脑静脉窦血栓形成的早期诊断与治疗

The early diagnosis and trea tment of cerebral venous sinus thrombosis

目的探讨脑静脉窦血栓形成的早期临床特点及治疗方法。方法回顾性分析16例脑静脉窦血栓形成患者的发病年龄、发病形式、首发症状、临床表现、影像学特征及脑脊液等检查结果与治疗方法。结果发病年龄以20～60岁多见,多数患者为急性发病,早期临床表现为头痛、呕吐,伴或不伴局灶性神经功能缺损或癫痫发作。影像学检查表现为静脉窦闭塞及局限性梗死灶。脑脊液压力明显增高,白细胞数及蛋白质含量正常或增高,但感染性或癌性脑静脉窦血栓形成除外。应用脱水、抗凝、局部溶栓及病因治疗等方法后,16例患者中6例基本痊愈,7例症状好转,1例无变化,2例死亡。结论脑静脉窦血栓形成的临床表现复杂多样,无特异性,对临床急性发病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的年轻患者,应高度怀疑脑静脉窦血栓形成,及时行磁共振成像(MRI)及磁共振血管造影(MRA)联合检查,以明确诊断。确诊后应尽早开始治疗。

Objective To study the early clinical char ac teristics and treatment of cerebral venous si-nus thrombosis(CVST).Methods The onset age and pattern,initial symptoms,clinical manifestations,imaging c haracteristics,changes of cerebrospinal fluid(CSF)and treatment in16patien ts with CVST were ret-rospectively analyzed.Re sults The CVST was mostly occur red at age of20-60,most patients developed in acute onset,presenting with headache,vomiting,with or without local neurological disorders or seizures a s the early clinical symptoms.Imaging findings included venous sinus thrombosis and limited cerebral infarction.The pressure of CSF was significantly elevated ,with normal or mild increase of WBC counts or protein(ex-ception of infectio us or cancerous CVST).Of 16cases treated with dehydration,anticoagulation, local throm-bolysis and etiological treatment,there were6complete recovery, 7improvement,1stable and2dead.Con-clu sion The clinical presentations of C VST are much complicated and without specificity.The young pa-tients manifest ed with acute onset of headache,vomiting,with or without local neurological d isorders or seizures should be highly suspected the CVST,thus early combined MR I with magnetic resonance angiography(MRA)are helpful for diagnosis,and earl y treatment should be begun as soon as diagnosis is established.