颅内静脉窦血栓形成32例的临床分析

目的分析颅内静脉窦血栓形成（CVST）的病因、临床特点、诊断治疗方法及预后。方法回顾性分析本院2008年4月～2013年3月收治的32例CVST患者的临床资料。结果CVST可发生于任何年龄，其中以中青年育龄妇女多发：病因以产后高凝状态最常见，其次为感染、口服避孕药、系统性红斑狼疮、血小板增多症等，有6例患者病因不明：多为急性、亚急性发病；临床表现以头痛、呕吐、视物不清、癫痫发作、意识障碍、局灶性神经缺损等多见：84．4％的患者D-二聚体增高；87．5％的患者存在不同程度的凝血功能异常。影像学表现颅内静脉窦狭窄或闭塞、脑梗死、脑梗死伴出血等；治疗以脱水降颅压、抗凝治疗为主，根据病因、高危因素及并发症给予抗炎（感染性血栓）、扩容改善循环、抗癫痫对症治疗等；临床治愈18例，好转12例，无效1例，出现脑疝自动出院1例，总有效率为93．8％。结论CVST临床表现缺乏特异性，对可疑患者及时做腰穿、凝血功能及D-二聚体化验，可为诊断提供支持．监测治疗效果；影像学检查CTV或MRI＋MRV、DSA具有确诊价值，是早期诊断CVST的关键；积极治疗原发病、去除和（或）干预高危因素、及早应用抗凝药物、脱水降颅压及对症治疗是治疗成功的关键。

Clinical analysis of cerebral venous and sinus thrombosis in 32 cases

Objective To analyze the etiology,clinical characteristics,diagnostic method,treatment and prognosis of cerebral venous and sinus thrombosis （CVST）.Methods Clinical data of 32 patients with CVST admitted into our hospi- tal from April 2008 to March 2013 were retrospectively analyzed.Results In any age,it could occur,but mostly in young and middle-aged fertile women.Postpartum hypercoagulability frequently led to CVST,then infection,oral contraceptive, systemic lupus erythematosus,thrombocythemia in turn.There were 6 patients with etiology unknown.The onset of CVST was acute or subacute.The clinical manifestations were mainly characterized by headache,vomiting,blurred vision, epileptic seizure,disturbance of consciousness,and focal nerve defect.There were 84.4% patients with D-dimer increase and 87.5% in coagulation disorders at varying degrees.Images displayed stenosis or blockage of cerebral venous sinus, cerebral infarction and/or hemorrhage.In the treatment,dehydration to decrease cerebral pressure and anticoagulant therapy were mainly emphasized.The anti-inflammatory in infectious thrombosis,dilatation to improve circulation,and anti-epileptic treatment were based on etiology,high risk factors and complications.The number of clinical cure,im- provement,ineffectiveness were 18 cases,12 cases,and 1 case.The rest one was discharged from hospital due to cerebral hernia following patient＇s will.The total effective rate reached 93.8% .Conclusion Lack of characteristics of clinical manifestations in CVST,timely lumbar puncture and tests of coagulation function and D-dimer for the suspected cases can offer support for the diagnosis as well as monitor the therapeutic effect.The imageological examinations like CTV, MRI and MRV,and DSA are of value in definite diagnosis,which is essential for early diagnosis of CVST.It is very im- portant to positively treat primary disease,remove and/or intervene in high risk factors,timely apply anticoagulant,dehy- drate for cerebral oressure reduction and svmntomatic treatment in CVST.