外伤性脑静脉窦血栓的临床诊治

Clinical diagnosis and treatment of traumatic cerebral venous sinus thrombosis

目的探讨外伤性脑静脉窦血栓的诊治方法。方法对近两年来临床工作中发现的27例外伤性脑静脉窦血栓患者资料进行回顾性分析。所有病例均采用核磁共振成像(MRV)证实,行尿激酶静脉溶栓治疗,首剂20万U,每日增加5万U。最大剂量达100万U。结果19例再通,7例建立侧支循环,1例死亡。结论对临床工作中出现的腰穿颅内压大于300mmH2O的病例、跨窦骨折的病例、病情平稳后又出现反复(如头痛加剧、呕吐等)而复查头颅CT无异常的病例,应高度怀疑脑静脉窦或深静脉血栓形成。MRV成像是脑静脉窦或深静脉血栓诊断的首选方法。

Objective To study pathogenesis and diagnosis and treatment of traumatic cerebral venous sinus thrombosis. Methods 27 cases with traumatic cerebral venous sinus thrombosis were analyzed retrospectively. All cases were diagnosed by magnetic resonance imaging （MRI） and magnetic resonance venography （MRV）. Urokinase was injected transvenously for thrombolysis with first dose of 0.2 million IU and final dose of 1 million IU （0.05 million IU more a day）. Results 19 cases got recanalized, 7 cases established collateral circulation and 1 case died. Conclusion Those with intracranial pressure by lumbar puncture over 300 mm H2O, or with transmural sinus fractures, or those whose condition got worse again after temporal control, for example, headache aggravated and emesia recurred but re-examination of skull CT showed negative, should be suspected as traumatic cerebral venous sinus thrombosis or deep venous thrombosis. Primary use of MRV is recommended for the diagnosis of traumatic cerebral venous thrombosis or deep venous thrombosis.