Phu Tho Provincial General Hospital has just received and treated a case of cerebral venous thrombosis.
Female patient, 38 years old, residing in Son Hung commune, Thanh Son district, Phu Tho province. Four days before being admitted to the hospital, the patient had a headache, took medicine at home but did not get better, then her consciousness slowed down, her family took her to Phu Tho General Hospital in a state of slow consciousness, Glasgow score 13, breathing on her own, and weakness in all four limbs. The doctor ordered an MRI scan, the results showed cerebral infarction at the bilateral thalamus.
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| Cerebral venous thrombosis is a dangerous and rare disease, difficult to diagnose. |
Realizing that bilateral thalamic infarction was a rather unusual lesion, the doctors at the Stroke Center consulted and raised suspicions about a rather rare disease, “Cerebral venous thrombosis”. The patient was ordered to have a brain MRI with venous sinus reconstruction (TOP2D) and a D-dimer blood clotting test.
The results determined that this was a case of "Cerebral venous thrombosis", conclusion: Image of right transverse sinus venous thrombosis, superior sagittal sinus, straight sinus vein spreading along the large cerebral vein and bilateral thalamic veins, with bilateral thalamic cerebral edema and right thalamic cerebral ischemia.
The patient was treated according to the Cerebral Venous Thrombosis protocol. Anticoagulants were used for treatment. The patient progressed well after treatment: from impaired consciousness, Glasgow 13 points, now fully conscious, Glasgow 15 points, improved limb strength, now able to walk on his own.
According to BSCKI. Nguyen Anh Minh, Emergency and Intensive Care Unit, Stroke Center, cerebral venous thrombosis is a type of stroke in which thrombosis occurs on the venous side of the cerebral circulation, leading to blockage of one or more cerebral veins and dural venous sinuses.
Cerebral venous thrombosis has an annual incidence ranging from 1.16 to 2.02 per 100,000, with a female/male ratio of 3:1, a mean age of 37 years, and an incidence rate of only about 8% in those over 65 years of age.
The disease is related to transient factors such as birth control pills, pregnancy, postpartum, infection, etc.; permanent factors include congenital coagulation disorders, malignant diseases, bone marrow, antiphospholipid syndrome, etc.
Cerebral veins are responsible for draining blood from the brain components to the heart. When there is cerebral vein thrombosis or dural sinus thrombosis, it will impede blood drainage from brain tissue, leading to damage to brain parenchyma (such as stroke), increasing venous and capillary pressure leading to breakdown of the blood-brain barrier, causing cerebral edema, increased intracranial pressure and venous hemorrhage (infarction and hemorrhage combined).
The manifestations of the disease are quite diverse, symptoms that may occur are headache, convulsions, increased intracranial pressure (blurred vision, papilledema), paralysis.
The 2017 ESO guidelines recommend cerebral venous MRI or cerebral venous CT to confirm the diagnosis of CVT. However, the diagnosis of cerebral venous thrombosis is quite difficult.
To diagnose, the doctor must think of venous thrombosis because clinical and paraclinical symptoms are often atypical and easily confused with other pathological conditions or easily overlooked.
Cerebral venous thrombosis is a dangerous and rare disease, difficult to diagnose. Therefore, early diagnosis of cerebral venous thrombosis when the patient is admitted to the hospital is very important for emergency treatment and treatment of cerebral venous thrombosis, helping to increase the patient's recovery ability.
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