颅内静脉窦血栓形成65例临床报告

目的探讨颅内静脉窦血栓形成(CVST)的临床和影像学特点及与预后关系。方法回顾性分析2006年1月至2011年5月哈尔滨医科大学附属第一医院诊断的65例CVST患者的病因,临床表现,影像学特征,治疗及预后。结果 65例患者的平均年龄(33.3±11.4)岁,男女比例为1∶1.95。感染和围生期是最常见的病因(63.46%)。头痛为最常见的临床表现(80.00%),其次为肢体无力等局灶性神经功能缺损症状(27.69%)及癫痫发作(21.54%)。颅脑CT及磁共振成像证实静脉窦内血栓影分别为15.38%(10/65)、24.19%(15/62);显示脑实质内局部或广泛水肿缺血损害者分别为30.77%(20/65)、32.26%(20/62)。61例行磁共振静脉血管成像(MRV),有不同程度的静脉窦病变,表现为受累静脉窦狭窄或闭塞;19例进行数字减影血管造影(DSA),均证实为一支或多支静脉窦狭窄或闭塞,静脉期延迟;14例行头MRV、DSA造影检查的患者,均予以证实为静脉窦血栓,两者改变基本相符。经低分子肝素抗凝、脱水降颅压等治疗后,65例患者中临床痊愈25例(38.46%),部分好转35例(53.85%),死亡5例(7.69%)。结论 CVST以进行性头痛为主要表现,可伴有神经功能缺损或癫痫发作。MRV结合腰椎穿刺检查是诊断的主要手段。抗凝及降颅压治疗具有良好的治疗效果,上矢状窦血栓及脑组织有大面积水肿缺血损害者预后不良。

Clinical Reports on 65 Cases of Cerebral Venous Sinus Thrombosis

Objective To discuss the clinical and imaging characteristics and the prognosis of cerebral venous sinus thrombosis（CVST）.Methods A total of 65 patients diagnosed as CVST from Jan.2006 to May 2011 were analyzed retrospectively in terms of causes,clinical manifestations,imaging features,treatmentand prognosis.Results The average age of the 65 cases of CVST was （33.3 ± 11.4） years and the ratio of male to female was 1∶ 1.95.The infection and perinatal stage had been proved to be the main causes of CVST（63.46 %）.Headache was the first and most common symptom,accounting for about 80.00% of all clinical manifestations.Focal neurological impairment,such as paralysis and epileptic attack followed behind,accounting for 27.69% and 21.54% respectively.There were 10 out of 65 cases of CVST confirmed through cranial CT scanning,while 15 out of 62 cases through MRI.And 20 cases were demonstrated as local or extensive hydrocephalus and ischemia via CT scanning or MRI.The images of 61 cases,checked via MRV,illustrated as varying degrees of venous sinus lesions,ranging from partially occluded to total occlusion.And 19 cases checked via digital subtraction angiography（DSA） confirmed one or several venous sinus had been totally or partially occluded,and illustrated venous phase delay.There were 14 cases both examined through MRV and DSA anddiagnosed as sinus thrombosis.After the treatments of dehydration,anticoagulation and others,25 out of the 65 cases（38.46%） were cured,35（53.85%）were improved,5（7.69%） died.Conclusion The most common manifestations of CVST is progressive headache,which is occasionally accompanied by neurologic impairment or epileptic attack.The examination of MRV combined with lumbar puncture serve as a major means for the diagnosis of CVST.Anticoagulant therapy and reducing the intracranial pressure through dehydration offer effective ways for treatment.Patients with superior sagittal sinus thrombosis or extensive hydrocephalus and ischemia have poor prognosis.