产褥期颅内静脉系统血栓形成临床分析

目的 探讨产褥期颅内静脉血栓形成的发病机制、临床表现及治疗对策。方法 回顾性分析2000年1月～2011年12月收治的46例产后颅内静脉血栓形成患者的临床资料,并进行归纳总结。结果 产后颅内静脉血栓形成患者以高颅内压及局灶性脑损伤为主要临床表现,经低分子肝素抗凝及对症治疗,患者症状均有改善。结论 对于存在静脉血栓形成风险的产褥期女性,应尽快完成相关检查,早诊断、早治疗,以期改善患者预后。     

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     

静脉侧支回流在多发性脑静脉窦血栓病中的作用(附89例分析)

目的 探讨静脉侧支回流在多发性脑静脉窦血栓病程中的作用。方法对我科收治的89例多发性脑静脉窦血栓病人采用经颈动脉溶栓、静脉窦内留置微导管连续溶栓等治疗方法，同时辅以全身抗凝治疗，观察临床效果和侧支循环的变化。结果所有病例治疗后颅内压均明显下降，DSA示残留静脉窦有回流63例，海绵窦代偿性引流75例，椎静脉丛引流35例，头皮静脉代偿引流14例。结论血管内溶栓和抗凝是治疗脑静脉血栓较为可靠和安全的方法：静脉侧支回流的建立和加强对于多发性脑静脉窦血栓的治疗和预后判断意义重大。     

Cerebral panthrombophlebitis in a paucisymptomatic patient

In most cases, extensive cerebral venous thrombosis present themselves with a severe clinical outcome and poor prognosis. We present the case of a 59-years-old patient with a slight rather unrevealing symptoms but suffering from a cerebral thrombosis impacting on both superficial and deep venous system. The etiologic assessment revealed activated protein C resistance. Clinical evolution under systemic anticoagulation was prompt, with complete repermeabilization of the various venous structures.     

脑静脉血栓的治疗方法探讨

目的 探讨脑静脉血栓的治疗方法。方法对133例脑静脉血栓单独或联合采用经颈动脉溶栓、静脉窦内留置微导管连续溶栓、静脉窦成形（支架置入或球囊扩张）等方法进行治疗，同时辅以全身抗凝治疗。结果治疗后颅内压均明显下降，除１例ICP降至350mmH2O者失明，1例行静脉窦球囊扩张成形者（拒绝接受静脉窦支架置入）由术前760mmH2O降至450mmH2O外．其余病人ICP基本稳定在200-260mmH2O。颅内出血严重致脑疝死亡2例。溶栓后发生脑出血3例．均经手术治愈。结论同时应用血管内溶栓和全身抗凝是治疗脑静脉血栓较为可靠和安全的方法；血栓部位不同者治疗方案应个性化。     

自发性低颅压并发静脉血栓形成和出血性梗死一例临床分析

目的自发性低颅压(SIH)多以与体位相关的剧烈头痛为主要症状,误诊率高。SIH并发静脉和(或)静脉窦血栓形成非常罕见。方法我们报道1例SIH并发静脉血栓形成和出血性梗死的患者,并复习相关文献。结果本例患者自发性低颅压在前,静脉血栓形成和出血性梗死在后,同时经过检查排除了其他可导致静脉血栓形成的危险因素。所以我们考虑SIH是静脉血栓形成的危险因素。假如SIH患者与体位相关的间断的头痛变成持续性头痛时,应考虑到有静脉血栓形成的可能。结论因为SIH的患者有形成硬膜下血肿的风险,所以对于静脉血栓形成的抗凝治疗应谨慎。     

