| OBJEVTIVE:Cerebral venous thrombosis (CVT), especially the cerebral venous sinus thrombosis (CVST) is a special and rare type of cerebral vascular disease caused by obstruction of venous drainage. With complicated etiological factors, low morbidity, diverse forms and manifestations and weak specificity, it is easy to be misdiagnosed. The purpose of this paper is to collect clinical data of CVST patients and make a summary, which could deepen the understanding about the clinical features of DVST to decrease the misdiagnosis rate and provide early intervention treatment, so as to decrease the disability and mortality rate and improve the prognosis of CVST. On the other hand, CVST is usually treated with low molecular weight heparin and warfarin. This paper is to report the CVST cases which were treated with new anticoagulants and promote a further understanding about the application of new anticoagulants on treatment of CVST.METHODS:We collected 66 cases of CVST patients who were hospitalized in Qilu Hospital of Shandong University during a period from 2012-01 to 2016-01 through digital retrieval software. Then we retrospectively analyzed all cases and obtained relevant information and statistical data, including patients’basic information, clinical manifestation, imaging findings, cerebrospinal fluid examination, diagnosis and treatment.RESULT:There were 66 cases of CVST diagnosed by CT or MRI, including 26 males and 40 females whose age ranged from 14 to 74 years old, and the length of hospital stays was from 5 to 28 days. Among 66 cases, possible etiological factors were puerperal period 16(24.2%), infection 16(24.2%), unknown reason 15(22.7%), anemia 7(10.6%), pregnancy 3(4.5%), contraceptives 2(3.0%), hyperthyroidism 2(3.0%), dehydration 1(1.5%), systemic lupus erythematosus 1(1.5%), anaphylactoid purpura 1(1.5%), polycythemia vera 1(1.5%), myelodysplastic syndrome 1(1.5%), primary thrombocytosis 1(1.5%), thrombocytopenia 1(1.5%), dural arteriovenous fistula 1(1.5%), sigmoid sinus meningioma 1(1.5%), and intracranial hypotension syndrome 1(1.5%). The manifestations include increased intracranial pressure 56 (84.8%)cases, followed by symptoms of pyramidal signs 33 (50%)cases, seizure 17(25.8%) cases, meningeal irritation sign14 (21.2%)cases, unconsciousness 7(10.6%)cases, high fever 3(4.5%)cases, ataxia 2(3.0%)cases, cognitive impairment 1(1.5%)cases, low intracranial pressure 1(1.5%)case.23 cases of lumbar puncture were recorded, of which 17 cases of intracranial pressure were higher than 200mmH20, and 6 cases of cerebral angiography were recorded. Venous cerebral infarction occurred in 23 (34.8%) cases, of which 8(12.1%) cases were hemorrhagic. Among involved venous sinus description of 61 patients, there are 2 cases of deep cerebral veins (cerebral internal vein, Galen vein) involved,1 case of multiple cerebral veins involved,1 case of superficial vein involved,1 case of internal jugular vein involved.lOcases of hospitalized patients were treated by new anticoagulants (rivaroxaban, dabigatran and argatroban), meanwhile 12 cases of discharged patients were advised to continue to take new anticoagulant.CONCLUSION:1. CVST is more common in young women. The main etiological factors are hypercoagulable state in puerperium, infection, anemia, pregnancy, contraceptives and hyperthyroidism. However, there are quite a number of patients with unknown causes. Its etiology is complex, and multiple etiological factors may exist at the same time.2. The clinical manifestations are mainly characterized by increased intracranial pressure, in addition, and include pyramidal sign, convulsions, meningeal irritation sign, unconsciousness, high fever. Imaging findings may involve multiple venous sinus, venous infarction, even hemorrhage infarction.3. In minority CVST patients early imaging examination could show no abnormalities, which we should also pay attention to. It is feasible to make a definitive diagnosis by cerebral angiography and reexamination of magnetic resonance imaging.4. The vast majority of patients are treated with anti-coagulation, anti-platelet and dehydration, which obviously improves symptoms. It also makes a good effect by combining low molecular heparin with new anticoagulant therapy. |
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