机构：[a]Department of Neurology, Beijing Shijitan Hospital affiliated Capital Medical University, the Ninth Clinical Medical College of Peking University, Beijing 100038, China[b]Cerebral Vascular Diseases Research Institute (China-America Joint Institute of Neuroscience), Xuanwu Hospital, Capital Medical University, Key Lab of Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China神经变性病教育部重点实验室首都医科大学宣武医院首都医科大学•脑血管病研究所中美神经科学研究所[c]Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA[d]Department of Biochemistry & Molecular Biology/Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA[e]Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
Background: Cerebral venous sinus thrombosis (CVST) is a rare stroke subtype, which has many overlapping symptoms with non-thrombotic cerebral venous sinus stenosis (CVSS) in the acute phase. Despite these similarities, their therapeutic regimens and outcomes are entirely different, and treatment delay is life-threatening. This study aims to address their clinical differences to help promote proper patient care. Methods: 34 cases of CVST and 34 cases of non-thrombotic CVSS diagnosed with digital subtraction angiography (DSA) in the acute phase (symptoms onset within 7 days) were consecutively enrolled in this prospective non-randomized and controlled study. Differences between CVST and CVSS in their clinical manifestation, plasma biomarkers, and MR or DSA imaging were compared. Results: CVST and CVSS overlap in many ways, but differ in their respective medical histories and neurological deficits. However, 20.6% of CVST and 64.7% of CVSS occur without a definitive medical history, and 70.6% of CVST and 64.7% of CVSS occur without focal neurologic deficits. In the acute phase of CVST, D-dimer and fibrinogen are found to be abnormally elevated in 94.1% and 73.5% of cases, respectively. In the CVSS group, D-dimer and fibrinogen are only elevated in 17.6% and 5.9% of cases, respectively (binary logistic regressions test, all P < 0.001). In the CVST group, the predominant features in MRI/MRV and DSA imaging include local brain lesions, flow void signal loss, non-visualization, and a local filling defect sign at the involved sinus. Conversely, in the CVSS group, imaging revealed symmetrically small bilateral ventricles and the spread of cerebral edema in MRI/MRV. DSA imaging in the CVSS group revealed external compression and a narrow sinus with disproportionate venous engorgement. Despite these findings, positive imaging only appears in a minority of patients in the two groups during the acute phase (Table 4). Conclusions: DSA may be beneficial to diagnose CVST in ambiguous patients suspected to have either CVST or CVSS. Clinically useful biomarkers (D-dimer and fibrinogen) may predict CVST in the emergency room in the ambiguous patients with or without equivocal MRI/MRV imaging. (c) 2012 Elsevier B.V. All rights reserved.
基金：
the National Natural Science Foundation (30770741)
the Foundation of the Beijing High Level Health Systems Talented Technical Personnel Program(2009–03–02)
第一作者机构：[a]Department of Neurology, Beijing Shijitan Hospital affiliated Capital Medical University, the Ninth Clinical Medical College of Peking University, Beijing 100038, China[b]Cerebral Vascular Diseases Research Institute (China-America Joint Institute of Neuroscience), Xuanwu Hospital, Capital Medical University, Key Lab of Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China
通讯作者：
通讯机构：[*1]Cerebral Vascular Diseases Research Institute, (China- America Joint Institute of Neuroscience), Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing 100053, China
推荐引用方式(GB/T 7714)：
Ran Meng,David Dornbos III[ c],Lu Meng,et al.Clinical differences between acute CVST and non-thrombotic CVSS[J].CLINICAL NEUROLOGY AND NEUROSURGERY.2012,114(9):1257-1262.doi:10.1016/j.clineuro.2012.03.036.
APA：
Ran Meng,David Dornbos III[ c],Lu Meng,Yan Wu,Yu Liu...&Xunming Ji.(2012).Clinical differences between acute CVST and non-thrombotic CVSS.CLINICAL NEUROLOGY AND NEUROSURGERY,114,(9)
MLA：
Ran Meng,et al."Clinical differences between acute CVST and non-thrombotic CVSS".CLINICAL NEUROLOGY AND NEUROSURGERY 114..9(2012):1257-1262
