| Objective A small sample case-controlled study confirmed that anemia is associated with the onset of cerebral venous sinus thrombosis(CVST).However,CVST associated with iron deficiency anemia(IDA)is limited to scattered case reports and small sample case studies at home and abroad,but there is a lack of large sample studies.In view of this,this study retrospectively analyzed the case data of 19 patients with cerebral venous sinus thrombosis associated with iron deficiency anemia admitted to our department.To investigate the clinical data,laboratory and imaging features of patients with cerebral venous sinus thrombosis associated with iron deficiency anemia and to analyze its possible pathogenesis.Thereby improving the clinician’s understanding of such diseases,and providing reference for the diagnosis and treatment of such patients with intracranial venous sinus thrombosis.Methods Eighteen patients with CVST associated with IDA,consecutively admitted to our hospital from January 2006 to August 2018,were chosen in our study.Their clinical presentations,laboratory and neuroimaging features,treatments and prognoses were retrospectively analyzed.The SPSS22.0 software package was used for statistical processing and normal distribution test for measurement data.The measurement data were expressed as((?) ±s),and the countingt data were expressed by rate.Results(1)A total of 174 cases of CVST were collected,and 54 cases(31.3%)were associated with anemia.35 cases were excluded because they did not meet the inclusion criteria,including 32 cases with pregnancy or puerperium,1 case with malignant tumor,1 case with inflammatory bowel disease,and 1 case with paroxysmal nocturnal hemoglobinuria.There were 19 cases(10.9%)of cerebral venous sinus thrombosis associated with iron deficiency anemia that met the inclusion criteria.(2)19 cases of cerebral venous sinus thrombosis associated with iron deficiency anemia were included.Of these,18(94.7%)were female and one(5.3%)was male,with a male-to-female ratio of 1:18.The average age was(44.6 ± 12.0)years old and the range was(26~71 years).There were 14 cases(73.7%)with acute onset and 5 cases(26.3%)with subacute onset.(3)Mean hemoglobin concentration was(81.9±15.6)g/L(53 g/L-112 g/L),with mild anemia in 5 patients(26.3%),moderate anemia in 12 patients(63.2%)and severe anemia in 2 patients(10.5%);mean platelet count was(372.1±196.8)×109/L([64-825]×109/L).(4)The clinical symptoms were highly variable: all the 19 patients had headache(5 with isolated headache);14 patients were combined with other neurological symptoms:focalneurological deficits(n=12,63.2%),including 8 cases of aphasia,6 cases of hemiplegia,1case of partial sensory disturbance;disturbance of consciousness(n=5,26.3%);and epilepsy(n=2,10.5%).(5)MR imaging showed that 15 patients(78.9%)were with venous infarction,in which11(57.9%)had hemorrhagic transformation,9 cases with unilateral infarction and 6 cases with bilateral infarction.The common infarction sites were temporal lobe infarction(n=8),frontal lobe infarction(n=6),parietal lobe infarction(n=5)and thalamic infarction(n=4).There is one case of subarachnoid hemorrhage.MR venography showed that 17 patients(89.5%)were with more than one cerebral venous thrombosis,and the most common sites were transverse sinus(n=17,89.5%),followed by sigmoid sinus(n=14,73.7%),and superior sagittal sinus(n=9,47.3%).(6)All 19 patients were treated with bridging anticoagulation therapy(low molecular weight heparin sequential warfarin anticoagulant therapy for 3-6 months).One case was treated with local sinus contact thrombolysis combined with mechanical thrombectomy;one case underwent intracranial hematoma puncture and drainage due to cerebral hemorrhage;and 2 cases underwent bone flap resection and decompression.One died at the acute phase,and 18 were with good prognosis after 3-6 months of follow-up.Conclusion CVST cases were often associated with anemia.CVST associated with IDA is common in young and middle-aged women with moderate and severe anemia;the common symptoms include headache and focal neurological deficits;the common imaging features include multiple venous sinus involvement with venous infarction and hemorrhagic transformation;good prognosis can be obtained after anticoagulant therapy. |
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