Yang Fu-Chi, Tso An-Chen, Chen Chun-Wen, Peng Giia-Sheun
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2 Cheng-Kung Road, Taipei, Taiwan.
Blood Coagul Fibrinolysis. 2010 Mar;21(2):182-4. doi: 10.1097/MBC.0b013e328333782c.
Cerebral venous thrombosis (CVT) can be difficult to diagnose because of its wide spectrum of clinical manifestations. In the present article, we report a 58-year-old man coming to our emergency department presenting with left temporal throbbing headache and right hemianopia. Computed tomography of the brain revealed acute hemorrhages over the left occipital area. Due to the unusual location of hemorrhage, magnetic resonance venography was performed, revealing absence of venous flow over the superior sagittal and transverse sinuses suggestive of CVT. He received anticoagulant therapy for 6 months and the headache subsided. We feel that a high index of clinical suspicion is needed to diagnose an intracerebral hemorrhage in an uncommon site caused by CVT, even if risk factors of CVT are not present, so that appropriate treatment can be initiated as promptly as possible. Failure to recognize the signs of CVT could result in inappropriate management and suboptimal secondary prophylaxis strategies, which could affect the patient's clinical outcome.
由于临床表现范围广泛，脑静脉血栓形成（CVT）可能难以诊断。在本文中，我们报告了一名58岁男性，他来到我们的急诊科，表现为左颞部搏动性头痛和右侧偏盲。脑部计算机断层扫描显示左枕叶区域有急性出血。由于出血位置不寻常，进行了磁共振静脉造影，显示上矢状窦和横窦无血流，提示CVT。他接受了6个月的抗凝治疗，头痛缓解。我们认为，即使不存在CVT的危险因素，对于由CVT引起的罕见部位脑出血的诊断也需要高度的临床怀疑，以便尽快开始适当的治疗。未能识别CVT的体征可能导致管理不当和二级预防策略欠佳，从而影响患者的临床结局。
