Jacob Manna S, Gunasekaran Karthik, Miraclin Angel T, Sadiq Mohammad, Kumar C Vignesh, Oommen Ajoy, Koshy Maria, Mishra Ajay Kumar, Iyadurai Ramya
Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Neurological Science, Christian Medical College, Vellore, Tamil Nadu, India.
Ann Indian Acad Neurol. 2020 Jul-Aug;23(4):477-481. doi: 10.4103/aian.AIAN_341_20. Epub 2020 Aug 14.
Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology.
This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study.
Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was . At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%.
Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial.
在抗生素时代，继发于感染性病因的脑静脉血栓形成（CVT）已变得罕见，但在临床实践中仍偶尔会遇到。在本研究中，我们描述了继发于感染性病因的CVT患者的临床特征、诊断和管理。
这项回顾性研究纳入了所有15岁以上的成年患者（2002年1月1日至2017年1月1日）。诊断为继发于细菌感染的感染性CVT的成年患者被纳入研究。
总共确定了22例患有CVT并伴有细菌感染的患者。12例（54.54%）患者的感染灶为化脓性脑膜炎，9例（40.9%）患者有脑外膜下感染灶，1例患者继发于远处病灶的细菌性败血症而发生CVT。发热是最常见的症状，77.3%的患者出现发热，其次是头痛，72.7%的患者出现头痛，63.6%的患者出现意识障碍。脑膜炎组最常见的病原体是链球菌属，脑外膜下组是……。就诊时，7例患者的MRI均发现了CVT，而增强CT脑扫描仅在2/3（66.6%）的患者中发现。横窦是脑膜炎中最常受累的窦。所有患者均接受了适当的抗生素治疗，50%的患者使用了抗凝治疗。住院死亡率为9%。
化脓性CVT虽然罕见，但可能是细菌性脑膜炎和面部感染的并发症。应尽早识别和诊断提示并存CVT的临床症状。治疗的主要手段是抗生素；抗凝的作用存在争议。
