Detecting stroke after headache

Phu Tho Provincial General Hospital has just received and treated a case of cerebral venous thrombosis.

The patient was a 38-year-old woman residing in Son Hung Commune, Thanh Son District, Phu Tho Province. Four days before being admitted to the hospital, she had a headache and took medicine at home but it did not help. Her consciousness then slowed down. Her family took her to Phu Tho General Hospital in a state of slow consciousness, Glasgow 13 points, breathing on her own, and weakness in all four limbs. The doctor ordered an MRI scan, which showed cerebral infarction at the bilateral thalamus.

Cerebral venous thrombosis is a dangerous and rare disease, difficult to diagnose.

Realizing that bilateral thalamic infarction is a rather unusual lesion, the doctors of the Stroke Center consulted and raised the question of a rather rare disease, the disease "Cerebral venous thrombosis". The patient was assigned to have a brain MRI with venous sinus reconstruction (TOP2D) and a D-dimer blood clotting test.

The results determined that this was a case of "Cerebral venous thrombosis", conclusion: Image of right transverse sinus vein thrombosis, superior sagittal sinus, straight sinus vein spreading along the large cerebral vein and bilateral thalamic veins, with bilateral thalamic cerebral edema and right thalamic cerebral ischemia.

The patient was treated according to the protocol for Cerebral Venous Thrombosis. Anticoagulants were used for treatment. The patient progressed well after treatment: from impaired consciousness, Glasgow 13 points, now fully awake, Glasgow 15 points, improved limb strength, now able to walk on his own.

According to Dr. Nguyen Anh Minh, Emergency and Intensive Care Unit, Stroke Center, cerebral venous thrombosis is a type of stroke in which thrombosis occurs on the venous side of the cerebral circulation, leading to blockage of one or more cerebral veins and dural venous sinuses.

Cerebral venous thrombosis has an annual incidence ranging from 1.16 to 2.02 per 100,000, with a female/male ratio of 3:1, a mean age of 37 years, and an incidence rate of only about 8% in those over 65 years of age.

The disease is related to transient factors such as birth control pills, pregnancy, postpartum, infection, etc.; permanent factors include congenital coagulation disorders, malignant diseases, bone marrow, antiphospholipid syndrome, etc.

Cerebral veins are responsible for draining blood from the brain components to the heart. When there is cerebral vein thrombosis or dural sinus thrombosis, it will obstruct the drainage of blood from brain tissue, leading to damage to brain parenchyma (such as stroke), increasing venous and capillary pressure leading to breakdown of the blood-brain barrier, causing cerebral edema, increased intracranial pressure and venous hemorrhage (infarction and hemorrhage combined).

The manifestations of the disease are quite diverse, symptoms that may occur are headache, convulsions, increased intracranial pressure (blurred vision, papilledema), and paralysis.

The 2017 ESO guidelines recommend cerebral venous MRI or cerebral venous CT to confirm the diagnosis of CVT. However, the diagnosis of cerebral venous thrombosis is quite difficult.

To diagnose, the doctor must think of venous thrombosis because clinical and paraclinical symptoms are often atypical and easily confused with other pathological conditions or easily overlooked.

Cerebral venous thrombosis is a dangerous and rare disease, difficult to diagnose. Therefore, early diagnosis of cerebral venous thrombosis when the patient is admitted to the hospital is very important for the emergency and treatment of cerebral venous thrombosis, helping to increase the patient's recovery ability.