| Objective: Studying the risk factors and etiology, clinical manifestation, CSF and imaging examination, treatment and prognosis of cerebral venous sinus thrombosis(CVST) patients.Methods: Collecting 200 CVST patients admitted to our hospital patients from 2007 to 2013 year, making a retrospective analysis of the clinical data, including onset characteristics of population, possible etiologic factors, clinical manifestations, cerebrospinal fluid inspection characteristics, imaging features, treatment and prognosis.Results:1 Gender, age and mode of onsetIn the 200 patients, 56 cases of male, 144 cases of female, the ratio of male to female was 1:2.6, age was 7~73 years old, the average age was 33.02±12.49 years, the patients of 21~40 years old was 129 cases, the ratio it accounted for this group of CVST patients was 64.5%, onset form was frequently acute or subacute onset.2 Risk factorsThe common causes of pathogenesis and possible risk factors of this group of CVST patients were 75 cases of infectious diseases(37.5%), 65 cases(32.5%) of pregnancy and puerperium, 43 cases of hematologic diseases(21.5%). In the most common causes and risk factors of the male CVST patients in this group, 31 cases of infectious diseases, accounting for 55.36% of all the males in this group of CVST patients, in the most common causes and risk factors of the male CVST patients in this group, 65 cases of pregnancy and puerperium, accounting for 45.14% of all the females in this group of CVST patients. In this group of CVST patients, 166 cases(83%) patients having one or more risk factors, in which, 60 cases(30%) having two or more risk factors, by history-taking, system physical examination and all kinds of relevant inspection after admission, 34 cases(17%) patients didn’t have the present know etiology and risk factors.3 Clinical manifestationThe most common symptom in this group of CVST patients was headache, having 172 cases(86%), this group of CVST patients with varied clinical manifestations, including 178 cases(89%) of headache with or without nausea and vomiting, 60 cases of epilepsy(30%), decreased visual acuity of 50 cases(25%), 45 cases of limb movement disorder( 22.5%), 42 cases of optic disc edema(21%), 40 cases of cervical resistance(20%), 27 cases of disturbance of consciousness(13.5%), 20 cases of restriction of eye movements(10%), 15 cases of the language barrier(7.5%), 11 cases of sensory disturbance(5.5%), 4 cases of memory decline(2%).4 Cerebrospinal fluid examinationThis group of CVST patients, 75 cases having lumbar puncture, 55 cases with elevated cerebrospinal fluid pressure, the cerebrospinal fluid pressure of 20 cases being normal, may have relationship with the establishment of collateral circulation compensation and taking cortical vein thrombosis as the principal thing, the cerebrospinal fluid protein of 10 cases increased, CSF glucose and chloride of 75 cases are at or close to normal.5 Imaging examinationImaging examination including CT, MRI, MRV and DSA, in this group of cases, 153 cases having head CT examination, in which the head CT scan of 56 cases showed no significant abnormality, the positive rate of head CT examination was only 63.4%, all the 200 patients underwent MRI and(or) MRV examination, in which 193 cases were found abnormal, the positive rate of examination was 96.5%, 101 cases underwent DSA examination, all can be found the location and outline of contour thrombosis, so obtained the diagnosis, the positive rate of examination was 100%, it is the gold standard for diagnosis of CVST. After the above imaging examination, we found that in the group of CVST patients, only 38 cases(19%) with single intracranial venous sinus, the remaining 162 cases(81%) of CVST patients with multiple intracranial venous sinus thrombosis, the predilection site thrombus of 155 cases(77.5%) being sinuses transversus, 129 cases(64.5%) being sinuses sigmoideus, 98 cases(49%) being superior longitudinal sinuses.6 Treatment and prognosisIn this study, all the 200 patients were treated with dehydration, anti- epileptic, anti-inflammatory, promoting blood circulation, nutrition nerve and other conventional treatment, among them 101 cases were cured, 70 cases improved, 29 cases ineffective(the rate of efficiency being 85.5%). Among them, 14 cases of patients with simple conventional therapy, 6 cases were cured, 1 cases improved, 7 cases ineffective( the rate of efficiency being 50%), 108 patients with heparin anticoagulant therapy, 47 cases were cured, 45 cases improved, 16 cases ineffective(the rate of efficiency being 85.19%), 78 patients treated with the therapy of combination of heparin and endovascular intervention, 48 cases were cured, 24 cases improved, 6 cases ineffective(the rate of efficiency being 92.31%), taking multiple comparisons χ2 detection on the plurality of sample rate of conventional treatment group, the heparin treatment group, heparin treatment+intravascular interventional treatment group, the effect of the heparin treatment group, heparin treatment+intravascular interventional treatment group were better than the effect of conventional treatment group, the treatment differences between the heparin treatment group, heparin treatment+intravascular interventional treatment group having no statistically significant, we can not think of the efficiency of two groups having difference.Conclusion:1 CVST is more common in young and middle-aged, mostly acute or subacute onset, morbidity of male being lower than women.2 The causes of CVST are diverse and complex, and it can be effected together by a variety of causes, the common causes being infectious diseases, pregnancy and puerperium, blood system diseases. For young women in pregnancy and puerperium, the clinical manifestations were headache, epilepsy and focal neurological deficit, to alert the possibility of CVST.3 The main and first symptom and clinical symptom of CVST was headache, clinical manifestations lacking of specific.4 The main performance of lumbar puncture of CVST patients was the pressure increasing, and the CSF routine biochemical lacking specificity, lumbar puncture check can only aid the diagnosis of CVST.5 The predilection sites of thrombosis are sinuses transversus, sinuses sigmoideus, superior longitudinal sinuses, many being multiple. The CT can have no positive found, MRI combined with MRV for the diagnosis of CVST being the best method, if necessary, taking DSA examination, can improve the accuracy.6 In the treatment, taking anticoagulation therapy early, if condition worsens, we can take reasonable intravascular interventional treatment. |
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