脑静脉血栓形成24例临床分析

目的探讨和研究脑静脉血栓形成（CVT）的临床特点。方法对24例CVT患者的一般情况、起病形式、临床表现、脑脊液特点、影像学特征、治疗及预后等临床资料进行回顾性分析。多数为亚急性或急性起病，早期表现多为头痛、呕吐，可伴有癫痫发作和各种神经功能缺损的症状和体征，脑脊液压力明显升高，蛋白质定量正常或轻度升高。MRI检查显示脑实质内出现异常信号。磁共振静脉造影（MRV）显示静脉窦闭塞或充盈缺损。治疗以脱水、抗凝、溶栓为主。结果24例患者中16例好转，6例死亡，2例自动出院。结论对于起病较急的高颅压伴或不伴有神经精神障碍的患者，应高度警惕CVT，尽早行MRV或数字减影血管造影（DSA）检查。治疗仍以抗凝、溶栓为主。

Clinical analysis of 24 cases of the cerebral venous thrombosis

Objective To approach and research the clinical characteristics of cerebral venous thrombosis (CVT). Methods Medical records of 24 CVT patients, including clinical manifestation, cerebral spinal fluid (CSF) and findings of neuroimaging, as well as the therapy and prognosis were analysed retrospectively.The onset was mostly subacute or acute. The first symptoms were almost headache and vomiting, with epilepsy and focal deficits. As for CSF examination, pressure increased remarkably, with protein normal or increased. MRI showed the normal flow void of the dural sinus disappeared, instead, abnormal high signal intensities were found. The signs of CVT in magnetic resonance venography (MRV) included loss of vascular flow of the venous sinus. The major treatment involved dehydration, anticoagulation and thrombolysis. Results There were 16 patients with complete recovery and improvement, 6 patients dead, 2 patients stopping treatment. Conclusions The patients with acute onset of intracranial hypertension with or without psychoneurological defect should be highly suspected the CVT, thus early combined MRV or digital subtraction angiography (DSA) are helpful for diagnosis. Anticoagulation and thrombolysis are the main treatments in CVT.