Headache in cerebral venous thrombosis

Neurological Sciences - In the past, cerebral venous thrombosis (CVT) was considered a rare, devastating disease. The widespread use of angiography, magnetic resonance imaging (MRI) and magnetic...     

脑深静脉血栓形成两例临床和病理报告

目的：分析脑深静脉血栓形成（DCVT）的临床和病理物点。方法：分析2例患者的临床床及尸检资料,结果：本病临床常表现呼精神障碍。CT、CT血管造影（CTA）、MRI和磁共振血管造影（MRA）等使早期临床诊断成为可能。早期诊断抗凝、溶栓治疗使本病预后趋于良好。DCVT往往累及整个深静脉表现各异,首发症状多为头痛、意识和精神障碍,CT检查显示双侧基底节或丘脑梗死;CTA或MRI（MRA）检查能够辅助临床诊断,早期抗凝和溶栓治疗使预后趋于良好。     

Diffusion-weighted mr in cerebral venous thrombosis

The diagnosis of cerebral venous thrombosis is often difficult both clinically and radiologically and until now there is no method available to predict if brain lesions, detected clinically and using conventional brain imaging methods, may lead to full recovery, as expected in vasogenic edema or ischemic infarcts and even a hematoma. New fast neuroimaging techniques such as diffusion-weighted imaging (DWI) are sensitive to different reasons of changes in local tissular water concentration thus giving further insight into the pathophysiological mechanism as well as prognosis of cerebral venous thrombosis. We report the cases of 18 consecutive patients with a diagnosis of cerebral venous thrombosis based on clinical and imaging criteria. All patients underwent magnetic resonance imaging (MRI) of the brain, which comprised isotropic diffusion-weighted MR. Diffusion-weighted MRI showed positive findings in 17/18 cases. In 7 cases the clot could be directly visualized as an area of hyperintensity in the affected vein on DWI. In 7 cases DWI showed areas of signal loss corresponding to hematomas. In 6 cases DWI showed changes in signal intensity that were more subtle. In 4 cases of superficial venous thrombosis, there were areas of decreased ADC values (0.65-0.79 x 10(-3) mm(2)/s) whereas in 2 cases of deep venous thrombosis, increased DWI intensities could be found that corresponded to both an increase and a decrease in ADC, corresponding to a coexistence of cytotoxic and vasogenic edemas. Diffusion-weighted MRI can demonstrate directly the presence of an intravenous clot in a select number of patients. It can also demonstrate early ischemic changes, and can differentiate conventional T2-weighted MR areas of cytotoxic from vasogenic edema.     

脑静脉系统血栓患者的脑血流动力学研究

目的观察脑静脉系统血栓(CVT)的脑静脉血流动力学变化。方法采用Doppler超声对患者进行脑静脉血流动力学前瞻性研究,测定51例患者(分3组)脑基底静脉(BVR)及其属支大脑中深静脉(DMCV)的最大平均血流速度(Vmax)。第一组为33例CVT,除诊断性探测外,对其中12例经过溶栓治疗者进行动态监测;第二组为11例存在颅内压增高而无CVT者;第3组为6例脑静脉窦结构变异而无CVT者。对3组患者均进行磁共振检查,并经数字减影血管造影或磁共振静脉血管成像证实诊断。结果第一组BVR和DMCV流速分别为( 64 6±22 9 )cm/s和( 70 7±28 6 )cm/s,明显高于正常值(P<0 01),但不受颅内压变化的影响(r=0 06, P>0 05),经溶栓治疗两静脉流速明显下降(P<0 01);第二组两静脉流速分别为(11 4±2 7)cm/s和(10 2±2 8 )cm/s,均在正常范围(P>0 05 ),不受颅内压变化的影响(r=0 053,P>0 05 );第三组两静脉流速分别为(12 0±4 6)cm/s和(11 1±6 8)cm/s,均在正常范围(P>0 05)。结论脑静脉血流动力学研究发现,BVR或DMCV血流速度代偿性增高是CVT特征性表现,不受颅内压增高及脑静脉窦结构变异的影响,可为CVT的早期诊断、病情监测和疗效观察提供可靠、无创和经济的检测手段。     

