颅内静脉窦血栓形成21例早期误诊分析

Early misdiagnosis and analysis of 21 cases of cerebral venous sinus thrombosis

目的分析颅内静脉窦血栓形成早期误诊原因,总结诊疗体会。方法报告21例临床误诊的静脉窦血栓形成病例,复习相关文献,总结并分析误诊原因。结果颅内静脉窦血栓形成易误诊为颅内肿瘤、良性颅内高压、假脑瘤综合征、蛛网膜下腔出血、出血性脑梗死、脑动静脉畸形等。本文21例有可能误诊为偏头痛、缺血性脑卒中、出血性脑卒中、病毒性脑炎、眼外直肌麻痹、炎症性脱髓鞘性脑病等。结论临床医师应强化对颅内静脉窦血栓形成的早期诊断意识,对可疑病例积极行CT、MRI、磁共振血管成像及数字减影血管造影等检查是及时确诊、减少误诊的关键。

Objective To analyze the reason of early misdiagnosis of cerebral venous sinus thrombosis（CVST）, summarize the diagnosis and clinical treatment. Methods We investigated 21 cases of clinical misdiagnosis of CVST, reviewed the related literature and analyzed the reasons of misdiagnosis. Results CVST was easily misdiagnosed as the following diseases., cerebral tumors, benign intracranial pressure, false brain tumor syndrome, subarachnoid hemorrhage, hemorrhagic cerebral infarction and cerebral arteriovenous malformation, etc. Twenty-one cases in our study might be misdiagnosed as migraine, ischemic stroke, hemorrhagic stroke, viral encephalitis, eye outside straigh~ paralysis and inflammatory demyelinating encephalopathy, etc. Conclusion The clinicist should strengthen the consciousness of the early diagnosis of CVST, and actively check suspected cases with CT and MRI, magnetic resonance vascular imaging（MRV） and digital subtraction angiography（DSA）.