Universiti Sains Malaysia, School of Medical Sciences, Department of Neurosciences, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
Med J Malaysia. 2020 Jan;75(1):38-42.
Cerebral venous sinus thrombosis (CVST) is a potentially fatal neurological condition. However, due to the non-specific clinical and radiological features of CVST, it can sometimes result in a delay in the diagnosis and subsequent management. The aim of this study was to evaluate the demography, risk factors and one-year outcome of CVST patients treated in Hospital Universiti Sains Malaysia.
In this retrospective study, we reviewed the cases diagnosed with CVST admitted to our centre from January 2011 until November 2015.
A total of 15 patients were included in this review. The patterns of imaging findings as well as risk factors for CVST is discussed with a review of the literature and current management practices. One year followed-up showed full recovery (Glasgow Outcome Scale (GOS) of 5) in 10 cases (66.7%), whereas 4 cases (26.7%) with GOS of 4 (three cases with neurological deficits, and 1 case with mild symptom. There was one case of mortality in this study secondary to sepsis during hospitalisation. The presenting symptoms were mainly headache, focal neurology deficits, seizure and altered sensorium. Risk factors identified were oral contraceptive pills usage, chronic sinuses or ear infections, and obesity. Initial computed tomography (CT) scan showed various findings and haemorrhagic infarct was one of the common findings. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) revealed majority of the patients had occlusion at two or more venous sinus sites. No patients had new or recurrent intracranial haemorrhage following initiation of anticoagulation therapy.
Thus it is considerable safe to start anticoagulation therapy in CVST patients including those with intracranial haemorrhage. We propose further neuroimaging to avoid missed diagnosis of CVST in patient presented with recent onset headache and CT evidence of unusual cerebral infarction.
脑静脉窦血栓形成（CVST）是一种潜在致命的神经疾病。然而，由于 CVST 的临床和影像学特征不具有特异性，因此有时会导致诊断和后续治疗的延迟。本研究旨在评估在马来西亚大学医院接受治疗的 CVST 患者的人口统计学、危险因素和一年预后。
在这项回顾性研究中，我们回顾了 2011 年 1 月至 2015 年 11 月期间在我院中心诊断为 CVST 的病例。
本研究共纳入 15 例患者。我们讨论了影像学发现的模式以及 CVST 的危险因素，并回顾了文献和当前的治疗方法。一年随访结果显示，10 例（66.7%）患者完全康复（格拉斯哥预后量表（GOS）评分为 5 分），4 例（26.7%）患者 GOS 评分为 4 分（3 例有神经功能缺损，1 例有轻度症状）。本研究中有 1 例患者因住院期间脓毒症死亡。主要的临床表现为头痛、局灶性神经功能缺损、癫痫发作和意识改变。确定的危险因素包括口服避孕药使用、慢性鼻窦或耳部感染和肥胖。初始计算机断层扫描（CT）显示了各种发现，出血性梗死是常见的发现之一。磁共振成像（MRI）和磁共振静脉造影（MRV）显示大多数患者在两个或更多静脉窦部位存在闭塞。在开始抗凝治疗后，没有患者出现新的或复发性颅内出血。
因此，在 CVST 患者中开始抗凝治疗是相当安全的，包括那些伴有颅内出血的患者。我们建议进一步进行神经影像学检查，以避免对近期出现头痛和 CT 显示不寻常脑梗死的患者漏诊 CVST。
