Severe cerebral venous thrombosis (CVT) is associated with serious clinical manifestations and poor prognosis, and current therapeutic strategies fail to substantially improve outcomes, necessitating exploration of novel therapeutic approaches. The latest studies have shown that inflammation is closely associated with the severity and poor prognosis of severe CVT, and anti?inflammatory therapy may be a very promising treatment. Despite ongoing debate regarding the role of glucocorticoids in severe CVT, recent studies indicate that short? term glucocorticoids pulse therapy may be a safe and effective intervention in acute/subacute severe CVT, which are likely due to suppression of the inflammatory response. This paper focuses on the latest research progress of glucocorticoids therapy for severe CVT, and points out that anti?inflammatory therapy targeting inflammation has great research potential in improving the prognosis of severe CVT. We wish to provide a novel, accessible, effective and safe anti? inflammatory therapy for patients with severe CVT.
Cerebral venous system diseases can lead to idiopathic intracranial hypertension (IIH), cerebral venous thrombosis (CVT) and pulsatile tinnitus (PT), and accurate evaluation of cerebral venous sinus hemodynamics is very important for the diagnosis and treatment of these diseases. In recent years, with the rapid development of hemodynamics research software and brain imaging technology, computational fluid dynamics (CFD), 4D Flow MRI, vitro simulation and transcranial Doppler ultrasonography (TCD) provide a multi-dimensional tool for the study of hemodynamics. In this paper, we will comprehensively introduce the research progress of above methods in the field of cerebral venous sinus hemodynamics, and provide innovative solutions for subsequent research of cerebral venous system diseases.
Inflammation plays a crucial role in the pathogenesis, diagnosis, treatment monitoring and prognosis assessment of cerebral venous system diseases. The application of inflammatory biomarkers provides important treatment monitoring and prognosis assessment tools for cerebral venous system diseases. Summarizing the pathophysiological mechanisms of inflammation in the development of cerebral venous system diseases, understanding its application value in the diagnosis and treatment, as well as its relationship with the prognosis of cerebral venous system diseases, reveals the multi? dimensional role of inflammation in cerebral venous system diseases. Additionally, proposing future research directions and suggestions can offer more insights for the clinical management and mechanistic exploration of cerebral venous system diseases.
Cerebral venous thrombosis (CVT) is a relatively uncommon but serious cerebrovascular disease. Anticoagulation therapy is the preferred treatment. In recent years, significant progress has been made in venous sinus mechanical thrombectomy. However, there is no consensus on mechanical thrombectomy in clinical practice. Issues such as how to bridge thrombectomy with anticoagulation therapy, the definition of severe CVT, and the determination of the mechanical thrombectomy "time window" need further exploration. This paper reviews the progress on anticoagulantion therapy and mechanical thrombectomy for CVT in recent years, and introduces the concept of the "time window" for mechanical thrombectomy, with the aim of providing some inspiration for future clinical research and practice.
Objective: To screen the influencing factors for increased intracranial pressure (ICP) in patients with cerebral venous thrombosis (CVT). Methods: A total of 102 patients with CVT admitted to Huashan Hospital, Fudan University from February 2021 to February 2023 were included. All patients underwent lumbar puncture cerebrospinal fluid examination. The clinical data of the patients were analyzed, and univariate and multivariate stepwise Logistic regression analyses were used to screen the influencing factors for increased ICP. Results: According to the lumbar puncture cerebrospinal fluid pressure value, the patients were divided into normal ICP group (< 200 mm H2O, n = 17) and increased ICP group (≥ 200 mm H2O, n = 85). The increased ICP group had lower hemoglobin (P = 0.027) and time from onset to lumbar puncture (P = 0.042), and higher CVT burden score (P = 0.000) than normal ICP group. Logistic regression analysis showed that large CVT burden was a independent risk factor for increased ICP in patients with CVT (OR = 2.956, 95%CI: 1.445-6.048; P = 0.003). Conclusions: The CVT burden has a significant impact on ICP in patients with CVT.
Objective: To examine the safety and efficacy of catheter aspiration combined with microcatheter venous sinus intraluminal thrombolysis in the treatment of severe cerebral venous sinus thrombosis (CVST). Methods and Results: We retrospectively analyzed the medical records of 10 patients with severe CVST who received catheter aspiration combined with microcatheter venous sinus intraluminal thrombolysis at The Affiliated Hospital of Northwest University, Xi'an No. 3 Hospital from January 2017 to December 2022. All 10 patients successfully completed the surgery. One patient achieved complete recanalization of the venous sinus immediately after the operation, 5 patients achieved partial recanalization, and 4 patients didn't recanalize. At the 90 d after the surgery, 5 patients achieved complete recanalization, 4 patients achieved partial recanalization, and one patient didn't recanalize. Among 7 patients who had intracranial hemorrhage (ICH) before the operation, head CT reexamination 7 d after the operation showed the hemorrhage at the original position was absorbed compared with that before the operation. Two patients developed newly ICH within 7 d after the operation. One patient experienced a poor prognosis [modified Rankin Scale (mRS) score of 3], while 9 had favorable prognosis (mRS ≤ 2) at 90 d after the operation. At the 12-month follow-up after the operation, all 10 patients had a favorable prognosis. Conclusions: Catheter aspiration combined with microcatheter venous sinus intraluminal thrombolysis maybe a safe and effective treatment for severe CVST, showing improvement in prognosis.
