以头痛为唯一临床表现的脑静脉窦血栓形成患者的头痛特征

Headache Characteristics of Cerebral Venous Thrombosis Patients with Headache as the Sole Presentation

目的探讨以头痛为唯一临床表现的脑静脉窦血栓形成(cerebral venous thrombosis,CVT)患者的头痛特征。方法回顾性纳入2012年1月-2018年12月北京航天总医院神经内科连续收治的以头痛为唯一临床表现的CVT患者。以头痛为唯一表现指除头痛外无提示颅内压升高的体征,且脑脊液压力正常,影像或脑脊液检测显示无蛛网膜下腔出血。分析这类患者的头痛特征(部位、发作模式、演变和强度)。结果共8例患者纳入本研究,中位年龄40岁,女性6例(75%)。最常受累的静脉窦是侧窦(7例,87.5%)。4例患者累及左侧侧窦,头痛均位于左侧;4例患者累及中线静脉窦(上矢状窦或直窦),头痛均为双侧性。头痛发作模式:进展性头痛7例,闪电样头痛1例;演变:持续性7例,间歇性1例;强度:严重头痛7例,中等程度头痛1例。结论对于仅表现为头痛并且颅内压正常以及无蛛网膜下腔出血的CVT患者,侧窦受累很常见,尤其是左侧。头痛部位与受累静脉窦位置一致。

Objective To describe the characteristics of headache in cerebral venous thrombosis(CVT)patients with headache as the sole presentation.Methods The data of CVT patients presenting with only headache admitted to Department of Neurology of Beijing Aerospace General Hospital between January 2012 and December 2018 were retrospectively analyzed.All the included patients met the following criteria:(1)CVT was confirmed by MRI/MRV;(2)presenting with only headache,in absence of the signs suggesting intracranial hypertension;(3)normal cerebrospinal fluid pressure;(4)no subarachnoid hemorrhage based on neuroimaging or cerebrospinal fluid examination on admission.The headache characteristics(location,headache pattern,evolution and severity)in these patients were described in detail.Results A total of 8 patients were included,with the median age of 40 years old and 6 females(75%).The most involved venous sinus was lateral sinus(7/8,87.5%).Only the left lateral sinus was involved in 4 patients,and the 4 patients presented with ipsilateral headache.In the other 4 patients,the middleline sinuses(superior sagittal sinus and/or straight sinus)were involved and these 4 patients presented with bilateral headache.Other characteristics of headache were as follows:progressive headache in 7 patients and thunderclap in 1 patient;persistent headache in 7 patients and intermittent in 1 patient;severe headache in 7 patients and moderate in 1 patient.Conclusions For some CVT patients with only headache and without intracranial hypertension and subarachnoid hemorrhage,the lateral sinus was often involved,especially the left lateral sinus.The headache site was consistent with the involved venous sinus.