颅内静脉血栓应用纤溶抗凝治疗预后分析

目的:观察颅内静脉血栓早期纤溶抗凝治疗疗效。方法 详细分析应用纤溶抗凝治疗前后15例颅内静脉系统血栓临床表现及影像学变化。结果 颅内静脉血栓患者应用纤溶抗凝治疗临床表现及影像学结果有明显改观。结论 脑静脉血栓患者早期纤溶抗凝治疗可以改善预后,具有较高的临床应用价值。     

产后颅内静脉系统血栓形成20例临床分析

目的：探讨产后颅内静脉血栓形成的临床特点及治疗方法。方法：对２０例产后颅内静脉血栓形成患者的临床资料进行分析。结果：２０例患者均系产后，年龄２４～３４岁，痊愈１４例，好转４例，死亡２例。结论：产后颅内静脉血栓的机率并不少见，ＣＴ扫描可做初步估计诊断，ＭＲＩ是敏感而特异的方法，ＤＳＡ虽为有创伤检查，但它是最可靠的诊断方法。     

11例颅内静脉血栓形成的临床诊断及治疗转归分析

目的 总结分析颅内静脉血栓形成的临床表现、影像学特征及治疗方法,为该疾病的诊断和治疗提供参考. 方法 对自2002年至2007年湘雅医院神经内科收治的11例颅内静脉血栓形成患者的临床表现、实验室资料、影像学特征、治疗经过及预后进行回顾性分析. 结果 10例患者临床表现为非特异性的头痛,其次为呕吐、肢体偏瘫、脑膜刺激征、抽搐等.确诊前有2例曾分别诊断为脑出血、蛛网膜下腔出血.11例患者均行头颅CT和(或)MRI,8例行MRV检查,1例行DSA,明确诊断为静脉血栓形成者10例.所有患者均行降颅压治疗,10例患者进行抗凝/抗血小板治疗,9例好转,1例加重,1例死亡. 结论 颅内静脉血栓形成l临床表现缺乏特异性,误诊率高,确诊有赖于影像学检查,早期抗凝治疗是一种安全有效的方法.     

产褥期颅内静脉窦血栓形成:1例报告及文献复习

目的 :旨在探讨低分子肝素联合华法林治疗产褥期颅内静脉窦血栓的疗效。方法 :报道1例产褥期颅内静脉窦血栓形成患者的诊治经过,同时结合国内外相关文献对颅内静脉窦血栓形成的临床特征及诊治进展进行复习。结果 :患者在产褥期以头痛、呕吐起病,伴癫痫样发作;腰椎穿刺检测颅内压明显升高,头颅磁共振静脉造影(magnetic resonance venography,MRV)显示上矢状窦血栓形成。结合临床表现及辅助检查,诊断为颅内静脉窦血栓形成。给予低分子肝素联合华法林治疗后,病情得到有效控制。结论 :对颅内静脉窦血栓形成患者进行抗凝治疗是安全且有效的,必要时可行溶栓治疗。     

颅内静脉血栓形成的临床特点分析

目的探讨颅内静脉血栓形成（CVT）的病因、临床特点、诊断、治疗。方法回顾性分析12例CVT患者的临床资料,并结合文献分析。结果12例CVT患者中8例病因明确,临床表现以头痛伴恶心呕吐、视乳头水肿为主,脑脊液（CSF）检查以压力升高为主要特点,D-二聚体（DD）检查有62.5%的患者高于正常,CT主要表现局限性脑梗死及脑水肿,MRI联合MRV表现静脉窦闭塞者占91.7%,病因及脱水、溶栓、抗凝治疗疗效较好。结论CVT临床表现复杂多样,产褥期、感染、白塞病可继发CVT,MRI和MRV相结合诊断率高,肝素抗凝为首选治疗。     

青年妇女中的颅内静脉血栓形成

本文报道20例分娩年龄的青年妇女颅内静脉血栓形成的病例.年龄在15～45岁(平均32岁),13例发生于产后,6例因口服避孕药,没有发现其他引起颅内静脉血栓形成的原因,在产褥期的患者,症状发作在1～16天,口服避孕药后发病在15天～30月.所有的病人均行双侧脑血管造影,静脉期摄片对于明确诊断是必要的.因有颅内高压故进行压颈摄片的仅6例,抵消法摄片14例,结果发现6例上     

颅内静脉血栓形成患者脑脊液细胞学特点

目的探讨脑脊液细胞学检查对颅内静脉血栓形成的临床诊断价值。方法对4例不同原因引起的颅内静脉血栓形成患者应用细胞玻片离心沉淀法进行脑脊液细胞学检查,并结合相关文献进行分析。结果本组4例患者以不同方式起病,病因各有不同,临床表现各异,但都伴有颅高压症状,腰穿压力增高,脑脊液细胞学可见数量不等的红细胞,2例患者脑脊液中还可见红细胞吞噬细胞和含铁血黄素吞噬细胞。结论观察颅内静脉血栓形成患者脑脊液细胞学变化有利于该疾病的临床诊断,尤其对于症状不典型且MRV上未显示明确颅内静脉异常及脑深部静脉血栓病人更具有临床价值。     

