颅内静脉窦血栓形成的头痛特点分析

Characteristics Analysis of Headache in Cerebral Venous Sinus Thrombosis

目的通过分析颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的病例,总结CVST患者头痛的特点,提高神经科医师对该病的认识。方法收集2007年1月-2016年12月在北京大学第三医院就诊的CVST病例,回顾其头痛特点、临床表现、影像学检查及化验结果,并复习相关文献进行分析总结。结果共入组18例CVST患者,本组CVST最常见的部位是横窦(77.8%,14/18),其次为乙状窦(61.1%,11/18)和上矢状窦(50%,9/18);14例(77.8%)存在多个颅内静脉窦血栓。所有患者均以头痛为首发症状,其中7例(38.9%)为单纯性头痛;11例合并其他临床症状,包括癫痫(38.9%,7/18)、呕吐(44.4%,8/18)、肢体麻木(11.1%,2/18)、肢体无力(16.7%,3/18)、眼部症状(22.2%,4/18)以及意识障碍(11.1%,2/18)。9例(50%)为偏侧头痛,其中8例(88.9%,8/9)存在同侧CVST;头痛视觉模拟评分法(visual analogue scale,VAS)评分平均7.0分(3～10分);头痛发病形式5例(27.8%)为急性,12例(66.7%)为亚急性,1例(5.6%)为慢性。结论头痛是CVST最常见的首发症状,偏侧头痛CVST患者血栓以头痛同侧多见;头痛亚急性起病的患者,尤其需注意CVST的可能性。

Objective To analyze the characteristics of headache in cerebral venous sinus thrombosis（CVST） through case report, so as to increase the understanding of CVST.Methods Cases of CVST who came to Peking University third hospital between January 2007 and December 2016 were collected. Retrospective review was made upon the characteristics of headache, clinical manifestations, clinical medical records, and neuroimaging studies. And the relevant literatures were reviewed for discussion.Results A total of 18 patients were enrolled into study. Transverse sinus was the most common site of thrombosis（77.8%, 14/18）, followed by sigmoid sinus（61.1%, 11/18） and the superior sagittal sinus（50%, 9/18）. There were 14 cases（77.8%） had involvement of multiple sinuses. Headache was the first symptom in all patients, including 7 cases（38.9%） with headache as the only symptom. There were 11 cases complicated with other symptoms, including epilepsy（38.9%, 7/18）, vomiting（44.4%, 8/18）, limb numbness（11.1%, 2/18）, limb weakness（16.7%, 3/18）, eye symptoms（22.2%, 4/18）, and disturbance of consciousness（11.1%, 2/18）. Headache was located in one side in 9 cases（50%）, and 8 cases（88.9%, 8/9） had ipsilateral CVST. The mean of visual analogue scale/score（VAS） was 7 points（3-10 points）. The onset of headache was acute in 5 cases（27.8%）, subacute in 12 cases（66.7%）, and chronic in 1 case（5.6%）.Conclusion Headache was the most common symptom of CVST. Venous sinus thrombosis located in the same side of headache in CVST patients with unilateral headache. Young patients withsubacute headache should be alert to the possibility of CVST.