颅内静脉窦血栓形成20例临床分析

目的:探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特点、影像学检查和诊治方法,为临床提供经验。方法:回顾分析20例CVST患者的临床资料,分析其发病原因、临床特点、实验室检查、影像学表现、治疗方案等。结果:20例患者均为中青年,大多为急性或亚急性起病,临床表现主要为高颅压综合征或局灶性神经功能缺损,出现头痛17例、视力障碍8例、肢体乏力麻木10例、癫痫发作6例。CVST的诊断主要依靠影像学表现。根据19例患者的磁共振静脉血管成像(magnetic resonance renography,MRV)或数字成影血管造影(digital subtraction angiography,DSA)检查结果(去除1例无效数据)发行,血栓累及2个或2个以上静脉窦15例(78.9%),累及上矢状窦9例、橫窦15例、乙状窦14例;脑实质损伤8例(40%)。经抗凝、降颅压和抗癫痫等对症治疗后,治疗有效(症状完全消失/缓解)17例(85%),无效3例(15%),病死2例。结论:CVST发病率低,容易漏诊和误诊,头痛、视力障碍、癫痫和肢体感觉运动障碍为常见临床表现,孤立性头痛和孤立性视乳头水肿(视物模糊/黑朦)患者需警惕CVST;D-二聚体检查阴性不足以排除CVST诊断;CT和MRI检查对CVST有重要提示作用,经静脉造影检查(MRV或DSA)发现血管腔内血栓是CVST确诊的关键;早期诊断,规范的抗凝治疗和积极的对症治疗有助于改善预后。

Clinical Analysis On 20 Cases of Cerebral Venous Sinus Thrombosis

Objective：To investigate the clinical features,imaging examination,diagnostic and therapeutic strategies of cere-bral venous sinus thrombosis（CVST）.Methods：Clinical data of 20 patients with CVST were retrospectively analyzed.The eti-ology,clinical features,laboratory examinations,imaging findings and treatment protocols were analyzed.Results：The twenty patients enrolled were young and middle-aged.Most cases had subacute or acute onset,and the main clinical manifestation was increased intracranial pressure syndrome or focal neurological deficits,which included headache （17 patients）,visual impair-ment （8 patients）,limb weakness and numbness （10 patients）,seizures （6 patients）,etc.The diagnosis mainly relied on ima-ging findings.The magnetic resonance renography （MRV）or digital subtraction angiography （DSA）findings of 19 patients（ex-cluding one invalid data）showed that more than one cerebral vein sinus was involved in 15 cases （78.9%）,while superior sag-ittal sinus,lateral sinus and sigmoid sinus were involved in 9,15 and 14 patients,respectively.Brain parenchyma impairment was found in 8 patients （40%）.Symptomatic treatments such as anticoagulant therapy,reducing intracranial pressure and anti-epileptic treatment etc.were effective （the symptoms disappeared or improved）in 17 patients （85%）and ineffective in 3 pa-tients among whom 2 patients died.Conclusions：CVST has low incidence rate and is easy to be missed or misdiagnosed.Head-ache and visual impairment,seizure and motor or sensory deficit are common symptorns.CVST should be eliminated in patients with isolated headache and isolated papilledema （blurred vision/amaurosis）should be valued.A negative result of D-dimer measurement is not enough to exclude the diagnosis of CVST.CT and MRI examination is of great value for the diagnosis,and the positive finding of intraluminal thrombus by venography （MRV or DSA）is the key to a definite diagnosis.Early diagnosis, standard anticoagulant treatment and posit