Nadir bir İnme: Serebral Venöz-Sinüs Trombozu; Acil Serviste bir Vaka Serisi ve Literatür Derlemesi

Year 2022, , 372 - 377, 17.05.2022

Selahattin Gürü Begüm Üzer , Hüseyin Avni Demir Sezer Eşfer Mehmet Akif Karamercan

https://doi.org/10.33631/sabd.1115791

Abstract

Serebral venöz sinüs trombozu (SVST) nadir görülen ancak akut ve yaşamı tehdit eden bir hastalıktır. Bu çalışmada, üçüncü basamak bir hastanenin acil servisinde tanı alan 10 hastalık SVST vaka serisini sunuyoruz. Hastaların demografik özellikleri, SVST etiyolojileri, özgeçmişlerindeki tanısal özellikler, radyolojik bulgular ve prognoz hastanede yattıkları süre boyunca kaydedildi. Hastaların ortanca yaşı 32 idi. Yarısı kadındı. Üç hastada orta kulak iltihabı, diğer üç hastada gebelik, lohusalık ve hormonal kontraseptif olduğu biliniyordu. Bir hastada kronik enflamatuvar hastalık mevcuttu ve bir hastada tromboz idiyopatikti. Hastaların biri hariç tümünde baş ağrısı vardır. Tanı aracı manyetik rezonans venografi idi ve tüm hastalarda transvers sinüs tıkalıydı. Tüm hastalar nöroloji bölümünde yatarak antikoagülan tedavi aldı, 9 hasta şifa ile taburcu edildi, 1 hasta öldü. Özellikle genç hastalarda ve trombotik risk faktörleri olan hastalarda acil servis klinisyenleri daha dikkatli olmalıdır. Hormonal kontraseptif önlenebilir bir majör risk faktörüdür. Ancak gebelik ve doğum sonrası dönem başlı başına bir trombotik risk faktörüdür. Otitis media gibi intrakraniyal enfeksiyonlar yayılarak serebral ven trombozuna neden olabilir. Manyetik rezonans venografi, SVST için en başarılı tanı aracıdır.

Keywords

Sinüs ven trombozu, acil tıp, baş ağrısı

A rare stroke: Cerebral Venous-Sinus Thrombosis; A Case Series Analysis Presented to Emergency Department and Review of the Literature

Abstract

ABSTRACT
Cerebral venous sinus thrombosis (CVST) is a rare but acute and life-threatening disease. In this study, we present a case series of 10 patients with CSVT diagnosed in the emergency department of a tertiary hospital. Demographic characteristics, CVST etiologies, diagnostic characteristics in their history, radiological signs and prognosis were recorded during their hospitalization. The median age of the patients was 32 years. Half of the patients were women. It was known that three patients had otitis media, and the other three patients had pregnancy, puerperium and hormonal contraceptives. One patient had chronic inflammatory disease and one patient had idiopathic thrombosis. All but one of the patients had headache. The diagnostic tool was magnetic resonance venography and all patients had transverse sinus occlusion. All patients received anticoagulant treatment in the neurology department, 9 patients were discharged with good recovery, 1 patient died. Emergency clinicians should be more careful, especially in young patients and patients with thrombotic risk factors. Hormonal contraceptives are a major preventable risk factor. However, pregnancy and the postpartum period are thrombotic risk factors on their own. Intracranial infections such as otitis media may spread and cause cerebral vein thrombosis. Magnetic resonance venography is the most successful diagnostic tool for SSVT.

