Clinical Manifestations And Radiological Analysis For Cerebral Venous Sinus Thrombosis

Objective: To explore the etiology and risk factors, clinicalmanifestations, cerebral spinal fluid, imaging characteristics, treatment andprognosis of cerebral venous sinus thrombosis, aims to enhance awarenessof the disease and improve diagnosis and treatment.Methods: Analyze the clinical characteristics, cerebral spinal fluid(CSF) and radiological features of11patients with CVST retrospectively,and discuss the diagnosis and treatment of CVST by reviewing theliterature, too.Results: Patients were between9-48years old, in which20-40yearsold patients accounted for81.8%. Male to female ratio was4:7. Therelevant risk factors can be found in64%of patients, including infectiousfactors and non-infectious factors. And the non-infectious factors were themain risk factors. Headache was the most common on-set symptom,accounting for90.9%. Headache was also the most common clinicalpresentation, accounting for100%, followed by visual impairment (45.4%),seizures and papilledema36.4%each. Nine patients had cerebral spinal fluid examination and the increased intracranial pressure was found in all(100%). Cerebrospinal fluid protein and cell count was normal or mildlyelevated in89%of them. High density in cerebral venous sinus area wasfound in14%of cases by CT scan while abnormal signal of cerebralvenous sinus or flow void signal disappearance was showed in27.3%ofcases on magnetic resonance imaging of brain. Filling defect or poordeveloping or nonvisualization of cerebral venous sinus were found in90.9%of patients on magnetic resonance venography or CT venography.One case was finally confirmed by cerebrovascular digital subtractionangiography (DSA) while his MRV did not give the final conclusion. Mostpatients improved (72.7%) and a small number of cases got worse (18.2%)after anticoagulant treatment, anti-platelet aggregation treatment,dehydration to decrease the intracranial pressure, anti-infection treatmentand other symptomatic treatments.Conclusion: Young and middle aged patients, acute or subacute onset,presentation with increased intracranial pressure symptoms as the mainclinical manifestations, such as headache, papilledema, and so on,associated with or without focal neurological symptoms and signs, shouldbe highly suspected as CVST after the exclusion of intracranial tumors,inflammation and arterial stroke. Patients who are suspected as CVST inclinical should accept MRI combination with MRV or CTV checks toconfirm the diagnosis as early as possible. DSA examination is necessary when MRV or CTV results are still inconclusive. Give patientsanticoagulant treatment after confirming the diagnosis as soon as possible,and most patients have good prognosis with low mortality and morbidity.