高原颅内静脉窦血栓形成的临床特点和急诊CT征象

Clinical features and emergency-CT features of cerebral venous sinus thrombosis in high altitude

目的探讨高原环境下颅内静脉窦血栓形成(CVST)的临床特点和急诊CT征象,以提高该病在高原地区的诊断准确率。方法选择海拔4 500 m以上我院高原医疗站点门诊2019年1月—2020年12月就诊患者中收治23例CVST患者为研究对象,首诊医疗接触后立即行急诊CT,初诊为颅内静脉血栓随后MRV确诊,收集并分析患者临床资料、影像学证据、治疗及预后。结果①高原环境下,CVST患者起病急,均为男性,平均年龄(27.96±5.27)岁,头痛是CVST患者最常见的临床表现(86.95%),23例患者上高原工作时间3个月以上,起病时间为24h至3周以内,发病前1周内有上呼吸道感染病史占72.2%。②检验:白细胞(WBC)(11.35±3.11)×10^(9)/L;中性粒细胞百分比(NEUT%)(79.03±5.89)%;红细胞(RBC)(5.41±0.56)×10^(12)/L;血红蛋白(HGB)(196±13.05)g/L;血小板(PLT)(155±22.04)×10^(9)/L,凝血指标D-二聚体(3.34±3.38)mg/L。血栓弹力图:R:(5.15±0.78)min;凝血时间K(1.62±0.60)min;α角(68.79±4.50)度;MA(69.09±3.13)mm。脑脊液检查均排除病毒性脑炎。③影像学:急诊CT提示静脉窦血栓高密度影(上失状窦52.17%,直窦43.47%,左右横窦30.43%)。④治疗与转归:所有患者首次接诊(FMC)CT确诊提示无动脉性出血或存在静脉窦内高密度影,初步诊断为颅内静脉窦血栓,均接受低分子肝素(LMWH),其中22例均存活,3例遗留部分神经损伤症状,1例并发脑疝死亡。结论高原环境医疗资源分散,根据病史、症状和体征、结合血栓相关检验对CVST早期筛查,急诊CT提供静脉窦血栓的特征性变化证据,在排除出血的情况下尽早启动抗凝,可有效改善患者预后并对安全后送提供有利支持。

Objective To investigate CVST occurring at high altitude and sight to describe patients’clinical manifestations and emergency CT signs,aim to incrasing the accuracy rate of diagnosis.Methods A retrospective analysis of 23 consecutive patients with CVST at a care center in high altitude from January 2019 to December 2020 was conducted.Emergency-CT was performed after first medical contact,and then MRV diagnosis.Clinical data,radiologic characteristics,therapeutic strategies,and outcomes were collected and analyzed.Results The study cohort comprised23 patients(100%males)with a mean of(27.96±5.27)years.The most common clinical manifestation of CVST was headache(86.95%).On average three months were spent at a high altitude prior to CVST.Totally,all of them had CVST for<3 weeks,Interestingly infection was important to note before they got CVST(72.2%).White blood cell(WBC)(11.35±3.11)×10^(9)/L;Percentage of neutrophils(Neut%)(79.03±5.89)%;Red blood cell(RBC)(5.41±0.56)×10^(12)/L;Hemoglobin(HGB)(196±13.05)mg/L;Platelet(PLT)(155±22.04)×10^(9)/L,coagulation index D-dimer(3.34±3.38)mg/L;Thromboelastic diagram:R(5.15±0.78)min;Coagulation time K(1.62±0.60)min;αAngle(68.79±4.50);MA(69.09±3.13).Emergency-CT showed 8 cases of single thrombosis and 12 cases of multiple thrombosis,which were located in superior sagittal sinus(52.17%);Straight sinus(43.47%);transverse sinus(30.43%).Treatment:All patients received low-molecular-weight heparin therapy(LMWH).22 cases were survived and 3 cases of all patients left part of the nerve injury symptomsInitially while one died.Conclusion The diagnostic accuracy of CVST can be improved by combining laboratory and emergency-CT,inducing factors and symptoms.Early anticoagulant therapy can effectively improve the prognosis of patients who were sent to lower altitude.Combining with the case of history,symptoms and signs,the test of the thrombosis and the special characteristics of the venous sinus thrombosis are provided by the emergency CT,anticoagulation was performed as early as possible,which can effectively improve the patients’outcome and safe delivery.