29例脑静脉窦血栓形成的早期诊断及临床分析

Early Diagnosis and Clinical Analysis for 29 Cases with Cerebral Venous Sinus Thrombosis

目的探讨脑静脉窦血栓形成（CVST）的早期诊断及预后。方法回顾性分析29例（男11例、女18例）CVST患者的发病年龄、发病形式、首发症状、临床表现、影像学特征、脑脊液检查结果及预后情况。结果CVST发病年龄多在20～40岁；多数为急性或亚急性发病；早期表现以头痛为主26例（89．66％）、以呕吐为主16例（55．17％），伴或不伴有局灶性神经功能缺损或癫痫发作；影像学表现为静脉窦闭塞伴局限性脑梗死15例（52％），其中伴有渗血或血肿7例（24％）；脑脊液压力明显增高者22例，蛋白正常17例（65．4％），增高9例（34．6％），白细胞正常20例，轻度增高6例；同型半胱氨酸增高5例（17％），均为男性患者；29例患者中，22例好转出院（75．86％），痊愈2例（6．95％），均为应用尿激酶局部静脉窦溶栓治疗患者。有4例因病情危重家属放弃治疗自动出院，有效率为82．81％，死亡1例（3．4％）。其中10例好转患者随访半年，6例仍有不同程度的颅内高压症状。结论对于急性发病的头痛、呕吐、伴或不伴有局灶性神经功能缺损或癫痫发作的青壮年患者，应高度怀疑CVST，及时行CT、MRI、磁共振动脉成像（MRA）、磁共振静脉成像（MRV）等检查，必要时行数控减影血管成像（DSA）检查。一旦诊断明确，应尽早选用肝素类抗凝药物治疗，并且要长时间足疗程。

Objective To explore the early diagnosis and prognosis for cerebral venous sinus thrombosis（CVST）. Methodes Retrospective analysis on the age and pattern of onset, first symptom, clinical characteristics, imaging characteristic, result of cerebrospinal fluid and prognosis in 29 CVST patients（male 11 and female 18）. Results The CVST occurred in the second and fourth decades mainly; acute or subacute onset. The early clinical characteristics were headache（accounted for about 89.66 % in all cases）, vomit（accounted for about 55. 17% in all cases）, some accompanied with focal neurologic impairment or seizure. The imaging findings in CVST were venous sinus occlusion and local infarction （accounted for about 52% in all cases）, some accompanied with capillary hemorrhage or haematoma（accounted for about 24% of cases）. The intracranial pressure increased obviously in CVST patients, but the protein concentration and white blood cell count in CSF were normal or increased slightly. In addition, homocysteine occurred about 17% in CVST patients and all the patients were male. 22 of 29 patients improved, 2 of 29 patients recovered with occurred after focal thrombolysis with urokinase. The total effective ratio accounted for 82.81%, in addition,1 of 29 patients died. Among all the effective cases, 10 cases were followed up for half a years, 6 of 10 remained increased intracranial pressure. Conclusion The young patients who with acute headache attack, vomit, focal neurologic impairment or seizure, should be suspected CVST and even DSA and immediately undertaken the examination of CT, MRI, MRA and MRV in order to make a definite diagnosis. It is essential to treat with anticoagulant after the diagnosis of CVST.