Objective: To explore the efficacy and prognosis of endovascular treatment for severe cerebral venous sinus thrombosis (CVST), providing new insights for the treatment of CVST. Methods: The clinical course of 31 severe CVST patients admitted to The First Hospital of China Medical University and Shengjing Hospital of China Medical University from October 2017 to December 2024 was analyzed retrospectively. The condition of venous sinus recanalization was assessed through immediately postoperative DSA examination, and the prognosis was evaluated based on criteria such as perioperative complication rate, mortality rate during follow‐up, and modified Rankin Scale (mRS) score at the last follow‐ up. Results: A combination of multiple endovascular treatment techniques was used. Immediately after the operation, 7 patients (22.58%) achieved complete recanalization of the venous sinus and 24 patients (77.42%) achieved partial recanalization. The incidence of perioperative complication rate was 6.45% (2/31), and there was no new cerebral infarction. The average follow ‐ up period was (6.60 ± 3.40) months. No deaths were reported during the follow ‐ up period. At the last follow ‐ up, 28 patients (90.32%) had a good prognosis (mRS score ≤ 2). Conclusions: Endovascular treatment can effectively reduce the mortality rate and improve the prognosis of patients with severe CVST, but individualized assessment is required, and indications must be strictly controlled.
Objective: To analyze the clinical manifestations, imaging features, treatment and prognosis of patients with systemic lupus erythematosus (SLE) combined with cerebral venous thrombosis (CVT). Methods and Results: Clinical data of 19 patients with SLE combined with CVT (SLE combined with CVT group) and 38 age and sex matched patients with SLE without CVT (SLE without CVT group) hospitalized in Xuanwu Hospital, Capital Medical University from January 2013 to December 2024 were retrospectively analyzed. SLE combined with CVT group had higher D ‐ dimer (P = 0.001), lupus anticoagulant (P = 0.001), and Systemic Lupus Erythematosus Disease Activity Index ‐ 2000 (SLEDAI ‐ 2000) at admission (P = 0.000) compared with SLE without CVT group. In SLE combined with CVT group, headache (18/19) was the most common neurological symptom. Cerebrospinal fluid (CSF) pressure increased in 14 cases (14/16). The most common cases of thrombosis were transversal sinus (17/19) and sigmoid sinus (17/19). Seventeen cases (17/19) had ≥ 2 venous sinuses involved. Twelve cases had other sites venous thrombosis occurred simultaneously. All patients of SLE combined with CVT group were treated with glucocorticoids, immunosuppressants and anticoagulation therapy. The average follow‐up period was (77.14 ± 33.46) months. During the follow‐up, 16 cases improved, one case died of concurrent infection, and 2 cases were lost to follow ‐ up. Conclusions: CVT is a rare and severity complication of SLE. Headache is the most common neurological symptom, and transversal sinus and sigmoid sinus are the most common sites of thrombosis. For patients of SLE combined with CVT, treatments such as glucocorticoids and immunosuppressants need to be strengthened after venous sinus mechanical thrombectomy. Early recognition and active treatment can obtain good curative effect.
Objective: To report a case of severe cerebral venous thrombosis (CVT) with an initial presentation of puerperium psychiatric and behavioral abnormalities, and to summarize and analyze its clinical manifestations and imaging changes, to enhance clinicians' awareness of this condition. Methods and Results: A 34 - year - old female patient developed psychiatric and behavioral abnormalities one month postpartum. She was initially presumed by her family to have "postpartum depression", and subsequently diagnosed at an external hospital as "psychiatric disorder of undetermined etiology". Following treatment with antipsychotic medications, the patient's psychiatric and behavioral abnormalities progressively aggravated. Upon the patient's development of right - sided limb weakness, a definitive diagnosis of severe CVT was ultimately established, corroborated by imaging findings. After a therapeutic regimen comprising fluid repletion, anticoagulation, reduction of fibrinogen level, corticosteroid anti - inflammatory therapy, and antipsychotic medications, the patient's psychiatric and behavioral abnormalities and right - sided limb weakness ameliorated, with a good prognosis. Conclusions: CVT manifesting with psychiatric and behavioral abnormalities is relatively uncommon. Its clinical presentation overlaps with that of various psychiatric disorders. Particularly in puerperium patients exhibiting psychiatric and behavioral abnormalities, a misdiagnosis of "postpartum depression" is frequent. Consequently, when such patients demonstrate an inadequate response to antipsychotic medications, the potential for CVT should be vigilantly considered, and comprehensive multimodal imaging should be pursued promptly to prevent misdiagnosis and inappropriate treatment.
