非神经科住院患者颅内静脉窦血栓形成临床和影像特征分析并文献复习

目的:探讨非神经科住院患者颅内静脉窦血栓形成(CVST)发生的病因、临床和影像学特征,提高临床医生对CVST的识别和诊断能力.方法:回顾性分析因非神经科疾病于其他科室接受住院治疗,并于住院期间确诊的CVST患者的临床和影像学资料,同时结合相关文献进行回顾性分析.结果:共纳入6例确诊的CVST患者,其原发性疾病分别为肾小...     

颅内静脉窦血栓形成20例临床分析

目的:探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特点、影像学检查和诊治方法,为临床提供经验。方法:回顾分析20例CVST患者的临床资料,分析其发病原因、临床特点、实验室检查、影像学表现、治疗方案等。结果:20例患者均为中青年,大多为急性或亚急性起病,临床表现主要为高颅压综合征或局灶性神经功能缺损,出现头痛17例、视力障碍8例、肢体乏力麻木10例、癫痫发作6例。CVST的诊断主要依靠影像学表现。根据19例患者的磁共振静脉血管成像(magnetic resonance renography,MRV)或数字成影血管造影(digital subtraction angiography,DSA)检查结果(去除1例无效数据)发行,血栓累及2个或2个以上静脉窦15例(78.9%),累及上矢状窦9例、橫窦15例、乙状窦14例;脑实质损伤8例(40%)。经抗凝、降颅压和抗癫痫等对症治疗后,治疗有效(症状完全消失/缓解)17例(85%),无效3例(15%),病死2例。结论:CVST发病率低,容易漏诊和误诊,头痛、视力障碍、癫痫和肢体感觉运动障碍为常见临床表现,孤立性头痛和孤立性视乳头水肿(视物模糊/黑朦)患者需警惕CVST;D-二聚体检查阴性不足以排除CVST诊断;CT和MRI检查对CVST有重要提示作用,经静脉造影检查(MRV或DSA)发现血管腔内血栓是CVST确诊的关键;早期诊断,规范的抗凝治疗和积极的对症治疗有助于改善预后。     

颅内静脉窦血栓形成误诊分析

目的:探讨颅内静脉窦血栓形成(CVST)的临床表现、影像学特征、治疗方法及误诊原因。方法:分析3例CVST误诊为产后抑郁症患者的临床资料,并复习相关文献。结果:3例患者均以持续性头痛为主诉,伴情绪低落及睡眠障碍,早期均被误诊为产后抑郁症,后症状加重,经头部核磁共振检查最终确诊为CVST。结论:CVST的发病率低,临床表现多样而不典型,易漏诊误诊,对急、慢性头痛,尤其慢性每日性头痛的产妇要想到CVST的可能。     

颅内静脉窦血栓形成误诊为出血性脑梗死21例分析

目的:探讨颅内静脉窦血栓形成(CVST)误诊为出血性脑梗死(HI)的原因。方法:回顾性分析1998/2007年收治的21例误诊为HI的CVST患者临床资料和影像资料。结果:21例误诊为HI的患者,临床表现或影像学资料与HI不符,提示CVST可能。结论:CVST可能误诊为HI,通过临床细致观察病情变化和分析影像学检查,能够降低误诊率。     

12例被误诊的颅内静脉窦血栓形成患者的 临床特点分析

目的:探讨被误诊的颅内静脉窦血栓形成(CVST)患者的临床特点、辅助检查及误诊情况。方法:回顾性分析12例被误诊的CVST患者的临床资料。结果:12例CVST患者分别误诊为蛛网膜下腔出血、血管性头痛、肥厚性脑膜炎、脑梗死、良性颅内高压、神经性头痛各1例,脑出血2例,脑炎4例。平均误诊时间为21.3 d(1~90 d)。头痛为CVST的最常见临床表现。脑脊液检查常为CVST的诊断提供重要线索。MRI联合MRV检查常作为CVST的首选检查方法。结论:CVST临床表现缺乏特异性,容易误诊,头痛是最常见症状,当患者出现不典型头痛和颅内压增高时,应高度警惕为CVST的可能,颅脑CT检查未见明显异常时,应及早行MRV检查,必要时DSA检查明确诊断,以减少误诊。     

颅内静脉窦血栓急性期治疗策略的初步研究

目的探讨颅内静脉窦血栓(CVST)急性期的临床特点及治疗策略的选择。方法回顾性分析26例急性期CVST患者的临床资料,住院期间分别接受全身抗凝、静脉溶栓和血管内治疗,并辅助华法林口服6~12个月。结果26例急性期CVST患者中16例患者接受单纯全身抗凝药物治疗,6例接受单纯静脉溶栓,4例接受全身抗凝+血管内溶栓治疗(其中2例因抗凝治疗过程中,病情加重,转为血管内溶栓治疗)。出院时,所有患者闭塞静脉窦均再通或部分再通,临床症状改善。随访6~26月,平均18月,无一例血栓再形成。结论急性期CVST应根据病情程度选择个性化治疗方案,其影响因素为临床表现、闭塞程度及侧支循环开放程度。     

D-二聚体在颅内静脉窦血栓形成中的临床意义

目的 检测颅内静脉窦血栓形成(CVST)患者的血浆D-二聚体水平,并探讨其临床意义.方法 采用酶联免疫吸附试验(ELISA)法检测20例CVST患者血浆D-二聚体含量,并与正常对照组比较.结果 CVST患者血浆D-二聚体水平明显增高,与对照组比较差异有统计学意义(P＜0.01)；CVST组80％患者血浆D-二聚体水平＞0.5 mg/L,即阳性.结论 血浆D-二聚体可以反映颅内静脉窦血栓形成后继发的纤溶亢进,可能会成为CVST患者有意义的实验室检测指标.     

