脑静脉窦血栓形成53例诊治分析

目的 分析脑静脉窦血栓形成(CVST)的临床特征、诊断方法及疗效.方法 回顾性分析2003年8月至2008年5月北京天坛医院住院的53例CVST患者的发病年龄、发病形式、临床表现、影像学特征及治疗预后情况.结果 本组患者男22例,女31例;年龄(15～52)岁,平均(34.92±9.69)岁.多数为急性、亚急性起病.主要临床表现为头痛,伴有呕吐,视物不清,复视,抽搐,肢体活动障碍或意识障碍等.影像学表现为静脉窦闭塞及局灶性梗死灶,部分伴发渗血或血肿.治疗以脱水降颅压、抗凝治疗为主,根据情况可联合溶栓治疗或支架置入治疗.痊愈12例,好转37例,无效2例,脑疝形成自动出院2例.结论 认识CVST的临床特征并及时行MRV检查是正确诊断和及早治疗的关键,CVST的治疗以抗凝治疗为基础,根据情况可联合溶栓治疗或支架置入治疗.

Clinical analysis of 53 cases of cerebral venous sinus thrombosis

Objective To analyze the clinical characteristics of cerebral venous sinus thrombosis(CVST)and evaluate the diagnosis and treatment.Methods All the medical records,including age,mode of onset,clinical manifestations,findings of neuro-imaging and prognosis were analyzed.retrospectively in 53 cases with CVST from August 2003 to May 2008 in Beijing Tian Hospital.Results Of the 53 cases(22 men,31 women),aged from 15 to 52(mean 34.92±9.69)years.Acute or sub-acme onset accounted mostly.The principal clinical characteristics were headache and vomit,weak sight,diplopia,focal deficit,conscious disturbance and seizures.The neuro-imaging findings of CVST were venous sinus occlusion and local infarction,sometimes accompanied by capillary hemorrhage or haematoma.The major treatment involve dehydration,anticoagulation,and thrombolysis or stent implanted.After the treatment,12 cases recovered completely,37 improved,2 invalided,and 2 cases discharged for herniation of brain.Conclusion Improvement in awareness of CVST and prompt MRI in combination with MRV examination is the key to accurate diagnosis and timely therapy.The treatment of CVST should be based on anticoagulatin,and acompanyed.by thrombolysis or stent implanted in cerebral venous sinus on the baisis of effect.