Anadure R K, Wilson Vinny, Sahu Samaresh, Singhal Anuj, Kota Satish
Senior Adviser (Medicine & Neuro), Command Hospital (Air Force), Bengaluru, India.
Classified Specialist (Medicine & Neuro), INHS Asvini, Mumbai, India.
Med J Armed Forces India. 2018 Oct;74(4):326-332. doi: 10.1016/j.mjafi.2017.11.004. Epub 2017 Dec 16.
A prospective, observational study was done at a tertiary care hospital in Western Maharashtra to describe the etiologies, clinical features, diagnosis and prognosis of cerebral venous sinus thrombosis in an Indian population.
54 patients with clinical and MRI features suggestive of cerebral venous sinus thrombosis (CVST), were studied with detailed clinical evaluation and pro-thrombotic work up. All were followed up monthly for 6 months, to assess the response to therapy and clinical outcomes.
The mean age of presentation was 35 years. Headache was the most common presenting symptom (94%) and hemi paresis (22%) was the most common neurological sign. The most common sinus involved was transverse sinus in 77% of cases. In the unprovoked CVST subset ( = 29), elevated factor VIII (72%) and protein C deficiency (24%) were the common prothrombotic states identified. In the provoked CVST subset ( = 18), puerperium (44%) and para-infectious (22%) accounted for majority cases. Idiopathic CVST accounted for 13% (7/54) in this study. A Modified Rankin Scale (MRS) of 0-1 was achieved in 96% of patients at the end of 6 months follow up with no mortality in this study.
CVST is an important yet under recognized cause of intracranial hypertension and stroke in young. Clinical presentation is extremely varied and a high index of suspicion is needed. Magnetic Resonance Imaging (MRI) brain with Magnetic Resonance Venography (MRV) is the current diagnostic modality of choice. Elevated factor VIII and puerperium are the common etiologies in an Indian population. Management with anticoagulants is safe and has excellent clinical outcomes.
在西马哈拉施特拉邦的一家三级护理医院进行了一项前瞻性观察研究，以描述印度人群中脑静脉窦血栓形成的病因、临床特征、诊断和预后。
对54例具有脑静脉窦血栓形成（CVST）临床和MRI特征的患者进行了详细的临床评估和血栓前状态检查。所有患者每月随访6个月，以评估治疗反应和临床结果。
出现症状的平均年龄为35岁。头痛是最常见的症状（94%），偏瘫（22%）是最常见的神经体征。最常受累的静脉窦是横窦，占77%的病例。在无诱因的CVST亚组（n = 29）中，发现常见的血栓前状态为因子VIII升高（72%）和蛋白C缺乏（24%）。在有诱因的CVST亚组（n = 18）中，产褥期（44%）和感染后（22%）占大多数病例。本研究中特发性CVST占13%（7/54）。在6个月随访结束时，96%的患者改良Rankin量表（MRS）评分为0 - 1，本研究中无死亡病例。
CVST是年轻人颅内高压和中风的一个重要但未被充分认识的原因。临床表现极为多样，需要高度怀疑。头颅磁共振成像（MRI）联合磁共振静脉血管造影（MRV）是目前的首选诊断方法。因子VIII升高和产褥期是印度人群中的常见病因。抗凝治疗安全且临床效果良好。