Objective To report one case of chronic cerebral venous thrombosis (CVT) caused by compound heterozygous mutation in MTHFR gene, and to investigate the association between compound heterozygous mutation in MTHFR gene and chronic CVT as well as its pathophysiology mechanism. Methods and Results A 27-year-old male patient presented to the hospital with sudden onset headache. Imaging findings showed chronic thrombosis of the left superior sagittal sinus, inferior sagittal sinus, straight sinus, transverse sinus and confluence of sinus, and laboratory tests revealed hyperhomocysteinemia (homocysteine > 100 μmol/L). Genetic testing showed that the patient had a compound heterozygous mutation of MTHFR gene c. 325C > G (p. Arg109Gly) and c. 277C > T (p. Arg93Ter), and the mother also carried the c. 277C > T (p. Arg93Ter) heterozygous mutation, suggesting a familial predisposition. The clinical diagnosis was chronic CVT caused by a compound heterozygous mutation in MTHFR gene. Following anticoagulation therapy combined with folate acid and vitamin B supplementation, symptoms improved, but homocysteine level remained elevated. Conclusions This paper first reports the association of MTHFR gene c.325C > G (p.Arg109Gly) and c.277C > T (p.Arg93Ter) compound heterozygous mutation with CVT. Compound heterozygous mutation in MTHFR gene play an important role in the chronicity of thrombosis, and the necessity of genetic testing and individualized therapy for patients with hereditary thrombophilia should be emphasized.
Objective To report one case with protein C deficiency (PCD) and protein S deficiency (PSD) associated cerebral venous thrombosis (CVT), and to explore diagnostic and therapeutic strategies. Methods and Results A 27-year-old male patient presented with positional headache, worsened in supine position and relieved upon standing. Imaging findings showed thrombosis in the right transverse sinus, sigmoid sinus, and confluence of sinus. Laboratory tests showed significantly reduced protein C and protein S activities (49% and 51%) and elevated cerebrospinal fluid (CSF) pressure (> 330 mm H2O). Genetic test identified a frameshift mutation in the PROC gene [c.574_577del (p.Val192Serfs*5)] and missense mutation in the PROS1 gene [c. 1915T > G (p. Cys639Gly) and c. 301C > T (p. Arg101Cys)]. After receiving heparin followed by non - vitamin K oral anticoagulants (NOACs), alongside intracranial pressure reduction, neurotrophic therapy, and analgesia treatment, the patient's headache symptom resolved, and at 4-month follow-up reexamination showed CSF pressure normalized (135 mm H2O), with protein C and protein S activities rising to 53% and 54.10% (still below normal ranges). No headache recurrence was observed. Conclusions PCD and PSD are critical etiological factors for CVT. NOACs effectively improve venous reflux and avoid warfarin - related coagulation dysfunction, representing a preferred therapeutic option. Screening for coagulation protein activity and genetic analysis in young patients is essential to guide precise anticoagulation management.
Objective: To report the clinical and typical imaging features of a patient with recurrent cerebral venous thrombosis (CVT) secondary to anemia, and to review the relevant literatures in order to enhance the understanding of recurrent CVT. Methods and Results: A 38 - year - old female patient initially presented with metamorphopsia and reading difficulties. Laboratory tests revealed significant decrease in hemoglobin and increase in platelet count. MRI and MRV showed thrombosis of the left transverse and sigmoid sinuses. She was diagnosed with CVT with secondary venous infarction and severe anemia. After anticoagulation therapy and treatment to correct the anemia, the condition improved. However, she stopped anticoagulation therapy on her own after 3 months. One year later, she experienced a recurrence of CVT. MRI and MRV showed cortical venous thrombosis. Anticoagulation therapy was restarted, and the symptoms improved. Conclusions: In patients with anemia and other hypercoagulable risk factors, CVT should be highly suspected when neurological deficits or epileptic seizures occur. A definitive diagnosis can be made with imaging findings. CVT requires both active etiological treatment and adequate anticoagulation therapy to prevent recurrence.
