Serebral venöz sinüs trombozlarının klinik değerlendirmesi

Öz

Amaç: Serebral venöz sinüs trombozu (SVST), genellikle genç erişkinlerde görülen, farklı klinik bulgular ve predispozan faktörlerle seyreden nadir bir inme türüdür. Klinik bulguların değişkenliği ve başvuru semptomlarının çeşitliliği nedeniyle tanı sürecinde zaman zaman güçlükler yaşanabilir. Bu çalışmada, SVST tanısı almış hastaların sosyo-demografik, klinik ve etiyolojik özellikleri ve prognozu etkileyen faktörler değerlendirildi. Yöntem: Retrospektif olarak planlanan bu çalışmada, 1996-2012 yılları arasında Şişli Hamidiye Etfal Eğitim Araştırma Hastanesi Nöroloji Kliniğine başvuran 15-82 yaşları arasındaki 56 hasta(41 kadın,15 erkek) incelendi. Bulgular: Ortalama yaş 34 ± 14 yıl idi. En sık gözlenen semptom baş ağrısıydı (%85,7). Klinik olarak 17 hastada (%30,4) izole intrakraniyal hipertansiyon, 21 hastada (%37,5) fokal nörolojik defisit saptandı; 18 hastada (%32,1) ise nörolojik muayene normaldi. Etiyolojik faktörler arasında oral kontraseptif kullanımı (n=7), gebelik (n=5), postpartum dönem (n=9), kalıtsal trombofili (n=16), Behçet sendromu (n=4), ülseratif kolit (n=1), sistemik lupus eritematozus (n=1), malignite (n=2), hormon replasman tedavisi (n=1) ve anemi (n=6) yer aldı; 13 hastada etiyolojik neden saptanamadı. Fokal nörolojik defisiti olan hastalarda sekeller ve mortalite oranları, diğer gruplara kıyasla anlamlı olarak daha yüksekti. Özellikle, bu grup ile nörolojik muayenesi normal olan hastalar arasındaki fark istatistiksel olarak belirgindi (Ki-kare testi: p=0,029 ve p=0,001). Sonuç: SVST’nin geniş semptom yelpazesi nedeniyle tanısı zor olabilir; bu nedenle klinik şüphe büyük önem taşımaktadır. Erken tanı ile morbidite ve mortalite azalabilir, klinik bulgulara hâkimiyet tanıda kritik rol oynar.

Anahtar Kelimeler

• Sinüs trombozu
• inme
• genç yetişkin
• baş ağrısı
• intrakraniyal tromboz

Clinical evaluation of cerebral venous sinus thrombosis

Öz

Objectives: Cerebral venous sinus thrombosis (CVST) is a rare type of stroke that predominantly affects young adults and is characterized by a wide range of clinical manifestations and predisposing factors. Due to the variability of symptoms at presentation and clinical findings, the diagnostic process can sometimes be challenging. This study aimed to evaluate the socio-demographic, clinical, and etiological characteristics of patients diagnosed with CVST, along with their prognosis and the factors influencing it. Methods: In this retrospectively designed study, data from 56 patients (41 females and 15 males), aged between 15 and 82 years, who were admitted to the Neurology Clinic of Şişli Hamidiye Etfal Training and Research Hospital between 1996 and 2012, were analyzed. Results: The mean age was 34 ± 14 years. The most common presenting symptom was headache (85.7%). Clinically, isolated intracranial hypertension was identified in 17 patients (30.4%), focal neurological deficits in 21 patients (37.5%), and normal neurological examination findings in 18 patients (32.1%). Etiological factors included oral contraceptive use (n=7), pregnancy (n=5), postpartum period (n=9), hereditary thrombophilia (n=16), Behçet’s syndrome (n=4), ulcerative colitis (n=1), systemic lupus erythematosus (n=1), malignancy (n=2), hormone replacement therapy (n=1), and anemia (n=6); no etiological cause could be identified in 13 patients. The rates of sequelae and mortality were significantly higher in patients with focal neurological deficits compared to the other groups. In particular, the difference between patients with focal deficits and those with normal neurological findings was statistically significant (Chi-square test: p=0.029 and p=0.001). Conclusion: Given the broad spectrum of symptoms associated with CVST, diagnosis may be difficult; thus, clinical suspicion plays a crucial role. Since early diagnosis can reduce morbidity and mortality, recognizing clinical features is essential for accurate and timely diagnosis.

Anahtar Kelimeler

• Sinusthrombosis
• stroke
• headache
• intracranial thrombosis
• young adult

Kaynakça

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