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Objective To analyze the clinical,imaging and pathological features of cortical vein thrombosis (CoVT). Methods Ten patients with CoVT (4 patients with CoVT alone and 6 patients with CoVT and venous sinus thrombosis)treated at Navy General Hospital from January 2006 to Jun 2013 were collected retrospectively.Its etiology,imaging,and pathological features of brain tissue in 3 patients were analyzed. Results Of the 10 patients with CoVT,3 were female and 7 were male.Their mean age was 31 ± 15 years old.(1)Brain CT scan and MRI showed hemorrhagic cerebral infarction,and contrast-enhanced MRI showed scattered heterogeneous enhancement within lesions. DSA could find CoVT at different parts.(2)3 patients underwent brain biopsy because they were initially diagnosed as brain tumor. Pathological examination showed glial cell,endothelial proliferation and phagocytic reaction.Scattered spotty bleeding was observed,and significant expansion of small veins,A few of them had blood stasis and thrombosis. Conclusion CoVT is one kind of intracranial venous thrombosis. It is more common occurred in young and middle aged adults,and most of them were venous sinus thrombosis.It is caused by retrograde thrombosis and spread to cortical veins.CoVT is easily to be misdiagnosed as brain tumor.Combination of clinical and imaging findings is needed for accurate diagnosis.
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Objective To analyze the characteristics of the common first attack of headache in patients with cerebral venous sinus thrombosis (CVST). Methods The clinical data of 51 patients who were diagnosed as CVST with MR venography (MRV)or DSA were collected retrospectively. The patients were divided into either a acute group (≤3 week,n= 32)or a chronic group (>3 weeks, n=19). Results (1)The age of onset of symptoms in these patients was 20 to 40 years,and most of them were females. Of all the first symptoms,headache ranked first,accounting for 84. 3%(43/51 );headache only accounted for 52. 9%(27/51 ),headache with other symptoms (ophthalmic symptoms, hemiplegia,and aphasia,etc. )accounted for 31. 4%(16/51 ),and other symptoms such as epilepsy, paralysis,and ophthalmic symptoms accounted for 15. 7%(8/51). (2)The proportion of headache only as the first symptom in the acute group was higher than that in the chronic group (65. 6% vs. 31. 6%,P0. 05 ). Conclusion Young patients without previous history of migraine,especially women of childbearing age with sudden onset and progressive worsening headache,and the patients with idiopathic intracranial hypertension,CVST should be considered as an important possibility.
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Objective: To compare the diagnostic value of two-dimensional time-of-flight (2D TOF) magnetic resonance venography in the sagittal plane, 2D TOF in the coronal plane, and three-dimensional contrast-enhanced magnetic resonance venography (3D CE-MRV) for intracranial venous sinus disease. Methods: Thirteen patients were suspected of having intracranial venous system abnormalities in the Neuro-surgical Outpatient Department, Xuanwu Hospital, Capital Medical University were included from July 2011 to March 2012. 2D TOF and 3D CE-MRV scan in the sagittal and coronal planes were performed at the same time. Maximum intensity projection (MIP) was used for 3D reconstruction. The diagnostic results were compared with DSA. The sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of the 8 main vein structures (superior sagittal sinus, straight sinus, bilateral transverse sinus, bilateral sigmoid sinus and bilateral transverse-sigmoid sinus junction) of the 2D TOF in the sagittal plane, 2D TOF in the coronal plane, and 2D TOF in the sagittal plane in combination with coronal plane were calculated. Results: Circled digit oneCompared to the diagnostic results of DSA, there was significant difference in using the diagnosis with TOF in the sagittal plane or coronal plane alone (all P 0.05). Circled digit twoTaking DSA as a standard, the consistency of 3D CE-MRV and DSA conclusions was the highest (P<0.01, Kappa =0.933). The sensitivity, specificity, positive predictive value, and negative predicting value were 94.4%, 98.8%, 94.4%, and 98.8%, respectively. The consistency of the diagnostic results of 2D TOF in the coronal plane in combination with sagittal plane and the DSA conclusions were higher than that of 2D TOF in the coronal plane or 2D TOF in the sagittal plane alone (Kappa values were 0.815, 0.635, and 0.608, respectively). Conclusion: When it is difficult to diagnose intracranial venous sinus disease with 2D TOF in the coronal plane or 2D TOF in the sagittal plane alone, the 2D TOF sequence of other direction should be added, the collaborative diagnosis of both may improve the accuracy of diagnosis. The diagnosis of 3D CE-MRV and DSA showed a high degree of consistency. They may be used as a routine examination for the diagnosis of cerebral venous sinus disease.