13例孕产妇并发颅内静脉窦血栓的临床分析

Clinical Analysis of 13 Pregnant Woman Complicated with Cerebral Venous Sinus Thrombosis

目的:分析妊娠期及产褥期颅内静脉窦血栓(CVST)患者病例资料,提高对孕产妇并发CVST的认识。方法:回顾性分析2013年1月至2019年1月昆明医科大学附属甘美医院诊断为孕产妇并发CVST患者的一般资料、临床表现、实验室及影像学检查结果、治疗方式与预后情况。结果:13例患者中,处于产褥期者10例,首发症状表现为头痛8例,实验室检查D-二聚体升高者5例,通过CT发现异常者11例。所有患者通过磁共振成像、磁共振静脉成像明确诊断,影像学检查结果示:累及上矢状窦9例,横窦8例,其中累及2个静脉窦及以上者8例。9例患者预后良好,5例手术患者中4例预后良好。结论:孕产妇并发CVST更易发生在产褥期,最常见临床症状为头痛,D-二聚体无异常不能排除CVST可能,CVST最易累及上矢状窦及横窦,尽早诊断、选择合适的治疗方法可使大部分患者取得较好预后。

Objective:To analyze the data of the patients with cerebral venous sinus thrombosis(CVST)in pregnancy and puerperium,and to improve the understanding of pregnancies complicated by CVST.Methods:We reviewed and analyzed the records of the pregnant patients who also had a diagnosis of CVST in Ganmei Hospital Affiliated to Kunming Medical University from January2013 to January 2019,including their general data,clinical manifestations,laboratory and imaging findings,treatment methods and prognosis.Results:Among the 13 patients,10 were in puerperium,8 had headache,5 had elevated D-dimer in laboratory examination,and 11 had abnormalities by CT.All patients were clearly diagnosed by magnetic resonance imaging and magnetic resonance venography.The imaging results showed that 9 cases involved superior sagittal sinus and 8 cases involved transverse sinus,including 8 cases with more than 2 venous sinuses.9 patients had a good prognosis,and 4 of the 5 surgery patientshad a good prognosis.Conclusion:CVST in pregnancies is more likely to occur in the puerperium.Headache is the most common clinical symptom.The possibility of CVST cannot be ruled out if there is no abnormality in D-dimer.The superior sagittal and transverse sinuses were the most commonly affected cerebral sinuses in the patients with CVST.So,the early diagnosis and selection of appropriate treatment methods can help most patients achieve a better prognosis.