| Early Diagnosis of a Cerebral Venous Thrombosis in the Emergency Department |
| Ji Yun Ahn, Kyoung Soo Lim, Jae Ho Lee, Hui Dong Kang, Bum Jin Oh, Won Kim |
| Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. kslim@amc.seoul.kr |
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| ABSTRACT |
PURPOSE:
Early diagnosis and heparin therapy have contributed to a decreased mortality in patients with a cerebral venous thrombosis (CVT). The aim of this study is to evaluate the clinical and the radiologic features of a CVT and to develop an algorithm for diagnosis and treatment.
METHODS:
Twenty (20) patients who were diagnosed at Asan Medical Center from 1997 to June 2004 as having a CVT were included in this study. The data in their medical records, including clinical features, predisposing factors, and diagnostic modalities, were reviewed. The cranial computed tomography findings of a CVT were investigated in 18 patients.
RESULTS:
Headache was the most common symptom, followed by seizure and focal neurologic deficits. Initially, 14 patients were misdiagnosed by the emergency physician as having another neurologic disease, though 5 patients had pathognomic CT signs of a CVT. CT signs, such as cord signs and empty delta signs, were present in 10 cases. Among them, the cord sign was positive in eight (8) cases (44.4%), the empty delta sign was positive in six (6) cases (46.2%), and both signs were positive in four (4) cases. The presence of CT signs correlated with the presence of seizure at onset, and the Modified Rankin Scale (MRS) was 1 or 2 at discharge (p<0.05). Parenchymal changes correlated with headache at discharge (p<0.05).
CONCLUSION:
Emergency physicians should consider CVT and look for pathognomic signs of a CVT when patients complain of sub-acute headaches or when the clinical features do not correlate with the neuroimage findings. |
| Key words:
Cerebral venous thrombosis, Neuroimaging, Cord sign, Empty delta sign |
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