脑静脉窦血栓形成的诊断及治疗

The Diagnosis and Treatment of Cerebral Venous Sinus Thrombosis

目的:探讨脑静脉窦血栓形成(CVST)的临床特点。方法:对20例CVST患者的一般情况、病因、临床表现、脑脊液特点、影像学特征、治疗及预后等资料进行回顾性分析。结果:20例患者多表现为头痛,可伴有癫疒间发作和各种神经功能缺损的症状体征,脑脊液压力明显升高,白细胞数和蛋白质定量可正常或升高,头颅CT示静脉窦高密度改变及脑实质异常信号,MRI示静脉窦异常信号,MRV示静脉窦闭塞或充盈缺损,DSA示静脉窦狭窄、血流中断或不显影。治疗以脱水、抗凝、溶栓为主,19例好转,1例死亡。结论:对于高颅压伴或不伴神经、精神障碍的患者,须高度警惕CVST,应尽早行MRV或DSA检查,治疗以抗凝、溶栓为主。

Objective： To investigate the clinical characteristics of cerebral venous sinus thrombosis（CVST）.Methods： Twenty CVST patients in the hospitol have been retrospectively analyzed.Results： The most frequent symptoms were headache,epilepsy and focal deficits.CSF pressure increased remarkably.WBC and protein in CSF displayed normal or increased by CSF examination.MRI showed the disappearence of normal flow void of the dural sinus and abnormal high signal intensities were observed.MRV indicated the block and loss of vascular flow of the venous sinus.Nineteen patients were improved and one patient died aften the treatment including dehydration,anticoagulation and thrombolysis.Conclusion： The patients of intracranial hypertension with or should be highly suspected as CVST.MRV or DSA should be applied as soon as possible to help the diagnosis.Anticoagulation and thrombolysis were the main treatments for CVST.