低颅压综合征合并颅内静脉血栓2例并文献回顾分析

目的总结分析低颅压综合征(SIH)合并颅内静脉血栓形成(CVT)的临床表现,诊断和治疗方法。方法报道2例低颅压综合征合并颅内静脉血栓形成,并回顾文献报道15例同类病例,分析其临床特征、影像学表现、治疗和病理生理机制。结果17例患者均以亚急性起病,其中14例患者表现为体位性头痛。常见的伴随症状有恶心、呕吐、复视、耳鸣等。所有患者的影像学检查都存在SIH和CVT的表现,头部核磁共振(MRI)加静脉成像(MRV)是诊断颅内静脉血栓形成的主要手段。结论低颅压综合征是颅内静脉血栓形成的危险因素之一,了解两者内在的病理生理联系和临床特征有利于对该病的早期诊断和及时治疗。     

妊娠与产褥期中风的病因及预后

妊娠期及产褥期脑卒中并非常见病,欧美国家报道的发生率在3.8/10万～62.5/10万孕产妇[1,2],我国尚没有大规模的流行病学调查的报道。妊娠及产褥期脑卒中包括动脉及静脉血栓形成、栓塞和脑及蛛网膜下腔出血,发生的时间各家说法不一。一般认为产褥期(产后6周内)缺血性及出血性卒中的发生率都较妊娠期高,可能是产后血容量的显著减少及激素水平的显著下降导致血流动力学、凝血及血管壁的改变而产生[1,3]。本文就妊娠和产褥期卒中的病因和预后进行综述。     

产褥期颅内静脉窦血栓形成10例护理体会

颅内静脉窦血栓形成(cranial venous sinus thrombosis,CVST)是颅内静脉系统血流堵塞所导致的闭塞性脑血管病,为产褥期较少见的危重并发症之一,诱因有长期服用避孕药物、妊高症、感染、剖宫产、高龄产妇等,发生于产后1个月内,有一定的致残和致死率[1]。我科2002-01—2012-12收治产褥期颅内静脉窦血栓形成患者10例,经及时诊治、精心护理均治愈出院,现将护理体会报告如下。     

Risk of recurrence of cerebral venous and sinus thrombosis during subsequent pregnancy and puerperium

OBJECTIVE: To assess the risk of recurrence of cerebral venous and sinus thrombosis (CVST) during subsequent pregnancy and puerperium in women with previous cerebral venous occlusive disease. METHODS: The authors retrospectively studied the relapse rate of CVST and the incidence of extracerebral venous thrombosis during subsequent pregnancies in 39 women (from 125 patients with CVST) who suffered a CVST at childbearing age. RESULTS: Mean follow up was 10.25 years (range 1 to 20). Twenty two pregnancies and 19 births were observed in 14 women without evidence of either recurrence of CVST or extracerebral venous thrombosis. One pregnancy occurred during oral anticoagulation and was interrupted and two pregnancies ended with spontaneous abortions. Low dose heparin had been given during five pregnancies. CONCLUSIONS: The risk of recurrence for CVST during pregnancy seems to be low and these data do not justify a negative advice on pregnancy in women with previous CVST. Further studies are needed to evaluate the need for a prophylactic anticoagulation during pregnancy and puerperium.     

The prothrombin gene G20210A variant and puerperal cerebral venous and sinus thrombosis in South Indian women.

Pregnancy and puerperium raise the risk of thrombotic events, and these risks are likely to be increased in women who are carriers of thrombophilic gene polymorphisms. Prothrombin G20210A variant is reported to be the second most frequent prothrombotic polymorphism in Caucasians. Our aim was to determine the prevalence of this variant in south Indian women and examine its association with cerebral venous and sinus thrombosis occurring during puerperium. We investigated 96 women with puerperal cerebral veno-sinus thrombosis (CVT) and 103 age-matched women with no post-partum complications. We used restriction fragment length polymorphism analysis to identify their genotypes. The prothrombin G20210A variant was not detected in either the CVT patients or the healthy control subjects. Our study on a large series of patients with puerperal CVT shows that the prothrombin G20210A variant is not present in south Indian women and is not associated with puerperal CVT. This study also highlights the fact that there are racial differences in the risk factors for thrombosis, which should be considered when investigating these patients.     

