The Clinical And Imaging Characteristics Of40Cases With Cerebral Venous Sinus Thrombosis

Objective to investigate the clinical and imaging characteristics of40cases with cerebral venous sinus thrombosis(CVST).Materials and methods Clinical and imaging data of40cases with cerebral venous sinus thrombosis from January2009to January2012were retrospectively analyzed.Results There are23males and17females of all the40patients;the ratio is1.4:1. Average age is32.8±13.6. Sixteen patients have etiological factors definitely; the causes of the disease for twelve patients are doubtful, and the others12cases can not find related factors. Thirty-one patients fall ill with a form of acute or subacute onset. Thirty-four patients present headache with or without nausea and vomitting as the first symptom, and other clinical symptoms include seizures, papilledema, physical activity disorders, disturbance of consciousness, diplopia, mental status disorders and so on. Seventeen cases of patients with D-Dimer increase.Thirty patients have the lumbar puncture checked, and the cerebrospinal fluid(CSF) pressure of twenty-eight cases is increased, and there are eleven patients with CSF pressure greater than400mmH2O. The vast majority of CSF routines are normal; only2cases have a mild elevation of CSF leukocytes; eighteen cases show a slight elevation of CSF protein. Imaging studies include computerized tomography (CT), magnetic resonance imaging(MRI), magnetic resonance venography (MRV) and digital subtraction angiography(DSA). All the patients accept the MRV check. The results show that the most common thrombosis as follows:transverse sinus(87.5%), sigmoid sinus(62.5%), superior sagittal sinus (60%). All the patients have a benign prognosis of clinical symptoms after the treatment with anticoagulation, antiepileptic drugs, controlling intracranial pressure, and symptomatic and supportive treatment. There is no dead case. The sinuses show to some extent recanalization for sisteen patients who received the MRV recheck when in the hospital.Conclusions1.The causes of CVST are sophisticated, and cerebral venous sinus thrombosis presents a remarkably wide spectrum of signs and modes of onset.2. Headache is the most common clinical symptom.The lumbar puncture show that intracranial pressure increase, sometimes up to more than400mmH2O, but the cerebrospinal fluid routine check is usually normal. The cerebrospinal fluid of CVST has no specific change.The level of D-Dimer also has no specificity in CVST. The normal level of D-Dimer can not exclude the cerebral venous sinus thrombosis.3. Young and middle age patients who suffered with headache, nausea and vomitting aggravation progressively, with or without seizures or focal neurological deficits in a form of acute or subacute onset should probably considered as CVST, especially pregnancy and puerperium females.4. MRV is considered to be the best non-invasive diagnosis of cerebral venous imaging method at present. Combined CT with MRI and MRV, necessary with DSA, CVST can be diagnosed easier than before.The CVST patients can receive effective treament.