Компенсаторні механізми при венозному тромбозі дурального синуса. Клінічний випадок

Abstract

SummaryPatients with cerebral venous thrombosis (CVT) present with range of symptoms,which vary widely from headache to coma. Chronic occlusion of venous dural sinusesleads to the initiation of compensation processes, such as vascular collateralization,recanalization of the organized thrombus. Consequently, their efficacy determinesdisease course and severity.The aim of our study was to highlight the clinical challenges, while managing apatient with subcompensated CVT. Taking into account the fact that mild severity isobserved in 20% of cases, eventually about a quarter of patients presenting withheadache of unclear etiology becomes unnoticed and results with their quality of life atlow level.To analyze the disease outcome and prognosis, we accurately studied compensationmechanisms, which occur in patient due to dural sinus thrombosis, notably venouscollateral circulation and thrombus recanalization. However, the most important«pitfall» of chronic dural sinuses occlusion, when not appropriately treated, is the factthat hemodynamic compensation also leads to high risk of cerebrovascular events,which may lead to death or disability.We presented the patient with cerebral venous thrombosis of the transverse andsigmoid sinuses manifested migraine-like headache with a vegetative issue and signs ofincreased intracranial pressure.162Due to the absence of anticoagulant therapy, venous drainage through collateralpathways and recanalization of thrombosed sinuses were insufficient to maintaincerebral blood supply, resulting in the diffuse cerebral edema as well as secondarybrain injury. After an accurate survey, diagnostic procedures, prescribing ofindividualized treatment and long-term follow-up with correction of therapy the patientexperienced regression of CVT symptoms.Cerebral magnetic resonance imaging venography is an important tool for thediagnosis and predictiction of prognosis of this condition. Thus, patients with a longhistory of untreatable headache and signs of intracranial hypertension should undergothis procedure. To consider intracranial vascular events and outcome, the evaluation ofvenous hemodynamics should be conducted. Moreover, it is often necessary to examinecerebral veins and sinuses, when hemorrhagic stroke does not correspond to cerebralarterial territories and has unclear etiology.