Recanalisation of cerebral venous thrombosis

OBJECTIVE: To investigate recanalisation in the first 12 months after cerebral venous thrombosis. METHODS: 33 consecutive patients presenting with cerebral venous thrombosis were enrolled in the study. Diagnosis was made by magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or catheter angiography. Patients were initially treated with intravenous heparin. Warfarin was given for at least four months. Cerebral MRI and MRV were done at four months and repeated after 12 months if venous thrombosis persisted. Outcome was evaluated by the Rankin scale at 12 months. RESULTS: Outcome at 12 months was good, with a median modified Rankin scale score of 0 (range 0 to 2); 27 patients (82%) had no residual deficits. No patient suffered recurrent cerebral venous thrombosis, deep vein thrombosis, or pulmonary embolism during follow up. After four months, all deep cerebral veins and cavernous sinuses, 94% of superior sagittal sinuses, 80% of straight sinuses, 73% of jugular veins, 58% of transverse sinuses, and 41% of sigmoid sinuses had recanalised. No further recanalisation was observed thereafter. CONCLUSIONS: The results suggest that recanalisation only occurs within the first four months following cerebral venous thrombosis and not thereafter, irrespective of oral anticoagulation.     

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。     

Headache in patients with cerebral venous thrombosis

Headache is the most frequent symptom of cerebral venous thrombosis. They do not have particular characteristics and can mimic other numerous varieties of headache. Frequently associated with other neurological symptoms, such as intracranial hypertension, seizures, focal deficits or disorders of consciousness, they are sometimes isolated, which stresses the need for investigations in all recent and unusual headache.     

Deep cerebral venous system thrombosis in adults

Two fatal cases of deep cerebral venous system thrombosis are reported in adults. The first case looked like a diencephalic tumor or encephalitis but the diagnosis was made antemortem by means of cerebral angiography. Autopsy found bilateral infarction of basal ganglia. The second patient presented with a hemorrhagic infarction of right thalamus and basal ganglia. Deep cerebral venous occlusion was diagnosed at autopsy. In spite of a few cases of survival, the thrombosis of the galenic system remains often fatal. The pathological changes and indications for anticoagulation are discussed.     

Thromboelastography in patients with cerebral venous thrombosis

IntroductionCerebral venous thrombosis (CVT) is a rare presentation of venous thrombosis and has been associated with many conditions. In about 20% no risk factor is identified. The aim of this study was to assess the clot formation by thromboelastography (TEG) in patients with a history of CVT compared with healthy controls.Materials and MethodsTEG analysis was performed on recalcified blood samples of 19 CVT patients from a single centre cohort and 1:1 sex/ age (± 3 year) matched controls. Four TEG parameters were monitored: reaction time (r) to clot initiation, time to reach a 20 mm level of clot formation (K), slope angle alpha from r to K (α) and maximum vertical amplitude (MA). Patients were tested for thrombophilic defects, including deficiencies of antithrombin, protein C and protein S, factor V Leiden, prothrombin G20210A mutation, lupus anticoagulant, antiphospholipid antibodies, and high factor VIII levels.ResultsThrombophilia testing identified a prothrombotic abnormality in 11 patients (58%). Sixteen patients (84%) had one or more transient risk factor. There were no significant differences in TEG parameters between CVT patients and controls, neither between the subgroup of patients with a thrombophilic defect and controls. Seven of all patients (37%), including 5 patients with abnormal thrombophilia testing, and 5 controls (26%) had one or more TEG hypercoagulable parameters.ConclusionsA persistent hypercoagulable state which could have predisposed to venous thrombosis in CVT patients and in the subgroup of patients with a thrombophilic defect could not be demonstrated by TEG.     

Recanalisation and outcome cerebral venous thrombosis

Little is known of the natural history and rate of sinus recanalisation after cerebral venous thrombosis (CVT). Although acute anticoagulation is effective, the duration of therapy remains speculative. We aimed to determine the relationship between sinus recanalisation and clinical outcome. We studied 12 consecutive patients with aseptic CVT with evidence of sinus thrombosis on initial magnetic resonance imaging, followed up 5-68 months after onset, using 15 repeat magnetic resonance scans in 9 of the patients to assess recanalisation. All patients initially had one or more thrombosed sinuses and were treated with anticoagulants for at least 6 months, including 3 with haemorrhagic infarction. Residual neurological deficits were present in only one patient. No patient had a recurrent thrombosis. Recanalisations was incomplete in 6 of the 9 cases. Sinus recanalisation after cerebral venous thrombosis does not correlate with clinical outcome. Although empirical, the general recommendation of 6 months anticoagulant therapy is appropriate.