脑静脉窦血管内治疗脑静脉窦血栓形成临床研究

目的对比静脉肝素抗凝与脑介入治疗脑静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析我院14例脑静脉窦血栓患者,按治疗方法分为介入组(脑静脉窦血管内治疗)和抗凝组(静脉肝素抗凝),每组7例,比较2组平均住院时间、血管完全再通率、mRS及并发症发生率。结果脑静脉窦介入组住院时间较抗凝组短,血管完全再通率高于抗凝组,mRS平均评分低于抗凝组,差异均有统计学意义(P0.05)。2组并发症发生率无显著差异(P0.05)。结论脑静脉窦血管内治疗可改善CVST患者的转归,疗效优于静脉肝素溶栓保守治疗。     

Diffusion-weighted magnetic resonance in deep cerebral venous thrombosis

Changes in the apparent diffusion coefficient (ADC) are well established in acute ischemic stroke of arterial origin. However, ADC behaviour and its prognostic significance in cerebral venous thrombosis (CVT) are not fully understood. Diffusion-weighted imaging (DWI) findings in a 34-year old woman with deep cerebral venous thrombosis are described. Recent literature concerning DWI and cerebral venous thrombosis is also reviewed. A MRI performed within 7 hours from onset revealed hyperintensities in deep grey matter bilaterally (FLAIR/T2), without changes in ADC maps, suggesting vasogenic edema. After anticoagulation a new MRA disclosed complete recanalization of venous thrombosis. Despite her good clinical outcome the MRI showed hemorrhagic lesions suggesting venous infarct. Lesions detected in acute CVT with DWI may have normal ADC values. There is no good correlation between the acute ADC values and clinical and radiological evolution. The prognostic value of ADC in the acute phase of CVT remains unsettled.     

重症脑静脉窦血栓形成的血管内溶栓抗凝治疗

目的探讨重症脑静脉窦血栓形成血管内溶栓抗凝治疗的效果与安全性。方法选择传统治疗方法无效的重症脑静脉窦血栓形成病例2例,采用在数字减影血管造影(DSA)下静脉窦接触性溶栓抗凝与颈内动脉抗凝溶栓联合治疗。结果2例病人临床症状全部缓解,闭塞静脉窦开通,无严重并发症发生。结论血管内介入溶栓抗凝治疗可能是治疗重症脑静脉窦血栓形成的一种安全有效的方法。     

Recanalisation and outcome cerebral venous thrombosis

Little is known of the natural history and rate of sinus recanalisation after cerebral venous thrombosis (CVT). Although acute anticoagulation is effective, the duration of therapy remains speculative. We aimed to determine the relationship between sinus recanalisation and clinical outcome. We studied 12 consecutive patients with aseptic CVT with evidence of sinus thrombosis on initial magnetic resonance imaging, followed up 5-68 months after onset, using 15 repeat magnetic resonance scans in 9 of the patients to assess recanalisation. All patients initially had one or more thrombosed sinuses and were treated with anticoagulants for at least 6 months, including 3 with haemorrhagic infarction. Residual neurological deficits were present in only one patient. No patient had a recurrent thrombosis. Recanalisations was incomplete in 6 of the 9 cases. Sinus recanalisation after cerebral venous thrombosis does not correlate with clinical outcome. Although empirical, the general recommendation of 6 months anticoagulant therapy is appropriate.     

Deep cerebral venous sinus thrombosis often presents with neuropsychologic symptoms.

The outcome of cerebral venous sinus thrombosis (CVST) depends on rapid diagnosis and initiation of effective anticoagulation. We report seven cases of a subgroup with deep cerebral venous sinus thrombosis (DCVST) treated in our institution since 1990. Six of our seven patients presented with early neuropsychological deficits (mental obtundation, bradyphrenia or apathia). This clinical presentation, in combination with headache, and focal neurological deficits, aids the early diagnosis of DCVST. Thalamic hyperintensities on T2-weighted MRI images, previously considered infarctions, were fully reversible during treatment with heparin. This indicates that early in the course of the disease they correspond to vasogenic oedema.     

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.     

Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States

This study presents a large multicenter cohort of children with cerebral venous thrombosis from 5 centers in the United States and analyzes their clinical findings and risk factors. Seventy patients were included in the study (25 neonates, 35%). The age ranged from 6 days to 12 years. Thirty-eight (55%) were younger than 6 months of age, and 28 (40%) were male. Presenting features included seizures (59%), coma (30%), headache (18%), and motor weakness (21%). Common neurological findings included decreased level of consciousness (50%), papilledema (18%), cranial nerve palsy (33%), hemiparesis (29%), and hypotonia (22%). Predisposing factors were identified in 63 (90%) patients. These included infection (40%), perinatal complications (25%), hypercoagulable/hematological diseases (13%), and various other conditions (10%). Hemorrhagic infarcts occurred in 40% of the patients and hydrocephalus in 10%. Transverse sinus thrombosis was more common (73%) than sagittal sinus thrombosis (35%). Three children underwent thrombolysis, 15 patients received anticoagulation, and 49 (70%) were treated with antibiotics and hydration. Nine (13%) patients (6 of them neonates) died. Twenty-nine patients (41%) were normal, whereas 32 patients (46%) had a neurological deficit at discharge. Seizures and coma at presentation were poor prognostic indicators. In conclusion, cerebral venous thrombosis predominantly affects children younger than age 6 months. Mortality is high (25%) in neonatal cerebral venous thrombosis. Only 18 (25%) patients were treated with anticoagulation or thrombolysis.     

Cerebral vein thrombosis as an exceptional cause of transient ischemic attack

We present a case of transient ischemic attack (TIA) as an extremely rare presentation of cerebral vein thrombosis. A 41-year-old man presented with a headache and episodes of hypoesthesia on his left side lasting approximately 30 minutes. Several vascular risk factors were remarkable in his medical history. The neurologic examination was normal. TIA of arterial origin was excuded by detailed investigations. Magnetic resonance imaging revealed acute thrombosis of the right superficial middle cerebral vein and the vein of Trolard. TIA-like episodes stopped with anticoagulation. Head trauma a few days earlier was the most likely mechanism of venous thrombosis. We suggest that the patients with TIA and headache should be carefully investigated in terms of cerebral venous thrombosis.     

Incidental Diagnosis of Cerebral Cortical Venous Thrombosis in Postdural Puncture Headache on Brain Computed Tomography

Diagnosis of cerebral cortical venous thrombosis in patients with postdural puncture headache (PDPH) is usually secondary to changes in headache pattern or cerebral infarctions. Nevertheless, incidental discovery of asymptomatic forms on brain imaging has never been reported before and its management thus remains ill‐defined. We describe 2 cases of patients with asymptomatic cortical vein thrombosis in the context of PDPH. In both cases, brain computed tomography (CT) scans showed an isolated cortical vein thrombosis without cerebral damage. Neurological examination revealed the typical orthostatic feature of PDPH, independently of cortical vein thrombosis which was considered as a radiological incidental finding. Clinical and radiological signs resolved after bed rest, oral caffeine, and anticoagulation therapy. Asymptomatic cortical vein thrombosis may be found on radiological exploration, even basic like brain CT scan without contrast, of PDPH. Utility of anticoagulation therapy, which could increase the risk of cerebral hemorrhagic complications in this specific context, has to be assessed.     

硬脑膜静脉窦血栓形成的血管内介入治疗

目的 探讨硬脑膜静脉窦血栓形成(DVST)的血管内介入治疗。方法 11例由CT、MRI、DSA确诊的硬脑膜静脉窦血栓形成患者经皮股动、静脉穿刺给予介入治疗；围手术期规范抗凝、抗血小板聚集等综合治疗。结果 2例患者临床症状戏剧性改善，10例患者临床症状消失或好转，1例无变化；术后影像学均有不同程度的改善；1例机械辅助溶栓患者介入治疗时发生导丝断裂；1例机械辅助溶栓后置人支架未成功；术中、术后无其它相关并发症发生。出院时临床痊愈5例，显效3例，好转2例，无效1例。随访9例患者3～6月无复发。结论 多种介入方法联合治疗DVST的方法是可行的且安全有效。是值得在临床推广的治疗DVST的方法，其远期效果尚需观察。     

Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study

BACKGROUND: The relative importance of previous diagnosis and hereditary prothrombotic risk factors for cerebral venous thrombosis (CVT) in children in determining risk of a second cerebral or systemic venous thrombosis (VT), compared with other clinical, neuroimaging, and treatment variables, is unknown. METHODS: We followed up the survivors of 396 consecutively enrolled patients with CVT, aged newborn to 18 years (median 5.2 years) for a median of 36 months (maximum 85 months). In accordance with international treatment guidelines, 250 children (65%) received acute anticoagulation with unfractionated heparin or low-molecular weight heparin, followed by secondary anticoagulation prophylaxis with low-molecular weight heparin or warfarin in 165 (43%). RESULTS: Of 396 children enrolled, 12 died immediately and 22 (6%) had recurrent VT (13 cerebral; 3%) at a median of 6 months (range 0.1-85). Repeat venous imaging was available in 266 children. Recurrent VT only occurred in children whose first CVT was diagnosed after age 2 years; the underlying medical condition had no effect. In Cox regression analyses, non-administration of anticoagulant before relapse (hazard ratio [HR] 11.2 95% CI 3.4-37.0; p<0.0001), persistent occlusion on repeat venous imaging (4.1, 1.1-14.8; p=0.032), and heterozygosity for the G20210A mutation in factor II (4.3, 1.1-16.2; p=0.034) were independently associated with recurrent VT. Among patients who had recurrent VT, 70% (15) occurred within the 6 months after onset. CONCLUSION: Age at CVT onset, non-administration of anticoagulation, persistent venous occlusion, and presence of G20210A mutation in factor II predict recurrent VT in children. Secondary prophylactic anticoagulation should be given on a patient-to-patient basis in children with newly identified CVT and at high risk of recurrent VT. Factors that affect recanalisation need further research.     

Recanalisation of cerebral venous thrombosis

OBJECTIVE: To investigate recanalisation in the first 12 months after cerebral venous thrombosis. METHODS: 33 consecutive patients presenting with cerebral venous thrombosis were enrolled in the study. Diagnosis was made by magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or catheter angiography. Patients were initially treated with intravenous heparin. Warfarin was given for at least four months. Cerebral MRI and MRV were done at four months and repeated after 12 months if venous thrombosis persisted. Outcome was evaluated by the Rankin scale at 12 months. RESULTS: Outcome at 12 months was good, with a median modified Rankin scale score of 0 (range 0 to 2); 27 patients (82%) had no residual deficits. No patient suffered recurrent cerebral venous thrombosis, deep vein thrombosis, or pulmonary embolism during follow up. After four months, all deep cerebral veins and cavernous sinuses, 94% of superior sagittal sinuses, 80% of straight sinuses, 73% of jugular veins, 58% of transverse sinuses, and 41% of sigmoid sinuses had recanalised. No further recanalisation was observed thereafter. CONCLUSIONS: The results suggest that recanalisation only occurs within the first four months following cerebral venous thrombosis and not thereafter, irrespective of oral anticoagulation.     

脑静脉窦血栓的局部溶栓治疗及随访分析

目的评估脑静脉窦血栓局部溶栓治疗的效果。方法脑静脉窦血栓13例经股动脉插管,行全脑血管造影。明确诊断后,经股静脉插管,微导管超选至血栓内局部溶栓。术后抗凝治疗。3～62个月,进行改良Rankin评分（mRS）,5例行MRI随访。结果 12例治疗后症状缓解或消失,1例死亡。1例复发再次局部溶栓治疗,其余病例疗效满意。结论局部溶栓治疗脑静脉窦血栓安全有效。