New Clinical-Imagistic Features in Cerebral Venous and Sinus Thrombosis

Abstract

ObjectiveThe cerebral venous and sinus thrombosis (CVST), severe neurological emergencies is an important pathology of the venous brain system. This paper is an on-going study about CVST, the first report was done in 2008. Material and methodsWe received 32 patients hospitalized on emergency between February 2006 – February 2013 (only self - casuistry). Demographic (sex, age), clinical, imagistic (cerebral MRI – venous angiography, cerebral CT), paraclinic (CSF, factor V Leiden mutation) data, as well as risk factors, treatment, evolution and neurologic recovery were all considered. ResultsWe studied 20 females and 12 males (62% versus 38%). Etiology: oral contraceptives (8 cases), otomastoiditis (7cases), dental abscess of the upper jaw (3 cases), maxilar sinusitis (2 cases), penetrating skull trauma (3 cases), ethmoidal puncture for frontal sinusitis (1 case), provoked abortion (2cases), pregnancy (1 case), puerperium (1 case), hereditary thrombophilia- factor V Leiden mutation (heterozigot fenotype - 3 cases), encephalitis with HSV (1case). The symptomatology varied according to the disease etiology and the location of CVST. Initial clinical symptoms include: coma (3 cases), headache (26 cases), seizures (20 cases), motor and mental disturbances (18 cases), cranial nerves palsy (18 cases), intracranial hypertension (8 cases), papilledema (4 cases), nausea and vomiting (20 cases). Cerebral MRI- venous angiography is the optimum diagnosis method we applied to all patients. ConclusionsCVST even with a reduced occurrence, represents a severe neurovascular emergency. CVST is more common in women, frequently associated with oral contraceptives, abortion, pregnancy or puerperium (37%). Young patients with CVST should be screened for thrombophilia. If diagnosed at an early stage, especially by cerebral MRI-venous angiography and correctly treated, the patients have a favorable evolution, the lethal cases decreasing until 3%. Patients with septic CVST and coma from the beginning have bad prognosis. The efficacy of heparin with APTT controlled has been shown.