Objective: To report one case of fulminant idiopathic intracranial hypertension (FIIH) associated with intracranial venous sinus stenosis, and explore its clinical characteristics, diagnostic strategies, and the feasibility and efficacy of endovascular treatment. Methods and Results: A 32 - year- old female patient presented with progressive headache and rapid visual deterioration. Imaging findings showed optic nerve sheath dilation, posterior globe flattening, and intracranial venous sinus stenosis. Laboratory tests showed iron deficiency anemia, and lumbar puncture showed markedly elevated cerebrospinal fluid (CSF) pressure (> 330 mm H2O). The clinical diagnosis was FIIH, right transverse sinus stenosis, and iron deficiency anemia. Emergency venous sinus stenting was performed, resulting in a marked reduction in CSF pressure and significant improvement in visual acuity. Conclusions: There may be a close association between intracranial venous sinus stenosis and FIIH. Early identification and timely intervention are critical for improving prognosis.
Objective: To explore the effect ofAPOEgene polymorphism on the clinical efficacy combined with oral atorvastatin in the treatment of chronic subdural hematoma (CSDH). Methods: A total of 104 patients with CSDH admitted in The First People's Hospital of Foshan from January 2022 to December 2023 were selected as the research subjects. TheAPOEgene of the extracted DNA samples of the patients was detected by real - time fluorescence quantitative polymerase chain reaction (PCR) technology, and 104 patients were divided into APOE2 type group (n = 9), APOE3 type group (n = 58) and APOE4 type group (n = 37) according to the genotype. All patients were treated with oral atorvastatin therapy for 3 months. The clinical efficacy, health status [Karnofsky Performance Status (KPS)], hematoma clearance, complication and recurrence of each group were compared. Results: The total effective rate (Fisher's exact probability: P = 0.011) and recurrence rate (Fisher's exact probability: P = 0.046) among the 3 groups were statistically significant. Further pairwise comparison showed that the total effective rate of APOE3 type group was higher (Fisher's exact probability: P = 0.045) and the recurrence rate was lower (Fisher's exact probability: P = 0.045) than the APOE2 type group. There were significant differences in KPS score, hematoma volume and hematoma area among the 3 groups (P = 0.000, for all). Further pairwise comparison between the groups showed that the APOE3 type group had higher KPS score (P = 0.009), larger hematoma volume (P = 0.000) and hematoma area (P = 0.000) before treatment than the APOE2 type group. The APOE4 type group had a larger hematoma volume than the APOE2 type group (P = 0.038). After one month of treatment, the KPS score of APOE3 type group was higher than that of APOE2 type group (P = 0.000) and APOE4 type group (P = 0.000), and the hematoma volume and hematoma area of APOE3 type group were smaller than those of APOE2 type group (P = 0.000, 0.000) and APOE4 type group (P = 0.000, 0.000). At the 3 months treatment, the KPS score of APOE3 type group was higher than that of APOE2 type group (P = 0.007), and the hematoma area was smaller than that of APOE2 type group (P = 0.046). Comparison of the same group at different observation time points showed that the KPS scores of APOE2 type group, APOE3 type group and APOE4 type group at one month after treatment were higher than those before treatment (P = 0.000, 0.000, 0.000), and the KPS scores at 3 months of treatment were higher than those before treatment (P = 0.000, 0.000, 0.000) and one month after treatment (P = 0.001, 0.000, 0.000); the hematoma volume (P = 0.000, 0.000, 0.000) and hematoma area (P = 0.000, 0.000, 0.000) at one month of treatment in the 3 groups were lower than those before treatment, and the hematoma volume and hematoma area at 3 months of treatment were lower than those before treatment (hematoma volume: P = 0.000, 0.000, 0.000; hematoma volume: P = 0.000, 0.000, 0.000) and one month after treatment (hematoma volume: P = 0.002, 0.000, 0.000; hematoma volume: P = 0.000, 0.000, 0.000). There was an interaction between the treatment factors of KPS score, hematoma volume and hematoma area and the measurement time (P = 0.000, for all). The changes of KPS score, hematoma volume and hematoma area in APOE3 type group were the largest, suggested that the APOE3 type group had the largest response to atorvastatin treatment and the best treatment effect. Conclusions: The polymorphism of the APOE gene is closely related to the therapeutic effect of oral atorvastatin in patients with CSDH, and patients with APOE3 type show the best efficacy and safety, which is help for the formulation of personalized treatment plans for CSDH.
Functional tic-like behaviors (FTLBs) is a kind of rare clinical phenotype of functional neurological disorder (FND), its etiology and pathogenesis have not been fully defined, and the clinical understanding of it is not comprehensive. This paper systematically reviews the relevant studies of FTLBs in recent years, and analyzes and summarizes its clinical characteristics, influencing factors, comorbidities, diagnosis, treatment and prognosis, aiming to provide theoretical reference for the subsequent diagnosis and treatment of FTLBs.
