Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.
Headache. 2022 Feb;62(2):212-219. doi: 10.1111/head.14254. Epub 2022 Feb 8.
Isolated cortical vein thrombosis (ICVT), a rare type of cerebral venous thrombosis (CVT), is diagnostically challenging in some cases, and intracranial hypotension (IH) is known to cause CVT.
In this study, we reviewed the clinical and imaging characteristics of ICVT in patients with IH caused by spinal cerebrospinal fluid leakage, based on a literature review and investigation of cases from our hospital.
Between January 1, 2007, and November 1, 2019, 735 patients were diagnosed with IH at our hospital; three patients developed ICVT (incidence ~ 0.4%, 3/735), and the literature review yielded an additional 23 cases. Therefore, 26 patients (mean age 35.9 ± 11.4 years old) were included in this study. The most common symptoms were headache (100.0%, 26/26), focal neurological deficits (53.8%, 14/26), and seizure (34.6%, 9/26). The initial headache was orthostatic in 96.2% (25/26) of patients, and 38.5% (10/26) of patients reported a change in the headache pattern following diagnosis of ICVT. Neuroimaging findings associated with ICVT included the cord sign (61.5%, 16/26) and parenchymal brain lesions (46.2%, 12/26), such as intracerebral hemorrhage (30.8%, 8/26), hemorrhagic infarcts (11.5%, 3/26), and localized edema (11.5%, 3/26). The percentage of patients who received anticoagulation and epidural blood patch therapy was similar (69.2% [18/26] vs. 65.4% [17/26]), and most patients recovered completely (92.3%, 24/26).
IH should be considered in the differential diagnosis in patients with ICVT. Knowledge of the relevant clinical and neuroimaging features is important to facilitate early diagnosis for favorable prognosis.
孤立性皮质静脉血栓形成（ICVT）是一种罕见的脑静脉血栓形成（CVT）类型，在某些情况下诊断具有挑战性，已知颅内低血压（IH）可引起 CVT。
本研究通过文献复习和我院病例调查，回顾了由脊柱脑脊液漏引起 IH 患者的 ICVT 的临床和影像学特征。
2007 年 1 月 1 日至 2019 年 11 月 1 日，我院共诊断 IH 患者 735 例，其中 3 例发生 ICVT（发生率~0.4%，3/735），文献复习又获得 23 例，因此共纳入 26 例（平均年龄 35.9±11.4 岁）患者。最常见的症状是头痛（100.0%，26/26）、局灶性神经功能缺损（53.8%，14/26）和癫痫（34.6%，9/26）。初始头痛为直立性 96.2%（25/26），10 例（26.3%，10/26）患者在诊断为 ICVT 后头痛模式发生改变。与 ICVT 相关的神经影像学表现包括索带征（61.5%，16/26）和实质脑病变（46.2%，12/26），如脑出血（30.8%，8/26）、出血性梗死（11.5%，3/26）和局部水肿（11.5%，3/26）。接受抗凝和硬膜外血贴治疗的患者比例相似（69.2%[18/26]比 65.4%[17/26]），大多数患者完全康复（92.3%，24/26）。
在 ICVT 患者的鉴别诊断中应考虑 IH。了解相关的临床和神经影像学特征对于早期诊断和良好预后至关重要。
