Meningeal Carcinoma With Cerebral Venous Sinus Thrombosis:a Case Report And Review Of The Literature

Objective:To investigate the clinical manifestation and diagnosis of meningeal carcinoma with cerebral venous sinus thrombosis.Methods:A case of meningeal carcinoma with intracranial venous sinus thrombosis was analyzed retrospectively and the literature was reviewed.Design:Case reportCase:The patient is a middle-aged women, experienced intermittent headache during two months before hospital. The pain happened on both sides of the temporal lobe, felt beating like pain, and lasted about5minutes. One week before admission, the headache worse and accompanied with dizziness, nausea and vomiting. Two days before admission, those symptoms were aggravated, and lost consciousness lasting about10seconds. CT of the head showed no abnormalities. MRI+MRA+MRV scan and contrast-enhanced MRI of head showed no obvious intracranial metastasis and venous sinus thrombosis. Lumbar puncture tip showed the pressure>350mmH2O. Cerebral angiography demonstrated that internal carotid artery, vertebral artery and intracranial artery branch are of normal shape, when blood flow velocity slowed down, cerebral circulation time was delayed, the superior sagittal sinus was of normal shape, torcular and left transverse sinus developing poor, contrast agent was shown retention phenomenon, the reflux speed of the deep vein on the left side of the brain were delayed, the left internal jugular vein displayed poor, and the collateral was opening.Intervention:Give the treatment of thrombolysis, anticoagulation, accompanied with lowering the intracranial pressure, control the seizures, pain, recovery the brain function and other symptomatic treatment.Prognosis:The high intracranial pressure symptoms of the patient was relieved after early anticoagulation and thrombolytic therapy and leaved hospital. However, the symptoms of intracranial hypertension were wore after one month, and went to the Chinese people’s Liberation Army Hospital, diagnosed as late period of metastatic secondary meningeal carcinoma, finished by a death. Conclusions:For patients with intractable headache, continuing symptoms of high intracranial pressure, and definite diagnosis of focal neurologic deficits, partial or total seizure and diagnosed as intracranial venous sinus thrombosis, whose symptoms are still short-term relief and still repeated exacerbations after treatment with anticoagulation, thrombolysis, and symptomatic treatment, especially with history of malignancy, meningeal carcinoma diagnosis should be inclined to. In clinical, cerebrospinal fluid should be repeated inspected to increase the positive rate. When the patient is stabilized, there is still a large degree of unpredictability because of the cause or the original disease.