Keywords

Venous sinus thrombosis, emergency medicine, headache

References

• Ferro JM, Canhao P. Cerebral venous sinus thrombosis: update on diagnosis and management. Current cardiology reports. 2014; 16(9): 523.
• Zuluaga MI, Massaro M, Franco CA. [Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis]. Biomedica: revista del Instituto Nacional de Salud. 2015;35(2):196-203.
• Masuhr F, Mehraein S, Einhaupl K. Cerebral venous and sinus thrombosis. Journal of neurology. 2004; 251(1): 11-23.
• Ferro JM, Correia M, Pontes C, Baptista MV, Pita F. Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998. Cerebrovascular diseases (Basel, Switzerland). 2001;11(3): 177-82.
• Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012; 43(12): 3375-7.
• Fischer C, Goldstein J, Edlow J. Cerebral venous sinus thrombosis in the emergency department: retrospective analysis of 17 cases and review of the literature. The Journal of emergency medicine. 2010; 38(2): 140-7.
• Coutinho JM, Zuurbier SM, Stam J. Declining mortality in cerebral venous thrombosis: a systematic review. Stroke. 2014;45(5): 1338-41.
• Vaartjes I, O'Flaherty M, Capewell S, Kappelle J, Bots M. Remarkable decline in ischemic stroke mortality is not matched by changes in incidence. Stroke. 2013; 44(3): 591-7.
• Kojan S, Al-Jumah M. Infection related cerebral venous thrombosis. JPMA The Journal of the Pakistan Medical Association. 2006; 56(11): 494-7.
• Khan M, Wasay M, Menon B, Saadatnia M, Venketasubramanian N, Gunaratne P, et al. Pregnancy and puerperium-related strokes in Asian women. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. 2013; 22(8): 1393-8.
• Edris F, Kerner CM, Feyles V, Leung A, Power S. Successful management of an extensive intracranial sinus thrombosis in a patient undergoing IVF: case report and review of literature. Fertility and sterility. 2007; 88(3): 705. e9-14.
• Amoozegar F, Ronksley PE, Sauve R, Menon BK. Hormonal contraceptives and cerebral venous thrombosis risk: a systematic review and meta-analysis. Frontiers in neurology. 2015; 6: 7.
• Bianchini C, Aimoni C, Ceruti S, Grasso DL, Martini A. Lateral sinus thrombosis as a complication of acute mastoiditis. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2008; 28(1): 30-3.
• Unsal EE, Ensari S, Koc C. A rare and serious complication of chronic otitis media: lateral sinus thrombosis. Auris, nasus, larynx. 2003; 30(3): 279-82.
• Koopman K, Uyttenboogaart M, Vroomen PC, van der Meer J, De Keyser J, Luijckx GJ. Risk factors for cerebral venous thrombosis and deep venous thrombosis in patients aged between 15 and 50 years. Thrombosis and haemostasis. 2009; 102(4): 620-2.
• Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004; 35(3): 664-70.
• Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. Journal of neurology, neurosurgery, and psychiatry. 2005;76(8): 1084-7.
• Tadi P, Behgam B, Baruffi S. Cerebral Venous Thrombosis. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
• Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke. 2008; 39(4): 1152-8.
• Erdem A, Çelikel E, Yilmaz M, Karapinarli B, Kaya U. Investigation of sinus vein thrombosis cases detected in the emergency department. Journal of Health Sciences and Medicine. 2021; 4: 428-33.
• Biousse V, Ameri A, Bousser MG. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology. 1999; 53(7): 1537-42.
• Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, Massaro A, et al. Delay in the diagnosis of cerebral vein and dural sinus thrombosis: influence on outcome. Stroke. 2009; 40(9): 3133-8.
• Wasay M, Azeemuddin M. Neuroimaging of cerebral venous thrombosis. J Neuroimaging. 2005; 15(2): 118-28.
• Garland J, Kesha K, Vertes D, Modahl L, Milne D, Ruder T, et al. Empty Delta Sign on Unenhanced Postmortem Computed Tomography Scan in Cerebral Venous Thrombosis. The American Journal of Forensic Medicine and Pathology. 2018; 39(4): 360-3.
• Casey SO, Alberico RA, Patel M, Jimenez JM, Ozsvath RR, Maguire WM, et al. Cerebral CT venography. Radiology. 1996; 198(1): 163-70.