脑静脉窦血栓27例回顾性分析

Cerebral Venous Thrombosis-a Retrospective Case Series Study of 27 Patients

目的探讨脑静脉窦血栓形成的病因、临床特点及诊治方法。方法回顾性分析27例脑静脉窦血栓患者的临床资料,总结患者的临床特点,按出院时改良Rankin量表(modified Rankin Scale,mRS)评分将患者预后分级。结果27例患者急性起病6例(22%),亚急性起病17例(63%),慢性起病4例(15%);产褥期3例,肾病综合征3例,下肢静脉炎、静脉血栓2例,产褥期+颅内感染1例,产褥期+系统性红斑狼疮1例,颅脑外伤1例,缺铁性贫血1例,颅内感染1例,房颤1例,原因不明14例;27例患者均行颅脑MRI和MRV检查,表现多个静脉窦受累人数为18例,表现单个静脉窦受累为6例,未发现异常3例;按出院时改良Rankin量表分级,0级11例(41%),1级7例(26%),2级4例(15%),3级1例(4%),4级0例,5级1例(4%),6级3例(11%)。结论脑静脉窦血栓部分患者可无明确病因,临床表现无特异性;MRI+MRV是一种安全无创有效的检查方法;抗凝是治疗脑静脉窦血栓首选、有效的治疗方法。

Objective To investigate the etiologies, clinical characteristics and treatment methods of cere- bral venous thrombosis （CVT）. Methods The clinical data of 27 patients with CVT were analyzed retrospec- tively, Clinical characteristics were summarized. The patients were divided into 6 degrees according to mRS. Re- suits 6 patients （22 % ） were acute onset, 17 patients（63 %） were subacute onset , 4 patients were chronic on- set （15%）; CVT was associated to puerperium in 3 cases, nephrotic syndrome in 3 cases, phlebitis, venous thrombosis in 2 cases, puerperium and intracranial infection in 1 case, puerperium and systemic lupus erythe- matosus in 1 case, cerebral trauma in 1 case, anemia in 1 case, intracranial infection in 1 case, auricular fibrilla- tion in 1 case, unknown origin in 14 cases. MRI and MRV examination was clone in 27 patients, thrombosis with multiple venous sinuses is in 18 cases, thrombosis with single venous sinus is in 6 cases and no abnormalities are found in 3 patients. According to mRS, level 0 is in 11cases, level 1 is in 7 cases, level 2 is in 4cases, level 3 is in 1 case, no patient with level 4 was found, level 5 is in leases and two cases were died. Conclusion CVT in some patients has no clear etiology and characteristic clinical manifestations; MRI ＋ MRV are a safe, nonin- vasive and effective method to diagnosis the CTV; Anticoagulation is the first choice for treatment of CVT.