham-embolism groups, the rat brains were resected at 6 hours, 1, 3, and 5 days post-surgery. MAIN OUTCOME MEASURES： （1） Brain surface appearance in the embolism and sham-embolism groups. （2） Thrombosis in the embolism group. （3） Cerebrospinal fluid content in the above-mentioned two groups. RESULTS： In the embolism group, the model success rate was 92% （24/26）. There was visible thrombosis in the superior sagittal sinus. Cerebral edema was noticeable under a microscope. These changes were visible at 6 h