Trombosis venosa cerebral en adultos en el Complejo Hospitalario-Universitario de A Coruña España. Revisión clínico-radiológica de 48 casos diagnosticados entre 1995 Y 2005
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Universidad Industrial de Santander
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INTRODUCCIÓN: La trombosis venosa cerebral es una patología del sistema nervioso central cuya incidencia es aún desconocida. El diagnóstico es difícil, teniendo en cuenta que las manifestaciones neurológicas así como su etiología pueden ser extremadamente variables.
OBJETIVOS: conocer la etiología, clínica y pronóstico de las trombosis de los senos venosos cerebrales en el Complejo Hospitalario Universitario Juan Canalejo de A Coruña. Pacientes y métodos: se revisaron de forma retrospectiva los casos diagnosticados de TVC desde 1995 a 2005. Se registró la etiología, las manifestaciones clínicas, los signos radiológicos en la TAC en el momento del ingreso, el tratamiento aplicado y el pronóstico a los 6 meses empleando la escala modificada de Rankin.
RESULTADOS: se registraron 48 casos de los cuales 27 eran mujeres y 21 hombres; el rango de edad fue de 21 a 88 años, con una mediana de 43 años. La etiología infecciosa estuvo presente en cinco casos equivalente al (10,4%). En pacientes jóvenes (<43 años) los trastornos de la coagulación y/o la toma de anticonceptivos hormonales se constató en el 66,7% de los casos, mientras que en los mayores de 43 años la etiología neoplásica se encontró en el 29% y no pudo identificarse en el 45,8%. El síntoma más frecuente fue la cefalea en el 72,9%. En la tomografía axial computarizada el signo radiológico más frecuente fue la hiperdensidad de uno o varios senos venosos (62,5%), pero fue estrictamente normal en el 20% de los casos. Treinta y cuatro pacientes recibieron tratamiento anticoagulante con buena evolución, así el 75% presentó puntuación en la escala modificada de Rankin ≤1 a los seis meses. Ocho pacientes (16,7%) fallecieron, pero la mortalidad estuvo fuertemente relacionada con la patología de base de los mismos (50% cáncer).
CONCLUSIONES: en pacientes jóvenes predomina la etiología por anticonceptivos y los trastornos de la coagulación, en cambio, a partir de la sexta década dominan las neoplasias subyacentes y causas indeterminadas. El tratamiento anticoagulante es eficaz y seguro. El pronóstico es excelente en la mayoría de los casos.
Palabras clave: Trombosis venosa cerebral. Senos durales. Ictus. Anticoagulantes. Heparina. Pronóstico.
INTRODUCTION: Central venous trombosis in adults in the complejo hospitalario-universitario de A Coruña Spain. Clinic-radiology review of 48 cases between 1955 and 2005. Introduction. Cerebral venous thrombosis is a pathology of the central nervous system which incident is still unknown. The diagnosis is difficult because the neurological manifestations and its etiology may be extremely varied. OBJECTIVES: The aim of our study was to ascertain the etiology, the clinical manifestations and the prognosis of the cases of Cerebral venous thrombosis diagnosed at our Hospital. Patients and Methods. It was reviewed retrospectively all histories of the patients who were diagnosed of cerebral venous thrombosis from 1995 to 2005. It was recorded the etiological factors, the clinical manifestations, the radiological signs in the computed tomography scan at admission, the treatment administered and the prognosis at six months was classified in accordance with the modified Rankin scale (mRS). RESULTS: We reviewed 48 cases (27 females; 21 males). The age range was 21 to 88 years old, with a median at 43 years. The infectious etiology was present in five patients (10,4%). In the young group (<43years), coagulation diseases and/or oral hormone contraceptives were involved in 66,7% of the cases, whereas in the age group (≥43 years), an underlying neoplasm was identified in 29% of the cases and no etiological factor in 45,8%. Headache was the most frequent symptom (72,9%). The most frequently observed radiological sign in the computed tomography scan was hyperdensity in one or more venous sinuses (62.5%), but it was normal in 20% of the cases. 34 patients received anticoagulant treatment with a good evolution, so 75% presented mRS ≤1 at six months. Death occurred in 8 patients (16,7%), although it was closely related to their basic condition (50% neoplasm). CONCLUSIONS: In young population, the most frequently etiologies are contraceptives and coagulation disease and in people older than 60 years, the underlying neoplasm and cases of unknown etiology prevail. The anticoagulant treatment is effective and safe. The prognosis was excellent in the most of the cases. Key words: Cerebral venous thrombosis. Venous sinuses. Stroke. Anticoagulant. Heparin. Prognosis.
INTRODUCTION: Central venous trombosis in adults in the complejo hospitalario-universitario de A Coruña Spain. Clinic-radiology review of 48 cases between 1955 and 2005. Introduction. Cerebral venous thrombosis is a pathology of the central nervous system which incident is still unknown. The diagnosis is difficult because the neurological manifestations and its etiology may be extremely varied. OBJECTIVES: The aim of our study was to ascertain the etiology, the clinical manifestations and the prognosis of the cases of Cerebral venous thrombosis diagnosed at our Hospital. Patients and Methods. It was reviewed retrospectively all histories of the patients who were diagnosed of cerebral venous thrombosis from 1995 to 2005. It was recorded the etiological factors, the clinical manifestations, the radiological signs in the computed tomography scan at admission, the treatment administered and the prognosis at six months was classified in accordance with the modified Rankin scale (mRS). RESULTS: We reviewed 48 cases (27 females; 21 males). The age range was 21 to 88 years old, with a median at 43 years. The infectious etiology was present in five patients (10,4%). In the young group (<43years), coagulation diseases and/or oral hormone contraceptives were involved in 66,7% of the cases, whereas in the age group (≥43 years), an underlying neoplasm was identified in 29% of the cases and no etiological factor in 45,8%. Headache was the most frequent symptom (72,9%). The most frequently observed radiological sign in the computed tomography scan was hyperdensity in one or more venous sinuses (62.5%), but it was normal in 20% of the cases. 34 patients received anticoagulant treatment with a good evolution, so 75% presented mRS ≤1 at six months. Death occurred in 8 patients (16,7%), although it was closely related to their basic condition (50% neoplasm). CONCLUSIONS: In young population, the most frequently etiologies are contraceptives and coagulation disease and in people older than 60 years, the underlying neoplasm and cases of unknown etiology prevail. The anticoagulant treatment is effective and safe. The prognosis was excellent in the most of the cases. Key words: Cerebral venous thrombosis. Venous sinuses. Stroke. Anticoagulant. Heparin. Prognosis.