脑内静脉窦血栓形成三例报告及文献复习

目的 探讨脑内静脉窦血栓形成（CVST）的临床表现、诊断和治疗。方法 回顾性分析3例经影像学检查诊断为CVST的患者，均行抗凝治疗和脑室-腹腔分流，随访1～2年。结果 CVST主要症状为外伤、感染后头痛，颅内压增高，视力减退，精神症状；神经影像学表现为CT增强扫描后可见静脉窦内“空三角征”，MRI示静脉窦正常流空影的形态消失，出现长T2、短T1信号；MRV示静脉窦血流不连续或缺失，梗阻远端侧支循环血管建立或其他引流静脉异常扩张；3例患者经抗凝及脑室-腹腔分流后症状均有不同程度的缓解。结论 对临床急性起病的颅高压征，伴或不伴局灶性神经功能缺损病人，应高度怀疑CVST，及时行MRI及MRV或DSA检查，明确诊断，尽早治疗。抗凝和溶栓治疗为治疗CVST的首选治疗方法，对于经济有困难的CVST患者，行抗凝及脑室-腹腔分流短期内疗效满意，不失为一种治疗方法的选择。

Diagnosis and treatment of cerebral venous sinus thrombosis: report of three cases and review of the literatures

Objective To explore the clinical manifestations, diagnosis and treatment of cerebral venous sinus thrombosis (CVST). Methods The hospital records, clinical manifestations and neuroimaging findings were analyzed retrospectively in 3 patients diagnosed as CVST by neuroimaging examination. They all underwent anticoagulant therapy and ventriculoperitoneal (V-P) shunt and got 1-2 year follow-up. Results CVST was observed in persons who suffered from infection or injury. The first and most common symptoms included headache and vomit, with or without hypopsia, psychiatric symptom. Neuroimaging findings showed cerebral venous sinus occlusion, CT scan exposed empty delta sign of sinus. MRI examination showed loss of flow-void-effect in venous sinus and high T2 intensive, low T1 signals inside the sinuses. MRV examination showed discontinuation or loss of normal blood flow in venous sinus. Compensatory circulation could be found in distal end of obstruction or draining vein becoming abnormal dilation. Favorable relieving was achieved in the 3 cases by anticoagulant therapy and V-P shunt. Conclusion Persons with intracranial hypertension sign with or without neurologic impairment as initial presentation should raise the suspicion of CVST, and its diagnosis can be further confirmed by neuroimaging examination (combination of MRI and MRV or DSA). Early administration of anticoagulants and thrombolysis is recommended. However, anticoagulant therapy and V-P shunt were another option for the patients with poor economic condition and its short-term curative effect is satisfied.