孕产妇脑静脉窦及静脉血栓形成的早期诊断及误诊分析

脑静脉窦及静脉血栓形成(cerebral venous and sinus thrombosis,CVST)是缺血性脑血管病的特殊类型,好发于妊娠期和产褥期的孕产妇。发病率低,起病隐匿,临床表现错综复杂,易于误诊、漏诊,死亡率、致残率高,但早期诊断和干预则预后良好。本文重点就孕产妇CVST的早期诊断及误诊相关研究做一综述,以促进临床医师及早识别危险预警,避免误诊,早期诊断,及时干预。     

Ischemic cerebrovascular disease in the young. Two common causes in India

Mandurai City is a composite of many villages with a total population not exceeding one million. Undoubtedly more than 95% of the hospital patients come from the rural areas. Our Government Hospital is the largest and reflects the medical assistance provided for people of average and low income. In our experience, 15% of cerebrovascular strokes occur in those below 40 years of age. Meningovascular neurosyphilis in men (10-15%) and puerperal cerebral venous thrombosis in women (20%) were the two commonly proved causes. Haemorrhagic stroke was uncommon. Embolic strokes from rheumatic heart disease formed 10%. In over 50%, the cause of stroke was not clear. Among 150 patients with neurosyphilis, mostly men, 25 had cerebral arterial thrombosis with stroke syndrome. This study reports on 138 patients with cerebral venous thrombosis and 7 patients with arterial thrombosis in puerperium. Mortality was 20% and quality of survival was good. The incidence, clinical picture, and diagnostic investigations are discussed with a review of literature.     

Postpartum cerebral vein thrombosis

Pregnancy increases the risk of cerebrovascular accidents to approximately 13 times the expected rate. Most of the cerebrovascular accidents are due to cerebral venous thrombosis. Headache, seizures and focal neurological deficits are some of the symptoms of cerebral venous thrombosis. Headache can also be due to postural puncture, pre eclampsia and eclampsia in the postpartum period. Neuroimaging with MRI with contrast helps in the diagnosis of cerebral venous thrombosis and giving a definite diagnosis, which aids in the treatment and prognosis. The cases presented in this report highlight the importance of investigations such as MRI or CT in the diagnosis of cerebral venous thrombosis in pregnancy and puerperium.     

Intracranial venous thrombosis in the first trimester of pregnancy.

We describe a fatal case of intracranial venous thrombosis occurring in early pregnancy. Such thrombosis usually occurs in late pregnancy or the puerperium but rarely during the first trimester of pregnancy. Computerized axial tomography suggested massive cerebral venous infarction. Necropsy findings showed not only cerebral venous thrombosis but also extensive pelvic and iliac vein thromboses. The relationship of cerebral venous thrombosis and pregnancy is discussed and the literature reviewed.     

Cerebrovascular disease in north-west India: a study of necropsy material.

The pattern of cerebrovascular disease in North-West India has been studied in a necropsy series of 362 cases over a 14 year period. One hundred and thirty eight cases of intracranial haemorrhage were found, 89 of cerebral embolism, 101 of cerebral arterial thrombosis and 34 of cerebral venous thrombosis. Nearly 37% of the affected patients were below 40 years of age. Cerebral embolism and cerebrovenous thrombosis were important causes of stroke in the young. Rheumatic heart disease and infective endocarditis formed the major causes of cerebral embolism. Cerebral venous thrombosis associated with pregnancy and puerperium was relatively more common in our series than has been reported in the West.     

颅内静脉系统血栓形成的临床特征与疗效分析

目的 探讨颅内静脉系统血栓形成的临床特征以及治疗原则.方法 分析14例颅内静脉系统血栓形成患者的发病年龄、发病形式、临床表现、影像学特征、脑脊液检查结果,并比较阿加曲班和低分子肝素对神经功能改善程度及预后的影响.结果 颅内静脉系统血栓形成可见于任何年龄段,中青年女性多见,以妊娠、感染、免疫性疾病等为常见发病原因.急性或...     

成人缺铁性贫血合并脑静脉血栓形成的临床特点及诊治

目的 探讨成人缺铁性贫血合并脑静脉血栓形成的临床特点及诊治。方法 对成人缺铁性贫血合并脑静脉血栓形成的临床特点及诊治进行回顾分析,并复习相关文献。结果 本研究报道的4例缺铁性贫血合并脑静脉血栓形成的患者均为女性,年龄33～47岁,缺铁性贫血的原因均为月经过多,其中1位33岁女性同时合并节食。4例患者否认肿瘤、凝血异常、自身免疫病、甲状腺功能异常病史,否认近期服用避孕药物、近期胃肠手术史及相关家族史等,筛查肿瘤、凝血功能、自身免疫、甲状腺功能等检查未见异常。4例患者均补铁治疗,2例患者经抗凝治疗后症状缓解,1例患者行支架治疗,1例患者经抗凝治疗后视力下降无缓解,予静脉支架置入术后症状未再进展。4例患者经补铁,抗凝或支架治疗后除1例抗凝治疗效果不佳未及时行支架术的患者预后差外,余3例均预后良好,未遗留神经系统症状。结论 缺铁性贫血为脑静脉血栓形成的可能原因之一,对于缺铁性性贫血患者,特别是女性患者如出现头痛,视物模糊等症状时,需注意并发脑静脉血栓形成的可能,如果能早期诊断,积极治疗,预后良好