The Clinical Analysis Of 23 Patients With Deep Cerebral Venous Thrombosis

Deep cerebral venous thrombosis (DCVT) is a rare cerebral venous occlusive disease,which means the thrombosis formed in cerebral internal vein,Galen and Rosenthal basal vein. It usual accompanys with extensive venous sinus thrombosis.The clinical manifestation of DCVT is variable and nonspecific. Death or long-term sequelae is far more likely to occur in DCVT than with venous sinus thrombosis, because of delayed diagnosis and treatment. Clinical doctors should pay more attention to it to avoid misdiagnosis or diagnosis omission. The early diagnosis of DCVT can be made by CT, MRI and MRV, DSA may still be necessary when the diagnosis is not clear. The early diagnosis and proper treatments as early as possible is critical for reducing the bleeding complications, mortality, and for improving prognosis.Objective and Methods: In order to study the etiologies, clinical manifestations, imaging traits, therapy and the prognosis, raise the doctors attention to it and build the basis for the clinic. A series of 23 patients consecutively admitted to our hospital between January 1997 to January 2007 with the diagnosis of DCVT were reviewed.Results:(1)Most the patients in this group are young, including eight males and fifteen females,whose ages ranged from 15 to 70 years (the average age was 33.17±13.20).(2)The riskiness of DCVT is excessive,34.78% were in the puerperal phage,21.74%were after caesarean operation, 13.04% had taken oral contraceptives for long time,8.70%had upper respiratory infection,4.34% had taken drugs for treating the disfunctional uterine bleeding, each was dehydration after desudation, cranial trauma, nephropathy symdrome, migraine, after operation of colonic cancer and appendicitis, 13.04% had no cause found. (3)The clinical manifestation of DCVT is variable and nonspecific.The familiar clinical feature were headache (18cases), paralysis (16cases), concious disturbance (14cases), dystonia (10cases), centrum facial paralysis (11cases), onvulsion (9cases),sense disturbance (8cases), aphasia (5cases), behavior abnormity (5cases), urinary incontinence (4cases), fever without sign of infection (3cases), tonic convulsion (3cases),each of visual disturbance, ataxia, choreic movement, paralysis agitans and stress ulcer. 78.26% appearred pathologic sign , 60.87% had meningeal irritation sign. (4) Imaging characters: CT is the early way for diagnosis of DCVT, on which showed the hyperdensity in the involved vein or venous sinus.52.17% (12/23) were Galen vein,one was cerebral internal vein,21.74% were simultaneity involved straight sinus.The indirect sign on CT is the venous edema or infarction in the basal nucleus or thalamus,which was usual low density.But DCVT usual accompanied with haemorrhage,while there would appearance confused image. Besides basal nucleus or thalamus involved,30.43%(7/23) involved other areas: brainstem infarct(3cases),temporal and parietal lobe infarct (2cases),each of frontal lobe infarct,temporal lobe haemorrhage and parieetal lobe infarct, lateral ventricle of cerebrum enlarged. Furthermore, 13.04% had no abnormal essential image,one just showed extended hydrocephalus, another could see hyperdensity image in the cerebral flax, the last one couldn't see any obvious singularity. All of the cases were diagnosed correctly by MRI and MRV, including 52.17% with acute phase,34.78%with subacute phase,and 13.044%with chronic phase. In the direct imaging,MRI showed the normal flow void of the vein or the venous sinus disappeared, instead of abnormal intensities, which were transformating depand on the phase of thrombosis.In acute phase, the signal intensities of venous thrombosis were very complicated, which were shown as hypo, iso of slightly hyperintensity on T1WI,but obviously hypointensity on T2WI.In subacute phase, the typically was demonstrated hyperintensity on T1WI and T2WI. Signal intensity gradually became lower in chronic phase.The indirect imaging on MRI was identical with CT,which showed veous edema or infarction image in basal nucleus and thalamus,including the 3 cases which didn't appear abnormal essential image. The signal intensities were hypointensity on T1WI, hyperintensity on T2WI. Besides,5of 23 cases showed infarction in the area of insular lobe,corpus callosum, cingulate gyrus and fornix.On MRV,the venous or venous sinus thrombosis were shown asocclusion or filling defects.Combining the result of MRI with MRV, 78.26% (18/23)were Galen venous thrombosis, others were cerebral internal venous thrombosis. 52.17% (12/23) of them accompanied with CVST, thereinto straight sinus(7cases),left transverse and sigmoid sinus(2cases),superior sagittal sinus(1case),straight sinus,left transverse and sigmoid all involved(1cases).(5)15of 23 cases with fibrinogen increased.73.68%(14/19) had intracranial hypertension, most of whom accompanied with CVST.(6)23cases had given anticoagulative, antiaccumulation of platelet, fibrinogen reducing,dehydrative, allopathic and supporting treatments, 8 were cured, 6 were obvious advanced, 3 improved, 1 unrelieved,1 went worsening, 4 died.Conclusion: (1)Most the DCVT patients are young,the female is more than male.(2)The riskiness of DCVT is excessive, at present , the most common etiologies are gestation, childbed and taking oral contraceptives in our country. (3) The most familiar clinical feature were headache,paralysis,concious disturbance, dystonia, sense isturbance, aphasia, behavior abnormity, pathologic sign and meningeal irritation sign.(4)CT is usual the early way for the dignosis of DCVT, when there is extensive hypodensity in the basal nucleus or thalamus,MRI shows edema imaging of this area,especially accompanied with haemorrhage, and which is hard explained by cerebral arterial infarct, we should take an ulterior step of MRV and DSA to definitude it. (5)Cruor routine and lumbar puncture have assistant fect on the diagnosis, most of them have fibrinogen increasing and intracranial hypertension. (6)People considered that the prognosis of DCVT was bad,which had a high mortality and disability rate, but now we believe that early diagnosis and proper treatment of this disease can achieve better prognosis.