93例脑静脉及静脉窦血栓的临床分析

Clinical Analysis of 93 Cases of Cerebral Venous Thrombosis

目的探讨脑静脉及静脉窦血栓（cerebral venous thrombosis，CVT）的危险因素、临床及影像学表现、治疗及预后影响因素。方法回顾性分析93例CVT病例的临床资料，包括患者的一般情况、病程及起病方式、危险因素、首发症状、腰椎穿刺结果、影像学表现、治疗及预后等，并比较急性起病及慢性病程患者在危险因素及首发症状方面的不同。结果93例CVT患者中，急性起病者（1周之内）45例，慢性病程逐渐加重者48例。两组最常见的危险因素为血液系统异常，除此之外，急性起病者危险因素构成为围产期、口服避孕药、病毒感染、大量失水，慢性病程者为中耳乳突炎、恶性肿瘤等。两组均以高颅压为首发症状，但慢性病程者较少出现意识障碍、癫痫发作等全脑受损的表现。37例行腰椎穿刺检查，脑脊液压力升高、正常、低于正常者分别占70．5％（26／37），24．3％（9／37），5．4％（2／37）。影像学方面，CT、磁共振静脉成像（magnetic resonance venography，MRV）、全脑血管造影（digital subtraction angiography，DSA）的阳性率分别为44．1％（41／93），92．9％（79／85），96．9％（31／32）。所有患者一经诊断，均给予常规治疗，共有15例患者接受介入治疗，其中14例临床症状有不同程度改善，有8例在术后6个月复查DSA，提示闭塞的静脉窦部分或完全再通。结论急慢性CVT患者的危险因素及首发症状存在区别，临床表现缺乏特异性，只有依据症状、腰椎穿刺检查结果、影像学等进行综合分析才能够避免漏诊或误诊。疾病早期应尽快行MRV或DSA检查以明确诊断，情况允许可给予介入治疗，可望获得良好预后。

Objective To explore the etiopathogenisis, clinical manifestation, radiological feature, management and prognosis of cerebral venous thrombosis （CVT）. Methods The clinical data of 93 patients with CVT was analyzed retrospectively, including course, symptoms, risk factors, cerebrospinal fluid and image findings. The differences of acute and chronic CVT in risk factors and on-set symptoms were compared also. Results Two groups of 45 acute onset and 48 chronic CVT patients were involved. Hematological disorder was the most common causes of both acute and chronic CVT（25/93）. In addition, risk factors of acute CVT included peripartum, contraceptive agent, viral infection, loss of body fluid. Otitis media, mastoiditis, malignant tumor were other risk factors of chronic CVT. The onset symptoms of both 2 groups were intracranial hypertensive signs, such as headache, vomiting, vision impairment. However, loss of consciousness and epilepsy were unusual in chronic CVT patients. Increased pressure of cerebrospinal fluid was found in 26 patients. Poor developing of venous sinus was found on MRV（magnetic resonance venography（79/85） and DSA（digital subtraction angiography（31/32）. Interventional therapy was performed in 15 patients. Most （14/15） improved in clinical symptoms and 8 improved in DSA. Conclusion The clinical manifestation of acute and chronic CVT is various and nonspecific, so integrative analysis of clinical data contributes to diagnosis. MRV or DSA should be undertaken as soon as possible to definite the diagnosis. Interventional therapy is an effective and safe procedure for CVT patients.