Trombose venosa cerebral: análise retrospectiva de 49 casos.

Abstract

Cerebral Venous Thrombosis (CVT) is a rare and potentially life-threatening disease, accounting for about 0.5% of stroke cases. However, it is believed to be an underdiagnosed condition. Early diagnosis requires a high degree of suspicion and appropriate use of imaging modalities.Imagiological and clinical characterization of CVT cases diagnosed at our hospital from 2004 to 2007.This study was a retrospective, cross-sectional analysis from 2004 to 2007, using our institution database. We reviewed hospital discharge data to assess the incidence of CVT. The study population consisted of 49 patients. Retrospective review of the clinical data and imaging studies of these patients was then performed.Of the 49 patients with confirmed CVT, 38 were female. Patient age varied between 16 and 75 years, with an average of 42.6 years. Thrombotic risk factors were found in 43 patients; the most frequent was dyslipidemia (n = 22) followed by oral contraceptive use (n = 18). Initial head Computerized Tomography (CT) was normal in six cases. Diagnosis was made by Magnetic Resonance (MR) in 38 cases, Cerebral CT-Venography in 10 cases and Digital Subtraction Angiography in one case. Average time from onset of symptoms to diagnosis was nine days; this was not significantly different when comparing the group diagnosed by MR with the group diagnosed by CT-Venography. Right transverse sinus was the most frequent location of thrombosis (n = 36). Only in four cases thrombosis did not involve the lateral sinuses.Lateral sinus thrombosis is a frequent variety of CVT, accounting for 91.8% of our cases. A negative Head CT scan does not exclude the presence of cerebral venous thrombosis; therefore appropriate imaging study should be performed whenever there's a high degree of clinical suspicion. Cerebral CT-Venography seems to be a good alternative to MR for the diagnosis of CVT.

Gradenigo’s Syndrome With Septic Lateral Sinus Thrombosis

“…Although CT scans are adequate for describing bone anatomy and bone destruction, other methods are preferred for diagnosing central nervous system pathologies and the composition of the lesion in the bone. In a series of 49 patients, head CT failed to identify 14% of the patients with central venous thrombosis, whereas venous CT or MRI venography could provide positive identification of abnormalities in all cases [15]. Clinical presentation may be atypical and high clinical suspicion may be needed to prompt image investigation [16].…”

Missed Cerebral Venous Thrombosis: A Diagnostic Challenge

“…Cerebral venous channel thrombosis (CVT) is one of the less suspected causes of stroke in young adults (mean age in the third decade with female accounting for two-thirds female preponderance) 1 constituting around 0.5%–2% of all stroke cases. 2 , 3 Complete or incomplete blockage of the major cerebral venous channels or the less common smaller feeding cortical veins involvement is the cause for thrombosis. In one autopsy series, venous thrombosis incidence is around 9.3% 4 suggesting that it might often be missed in life.…”

Atherogenic Index of Plasma is an Independent Risk Factor for Contrast Induced Nephropathy in Patients With Non-ST Elevation Myocardial Infarction

“…1 CIN is defined as an increase in serum creatinine by either ≥.5 mg/dl or by ≥25% from baseline within 48–72 h after contrast administration, in the absence of other causes of acute renal failure. 2 Many mechanisms are implicated in the development of CIN (e.g., renal medullary hypoxia, direct cytotoxicity, preexisting renal failure, and congestive heart failure). 3 With the widespread use of contrast media, CIN has become an important cause of morbidity and mortality.…”