| Objective:Cerebral venous sinus thrombosis(CVST)in the pathogenesis,clinical features,laboratory examination,imaging examination,misdiagnosis and therapy,so as to deepen the understanding of the disease,improve the early diagnostic rate,reduce misdiagnosis and missed diagnosis and mortality.Medhods : This study adopts the method of retrospective study,selected object is between January 2012 and January 2018 in Xiangxi autonomous prefecture people's hospital for treatment of intracranial venous sinus thrombosis in patients with a total of 30 cases,including 15 cases were misdiagnosed,this group of 15 patients with CVST were misdiagnosed,the male in 5 cases,10 cases of female,male to female ratio of 1:2.The average age is 42.8 years.Collect the patient's age,gender,possible etiology,onset form,the main clinical symptoms and clinical signs,with basic diseases and thrombosis,cerebrospinal fluid examination,imaging characteristics and the main treatment method,curative effect,prognosis and other data to conduct a comprehensive analysis and summary.Results:(1)The group of 15 cases of misdiagnosed patients with CVST,onset age between 24 ~ 82 years old,the average age of 42.8 years,including the highest incidence of 24 ~ 40 years old,accounted for 80%,the male in 5 cases,10 cases of female,male to female ratio of 1:2.(2)15patients had 10 cases(66.7%)patients with definite risk factors can be found,of which 8 cases of infectious factors(including upper lip herpes virus infection in 1 case,pulmonary infection in 1 case,intracranial infection in 1 case,inflammation of department of gynaecology in 1 case,upper respiratory tract infection in 1 case,chronic sinusitis and chronic otitis media in 1 case,puerperal infection,1 case of acute suppurative tonsillitis in 1 case),the emotional factors in 2 cases(including oral estrogen and progestogen therapy for menstrual disorders in 1 case,oral contraceptive 1 case),no obvious cause of 5 cases(33.3%).(3)5 cases(33.3%)in this group of acute onset(1 week);Subacute onset(1 week to 1month)6 cases.(40.0%);Chronic onset(greater than 1 month)4 cases(26.7%).Major clinical symptoms: 15 cases of headache(100%),including5 cases of severe headache(33.3 %)and 10 cases of non-violent headache(66.7%);5 cases of nausea and vomiting(33.3%),including 2 cases of projectile vomiting;There were 3 cases of convulsion,1 case of epileptic seizure,1 epileptic seizure,and 1 case of persistent epileptic seizure.1 case of anxiety and tension;2 cases of blurred vision;Tinnitus 2 cases,hearing loss 1 case;1 case of diplopia;2 cases of body weakness.Main clinical signs: 5 cases of consciousness disorder(2 cases of somnolence,1 case of coma,1 case of shallow coma,1 case of deep coma);2 cases with limited eye movement;5 cases of bilateral papillary edema;4 cases of limb paralysis(1 case of right limb hemiplegia,2 cases of left limb hemiplegia,1 case of paralysis of lower limbs);There were 5 cases of pathological signs and meningeal stimulation(2 cases of neck resistance,2 cases of pap and 1 case of gram positive).3 cases of facial palsy;Two cases of deep and shallow sensory disturbance;Two eyes with horizontal eye tremor.There were 7 cases without obvious neural positivity.Merger basic diseases: 1case of disease of grow in quantity of platelet reduction,bone marrow value-added STD in 1 case,cerebral infarction in 1 case,2 cases of hypertension,hyperlipidemia in 1 case,1 diabetes,chronic renal insufficiency in 1 case,chronic cardiac insufficiency in 2 cases,3 cases of cervical spondylosis,high homocysteine levels,1 case of pulmonary tuberculosis in 1 case,hyperthyroidism in 2 cases,1 case of chronic rhinitis,brain injury in 1 case,intracranial tumor 1 case,eyes retinopathy in 1 case.(4)Cerebrospinal fluid changes: in 15 patients,there were 12 cases with increased cerebrospinal fluid pressure,and the positive rate was 80.0%.The total protein concentration increased by 8 cases,and the positive rate was 66.7%.In 15 patients,the number of cells increased by 6,and the positive rate was 40%.(5)CT findings of this group: there were 7abnormal cases,3 cases of low density of brain tissue,1 case of cerebral infarction and 2 cases of encephalitis.A case of free triangle was diagnosed as CVST.There were 3 cases of high density shadow,including 1 case of cerebral falx and posterior longitudinal fracture,which was diagnosed as subarachnoid hemorrhage,1 case of left occipital lobe and left thalamus,which was diagnosed as cerebral hemorrhage.No significant abnormality in CT was observed in 8 cases.(6)Brain MRI in this group: 7 cases of abnormal brain tissue were detected,2 cases were diagnosed as cerebral infarction,2 cases of cerebral hemorrhage and 3 cases of encephalitis.The blood flow of brain tissue was found in 3 cases,and the diagnosis was CVST.No abnormalities were seen in 5 cases.(7)This group of craniocerebral 5.MRV performance: the thrombophlebitic parts of transverse sinus,sigmoid sinus thrombosis in 5 cases,2 cases of sigmoid sinus thrombosis,superior sagittal sinus thrombosis in 2 cases,transverse sinus,superior sagittal sinus thrombosis in 1 case,transverse sinus,sigmoid sinus,superior sagittal sinus thrombosis in 1 case,transverse sinus thrombosis in 1 case,superior sagittal sinus,straight sinus and transverse sinus,sigmoid sinus thrombosis in 1 case,2 cases of suspected the sagittal sinus,sigmoid sinus variation or narrow.(8)Misdiagnosed type: for subarachnoid hemorrhage in 1 case,vascular headache in 2 cases,tension headaches in 2 cases,hypertrophic 1 case of meningitis and cerebral infarction in 2 cases,benign cranial pressure in 1 case,cerebral hemorrhage in 2 cases,4 cases of encephalitis.The average misdiagnosis time was 21.3days(5 ~ 90 days).Conclusion:(1)The ratio of males to females in this group is 1:2,which may be related to the number of selected cases,and the onset age is mainly middle-aged and young.The cause is complex,the clinicalmanifestation is varied,easy to misdiagnose,the misdiagnosis rate is as high as 50%.(2)Clinical manifestations of patients with venous sinus thrombosis and the etiology of different parts and complex and diverse,with acute and subacute onset,common clinical symptoms were headache,nausea,vomiting,convulsions,anxiety,tension,blurred vision,tinnitus,hearing loss,diplopia and limb hemiplegia.(3)In this group,the site of thrombosis was most seen in the transverse sinus,followed by the sigmoid sinus.Most patients can be involved in 2 or more venous sinuses.(4)The increase in headache and cerebrospinal fluid pressure is an important clue for the diagnosis of CVST.When the CT examination of the craniocerebral brain is not clearly abnormal,the MRV examination should be performed as early as possible.When necessary,DSA should be diagnosed to reduce misdiagnosis. |
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