Department of Neurology, Mustafa Kemal University, Hatay, Turkey.
Department of Neurology, Maltepe University, İstanbul, Turkey.
Agri. 2021 Jan;33(1):7-14. doi: 10.14744/agri.2020.77698.
Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]).
A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared.
There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group.
IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.
头痛是脑静脉窦血栓形成（CVST）最常见的症状，有时也是这些患者唯一的症状。本回顾性和前瞻性研究旨在调查孤立性头痛（IH）和其他伴随症状（非孤立性头痛[ NIH ]）患者的临床危险因素、影像学表现或预后是否存在差异。
本研究纳入了一项多中心脑静脉窦血栓形成（VENOST 研究）的 1144 例患者。比较了 287 例 IH 病例和 857 例 NIH 病例的人口统计学、生化、临床和影像学特征。
研究组中女性人数是男性的两倍。在 IH 组中，按年龄组评估性别分布时，差异无统计学意义。IH 组头痛发作多为亚急性和慢性，但 NIH 组头痛多为急性发作。IH 组在随访期间有 29%的患者出现其他神经系统表现。IH 组既往有深部、脑内或其他静脉血栓栓塞史的患者少于 NIH 组。IH 组横窦受累较多，而 NIH 组矢状窦受累较多。IH 组存在纤溶酶原激活物抑制剂（PAI）突变的患者明显更多。
如果患者出现亚急性或慢性头痛，应考虑 IH 和 CVST。在溶栓事件中起重要作用的 PAI 可能是 CVST 的一个危险因素。应考虑进行详细的血液学检查。需要进一步研究。
