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Clinical profile and outcome of patients with cerebral venous thrombosis secondary to bacterial infections
Annals of Indian Academy of Neurology ( IF 1.7 ) Pub Date : 2020-07-01 , DOI: 10.4103/aian.aian_341_20 Manna S Jacob 1 , Karthik Gunasekaran 1 , Angel T Miraclin 2 , Mohammad Sadiq 1 , C Vignesh Kumar 1 , Ajoy Oommen 1 , Maria Koshy 1 , Ajay Kumar Mishra 1 , Ramya Iyadurai 1
Background: Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology. Methods: This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study. Results: Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was Staphylococcus aureus. At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%. Conclusion: Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial.
中文翻译：
继发于细菌感染的脑静脉血栓形成患者的临床特征和结果
背景：继发于感染性病因的脑静脉血栓形成 (CVT) 在抗生素时代已变得罕见，但在临床实践中仍偶尔会遇到。在这项研究中，我们描述了继发于感染性病因的 CVT 患者的临床特征、诊断和治疗。方法：这项回顾性研究包括所有 15 岁以上的成年患者（2002 年 1 月 1 日至 2017 年 1 月 1 日）。该研究包括诊断为继发于细菌感染的感染性 CVT 的成年患者。结果：总共有 22 名患者被确定为 CVT 并发细菌感染。12 名 (54.54%) 患者的感染病灶为化脓性脑膜炎，9 名 (40.9%) 患者有脑膜旁病灶，1 名患者发生继发于远距离细菌性败血症的 CVT。发热是最常见的症状，占 77.3%，其次是头痛和感觉抑制，分别占 72.7% 和 63.6%。脑膜炎组最常见的微生物是链球菌，脑膜旁组是金黄色葡萄球菌. 与 CT 相比，MRI 在所有 7 名患者中均发现 CVT，对比度为 2/3（66.6%）。横窦是脑膜炎最常累及的窦。所有患者都接受了适当的抗生素治疗，50%的患者使用了抗凝剂。住院时，死亡率为9%。结论：脓毒性 CVT 虽然罕见，但可能是细菌性脑膜炎和面部感染的并发症。应尽早识别和诊断提示同时存在 CVT 的临床症状。治疗的主要手段是抗生素；抗凝的作用是有争议的。
更新日期：2020-08-21
Annals of Indian Academy of Neurology ( IF 1.7 ) Pub Date : 2020-07-01 , DOI: 10.4103/aian.aian_341_20 Manna S Jacob 1 , Karthik Gunasekaran 1 , Angel T Miraclin 2 , Mohammad Sadiq 1 , C Vignesh Kumar 1 , Ajoy Oommen 1 , Maria Koshy 1 , Ajay Kumar Mishra 1 , Ramya Iyadurai 1
Affiliation
Background: Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology. Methods: This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study. Results: Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was Staphylococcus aureus. At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%. Conclusion: Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial.
中文翻译：
继发于细菌感染的脑静脉血栓形成患者的临床特征和结果
背景：继发于感染性病因的脑静脉血栓形成 (CVT) 在抗生素时代已变得罕见，但在临床实践中仍偶尔会遇到。在这项研究中，我们描述了继发于感染性病因的 CVT 患者的临床特征、诊断和治疗。方法：这项回顾性研究包括所有 15 岁以上的成年患者（2002 年 1 月 1 日至 2017 年 1 月 1 日）。该研究包括诊断为继发于细菌感染的感染性 CVT 的成年患者。结果：总共有 22 名患者被确定为 CVT 并发细菌感染。12 名 (54.54%) 患者的感染病灶为化脓性脑膜炎，9 名 (40.9%) 患者有脑膜旁病灶，1 名患者发生继发于远距离细菌性败血症的 CVT。发热是最常见的症状，占 77.3%，其次是头痛和感觉抑制，分别占 72.7% 和 63.6%。脑膜炎组最常见的微生物是链球菌，脑膜旁组是金黄色葡萄球菌. 与 CT 相比，MRI 在所有 7 名患者中均发现 CVT，对比度为 2/3（66.6%）。横窦是脑膜炎最常累及的窦。所有患者都接受了适当的抗生素治疗，50%的患者使用了抗凝剂。住院时，死亡率为9%。结论：脓毒性 CVT 虽然罕见，但可能是细菌性脑膜炎和面部感染的并发症。应尽早识别和诊断提示同时存在 CVT 的临床症状。治疗的主要手段是抗生素；抗凝的作用是有争议的。
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