Clinical Research Of Cerebral Venous Sinus Thrombosis With Intracranial Hemorrhage

Objective To summarize and analyze the clinical characteristics of intracranial venous sinus thrombosis and to explore the independent risk factors of CYST with intracranial hemorrhage,and to further compare the efficacy and prognosis of anticoagulation and mechanical thrombolysis combined with local thrombolysis in the treatment of CYST with intracranial hemorrhage.Methods Patients with CYST who met the screening criteria were collected continuously from November 2011 to June 2018 in the Department of Neurology,Zhongnan Hospital of Wuhan University.According to whether there was intracranial hemorrhage,they were divided into the hemorrhage group and the non-hemorrhage group.Descriptive analysis was performed on gender,age,onset form,initial symptoms,clinical manifestations,risk factors,imaging and laboratory examinations in the whole or between the groups.Univariate analysis and multivariate Logistic regression analysis of CVST with intracranial hemorrhage were performed.Results A total of 56 patients with CVST were included in this study,including 31 females(55.4%)and 25 males(44.6%),with an average age of 40.82±14.52.There were 41 cases of acute onset(73.2%),11 cases of subacute onset(19.6%),and 4 cases of chronic onset(7.1%).The first symptom was headache in 46 cases(82.1%).The main symptoms were headache in 51 cases(92.1%),epileptic seizures in 21 cases(37.5%),dyskinesia in 20 cases(35.7%),and disturbance of consciousness in 15 cases(26.8%).Thirty-four patients(60.7%)were screened for risk factors,nine for infection,21 for acquired hypercoagulability,5 for hereditary hypercoagulability,10 for blood system disease,and 6 for other rare factors.A total of 29 cases of brain parenchymal damage occurred,among which 12 cases of cerebral parenchymal hemorrhage(41.4%),12 cases of cerebral parenchymal hemorrhage(41.4%),12 cases of hemorrhagic infarction(41.4%),3 cases of simple SAH(10.3%),1 case of simple cerebral edema(3.4%),and 1 case of cerebral parenchymal hemorrhage with hemorrhagic infarction(3.4%)were occurred.Thrombosis occurred in 27 cases(48.2%)of the superior sagittal sinus,45 cases(80.4%)of the transverse sinus,31 cases(55.4%)of the sigmoid sinus,9 cases(16%)of the straight sinus and Galen veins,5 cases(8.9%)of the sinuses,1 case(1.8%)of the inferior sagittal sinus,and 11 cases(19.6%)of the internal jugular vein.There were 28 cases in the bleeding group and 28 cases in the non-bleeding group,and the proportion of patients in the bleeding group with dyspraxia,seizures and aphasia/speech loss was higher than that in the non-bleeding group,and the difference was statistically significant(P<0.001).Multivariate Logistic showed pregnancy/puerperium(OR=12.22,P=0.019,95%CI 1.511～98.833)and thrombosis involving the superior sagittal sinus(OR=17.67,P=0.002,95%CI 2.894～107.926),D-dimer increased(OR=12.22,P=0.019,95%CI 1.158～123.170).Among the 28 patients with intracranial hemorrhage,12 were in the simple anti coagulation group and 16 were in the mechanical thrombectomy group.The clinical efficacy,vascular recanalization and prognosis of mechanical thrombectomy group were superior to that of simple anticoagulation group(P<0.05).No new blood foci were found in the simple anticoagulation group,and only one case in mechanical thrombectomy group had vaginal bleeding after operation.Conclusions CVST was more common in women,presenting acute onset with headache as the first symptom;transverse sinus,sigmoid sinus and superior sagittal sinus are common sites of cerebral venous sinus thrombosis.Hemorrhage is the most common cerebral parenchymal lesion in CVST.Patients with intracranial hemorrhage are more likely to have seizures,limb weakness and disturbance of consciousness.Thrombotic involvement of the superior sagittal sinus and Pregnancy/puerperium were independent risk factors for CVST associated with intracranial hemorrhage.For CVST patients with intracranial hemorrhage,mechanical thrombectomy combined with local thrombolysis can effectively promote the recovery of venous blood flow,relieve clinical symptoms and improve prognosis.