18例颅内静脉窦血栓形成误诊分析

A Retrospective Analysis of 18 Misdiagnosed Cases of Cerebral Venous Sinus Thrombosis

目的：对18例颅内静脉窦血栓（CVST）形成患者临床资料、误诊原因进行分析，减少误诊率。方法回顾分析18例被误诊的CVST患者的临床特点、误诊原因。结果18例CVST患者以年轻人为主，发病初期分别误诊为：中枢神经系统感染5例、病毒性脑膜炎3例、病毒性脑炎1例、病毒性脑膜脑炎1例、脑出血2例、偏头痛2例、脑梗死和出血性脑梗死2例、蛛网膜下腔出血1例、脑梗死合并蛛网膜下腔出血1例。平均误诊时间7 d （1~30 d）。CVST以上矢状窦、横窦、乙状窦最为常见，绝大多数病因不明。结论 CVST临床表现复杂多样，误诊率极高。针对年轻、产褥期妇女、突发进行性加重或不典型头痛，或既往头痛性质如头痛频率、部位、程度发生变化时都要排查CVST。应重视腰穿和脑脊液测压检查，发现头痛伴颅内压增高时需行头颅MRV或DSA检查尽早明确诊断，减少CVST误诊和漏诊。

Aim To analyze the clinical data of ever misdiagnosed CVST cases and reduce the misdiagnosis rate of cerebral venous sinus thrombosis （CVST）.Methods The clinical characteristics and misdiagnosis causes of 18 ever misdiagnosed CVST patients were retrospectively analyzed.Results Most CVST patients were young. The initial misdiagnosed diseases were as follow. Five cases of central nervous system infection, 3 cases of viral meningitis, one case of viral encephalitis, one case of viral meningeal and encephalon infections, 2 cases of cerebral hemorrhage, 2 cases of migraine attack, 2 cases of cerebral infarction and hemorrhagic infarction, one case of subarachnoid hemorrhage, one case of cerebral infarction complicated with subarachnoid hemorrhage. The correct diagnosis of CVST had been made at the median 7 （1~ 30） days after initial symptoms occurrence. CVST mainly occured in superior sagittal sinus, sigmoid sinus and transverse sinus, most of patients couldn’t determine the etiology.Conclusion The clinical manifestation of CVST are considerably complicated with high misdiagnosis rate. A sudden progressive＇nbsp;or atypical headache may be presented in young people and puerperal women. And previous headache properties may change with headache frequency, location and intensity. So CVST should be eliminated before.