非神经科住院患者颅内静脉窦血栓形成临床和影像特征分析并文献复习

Analysis of Clinical and Imaging Features of Cerebral Venous Sinus Thrombosis in Non-Neurological Hospitalized Patients and Literature Review

目的:探讨非神经科住院患者颅内静脉窦血栓形成(CVST)发生的病因、临床和影像学特征,提高临床医生对CVST的识别和诊断能力。方法:回顾性分析因非神经科疾病于其他科室接受住院治疗,并于住院期间确诊的CVST患者的临床和影像学资料,同时结合相关文献进行回顾性分析。结果:共纳入6例确诊的CVST患者,其原发性疾病分别为肾小球肾炎(2例)、白血病(1例)、产后(1例)、抗磷脂抗体综合征(1例)、多发伤(1例)。临床表现以头痛最为常见(4例),5例接受D-二聚体检测的患者中有4例升高。MRV提示4例为多发性血栓形成,部位以横窦(5例)最易受累,其次为上矢状窦(3例)和乙状窦(3例)。除1例患者出院时遗留一定的残疾外,其他5例患者均预后良好。检索既往相关个案报道,横窦为妊娠相关CVST最易累及的部位,难治性颅内压升高往往是外伤性CVST患者较为特征性的临床表现,抗磷脂抗体综合征相关CVST患者易表现为广泛的脑静脉窦血栓及皮质静脉血栓形成,门冬酰胺酶药物治疗是急性白血病患者发生CVST的重要因素。结论:CVST病因复杂,临床表现多样,头痛是其最常见的临床表现,其临床表现和原发性疾病可存在一定程度的重叠,非神经科医生应提高对CVST的识别能力并及时予以治疗。

Objective:To investigate the etiology and clinical and imaging features of cerebral venous sinus thrombosis(CVST)in non-neurological hospitalized patients,so as to improve the ability of clinicians to identify and diagnose CVST.Methods:The clinical and imaging data of patients with CVST who were hospitalized due to non-neurological diseases were retrospectively analyzed along with relevant literature.Results:A total of 6 patients with CVST were included.The primary diseases were glomerulonephritis(2 cases),leukemia(1 case),postpartum(1 case),antiphospholipid antibody syndrome(1 case),and multiple injuries(1 case).Headache(4 cases)was the most common clinical manifestation.Of the 5 patients who received the D-dimer test,4 showed increased D-dimer levels.Magnetic resonance venography(MRV)showed that 4 cases were multiple thrombosis,and that the transverse sinus(5 cases)was most frequently involved,followed by the superior sagittal sinus(3 cases)and sigmoid sinus(3 cases).Apart from 1 patient who was left with a certain disability at the time of discharge,the other 5 patients showed good prognosis.According to previous related case reports,the transverse sinus is the most commonly affected site of pregnancy-related CVST,and refractory intracranial hypertension is often a characteristic clinical manifestation of traumatic CVST patients.CVST patients with antiphospholipid antibody syndrome are prone to extensive cerebral venous sinus thrombosis and cortical venous thrombosis.Asparaginase drug therapy is an important factor in the occurrence of CVST in patients with acute leukemia.Conclusion:The etiology of CVST is complex and its clinical manifestations are diverse.Headache is the most common clinical manifestation.There may be some overlap between the clinical manifestations of CVST and the primary disease.Improving the ability of non-neurologists to recognize CVST is of great significance for a timely diagnosis.