新生儿脑静脉窦血栓五例诊断和治疗

Diagnosis and treatment of five neonatal cerebral venous sinus thrombosis

目的总结5例新生儿脑静脉窦血栓的临床表现和影像学特点。方法通过对2017年2月至2018年4月湖北省妇幼保健院新生儿科收治的5例新生儿脑静脉窦血栓的临床资料进行回顾性病例总结,了解脑静脉窦血栓的高危因素、临床表现、影像学表现和治疗情况。结果5例患儿均为足月新生儿，其中男4例、女1例，年龄≤7日龄4例；〉7日龄1例。母亲妊娠期糖尿病1例，妊娠期高血压1例。临床表现：惊厥3例，发热3例，脱水1例，反应差2例，低血糖2例，血小板降低2例。脑电图电发作3例。磁共振及静脉成像显示颅内出血4例，脑实质梗死灶3例；血栓位于上矢状窦4例，直窦3例，横窦2例，窦汇1例。普通CT显示颅内出血2例，静脉窦扩张2例。多普勒超声显示脑室内出血2例，静脉窦血流改变2例。3例患儿给予抗凝和溶栓治疗后，静脉再通，惊厥停止。结论惊厥是脑静脉窦血栓的重要临床表现。脑部梗死灶和出血是其影像学主要表现，及时进行脑部磁共振和静脉成像检查有助于脑静脉窦血栓早期诊断和治疗。

ObjectiveTo summarize the clinical presentations and imaging features of cerebral venous sinus thrombosis （CVST） in 5 newborns.MethodsThe clinical data of 5 newborns with CVST admitted to Department of Neonatology of Maternal and Children Hospital of Hubei Province from February 2017 to April 2018 were analyzed retrospectively. The risk factors, clinical presentations, imaging manifestations and treatment of CVST were investigated.ResultsOf the 5 full term neonates, 4 were males and 1 female, with 4 aged less than 7 days and 1 more than 7 days; one with the history of maternal gestational diabetes mellitus, one with maternal gestational hypertension. The clinical presentations included seizures （3 cases）, fever （3 cases）, dehydration （1 cases）, lethargy （2 cases）, hypoglycemia （2 cases）, thrombocytopenia （2 cases）. Electroencephalogram （EEG） showed electrical seizures in 3 cases. Magnetic resonance imaging （MRI） and magnetic resonance venography （MRV） showed 4 cases of intracranial hemorrhage, 3 cases of cerebral parenchymal infarction. For the sites of the thrombi, 4 were in the superior sagittal sinus, 3 in straight sinus, 2 in transverse sinus and 1 in sinus confluence. CT showed intracranial hemorrhage in 2 cases and venous sinus dilatation in 2 cases. Doppler ultrasound showed 2 cases of intraventricular hemorrhage and 2 cases of changes of venous sinus blood flow. Three neonates were treated with anticoagulant and thrombolytic therapy, followed by recanalization of the veins and discontinuing of seizures.ConclusionsSeizure is the main clinical presentation of CVST. The main radiologic manifestations are cerebral infarction and hemorrhage. Timely brain MRI and MRV are helpful in the early diagnosis and treatment of CVST.