儿童颅内静脉窦血栓形成的诊疗策略

目的 探讨儿童颅内静脉窦血栓形成的高危因素、常见临床表现、影像学特征及诊疗策略。方法 对2014年1月-2018年12月收住西安交通大学第一附属医院儿科的3例颅内静脉窦血栓形成患儿病例资料进行回顾性分析。结果 持续而严重的头痛是颅内静脉窦血栓形成最常见的临床表现; 3例患儿发病原因不一,与文献报道感染为主要原因不符,可能与病例数较少有关; 影像学最常见的受累部位为乙状窦和横窦; 经降颅内压、抗凝及对症治疗,1例痊愈,1例死亡,1例遗留颅神经功能异常。结论 儿童以急性发作的头痛起病伴孤立性颅内压增高综合征表现者均应警惕颅内静脉窦血栓形成的可能; 对脑脊液压力轻度升高的患儿仍需动态监测颅内压的变化; 儿童目前推荐的影像学检查方法为颅脑磁共振成像联合磁共振静脉成像,并具有长期随访优势; 全脑血管造影术在儿童中并非禁忌,在严格控制操作时间及造影剂剂量的前提下由技术熟练的专科医生操作亦是可行的; 强调早期抗凝治疗,治疗药物的选择、剂量及持续时间仍有待大样本病例的研究。

Diagnosis and treatment strategy of cerebral venous sinus thrombosis in children

ObjectiveTo explore the risk factors,common clinical manifestations,imaging features,diagnosis and treatment of cerebral venous sinus thrombosis(CVST)in children.Methods A retrospective study was performed in 3 cases that were diagnosed with CVST in First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2018.Results Persistent and severe headache was the most common clinical manifestation of CVST.The causes of 3 cases were different,which was inconsistent with the reported infection in the literature.It might be related to the fewer cases.The most common imaging sites involved were sigmoid sinus and transverse sinus.Cranial hypertension,anticoagulation and symptomatic treatment were performed.One case recovered,one case died,and one case had residual cranial nerve dysfunction.Conclusion Children with acute onset headache and intracranial hypertension syndrome should be alert to the possibility of CVST.If the cerebrospinal fluid pressure slightly elevated,it was still necessary to detect the changes of cerebral pressure.Brain magnetic resonance imaging(MRI)combined with magnetic resonance venography(MRV)was currently recommended for children,and had the advantage of long-term follow-up.Digital subtraction angiography(DSA)was not a taboo in children.It was also feasible to strictly control the operation time and the dosage of contrast medium and to be operated by a skilled specialist.It was emphasized that early anticoagulation therapy and duration of treatment still needed to be studied in large sample cases.