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Early Diagnosis of Cerebral Venous Sinus Occlusion Secondary to Traumatic Brain Injury

Author: LiJun
Tutor: WangShouSen; WangRuMi
School: Fujian Medical
Course: Surgery
Keywords: cerebral venous sinus thrombosis cerebral venous sinus occlusion traumaticbrain injury early diagnosis
CLC: R651.1
Type: Master's thesis
Year: 2012
Downloads: 37
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Abstract

Objective Following up102cases of the traumatic patients with moderate and severetraumatic brain injury, we are willing to get the notable risk factor which may be one ofseveral risk factors we are going to focus on; we are also to analysing the hospitalized imagingdata and early clinic symptoms of all of the cases which is diagnosed as traumatic venous sinusocclusion and get to know how to let them get an early diagnosis of traumatic sinus occlusion.Method Consecutively collecting the probable risk factor of102cases of closed head injurywith moderate and severe brain injury during this period from August,2011to March,2012,we will arrange risk factors as independently factor which are respectively gender、age、GCSscore when admitted to our hospital、 the experience of hernia、experience treated withhemostatic agents intravenously、skull fracture crossing a dural sinus or a julgular bulb、epidural hematoma crossing a dural sinus，diagnosis of venous sinus occlusion as thedependent variable. We are using logistic stepwise regression analysis to establish the notablerisk factor which may help us establish an optimal regression equation predicting of traumaticvein sinus occlusion; we are also to analysing the hospitalized imaging data and early clinicsymptoms of all of the cases which is diagnosed as traumatic venous sinus occlusion and get toknow how to let them get an early diagnosis of traumatic sinus occlusion.Result (1) Skull fracture extending to a sinus or a jugular bulb、epidural hematomacrossing the sinus are risk factors predicting of CVSO, twenty seven (55.3%) of thepatients with skull fracture extending to a sinus or a jugular bulb suffered from cerebralvenous sinus occlusion;(2) The “depress type” of occlusive sinus more display positivesings than “thrombus type” in unenhanced brain CT ordered when admitted to theneurosurgery center, the incidence of depressed occlusive sinus was higher and thedifferences reach the statistical significance (96.2%[25of26] VS45.8%[11of24], P=0);(3) The incidence of “depressed type” of occlusive sinus is significantly higher in thesuperior sagittal sinus than in the sigmoid sinus (81.25%[13of16] VS16.7%[3of18], P<0.016); The incidence of “thrombus type” of occlusive sinus is significantly higher inthe sigmoid sinus than in the superior sagittal sinus (83.3%[15of18] VS18.75%[3of16],P <0.016);(4) The positive sings in early enhanced brain CT is higher in superior sagittalsinus than sigmoid sinus, but did not reach the statistical significance (93.75%[15of16] VS 55.6%[10of18], P=0.019, α ’=0.016);(5) The majority of conscious patients with CVSOsuffered from persistent headache, and mostly develop between2to7days after trauma, themajority of CT do not show clear organic disease;(6) Patients suffered from superiorsagittal sinus occlusion suffered from seizures or deteriorated consciousness;(7) Patientssuffered from sinus occlusion did not have to suffered from clinical symptoms;(8) Four(14.3%) of the CVSO patients suffered from depress and thrombus type of sinus occlusion;Ten (35.7%) of the CVSO patients only suffered from “thrombus type” of CVSO; Fourteen(50%) of the CVSO patients only suffered from “depressed type” of CVSO;(9) The patientswith cerebral venous sinus occlusion show a higher mortality, and the difference reachstatistical significance (14.3%[4of28]VS2.7%[2of74], P <0.05);(10) The CVSO alwaysoccurred during the period between the day suffered trauma to5days after trauma.Conclusions (1) Skull fracture extending to a sinus or a jugular bulb is a significant riskfactor predicted of CVSO in patients with moderate and severe traumatic brain injury;(2) The“depress type” of occlusive sinus more display positive sings than “thrombus type” inunenhanced brain CT ordered when admitted to the neurosurgery center, and can be moreeasily be diagnosed, especially for patients suffered from sigmoid sinus thrombosis;(3) Themajority of conscious patients with CVSO suffered from persistent headache, and mostlydevelop between2to7days after trauma, the majority of CT do not show clear organicdisease;(4) early clinical symptoms of patient suffered traumatic venous sinus occlusion can besignificantly vary from person to person, severe cases may manifest as seizures withdeteriorate consciousness and may indicate a poor outcom;(5) Traumatic CVST occuredduring the period between the day when suffered from trauma to5days after trauma, it canoccur in isolation, but also can be secondary to the the“depress type”of CVSO;(6) Theincidence of mortality in patients with CVSO is higher than in the patients without CVSO,the effect of anticoagulation for patients with CVSO is uncertain.

Early Diagnosis of Cerebral Venous Sinus Occlusion Secondary to Traumatic Brain Injury

Abstract

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