Clinical analysis of cerebral venous sinus thrombosis and its combined treatment of anticoagulation and endovascular thrombolysis

Abstract

Objective To investigate the clinical and imaging manifestations of cerebral venous sinus thrombosis (CVST), and the clinical effect of combined treatment of anticoagulation and endovascular thrombolysis.  Methods and Results The clinical manifestations of 22 CVST patients were highly variable. Headache (90.91%, 20/22) was the most frequent symptom, and conscious disturbance, seizure and focal neurological deficits were commonly present. Plasma D-dimer level was elevated in 12 patients (54.55%). Lumbar puncture was performed in 14 patients, in whom intracranial hypertension was present in 9 patients (9/14) with no characteristic changes in routine and biochemical examination of cerebrospinal fluid (CSF). Brain CT/MRI and CTV/MRV showed direct signs of CVST in all 22 patients, involving superior sagittal sinus, transverse sinus, sigmoid sinus, straight sinus and cortex veins, parenchymal lesions (infarction, hemorrhage and white matter abnormalities) in 13 patients (59.09%), subarachnoid hemorrhage (SAH) in 2 patients (9.10%) and subdural hematoma in one patient (4.55%). The involved cerebral sinuses revealed by DSA were superior sagittal sinus in 13 patients (59.09% ), transverse sinus in 17 patients (77.27%), sigmoid sinus in 14 patients (63.64%), inferior sagittal sinus in 2 patients (9.10%), straight sinus in 4 patients (18.18%), vein of Galen in one patient (4.55%) and jugular vein in one patient (4.55%). Two thrombosed sinuses were found in 9 patients (40.91% ) and 3 or more thrombosed sinuses in 8 patients (36.36% ). As no clinical improvements and progressive exacerbation were observed several days after heparin sodium intravenous drip or lower molecular weight heparin (LMWH) hypodermic injection with oral warfarin anticoagulant therapy, urokinase thrombolysis in venous sinus or artery was applied in 21 patients (95.45%). After (25.70 ± 12.18) d treatment with anticoagulation, the modified Rankin Scale (mRS) score of 13 patients (59.09% ) reached 0-1, 4 patients (18.18% ) 2 and 5 patients (22.73% ) 3-4, with the total effective rate reaching 77.27% (17/22). Conclusions The severely affected CVST usually have multiple sinus thromboses, deep venous thrombosis and parenchymal lesions. Endovascular thrombolysis together with primary anticoagulation may result in good outcomes in these patients. DOI: 10.3969/j.issn.1672-6731.2017.12.006