J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):185-193. 10.7461/jcen.2016.18.3.185.

Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

• Rim HT
• Jun HS
• Ahn JH
• Kim JH
• Oh JK
• Song JH
• Cho BM
• Chang IB

• KMID: 2355640
• DOI: http://doi.org/10.7461/jcen.2016.18.3.185

Abstract

OBJECTIVE
Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers.
MATERIALS AND METHODS
A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed.
RESULTS
Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes.
CONCLUSION
Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident.

Keyword

Sinus thrombosis; Venous thrombosis; Anticoagulants

MeSH Terms

Americas
Anticoagulants
Causality
Colon, Sigmoid
Decompression, Surgical
Diagnosis
Dysarthria
Europe
Headache
Humans
Hyperthyroidism
Infarction
Korea
Patient Care
Retrospective Studies
Risk Factors
Seizures
Sinus Thrombosis, Intracranial
Superior Sagittal Sinus
Thrombosis
Venous Thrombosis*
Anticoagulants

Figure

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  Fig. 1 Contrast enhanced computed tomography of brain showing 'empty delta sign' (arrow), indicative of sinus thrombosis (triangular area of enhancement with relatively low-attenuating center).

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  Fig. 2 MRV of brain: signal loss in superior sagittal sinus (arrow heads), reflecting thrombosis with occlusion. MRV = magnetic resonance venogram.

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  Fig. 3 Follow-up MRV of brain: signal visible in superior sagittal sinus (arrowheads) indicates recanalization (5 months after onset). MRV = magnetic resonance venogram.

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  Fig. 4 Contrast enhanced computed tomography of brain: intracerebral hematoma of left temporal lobe (arrow). Venous infarction with hemorrhage was also considered because of sole symptom without prominent factor.

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  Fig. 5 MRV of brain: occlusion of left transverse/sigmoid sinus and left internal jugular vein (arrowheads). MRV = magnetic resonance venogram.

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  Fig. 6 Follow-up MRV of brain: flow signal in left transverse and sigmoid sinuses (arrowheads) now visible (9 months after onset). MRV = magnetic resonance venogram.

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