1 Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
2 Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
Cephalalgia. 2018 Mar;38(3):503-510. doi: 10.1177/0333102417698707. Epub 2017 Mar 12.
Background and purpose Headache constitutes the most common symptom of cerebral venous sinus thrombosis (CVST), but its pathophysiology is unclear. We sought to investigate the potential mechanism for headache genesis in patients with CVST based on its imaging correlates. Methods A subgroup of CVST patients having headache as the predominant symptom without significant parenchymal lesion were retrospectively analysed for imaging features of vascular congestion (VC), in addition to cortical venous (CVT) and dural sinus thrombosis (DST) on magnetic resonance imaging. Headache and imaging patterns were classified into lateralized and nonlateralized phenotypes and their correlation was sought. Results Among 41 patients included, 28 had lateralized headache (LH group; 15 males; mean age 32.25 ± 9.19 years) while 13 had nonlateralized headache (non-LH group; six males; mean age 27.15 ± 8.65 years). Headache characteristics in both the groups were quite similar. Imaging showed VC in 39 of 41 and CVT among 35 of 41 patients, which were lateralized in 23 of 39 and 18 of 35 patients, respectively. Nearly all lateralized imaging patterns (21 of 23 for VC and 17 of 18 for CVT) occurred in the LH group and ipsilateral to (concordant) headache, while the non-LH group showed lateralized VC and CVT in only two and one patient respectively. Sinus thrombosis was lateralized in both groups irrespective of headache laterality. Whole cohort headache-imaging laterality (including patients with nonlateralized headache and nonlateralized imaging) concordance was 31 of 39, 24 of 35 and 18 of 41 for vascular congestion, cortical vein thrombosis and dural sinus thrombosis respectively. Conclusion Co-localization of VC and CVT with overlying headache might provide a possible explanation of headache and its laterality in patients with CVST.
背景与目的
头痛是脑静脉窦血栓形成（CVST）最常见的症状，但头痛的病理生理学机制尚不清楚。我们试图通过 CVST 的影像学特征来研究头痛发生的潜在机制。
方法
对头痛为主要症状且无明显实质病变的 CVST 患者进行回顾性分析，以探讨其血管充血（VC）的影像学特征，以及磁共振成像上的皮质静脉血栓形成（CVT）和硬脑膜窦血栓形成（DST）。将头痛和影像学模式分为局灶性和非局灶性表型，并寻求它们之间的相关性。
结果
在纳入的 41 例患者中，28 例有局灶性头痛（LH 组；15 例男性；平均年龄 32.25±9.19 岁），13 例有非局灶性头痛（非 LH 组；6 例男性；平均年龄 27.15±8.65 岁）。两组患者的头痛特征非常相似。41 例患者中有 39 例存在 VC，35 例患者中有 35 例存在 CVT，其中 39 例中有 23 例存在局灶性 VC，35 例中有 18 例存在局灶性 CVT。几乎所有局灶性影像学模式（23 例 VC 中有 21 例，18 例 CVT 中有 17 例）均发生在 LH 组，且与头痛同侧（一致），而非 LH 组中只有 2 例和 1 例患者分别出现局灶性 VC 和 CVT。两组患者的窦血栓形成均与头痛侧别无关。全组头痛-影像学侧别（包括非局灶性头痛和非局灶性影像学患者）的一致性分别为 39 例 VC、35 例 CVT 和 41 例 DST 中的 31 例、24 例和 18 例。
结论
CVST 患者头痛同侧的 VC 和 CVT 的共存可能为头痛及其侧别提供了一种可能的解释。
