PDF(Pubmed)
Abstract：
Cerebral venous thrombosis (CVT) is a cerebrovascular disorder caused by complete or partial occlusion of the cerebral venous and sinus system. The etiology has been attributed to hypercoagulability and pro-thrombotic states, leading to raised intracranial pressures that often manifest as headaches and focal neurological deficits. However, the multifactorial nature of CVT can create a diagnostic conundrum for clinicians. We describe a unique case of a 16-year-old female who presented with convulsions, postictal confusion, and drowsiness followed by residual weakness of her extremities. She initially presented to the primary care center with headache, high-grade fever, and altered mental status and was empirically treated for pyogenic meningitis. The patient failed to improve with a week of antibiotics and was referred to the tertiary care center for urgent attention. On presentation, the patient developed VI and VII cranial nerve palsy. Subsequently, MRI images showed filling defects in the superior sagittal, right transverse, and sigmoid sinuses with right parietal gyral T1 hyperintensity and T2 hypo-intensity. She was diagnosed with septic CVT based on sinus venous thrombosis and venous infarction, probably secondary to meningococcal pneumonia. It can be challenging to distinguish between both conditions as their presentations overlap. Moreover, cranial nerve palsy is an infrequent manifestation of CVT, with unclear pathogenesis. We highlight the role of neuro-imaging in the early detection of CVT and bring to light the unfamiliar symptoms and a more varied clinical spectrum that may hinder the diagnosis in a limited-resource setting. Future research should be explicitly modeled to improve the diagnostic efficiency of CVT and improve outcomes in younger patient populations.
摘要：
脑静脉血栓形成（CVT）是由脑静脉和窦系统完全或部分闭塞引起的脑血管疾病。病因已归因于高凝状态和血栓前状态，导致颅内压升高，通常表现为头痛和局灶性神经功能缺损。然而,CVT的多因素性质可能给临床医生带来诊断难题.我们描述了一个16岁女性出现抽搐的独特病例，后意识错乱,和困倦，然后是她四肢的残余无力。她最初带着头痛来到初级保健中心，高烧,并改变了精神状态，并对化脓性脑膜炎进行了经验性治疗。患者一周的抗生素治疗未能改善，并被转介到三级护理中心进行紧急护理。在介绍时，患者出现VI和VII颅神经麻痹。随后，MRI图像显示上矢状充盈缺损，右横向,乙状结肠窦右顶叶T1高强度和T2低强度。根据窦静脉血栓形成和静脉梗塞，她被诊断为化脓性CVT，可能继发于脑膜炎球菌肺炎。区分这两种情况可能是具有挑战性的，因为它们的呈现重叠。此外，颅神经麻痹是CVT的罕见表现，发病机制不清楚。我们强调了神经成像在CVT早期检测中的作用，并揭示了不熟悉的症状和更多样化的临床谱，这可能会在资源有限的情况下阻碍诊断。未来的研究应明确建模，以提高CVT的诊断效率，并改善年轻患者人群的预后。
