Meira Goncalves Joao, Carvalho Vasco, Cerejo António, Polónia Patricia, Monteiro Elisabete
Neurosurgery Department, Centro Hospitalar Universitário de São João, Porto, PRT.
Faculty of Medicine, Oporto University, Oporto, PRT.
Cureus. 2024 Mar 8;16(3):e55775. doi: 10.7759/cureus.55775. eCollection 2024 Mar.
The natural history and epidemiological aspects of traumatic cerebral venous thrombosis (CVT) are not fully understood. Due to the concomitant occurrence with intracranial hemorrhages, guidelines for medical treatment have been highly controversial. In this study, our objective was to carry out an analysis description of the population and to conduct a literature review. A prospectively gathered radiology registry data of patients hospitalized at the tertiary hospital of Centro Hospitalar Universitário do São João, Porto, Portugal, between 2016 and 2021 was carried out. All patients with traumatic brain injury (TBI) and concomitant CVT were identified. CVT was confirmed by CT venogram. Demographic, clinical, and radiological data and their medical management were reported. In-hospital complications and treatment outcomes were compared between patients measured by the Glasgow Outcome Score Extended (GOSE) at discharge and GOSE at three months. There were 41 patients with traumatic CVT admitted to this study. The majority (45.2%) had a hyperdense signal near the lateral sinus at admission, and only 26.2% presented with skull fractures. Of this cohort, 95% had experienced lateral sinus thrombosis. Twenty-five patients (60%) had occlusive venous thrombosis. Venous infarct was the main complication following CVT. Thirty-two patients (78%) were anticoagulated after CVT and four developed complications. At the three-month follow-up after discharge, 28.2% had good recovery (GOSE > 6). This study revealed a higher incidence of CVT in severe TBI and a mild association with skull fractures. There is a higher incidence of CVT in the lateral sinus. Management was inconsistent, with no difference in outcome without or with anticoagulation. Larger, prospective cohort studies are required to better comprehend this condition and determine evidence-based guidelines.
创伤性脑静脉血栓形成（CVT）的自然史和流行病学方面尚未完全明确。由于其常与颅内出血同时发生，医学治疗指南一直存在很大争议。在本研究中，我们的目的是对研究人群进行分析描述并开展文献综述。我们对葡萄牙波尔图圣若昂大学中心医院三级医院2016年至2021年期间住院患者的前瞻性收集的放射学登记数据进行了分析。识别出所有患有创伤性脑损伤（TBI）并伴有CVT的患者。CVT通过CT静脉造影得以确诊。报告了患者的人口统计学、临床和放射学数据及其医疗管理情况。比较了出院时通过扩展格拉斯哥预后评分（GOSE）测量的患者与三个月时GOSE测量的患者的院内并发症和治疗结果。本研究纳入了41例创伤性CVT患者。大多数患者（45.2%）入院时在外侧窦附近有高密度信号，仅有26.2%的患者出现颅骨骨折。在这一队列中，95%的患者发生了外侧窦血栓形成。25例患者（60%）出现闭塞性静脉血栓形成。静脉梗死是CVT后的主要并发症。32例患者（78%）在CVT后接受了抗凝治疗，4例出现并发症。出院后三个月的随访中，28.2%的患者恢复良好（GOSE>6）。本研究显示严重TBI中CVT的发生率较高，且与颅骨骨折的关联较弱。外侧窦中CVT的发生率较高。治疗方法不一致，抗凝与否对预后无差异。需要开展更大规模的前瞻性队列研究，以更好地了解这种情况并确定循证指南。
