Headache in cerebral venous thrombosis
Headache in cerebral venous thrombosis
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DOI：
10.1007/s10072-004-0287-3
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发表时间：
2004-10-01
影响因子：
3.3
通讯作者：
Agostoni, E
中科院分区：
文献类型：
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作者：
Agostoni, E
在过去，脑静脉血栓形成（CVT）被认为是一种罕见的，毁灭性的疾病。血管造影术、磁共振成像（MRI）和磁共振血管造影术（MRA）的广泛使用，使CVT的早期诊断成为可能，并完全改变了对这种疾病的看法。CVT比以前想象的要普遍得多。它具有广泛的临床表现，多种原因和不可预测的结果。与动脉卒中不同，头痛是CVT最常见的症状，有时也是唯一的症状。关键是要认识到头痛与CVT的关联，以便达到正确的诊断，并尽快开始适当的治疗。因此，为了确定有助于CVT早期诊断的头痛特征，我们回顾了当前关于此主题的文献，并进行了回顾性和前瞻性研究。在文献中，我们发现这种头痛没有特殊的特征，因为它可以是任何级别的严重程度，并且弥漫性比局部性略多。它的发作通常是亚急性的几天，但也可以是急性或慢性的。它大多是持续性的，但偶尔也会间歇性的。由CVT引起的头痛有时会引起误解，与偏头痛、蛛网膜下腔出血、CSF高血压或低血压相似。然而，这些信息来自缺乏对照组的病例系列，因此统计强度较低。我们的回顾性研究，证实了在前瞻性多中心研究的初步结果，显示在CVT头痛往往是急性和亚急性，而且它更常见的局部比弥漫性。最后，两项研究均显示急性发作和严重程度的头痛与CVT之间存在显著相关性。我们的结论是，这些头痛的特点，特别是在潜在的血栓前条件的存在下，应导致临床医生考虑CVT的诊断，并需要适当的神经影像学检查。
In the past, cerebral venous thrombosis (CVT) was considered a rare, devastating disease. The widespread use of angiography, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) over the years has made early diagnosis of CVT possible and has completely changed the perception of this condition. CVT is much more common than previously thought. It has a wide spectrum of clinical presentation, multiple causes and unpredictable outcome. In contrast to arterial stroke, headache is the most frequent and, at times, the only symptom of CVT. It is crucial to recognise the association of headache with CVT in order to reach a correct diagnosis and to start the appropriate treatment as soon as possible. Therefore in order to define the headache features useful for an early diagnosis of CVT we reviewed the current literature on this topic and performed both a retrospective and a prospective study. In the literature we found that this headache has no specific features as it can be of any grade of severity and is slightly more frequently diffuse than localised. Its onset is usually subacute over a few days but it can also be acute or chronic. It is mostly persistent but can occasionally be intermittent. Headache attributed to CVT is sometimes misleading, mimicking migraine, subarachnoid haemorrhage, CSF hypertension or hypotension. However this information has been derived from case series which lacked a control group and thus have low statistical strength. Our retrospective study, confirmed by preliminary results in the prospective multicentric study, showed that headache in CVT is as often acute as subacute, and that it is more frequently localised than diffuse. Finally, both studies showed a significant correlation between headache of acute onset and severe intensity and CVT. We then conclude that these headache features, especially in the presence of underlying prothrombotic conditions, should lead clinicians to consider the diagnosis of CVT and to require appropriate neuroimaging examinations.