颅内静脉窦血栓形成的诊治体会

Diagnosis and treatment of cerebral vein and sinus thrombosis

目的探讨颅内静脉窦血栓形成的诊断及治疗体会。方法回顾性分析我科收治的30例颅内静脉窦血栓形成患者的病因、临床表现、影像学特征、诊疗方案及预后情况。结果颅内静脉窦血栓形成多数为急性或亚急性发病,继发于感染7例,非感染性18例,其中产褥期发病12例;5例病因不明。上矢状窦血栓形成是最常见的。头痛、恶心、呕吐、视力下降、癫痫及局灶性神经系统症状为主要临床表现。治疗方案中单纯肝素抗凝治疗23例,肝素联合静脉窦内溶栓治疗7例。本组22例患者痊愈,4例遗留残疾或后遗症,4例死亡。结论 CVST的临床表现变异很大且缺乏特异性,常见于育龄期妇女。因此关注患者是否存在CVST发生的高危因素,尽早行颅脑CT、MRI、MRV或DSA检查,明确诊断后应积极地抗凝治疗,必要时联合介入溶栓治疗,并纠正病因、对症治疗,大多预后较好。

Objective To study diagnosis and clinical treatment of cerebral vein and sinus thrombosis.Methods To analyze cause,clinical represent,imaging features,treatment and prognosis of 30 patients with CVST.Results The most cases had acute or subacute course.Secondary to infection had 7 cases,noninfection had 18 cases,puerperium plentiful 12 cases,unknown etiology 5 cases.The most common was sagittal sinus thrombosis.The major clinical manifestations included head-ache,nausea,vomiting,Vision loss,epilepsy and local nervous system symptoms.To adopt treatment anticoagulant therapy with iv-heparin alone was 23 cases and anticoagulant therapy combined with intravenous sinus thrombolytic therapy was 7 cases.22 cases were well,4 caes left disability or sequela.4 caes were died.Conclusion The clinical manifestations of CVST had the huge variations and lack of specificity,it was common in women of reproductive age.So whether patients with CVST happen there on the risk factors,as early as to exam CT scan,MRI,MRV or DSA.After diagnosis,it should actively anticoagulation,when necessary joint intervention fibrinolytic therapy,and correct etiology,symptomatic treatment,most prognosis was good.