Agostoni E
Stroke Unit, Clinica Neurologica, Università degli Studi Milano Bicocca, Ospedale San Gerardo, Via Donizetti 106, I-20052 Monza (MI), Italy.
Neurol Sci. 2004 Oct;25 Suppl 3:S206-10. doi: 10.1007/s10072-004-0287-3.
In the past, cerebral venous thrombosis (CVT) was considered a rare, devastating disease. The widespread use of angiography, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) over the years has made early diagnosis of CVT possible and has completely changed the perception of this condition. CVT is much more common than previously thought. It has a wide spectrum of clinical presentation, multiple causes and unpredictable outcome. In contrast to arterial stroke, headache is the most frequent and, at times, the only symptom of CVT. It is crucial to recognise the association of headache with CVT in order to reach a correct diagnosis and to start the appropriate treatment as soon as possible. Therefore in order to define the headache features useful for an early diagnosis of CVT we reviewed the current literature on this topic and performed both a retrospective and a prospective study. In the literature we found that this headache has no specific features as it can be of any grade of severity and is slightly more frequently diffuse than localised. Its onset is usually subacute over a few days but it can also be acute or chronic. It is mostly persistent but can occasionally be intermittent. Headache attributed to CVT is sometimes misleading, mimicking migraine, subarachnoid haemorrhage, CSF hypertension or hypotension. However this information has been derived from case series which lacked a control group and thus have low statistical strength. Our retrospective study, confirmed by preliminary results in the prospective multicentric study, showed that headache in CVT is as often acute as subacute, and that it is more frequently localised than diffuse. Finally, both studies showed a significant correlation between headache of acute onset and severe intensity and CVT. We then conclude that these headache features, especially in the presence of underlying prothrombotic conditions, should lead clinicians to consider the diagnosis of CVT and to require appropriate neuroimaging examinations.
过去，脑静脉血栓形成（CVT）被认为是一种罕见的、具有毁灭性的疾病。多年来血管造影、磁共振成像（MRI）和磁共振血管造影（MRA）的广泛应用使得CVT的早期诊断成为可能，并彻底改变了对这种疾病的认识。CVT比之前认为的更为常见。它具有广泛的临床表现、多种病因且预后不可预测。与动脉性卒中不同，头痛是CVT最常见的症状，有时甚至是唯一症状。认识到头痛与CVT之间的关联对于做出正确诊断并尽快开始适当治疗至关重要。因此，为了确定有助于CVT早期诊断的头痛特征，我们回顾了关于该主题的当前文献，并进行了一项回顾性研究和一项前瞻性研究。在文献中我们发现，这种头痛没有特定特征，因为它可以是任何严重程度，且弥漫性发作比局限性发作略为常见。其发作通常在几天内呈亚急性，但也可以是急性或慢性的。大多为持续性，但偶尔也可为间歇性。归因于CVT的头痛有时具有误导性，可模仿偏头痛、蛛网膜下腔出血、脑脊液高压或低血压。然而，这些信息来自缺乏对照组的病例系列，因此统计效力较低。我们的回顾性研究，在前瞻性多中心研究的初步结果中得到了证实，表明CVT中的头痛急性发作与亚急性发作的频率相同，且局限性发作比弥漫性发作更为常见。最后，两项研究均显示急性发作且强度严重的头痛与CVT之间存在显著相关性。我们由此得出结论，这些头痛特征，尤其是在存在潜在血栓形成倾向的情况下，应促使临床医生考虑CVT的诊断并要求进行适当的神经影像学检查。
