The Analysis Of Clinical Features Of Intracranial Venous Sinus Thrombosis

Background and ObjectiveCerebral venous sinus thrombosis(CVST) is a class of diseases collectively, based on sinus venous sinus thrombosis leading to occlusion/stenosis, causing cerebral venous obstruction and then producing a series of pathophysiological changes. CVST is related to a variety of infectious and non-infectious factors, which caused to thrombosis and obstruction of cerebral blood flow, occurring brain edema and increased intracranial pressure. Study found that CVST can caused by infection, cancer, autoimmune diseases, pregnancy, oral contraceptives, and puerperal factors. CVST incidence is relatively low, about3to4/100million, accounting for only1%of the proportion of all stroke patients, and no specific clinical manifestations existed, which resulting in misdiagnosis and mistreament.In this study, clinical data of45patients with CVST were retrospectively analyzed and the characteristics of risk factors of CVST, etiology, clinical diagnosis, treatment and prognosis were summarized, which was useful for improvement of clinical diagnosis and treatment of CVST.Method45consecutive patients admitted to The Second Clinical College of Zhengzhou University and the Affiliated Hospital of Xinxiang Medical College from2006.01to2013.12were enrolled. Detail information on the retrospective analysis of clinical manifestations, image investigation, treatment, prognosis and follow-up data were collected carefully. Characteristics of the incidence of risk factors, etiology, clinical symptoms and signs, imaging, venous sinus thrombosis parts, laboratory test results, treatment and prognosis were summarized.ResultsThe group of45cases included18male patients and27female patients. Male to female ratio was about1:1.5. The minimum age was8years old and the maximum age is83years, the mean was41±5.13years.In the group,16patients (35.6%) were in acute phase,22cases (48.9%) in sub-acute phase, and7patients (11.1%) in chronic phase.38patients (84.4%) had one or more risk factors which were known. Seven cases were confirmed with no clear risk factors.14cases (31.1%) had two or more risk factors. Of the patients whose causes of disease were clear,65.8%were the non-infected, and34.2%were the infected. With a headache as the first symptom of28patients accounted for62.2%, with focal neurological symptom onset in7patients,4cases with epilepsy onset, and3cases were with disturbance of consciousness, and each symptom like diplopia, mental disorder or limb paralysis had1case.33cases involving more than two venous sinus, taking up73.33%of the total number of cases, with31cases involving superior sagittal sinus (68.89%),24cases involving the transverse sinus (53.33%),12cases involving the sigmoid sinus (26.67%),9cases involving straight sinus (20%),5cases involving the confluence of sinuses (11.11%),1cases involving cavernous sinus (2.22%).12of the45cases were cured and the symptoms of30cases were improved,3cases deteriorated. By comparing mRS scores before and after treatment, the effect of intravenous thrombolytic therapy group better than anticoagulant group and systemic anticoagulant combined fibrinolytic therapy, the difference was statistically significant.Conclusions1. The incidence of CVST is higher among young adults, often subacute or acute onset, and there were more females than male patients. 2. Non-infectious factors have a higher proportion in the patients with CVST, which should be taken seriously enough.3. Headache is the most common and always the initial symptom in the patients with CVST.4. The sites of thrombosis of CVST are varied. Superior sagittal sinus, the transverse sinus, sigmoid sinus are most likely involved.5. Once the diagnosis is definite, the patient should be treated as soon as possible. The effect of intravenous thrombolytic therapy may be better than anticoagulation or combined anticoagulant and fibrinolytic therapy.