儿童脑静脉窦血栓形成合并肺栓塞1例报告

<正>患儿男,13岁,因头痛、呕吐、耳鸣2周余入院。入院前2周,患儿无明显诱因出现头痛,表现为两侧额颞阵发性疼痛,布洛芬可缓解,偶尔伴有腹痛、非喷射性呕吐和耳鸣。脑电图检查示慢波异常。CT示左侧小脑幕可疑小圆形低密度灶;上矢状窦的空三角征;副鼻窦炎。当地医院诊断为"上呼吸道感染;副鼻窦炎",予以抗感染治疗,后症状稍有缓解。病程中无腹泻、出汗等脱水史,无发热、抽搐等症状。既往体健,否     

MRI findings in a child with sigmoid sinus thrombosis following mastoiditis

We describe the MRI features of sigmoid sinus thrombosis following mastoiditis in a 3-year-old girl. The features consisted of increased signal from the sinus on T2-weighted images and absence of flow on MR venography. It is concluded that MRI enabled a timely diagnosis of this life-threatening disease. MRI, as a non-invasive technique that does not use ionizing radiation, should be considered the investigation of first choice, especially in young patients.     

Sigmoid sinus thrombosis following mastoiditis: early diagnosis enhances good prognosis

Sigmoid sinus thrombosis following mastoiditis is a rare, but potentially life-threatening, condition. Its treatment usually consists of systemic antibiotics and mastoidectomy. In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging. The patient responded very well to intravenous antibiotics with a rapid clinical improvement and complete recanalization of the thrombosed sigmoid sinus. In conclusion, mastoiditis may present few clinical symptoms. In case of treatment failure or new-onset neurologic deficit in children with acute otitis media, life-threatening complications associated with mastoiditis should be considered. Early diagnosis is important, as favorable prognosis can be achieved with conservative management without performing any surgical intervention.     

Ocular complications of sigmoid sinus thrombosis from L-asparaginase

This article presents a 9-year-old boy with acute lymphocytic leukemia who developed ocular complications after beginning treatment with L-asparaginase. Ocular motor examination revealed esotropia with a right abduction deficit, consistent with a sixth nerve palsy, and funduscopy revealed bilateral optic disc edema. Thrombosis of the right sigmoid sinus was noted on magnetic resonance imaging and magnetic resonance venography. Symptoms gradually resolved after discontinuing L-asparaginase and treatment with heparin.     

Cerebral venous sinus thrombosis: report of a case and review of the literature

Cerebral venous sinus thrombosis is a condition that is well documented as a complication of the latter stages of pregnancy and with an even greater incidence during the puerperium. More recently this entity had been associated with the use of oral contraceptives. A case is presented of a 15-year-old girl with this condition, in whom the occurrence as well as the resolution of a superior sagittal sinus thrombosis was demonstrated with serial computed tomography (CT) scans and radionuclide studies. The discussion of this case, coupled with a review of the literature, describes the clinical presentation, explores the possible etiology, offers a noninvasive technique for confirming the diagnosis, and presents the medical management of this condition. It is postulated that cerebral venous sinus thrombosis occurs with a greater frequency than is currently recognized. Health professionals involved with monitoring the health care of adolescents during pregnancy and in the puerperium should be aware of this potential complications. In addition, association of this condition with oral contraceptive use should be recognized.     

肾病综合征合并颅内静脉窦血栓致失明1例报告

目的探讨肾病综合征(NS)合并颅内静脉窦血栓(CVST)致失明患儿的临床表现、治疗方案及其预后。方法分析1例NS合并CVST患儿的临床特点及诊治经过,并复习和总结国内外有关儿童CVST治疗相关研究的最新进展。结果患儿在NS标准化抗凝治疗过程中突然出现抽搐等癫发作症状,并有复视、双眼视力下降、失明,头颅磁共振及脑血管造影检查(MRV)示CVST形成,肝素化抗凝治疗效果不佳,后予尿激酶溶栓治疗1个月,复查MRV示颅内血栓已完全溶解。目前国际上针对CVST患儿已采取标准化抗凝治疗方案,并随时监测凝血功能如活化部分凝血活酶时间(APTT)、国际标准化比值(INR)等预防出血风险。结论临床考虑CVST的患儿需早期及时完善神经影像学检查,在排除出血风险后应立即予以抗凝或溶栓治疗,并按疗程使用3~6个月。