Trombosi venose cerebrali: Studio retrospettivo multicentrico

Cerebral venous thrombosis (CVT) are rare, with different signs and symptoms and different types of onset. Early diagnosis and treatment have improved prognosis; mortality is less than 10% in the most recent series. We collected 43 patients with a diagnosis of CVT in 9 Neurological Departments in the Piemonte and Valle d'Aosta Regions (North West Italy), from 1995 through 2000: 33 women and 10 males. Mean age was 46 years (SD = 12, range 19 - 67) for women and 52 years (SD = 8, range 41 - 61) for men. Onset was acute ( di 7 days) in 16 %. More frequent onset symptoms were: headache, focal neurological signs, epileptic seizures. Thirty-two patients had etiological factors: use of oral contraceptive, history of venous thrombosis or phlebitis, family history of thromboembolia, inherited thrombophilias, substitutive hormonal therapy. Diagnosis was confirmed in 25 patients with MRI and angio-MRI and in 16 with angiography. Most cases had thrombosis in multiple sites: superior sagittal sinus (56%), lateral sinus (58%), straight sinus (26%); cavernous sinus; superficial and deep cerebral veins were less frequently affected. In 86% of cases heparin was started acutely (i.v. or s.c.), while 5% of cases were treated with anticoagulants only. Therapy at dismissal was oral anticoagulants in most cases. Intra-hospital mortality was 12%; 62% of patients were discharged asymptomatic and 26% with neurological signs. At this moment in time we need further studies on natural history, risk factors, prognostic factors, and clinicl trials to compare efficacy of different therapies. Our group has started a prospectic study since January 2001.