| Object i ve To discuss the risk factors, clinical features, imaging features, treatment and prognosis of cerebral venous thrombosis(CVT), in order to improve the diagnosis and treatment of this disease.Methods We analysised retrospective112cases of the CVT patients in Tianjin Huanhu Hospital from February2003to February2013, including gender, age, onset form, risk factors, clinical manifestations, imaging features, intracranial pressure and other cerebrospinal fluid findings, treatment, efficacy, short-term prognosis and follow-up. We divided them into two groups:secondary brain parenchyma injury group(excluding parenchymal damage from other causes, such as trauma, tumors, etc) and normal brain parenchyma group,and analysised the clinical features of the two groups. Evaluation the efficacy of anticoagulation and anticoagulation associated with thrombolytic therapy throughs the improvement of clinical symptoms and recanalization of vascular.Results1. The age of onset ranged from14to65years old, mean37.20years old,75%of patients between21to50years old,the male to female ratio was1.15:1. There were no significant difference between secondary brain parenchyma injury group and normal brain parenchyma group in the average age(t=0.454, P=0.651)and age composition. Gender had significantly between the two groups(x2=7.420P=0.006),the proportion of male in normal brain parenchyma group was greater than that in secondary brain parenchyma injury group.2. Acute and subacute onset accounted for88.39%, the average length of hospital stay was(16.83±10.38)days. The length of hospitalation had no significant difference between the two groups(t=0.332. P=0.741), but the onset to treatment time was shorter in secondary brain parenchyma injury group(t=2.059, P=0.042). The rates of secondary brain parenchyma injury group in acute, subacute and chronic onset were72.41%,68.29%,46.15%.3. Risk factors were found in51.79%of patients. including infections(16.96%),pregnancy-related factors(13.39%),blood disorders(10.71%),oral contraceptives(6.25%), nephrotic syndrome(4.46%), postoperative (3.57%), autoimmune diseases (2.68%), head trauma(0.89%), meningeal metastases(0.89%), hyperthyroidism(0.89%). Infections, pregnancy-related factors and blood disorders shared a larger proportion.14.28%had two and two or more risk factors,48.21%of unknown etiology.4. The major clinical symptoms in this study were:headache(80.36%), vomiting(47.32%), paralysis(45.53%), seizures(32.14%), unconsciousness(21.43%), dizziness(12.5%), visual impairment11.61%), speech disorder(5.36%), sensory disturbances(4.46%), fever(2.68%).The major clinical symptoms in secondary brain parenchyma injury group were:headache(77.63%), paralysis(60.53%), seizures (43.42%), unconsciousness(30.26%). The major clinical symptoms in normal brain parenchyma group were:headache(86.11%),dizziness(22.22%),visual impairment and paralysis(13.89%),seizures(8.33%). Seizures, paralysis and unconsciousness were more likely to be seen in the secondary brain parenchyma injury group, and the modified Rankin scale(mRS) score (t=6.396, P<0.001)and National Institute of Health stroke scale(NIHSS) score(t=5.682, P<0.001)were higher than the other group.5. Thrombosis site were:superior sagittal sinus(82.14%),transverse sinus(76.79%),sigmoid sinus(54.46%),straight(35.71%),inferior sagittal(8.04%).81.25%involved two or more venous sinus,18.75%involved only one venous sinus. There was no difference in the thrombosis site of the two groups. Brain parenchyma injury site were:parietal lobe(48.68%),frontal lobe(44.74%),temporal lobe(27.63%), basal ganglia(17.11%),thalamus(13.16%),periventricular(10.53%),occipital lobe (9.21%), corpus callosum(5.26%),brainstem(3.95%)cerebellum(2.63%).36.84%was bilateral brain parenchyma injury.6. Imaging examination:87patients underwent head CT plain scan,39.08%showed dense triangle sign or cord sign,52.87%showed brain parenchymal injury,16.09%were normal.99cases underwent head MRI,66.67%found bad sinus flow void or abnormal signals,70.71%showed brain parenchymal injury,1.01%were normal.MRI was better than CT to found the direct signs of CVT (x2=14.176, P=0.000) and brian parenchymal injury (x2=6.275, P=0.012).the differences had statistically significant. 