脑静脉窦血栓形成60例临床分析

目的:分析脑静脉窦血栓形成(CVST)的临床特点。方法:回顾性分析60例CVST患者的临床资料。结果:本组患者多为急性、亚急性起病;头痛48例(80%),癫23例(38.3%),出现视觉症状22例(36.7%),出现局灶性神经受损症状16例(26.7%),意识障碍9例(15%);影像学表现为以皮质为主的梗死或水肿,可伴发出血,行磁共振静脉成像(MRV)检查48例(80%),行数字减影血管造影(DSA)40例(66.7%),血管造影证实存在静脉和/或静脉窦狭窄或闭塞;抗栓治疗56例(93.3%),其中抗凝治疗51例(91.1%);痊愈51例(85%),好转7例(11.7%),脑疝形成2例(3.3%),自动出院。结论:认识其临床特征并及时行MRV检查是正确诊断CVST的关键,治疗以抗凝为主,需及早治疗。

Clinical Analysis of Sixty Cases with Cerebral Vein and Sinus Thrombosis

Objective:To analyze the clinical characteristics of cerebral vein and sinus thrombosis (CVST). Methods:All the medical records,including sex,age,clinical manifestations,findings of neuroimaging,treatment and prognosis were analyzed retrospectively in sixty cases of CVST from Jan. 2003 to Dec. 2009 in Huashan Hospital.Results:Of the 60 cases (35men,25 women),aged from 8 to 73 (mean 35.5±14.6) years old. Most patients had acute or subacute onset. Forty-eight cases (80%) had headache,23 cases (38.3%) had epilepsy,22 cases (36.7%) had visual symptoms,16 cases(26.7%)had focal deficits,and 9 cases(15%)had conscious disturbance. CT or MR imaging showed cortical infarction or edema,often accompanied by hemorrhage. Veins and sinus stenosis or occlusion showed by angiography. Fifty-six cases (93.3%) were treated by antithrombosis methods. Among them,91.1% were treated with anticoagulation. After the treatment,51 cases (85%) recovered completely,7 cases improved,and 2 cases discharged for brain herniation. Conclusion:Increased consideration of CVST and prompt MRV and MRI examination are the key to accurate diagnosis and timely therapy.The treatment of CVST should be based on anticoagulation.