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Clinical differences between acute CVST and non-thrombotic CVSS.
Ran Meng1, David Dornbos, Lu Meng
1Department of Neurology, Beijing Shijitan Hospital affiliated Capital Medical University, the Ninth Clinical Medical College of Peking University, Beijing, China.
Clinical Neurology and Neurosurgery
|June 9, 2012
Summary
Cerebral venous sinus thrombosis (CVST) and stenosis (CVSS) share symptoms, but elevated d-dimer and fibrinogen levels, along with specific imaging findings, can help differentiate them. Prompt diagnosis is crucial for effective treatment and improved outcomes in these rare stroke subtypes.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Cerebral venous sinus thrombosis (CVST) and non-thrombotic cerebral venous sinus stenosis (CVSS) present with overlapping acute symptoms, necessitating accurate differentiation for appropriate management.
- Delayed diagnosis in CVST or CVSS can lead to severe consequences due to their distinct therapeutic approaches and prognoses.
Purpose of the Study:
- To elucidate the clinical, biomarker, and imaging differences between acute-phase CVST and CVSS.
- To aid in the accurate diagnosis and timely management of patients presenting with symptoms suggestive of CVST or CVSS.
Main Methods:
- A prospective, non-randomized, controlled study enrolled 34 patients with acute CVST and 34 with acute CVSS, diagnosed via digital subtraction angiography (DSA).
- Comparative analysis included clinical manifestations, plasma biomarkers (d-dimer, fibrinogen), and Magnetic Resonance (MR) or DSA imaging findings.
Main Results:
- While overlapping, CVST and CVSS differ in medical history and neurological deficits; however, a significant proportion in both groups lacked definitive history or focal deficits.
- Acute CVST showed significantly elevated d-dimer (94.1%) and fibrinogen (73.5%) compared to CVSS (17.6% and 5.9%, respectively; P<0.001).
- Imaging revealed distinct patterns: CVST showed local lesions and filling defects, while CVSS exhibited small ventricles, cerebral edema, external compression, and sinus narrowing.
Conclusions:
- Digital subtraction angiography (DSA) is valuable for diagnosing CVST in ambiguous cases of suspected CVST or CVSS.
- Plasma biomarkers, specifically d-dimer and fibrinogen, can aid in predicting CVST in emergency settings, particularly when MRI/MRV findings are equivocal.
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