8patients underwent MRA, in which3cases (37.50%) had poor visualization of sinus,5cases (62.50%) did not find abnormal cerebral venous sinus.4cases underwent CTA,2cases (50.00%) had poor visualization of sinus;1cases (25.00%) did not find abnormal cerebral venous sinus;1cases (25.00%) was found only cortical vein thickening.85patients underwent MRV, they all(100%) found sinus poor visualization or undeveloped.63patients underwent DSA were all (100%) abnormal, showing sinus does not develop or filling defects, long cerebral circulation time, cortical or deep vein dilation, blood flow reversal.25patients underwent both MRV and DSA, they had the same results, but DSA is better to show cortical vein dilation, with or without blood reflux, straight sinus and deep vein. The patients were accepted anticoagulation, thrombolytic and symptomatic treatment,79.46%patients were effective,42.86%clinical symptoms were completely relieved,20.54%were ineffective. There was no significant difference between anticoagulation group and anticoagulation plus thrombolysis group in age,(t=0.146, P=0.884), gender (x2=0.262, P=0.609), admission mRS score (t=0.590, P=0.556). Anticoagulation plus thrombolysis group had higher admission NIHSS score than the anticoagulation group (t=2.103, P=0.038).78.57%of patients in anticoagulation group treatment were effective,40.48%clinical symptoms were completely relieved;7.81.03%of patients in anticoagulation plus thrombolysis group treatment were effective,46.55%clinical symptoms were completely relieved.anticoagulation plus thrombolytic group’s treatment efficiency and clinical symptoms’completely relieved rate higher than the anticoagulation group, the differences had no statistically significant(P>0.05).After the treatment,17cases of the anticoagulation group underwent MRV or DSA showed vascular recanalization rate was70.59%;29cases of anticoagulation plus thrombolysis group underwent MRV or DSA showed vascular recanalization rate was75.86%. The vascular recanalization rate of anticoagulant plus thrombolytic group was higher than that of anticoagulant group, the differences had no statistically significant (x2=0.155, P=0.694).The NIHSS score (t=0.982, P=0.329), mRS score (t=0.242, P=0.809) and short-term prognosis(x2=0.087, P=0.768) of the two groups had no statistically different.8. Follow up38patients (3months to65months),34patients had varying degrees of vascular recanalization and their symptoms had improved,4cases recrudescences who didn’t insist on oral anticoagulants.Conclusion1. The etiology of CVT is complex. In our study, infection pregnancy related factors, blood system disease were the most common etiology.14.28%of patients had more than two kinds of risk factors,51.79%can find relative risk factors,48.21%of unknown etiology.2. The clinical manifestations are different due to different etiology and lesion. The common clinical symptoms were headache, vomiting, paralysis, seizures, disturbance of consciousness, dizziness, visual disorders. secondary brain parenchyma injury group’s clinical symptom was heavier than the other group, and seizures, paralysis, disturbance of consciousness were more commom in secondary brain parenchyma injury group.3. Superior sagittal sinus was the most common sites of thrombosis, followed by the transverse sinus, sigmoid sinus.81.25%involved two or more than two venous sinus. Parietal lobe, frontal lobe, temporal lobe were the common bain injury sites.4. DSA is the gold standard for diagnosis CVT, MRI combined with MRV is the preferred method to diagnosis and follow-up of CVT.5. Anticoagulation is the first choose for CVT, anticoagulation plus thrombolysis is good for those whose clinical symptom was heavier and anticoagulation was useless.6. We should actively look for the cause of CVT patients, and treat them early. Patients should insist on oral anticoagulant therapy for at least three months or more after acute phase. |
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