颅内静脉窦血栓形成临床观察

目的 观察颅内静脉窦血栓形成的发病原因及临床表现和治疗情况.方法 对24例颅内静脉窦血栓形成患者的临床资料进行分析.结果 对本组发病患者经早期诊断,早期治疗,病死率明显下降.结论 对临床早期有头痛、恶心、呕吐等高颅压症状者,CT、MRI检查未发现阳性病灶,应行DSA检查以进一步确诊.     

脑静脉窦血栓临床诊治现状

由于脑静脉窦血栓（cerebralve Hous sinus thrombosis,CYST）多样性的临床表现和缺乏一个明确的治疗共识,CVST的诊断和治疗目前仍然是一个重要的挑战,尤其是抗凝和溶栓治疗的有效性和安全性尚未达成临床共识。本文根据国内外最新研究结果,就CVST诊治现状综述如下。     

颅内静脉窦血栓形成的主要特点及诊治策略

 目的 探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis, CVST)的主要特点及诊治。方法 对我院收治的14例CVST患者进行回顾性分析。结果 CVST是一种少见的脑血管疾病,通常以中青年多见,往往急性起病,临床表现主要有颅高压症状或者局灶性神经功能缺损,如头痛、头晕、恶心、呕吐,癫痫、偏瘫等。早期使用抗凝治疗是取得良好预后的关键。结论 CVST临床表现复杂多样,利用MRV、CTV或DSA发现静脉窦狭窄、闭塞是确诊CVST的关键之一;有助于临床工作的要做到早期诊断和规范有效治疗。     

Simultaneous occurrence of subarachnoid hemorrhage and cerebral venous sinus thrombosis: A systematic review of cases

Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done. Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female‐to‐male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty‐nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board.     

Risk of cerebral venous thrombosis in oral contraceptives pills users

The aim of this study is to assess the relative risk of cerebral venous sinus thrombosis (CVST) in Oral contraceptive pills (OCP) users compared with a control group of non-hormone users.

Paroxysmal nocturnal haemoglobinuria presenting as cerebral venous sinus thrombosis

Paroxysmal nocturnal haemoglobinuria (PNH) is associated with anaemia, intravascular haemolysis and venous thrombosis. Cerebral venous sinus thrombosis (CVST) is a late but serious complication of PNH. We for the first time report a young man who presented with CVST and was diagnosed to have PNH after 11 months. We highlight the reasons for delay in the diagnosis and discuss the special issues in the management.     

Intracranial hemorrhage in neonates: A review of etiologies,patterns and predicted clinical outcomes

Intracranial hemorrhage (ICH) in neonates often results in devastating neurodevelopmental outcomes as the neonatal period is a critical window for brain development. The neurodevelopmental outcomes in neonates with ICH are determined by the maturity of the brain, the location and extent of the hemorrhage, the specific underlying etiology and the presence of other concomitant disorders. Neonatal ICH may result from various inherited and acquired disorders. We classify the etiologies of neonatal ICH into eight main categories: (1) Hemorrhagic stroke including large focal hematoma, (2) Prematurity-related hemorrhage, (3) Bleeding diathesis, (4) Genetic causes, (5) Infection, (6) Trauma-related hemorrhage, (7) Tumor-related hemorrhage and (8) Vascular malformations. Illustrative cases showing various imaging patterns that can be helpful to predict clinical outcomes will be highlighted. Potential mimics of ICH in the neonatal period are also reviewed.     

The cognitive effects of oxcarbazepine versus carbamazepine or valproate in newly diagnosed children with partial seizures

OBJECTIVE: To investigate the effect of oxcarbazepine against standard antiepileptic drug therapy (carbamazepine and valproate) on cognitive function in children and adolescents (aged 6 to <17 years) with newly diagnosed partial seizures. METHODS: A multicentre, open-label, randomised, active-control, three-arm, parallel-group, 6-month study. The primary cognitive variable, the Computerized Visual Searching Task (CVST), assessed mental information processing speed and attention. Secondary variables included additional tests assessing psychomotor speed, alertness, memory and learning, and non-verbal intelligence. RESULTS: Of 112 patients randomised, 99 completed the study. The dropout rate was 11.6%; 13 patients discontinued due to adverse events (n=5) or unsatisfactory therapeutic effect (n=8). Mean CVST time decreased in all groups, indicating an improvement of mental processing speed and no cognitive impairment in any treatment group. No statistically significant difference was observed between oxcarbazepine and combined carbamazepine/valproate. Analysis of secondary variables did not show statistically significant differences between oxcarbazepine, carbamazepine and valproate. Analysis of intelligence test results showed that the number of correct answers increased at end point in all groups. The percentage of patients remaining seizure free throughout treatment was comparable across all groups (oxcarbazepine 58%; carbamazepine 46%; valproate 54%; carbamazepine/valproate 50%). The most common adverse events were fatigue and headache for oxcarbazepine, fatigue and rash for carbamazepine, and headache, increased appetite and alopecia for valproate. CONCLUSION: Oxcarbazepine treatment over 6 months does not display any differential effects on cognitive function and intelligence in children and adolescents with newly diagnosed partial seizures relative to standard antiepileptic drug therapy. No impairment in cognitive function was observed in any treatment group over a 6-month period.     

Prognostic indices for cerebral venous thrombosis on CT perfusion: A prospective study

Purpose

We determined the prognostic significance of CT perfusion characteristics of patients with cerebral venous sinus thrombosis (CVST) and assessed the change in perfusion parameters following anticoagulation therapy.

Materials and methods

20 patients with CVST diagnosed on non-contrast computed tomography (NCCT), magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) were included in this study. The initial CT perfusion study was performed at the time of admission. The following perfusion parameters: relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) were calculated in the core and periphery of the affected area of the brain. Follow-up CT perfusion studies were performed at 1 month following anticoagulation therapy and the perfusion parameters thus obtained were compared with pre-treatment results. Receiver operating characteristic (ROC) curve analysis was performed to determine the prognostic significance of perfusion parameters.

Results

All patients in this study showed areas of hypoperfusion on CT perfusion. To determine the favorable clinical outcome on basis of perfusion parameters, ROC curve analysis was performed which showed that the optimal threshold for rCBF > 60.5%, rCBV > 75.5%, and rMTT < 148.5% correlated with better clinical outcomes. Post treatment perfusion parameters showed significant correlation in core of the lesion (p < 0.05) than in the periphery.

Conclusion

CT perfusion studies in CVST are a good prognostic tool and yield valuable information regarding clinical outcome.