妊娠期和产褥期并发颅内静脉窦血栓形成的早期诊断与治疗

Early diagnosis and treatment of cerebral venous sinus thrombosis during pregnancy and puerperium

目的总结妊娠期和产褥期孕产妇颅内静脉窦血栓(cerebral venous and sinus thrombosis,CVST)的临床特点、诊治及预防措施,以提高对本病的诊治水平。方法回顾性分析22例发生颅内静脉窦血栓孕产妇的临床资料。结果 22例患者进行DAS检查确诊,最常见部位是上矢状窦(68.2%)。早期表现为头痛(90.9%),脑脊液压力明显升高,白细胞及蛋白含量正常或升高。应用脱水、抗凝、溶栓及病因治疗等疗效好,12例痊愈,9例留有后遗症,1例死亡。结论当孕产妇出现神经症状及体征时,医师应考虑CVST的可能,DSA是诊断金标准,及时准确的诊断CVST可以改善孕妇的妊娠结局和防止远期不良并发症的发生。抗凝或者溶栓治疗安全有效,重点在于预防。

Objective To investigate the clinical characteristics, inducing risk factors, diagnosis, treatment and preventive measures of cerebral venous sinus thrombosis（ CVST）. Methods A retrospective review was concluded based on the clinical data of pregnant women and parturients （ n = 22 ） who suffered from CVST from Jan. 2000 to Jun. 2010 in this Hospital. Results Twenty - two patients underwent digital subtraction arteriography（DSA） ,leading to a final diagnosis. The most common thrombosis site was superior sagittal sinus. Neuroimaging findings showed parenchymal focal infarction and cerebaral venous and sinus occlusions. Headache was the first common and major clinical manifestatinn（90.9% ） ,On examination CSF, pressure increased remarkably , with WBC and protein normal or increased slightly. Dehydration, lumbar punctures, anticoagulation, thrombolysis and etiologic treatment were adopted. Of 22 patients,including 8 pregnant women and 14 puerperants. The patients received anticoagulant or thrombolysis therapy, after which 12 fully recovered ,9 left behind functional disturbance and one died. Conclusions Whenever the pregnant women or puerperants developed neurological symptoms and signs, the clinicians should think of CVST. DSA is the golden standard for the diagnosis of CVST. Ac- curate diagnosis and prompt treatment can provide a good outcome of pregnancy and can prevent long - term complications. Therapeutic principle is comprehensive treatment. Anticoagulant therapy or endovascular thrombolysis is safe and effective therapy. Preventive measures are very important.