Amaç: Serebral sinus ven trombozu (SSVT) inmenin nadir nedenlerindendir. SSVT kadınlarda erkekleklere göre üçe bir oranında daha sık görülür. Bu kadın baskınlığı cinsiyete özgü rik faktörlerine bağlanmaktadır. Hastaların çoğunda semptomlar günler veya haftalar içinde yerleşmektedir. Bazı hastalarda klinik görünüm nonspesifik olmaktadır. Yöntem: Haseki Eğitim ve Araştırma Hastanesinde 2001-2011 yılları arasında cranial MR ve MR venografi ile tanısı doğrulanarak SSVT tedavisi almış hasta kayıtlarını inceledik. Çalışmaya otuz dört hasta dahil edildi. Kadın/ erkek oranı 3.25/1 idi. Hastaların demografik özelliklerini, komorbid durumlarını, klinik görünümlerini, nöroradyolajik bulgularını inceledik. Bulgular: Çalışmaya otuz dört hasta dahil edildi. Başağrısı hastaların %47.1’inde (n=16) izole olmak üzere tüm hastalarda mevcuttu. Semptomların başlangıcı hastaların %52.9’unda (n=18) subakut, %29.4’ünde (n=10) kronik, %17.6’sında (n=6) akut idi. Tüm hastaların %76.5’i (n=26) kadındı. Her iki cinsiyette de en sık etkilenen sinus transvers sinus olarak saptandı (20 kadın ve 8 erkek). Başvurudaki en sık semptom kadınlarda başağrısı (%43.78) iken, erkeklerde intracranial hipertansiyon (%34.78) idi. Cinsiyete özgü risk faktörü saptanan kadın hastalarımızdan %26.92’si (n=7) doğum control hapı kullanmakta, %15.38’i (n=5) ise gebelik veya lohusa dönemindeydi. Sonuç: Klinik görünüm ve risk faktörleri açısından kadın ve erkeklerde farklılıklar olduğunu gözlemledik.
Objective: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke. CVST is much more common in women than men with a ratio of three to one. This women preponderance is attributed to gender-specific risk factors (GSRF). In many patients, symptoms develop over days or weeks. In some patients, clinical presentations are nonspesific. Patients and Methods: We reviewed the records of patients with CVST treated at Neurology department of Haseki Training and Research Hospital between 2001-2011, which diagnoses were confirmed with cranial magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Thirty- four patients were included the study. Women/men ratio was 3.25/1. We analyzed the demographic features, comorbid conditions, clinical presentation, neuroradiological findings. Results: Thirty- four patients were included the study. Headache was present in all patients and it was present as isolated in 47.1% (n=16) of the patients. In 52.9% (n=18) of the patients onset of the symptoms were subacute, 29.4% (n=10) chronic, 17.6 (n=6) acute. Of all patients, 76.5% (n=26) were women. Transverse sinus was the mostly affected sinus as either isolated or with the other CSVT in both groups (in 20 women and 8 men). The most common presentation symptom (43.78%) in women was headache whereas; it was intracranial hypertension (34.78%) in men. Half of our women patients with GRSF; 7 (26.92%) women were oral contraceptives user and 5 (15.38%) women were in pregnancy or puerperium period. Conclusion: We have found differences between women and men in the presentation and risk factors.
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1. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6:162-170.
2. Allroggen H, Abbott RJ. Cerebral venous sinus thrombosis. Postgrad Med J 2000; 76: 12-15.
3. Tiede DJ, Tefferi A, Kochhar R, Thompson GB, Hay ID. Paraneoplastic cholestasis and hypercoagulability associated with medullary thyroid carcinoma. Resolution with tumor debulking. Cancer 1994; 73:702-705.
4. Saadatnia M, Tajmirriahi M. Hormonal contraceptives as a risk factor for cerebral venous and sinus thrombosis. Acta Neurol Scand 2007; 115:295-300.
5. Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35:664-670.
6. Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral venous sinus thrombosis risk factors. Int J Stroke 2009 Apr; 4:111-123.
7. de Bruijn SF, Stam J, Kapelle LJ. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. Lancet 1996; 348:1623-1625.
8. Cohen JE, Boitsova S, Itshayek E. Cerebral venous sinus thrombosis. IMAJ 2009; 11: 685-688.
9. Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol 2000; 247:252-258.
10. Breteau G, Mounier-Vehier F, Godefroy O, Gauvrit JY, Mackowiak-Cordoliani MA, Girot M, Bertheloot D, Hénon H, Lucas C, Leclerc X, Fourrier F, Pruvo JP, Leys D. Cerebral venous thrombosis; 3-year clinical outcome in 55 consecutive patients. J Neurol 2003; 250:29-35.
11. Baumgartner RW, Studer A, Arnold M, Georgiadis D. Recanalisation of cerebral venous thrombosis. J Neurol Neurosurg Psychiatry 2003; 74:459-461.
12. Crassard I, Bousser MG. Cerebral venous thrombosis. J Neuroophthalmol 2004; 24:156-163.
13. Biousse V, Bousser MG. Cerebral venous thrombosis. Neurologist 1999; 5:236-249.
14. Coutinho JM, Ferro JM, Canhão P, Barinagarrementeria F, Cantú C, Bousser MG, Stam J. Cerebral venous and sinus thrombosis in women. Stroke 2009; 40:2356-2361.
15. Cantu C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke 1993; 24:1880-1884.
16. Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middeldorp S, Helmerhorst FM, Bouma BN, Rosendaal FR. Oral contraceptives and the risk of venous thrombosis. N Engl J Med 2001; 344:1527- 1535.
17. Raizer JJ, DeAngelis LM. Cerebral sinus thrombosis diagnosed by MRI and MR venography in cancer patients. Neurology 2000; 54:1222-1226.
18. Lopez-Pelaez MF, Millan JM, de Vergas J. Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: computed tomography and magnetic resonance findings. J Laryngol Otol 2000; 114:798-801.
19. Mossadeq R, Karouache A, Bouraza A, Ouhabi H, Reda R, Boutaleb N et al. Neuro-Behcet’s syndrome and thrombosis of Rosenthal’s basilar vein: a report of twelve cases. Rev Neurol (Paris) 2004; 160:935-938.
20. Srivastava AK, Khanna N, SardanaV, Gaekwad S, Prasad K, Behari M. Cerebral venous thrombosis in ulcerative colitis. Neurol India 2002; 50:215-217.
21. Terazzi E, Mittino D, Rudà R, Cerrato P, Monaco F, Sciolla R, Grasso E, Leone MA, Cerebral Venous Thrombosis Group. Cerebral venous thrombosis: a retrospective multicentre study of 48 patients. Neurol Sci 2005; 25:311-315.