脑静脉窦血栓形成的诊断

Diagnosis of Cerebral Venous Sinus Thrombosis

目的探讨诊断脑静脉窦血栓形成(CVST)的方法。方法对54例CVST患者的发病诱因、起病形式、临床表现、影像学特征以及血液和脑脊液检查等资料进行回顾性分析。结果 54例CVST患者平均年龄(33.33±12.20)岁,其中45岁以下45例。在妊娠和产褥期(31.5%)、脱水(22.2%)、上呼吸道感染(18.5%)、乳突炎(9.3%)等诱因下急性或亚急性起病,首发出现头痛(87.0%)、恶心(50.0%)、性发作(7.4%)、意识障碍(5.5%)以及肢体无力(3.7%)等症状,同时有D-二聚体水平增高,影像学表现为静脉窦闭塞及脑组织水肿或梗死,伴有出血性病变。多数脑脊液压力增高、白细胞数正常。结论在妊娠、产褥、脱水、感染等诱因下,出现头痛、恶心、意识障碍、性发作等症状的青年患者,要高度怀疑CVST,应及时行头颅CT或MRI检查;D-二聚体增高的情况下,脑静脉造影和脑脊液检查有助于进一步确诊。

Aim To investigate the approach of diagnosis of cerebral venous sinus thrombosis （CVST）. Methods Medical records, including inducing factors, the mode of onset, clinical presentations, findings of neuroimaging, blood and cerebral spinal fluid, were analyzed retrospectively in 54 CVST patients. Results CVST most acutely affected young people in the following conditions, including pregnancy and puerperium （31.5%）, dehydration （22.2%）, upper respiratory tract infection（18.5%） and mastoiditis（9.3%）. The first symptoms included headache （87.0%）, nausea （50%）, epileptic seizure （7.4%）, disturbance of consciousness（5.5%）, limb weakness （3.7%） and so on. At the same time, D-dimer increased and Neuroimaging findings showed cerebral venous sinus occlusions and parenchymal edema or focal infarction （sometimes hemorrhage）. Conclusion Young people presenting with headache with or without nausea, disturbance of consciousness with or without epileptic sezure should be suspected to have CVST under the condition of pregnancy, puerperium, dehydration, infection. Then cerebral CT or MR/scans were required. Cerebral venous imaging and cerebrospinal fluid test could further establish the diagnosis under the condition of increased D-dimer.