Headache for 4 days without improvement, 38-year-old woman has dangerous brain disease

Information from Phu Tho Provincial General Hospital said that recently, this unit received and treated a case of cerebral venous thrombosis.

The patient is a 38-year-old woman residing in Son Hung Commune, Thanh Son District, Phu Tho Province. Four days before being admitted to the hospital, the patient had a headache and took medicine at home but it did not help.

After that, the patient had slow consciousness, and was taken by his family to Phu Tho General Hospital in a Glasgow score of 13, breathing on his own, with weak limbs and slowness. The patient was ordered by doctors to have an MRI scan, which showed cerebral infarction at the bilateral thalamus.

MRI scan of patient's brain: Image of bilateral thalamic infarction. Photo: BVCC

Realizing that bilateral thalamic infarction is a rather unusual lesion, the doctors of the Stroke Center consulted and raised suspicions about a rather rare disease, cerebral venous thrombosis.

The patient was ordered to have a brain MRI with venous sinus reconstruction (TOP2D) and a D-dimer blood test. The results determined that this was a case of cerebral venous thrombosis.

The patient was concluded: 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.

After intensive treatment, the patient has made good progress. From impaired consciousness, Glasgow 13 points, the patient is now fully awake, Glasgow 15 points, limb strength has improved, and can now walk on his own.

What is cerebral venous thrombosis?

According to Dr. Nguyen Anh Minh, Stroke Center, Phu Tho General Hospital, 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 2.02/100,000, 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 old.

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.

Dr. Minh said that the 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 impede 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), paralysis.

The 2017 ESO guidelines recommend cerebral venous MRI or cerebral venous CT to confirm the diagnosis of cerebral venous thrombosis. 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.

Experts warn that 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 emergency care and treatment, helping to increase the patient's recovery ability.

Source: https://giadinh.suckhoedoisong.vn/dau-dau-4-ngay-uong-thuoc-khong-do-nguoi-phu-nu-38-tuoi-mac-benh-nguy-hiem-o-nao-172240913122633453.htm