9例脑静脉窦血栓形成分析

Analysis of Cerebral Venous Sinus Thrombosis

目的 :探讨脑静脉窦血栓形成 (CVT)的早期临床特点、影像诊断及治疗方法。方法 :通过分析 9例CVT病人的发病年龄、发病形式、临床表现、影像学特征及脑脊液检查结果等临床资料 ,以期发现其规律性。结果 :发病年龄多在 2 0岁～ 40岁 ,多数为急性起病 ,早期表现为头痛、呕吐 ,伴或不伴局灶性神经功能缺损或癫痫发作 ,影像学表现为静脉窦闭塞、局限性梗死灶及伴有渗血或血肿 ,脑脊液压力明显升高 ,白细胞及蛋白含量正常或升高 ,应用脱水、间断穿刺颈动脉内注入尿激酶 ,并辅以口服华法令抗凝及病因治疗等 ,本组 9例病人中 ,4例基本痊愈 ,4例症状好转 ,1例自行出院。结论 :对临床急性起病的头痛、呕吐 ,伴或不伴局灶性神经功能缺损及癫痫发作的年轻病人 ,应高度怀疑CVT ,及时行MRI及MRA或DSA检查 ,以明确诊断 ,抗凝和溶栓治疗为治疗CVT的首选治疗方法。

Objective:To investigate the clinical characteristics, imaging diagnosis and treatment of cerebral venous sinus thrombosis(CVT). Methods:Medical records, including age and the mode of onset, early symptoms, clinical presentations, imaging characteristics and cerebral spinal fluid (CSF), were analyzed in detail in 9 CVT patients. Results:CVT was most commonly seen in peoples of 20～40 years old, and the onset was acute in roughly 55.5% of cases. The first and most common symptoms included headache (100%) and vomit (66.6%), with or without focal cerebral function deficits and/or falling sickness. Neuroimaging fingdings showed cerebral venous sinus occlusions、focal infarction、with hemorrhagic infarction or hematoma. As for CSF examination, pressure of CSF increased remarkably, with WBC and protein normal or increased slightly. Dehydration, intermittent injection of urokinase viacommon carotid artery and oral administration of warfarin, etiologic treatment were utilized in the management of CVT, and better outcomes were achieved. Conclusion:Headache, vomit with or without focal deficits and/or seizures as initial presentation should raise the suspicion of CVT, and its diagnosis can be further established by neuroimaging examination(combination of MRI、MRA or DSA). Anticoagulation and thrombolysis were recommended as first-line treatment of CVT.