Serebral ven trombozlu hastaların etiyolojik, topografik ve klinik değerlendirilmesi

Abstract

Giriş ve Amaç: Serebral ven trombozu (SVT) arteriyal inmeye oranla daha seyrek görülmekle birlikte her yaş grubunu etkileyebilmektedir. Başlangıç şekli ve seyri değişken olup genellikle iyi prognoza sahiptir. Erken gelişen koma ve intrakraniyal kanama ise kötü prognostik faktörlerdendir. Gereç ve Yöntem: 01 Ocak 2006 – 1 Ekim 2011 tarihleri arasındaki 5 yıllık dönemde, SVT tanısı ile takip edilen 30 kadın 16 erkek toplam 46 hasta retrospektif olarak incelendi. Bulgular: 46 olgunun 30’u kadın, 16’sı erkekti. Yaş ortalaması 39,3+12,29, yaş aralığı 13-69 olup 22’si subakut, 20’si akut, 4’ü kronik dönemde başvurdu. En sık yakınma başağrısı olup (%69,6) en sık tespit edilen bulgu papilla ödemiydi (%56,5). Çalışmaya alınan 15 hastada epileptik nöbet izlendi. Görüntüleme bulguları incelendiğinde 24’ünde parenkimal lezyon yokken, 13’ünde hemorajik infarkt, 6’sında iskemik infarkt, 2’sinde subaraknoid kanama, birinde epidural apse saptandı. 16 hastada tek bir dural sinüs trombozu izlenirken, 30 hastada birden fazla sinüs tutulumu mevcuttu. İzole ve izole olmayan sinüsler birlikte alındığında en sık transvers sinüs (n=37), trombozu saptandı. Hastaların 11’inde etyolojik neden saptanamazken, 18 hastada birden fazla etyoloji saptandı. Saptanan predispozan faktörler; infeksiyon (n=21), gebelik ve postpartum (n=5), oral kontraseptif ilaç (n=7), kalıtımsal trombofili (n=21), Behçet Hastalığı (n=2), ülseratif kolit (n=1), kafa travması (n=1) idi. Hastaların izleminde 38 hastada tam düzelme kaydedildi, 1 hasta vefat etti, 7 hastada defisit saptandı. Sonuç: SVT yüksek klinik şüphecilik gerektiren bir durumdur. Erken tedavi; ölüm ve ağır dizabilite riskini azaltır. SVT özelikle sebebi bilinmeyen baş ağrıları olan hastalarda ayırıcı tanıda akla gelmelidir.

Keywords

• Serebral venöz tromboz
• klinik özellikler
• etyoloji
• MR venografi

Etiological, topographic and clinical evaluation of patients with cerebral vein thrombosis

Abstract

Objective: Cerebral venous thrombosis is seen more infrequent than arterial stroke and effects every age group. Onset and process is variable and usually a good prognosis occurs. Early devolopment of coma and intracranial hemorrhage are bad prognostic factors. Methods: In our retrospective study, it’s aimed to investigate the neurological deficits, etiological factors, localisation and prognosis of the 46 patients who are hospitalized with the diagnosis of cerebral venous thrombosis. Results: Of 46 patients, 30 were women, 16 were men. Mean age was 39+12,29 and age interval was 13-69. 22 patients in subacute, 20 patients in acute and 4 patients in chronic stage had admitted to our clinics. The most frequent symptom was headache (%69,6) and the most frequent neurological sign was papillaedema (%56,5). 15 patients had subarachnoid hemorrhage, 6 patients had venous ischemic infarct, 1 patient had epidural abscess. 16 patients had one dural sinus thrombosis, 30 patients had more than one dural sinus thrombosis. The most commonly affected sinus in isolated or combined sinus thrombosis is transverse sinus (n=37). We hadn’ t found any etiological factor in 11 patients; versus 18 patients had more than one etiological factor. The predisposing factors were infections (n=14), pregnancy and postpartum period (n=5), oral contraceptive pills (n=7), hereditary thrombophilia (n=21), Behçet Disease (n=2), ulcerative colitis (n=1) and head injury (n=1). In follow up, 37 patients had complete recovery, one patient died in the early period. 7 patients are disabled. Conclusion: Cerebral venous thrombosis needs highly suspection in order to define the clinical signs. As the early treatment prevents exitus and severe disability, early diagnosis is very important. Cerebral venous thrombosis must be remembered in the differential diagnosis of headaches of unknown etiology.

Keywords

• cerebral vein thrombosis
• clinical features
• etiology
• MR venography.

References

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