颅内静脉窦血栓形成误诊报告

Misdiagnosis Analysis of Cerebral Venous and Sinus Thrombosis

目的探讨颅内静脉窦血栓形成(cerebral venous and sinus thrombosis, CVST)的临床特点、诊治方法及误诊原因、防范措施。方法对曾误诊的CVST 5例的临床资料进行回顾性分析,并复习相关文献。结果本组均表现为急性神经功能缺损症状,其中伴脑病症状4例,颅内高压症状2例;局灶神经功能缺损4例。发病初期误诊为脑梗死、胶质瘤,脑梗死,病毒性脑炎,脑出血及蛛网膜下腔出血各1例。误诊时间3~40 d,平均18.4 d。后5例经磁共振静脉成像(MRV)和数字减影血管造影(DSA)检查确诊。5例确诊后均给予抗凝治疗,除1例死亡外,余4例病情均得到改善;随访1年未见复发。结论 CVST可表现为进展性脑梗死,临床表现不典型,易误诊。临床遇及类似本文可疑CVST患者及时行MRV和DSA等检查是确诊的关键。

Objective To analyze the clinical features, diagnosis and treatment methods of ever misdiagnosed cerebral venous and sinus thrombosis(CVST), and to explore causes of misdiagnosis and preventive measures. Methods The clinical data of 5 ever misdiagnosed CVST patients were retrospectively analyzed, and relevant literature was reviewed. Results Patients in this group showed symptoms of acute neurological deficits, including 4 accompanied with encephalopathy, 2 with intracranial hypertension, 4 with focal neurological deficits, 1 with somnolence and 1 with meningeal irritation. The initial misdiagnosed diseases included one case of cerebral infarction and glioma, one case of cerebral infarction, one case of viral encephalitis, one case of cerebral hemorrhage and one case of subarachnoid hemorrhage. The correct diagnosis of CVST had been made at 3-40 d after initial symptoms occurrence, with a median of 18.4 d. Then all cases were diagnosed by magnetic resonance venography(MRV) and digital subtraction angiography(DSA). Anticoagulant therapy was given to all the 5 patients after diagnosis. Except one death, the other 4 cases all had improved condition. No recurrence was found during the one-year follow-up. Conclusion Manifested as progressive stroke, CVST can be atypical in clinical practice and therefore be easily misdiagnosed, and timely MRV and DSA examination is the key to diagnosis of patients with suspected CVST as described above in clinical practice.