脑静脉窦血栓形成21例分析

目的 探讨脑静脉窦血栓形成(CVST)的早期诊断及治疗方法.方法 回顾性分析21例CVST患者的发病年龄、发病形式、临床表现、影像学特征及预后.结果 CVST发病年龄多在20～40岁;多数为急性或亚急性发病；早期多表现为头痛、呕吐、视盘水肿；伴或不伴有局灶性神经功能缺损或癫痫发作;影像学表现为静脉窦闭塞伴非动脉分布区多发性脑梗死,有的伴有出血；颅压明显增高,脑脊液蛋白及细胞升高.结论 认识CVST的临床特征及时行CT、MRI、MRV等检查,必要时行数字减影血管造影(DSA)检查.一旦诊断明确,应尽早选用抗凝治疗.     

经静脉窦微导管接触性rt-PA溶栓治疗颅内静脉窦血栓形成患者一例的护理

目的探讨经静脉窦微导管接触性溶栓治疗颅内静脉窦血栓形成(cerebral venous and sinus thrombosis,CVST)患者的护理方法。方法回顾性分析并总结2016年3月17日第二军医大学长海医院脑血管内科收治的1例经静脉窦微导管接触性rt-PA溶栓治疗CVST患者的临床资料。结果患者经积极有效护理,术后未出现任何并发症,病情稳定,准予出院。结论CVST患者采取血管介入接触性溶栓治疗,同时在围术期做好观察及各项护理措施,有利于促进患者康复。     

颅内静脉窦血栓形成42例分析

目的：探讨脑静脉窦血栓形成（CVST）的病因、临床特点及治疗。方法：回顾性分析42例CVST患者病因、临床表现、影像学特征及脑脊液结结果等。结果：（1）临床表现缺乏特异性,易漏诊或误诊。（2）常见症状头痛、呕吐和（或）神经功能障碍。（3）年轻患者及女性多发。结论：CVST病因复杂,起病形式多样,临床表现无特异性,因此对可疑患者尽早CT、MRI及MRV检查。早期溶栓及抗凝治疗是安全、有效的治疗手段。     

Cancer and risk of cerebral venous thrombosis: a case–control study

Essentials

The risk of cerebral venous thrombosis (CVT) in patients with cancer is not known.

We performed a case‐control study including 594 patients with CVT and 6278 controls.

History of cancer increased the risk of CVT approximately 5‐fold.

The association was strongest with hematological cancer in the first year after diagnosis.

Summary

Background

Cancer is an established risk factor for leg vein thrombosis and pulmonary embolism. Controlled studies assessing the risk of cerebral venous thrombosis (CVT) in patients with cancer have not been performed.

Objective

To assess whether cancer is a risk factor for CVT.

Patients/Methods

This was a case–control study. We assessed consecutive adult patients with CVT from three academic hospitals from 1987 to 2015, and control subjects from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). We adjusted for age, sex and oral contraceptive use, and stratified for type of cancer and time since diagnosis of cancer.

Results

We included 594 cases and 6278 controls. In total, 53 cases (8.9%) and 160 controls (2.5%) had a history of cancer. Cases were younger (median 42 vs. 48 years), more often female (68% vs. 54%) and more often used oral contraceptives (55% vs. 23%) than controls. The risk of CVT was increased in patients with cancer compared with those without cancer (adjusted odds ratio [aOR], 4.86; 95% confidence interval [CI], 3.46–6.81). Patients with a hematological type of cancer had a higher risk of CVT (aOR, 25.14; 95% CI, 11.64–54.30) than those with a solid type of cancer (aOR, 3.07; 95% CI, 2.03–4.65). The association was strongest in the first year after diagnosis of cancer (hematological aOR, 85.57; 95% CI, 19.70–371.69; solid aOR, 10.50; 95% CI, 5.40–20.42).

Conclusions

Our study indicates that cancer is a strong risk factor for CVT, particularly within the first year of diagnosis and in patients with a hematological type of cancer.     

Is it worth diagnosing and treating distal deep vein thrombosis? No

Summary.  The standard diagnostic approach to suspected deep vein thrombosis (DVT) is serial lower limb compression ultrasound (CUS) of proximal veins. Although it only assesses the proximal veins, withholding anticoagulant treatment in patients with a negative CUS on day 1 and after 1 week has been proved safe. In particular, studies evaluating CUS limited to the proximal veins showed a good safety profile with a pooled estimate of the 3-month thromboembolic rate of 0.6% (95% CI, 0.4–0.9%) in non-anticoagulated patients. However, performing two lower limbs CUS is cumbersome and expensive. Recently, studies using a unique complete (proximal and distal) CUS showed a similar pooled estimate of the 3-month thromboembolic rate (0.3%; 95% CI, 0.1–0.6%) but distal DVTs accounted for as many as 50% of all diagnosed DVTs in those series. Comparing these studies may suggest that systematically searching for calf DVTs potentially doubles the number of patients given anticoagulant therapy and entails a risk of over-treatment. Admittedly, performing calf CUS is highly useful in diagnosing other conditions such as popliteal cyst, hematoma or muscle rupture. Performing a CUS limited to the popliteal site in the presence of calf pain may be not well accepted by the patient. However, the advantage of calf CUS in diagnosing venous thromboembolism appears to be at the least debatable. Data suggesting that anticoagulation is indicated for distal DVT are limited, and realizing systematic distal CUS entails a risk of over-treatment. There is an urgent need for randomized trials assessing the usefulness of anticoagulant treatment in distal DVT.     

From Trousseau to targeted therapy: new insights and innovations in thrombosis and cancer

Summary.  Venous thromboembolism (VTE) commonly occurs in patients with malignant disease. At the 1997 ISTH meeting, cancer and thrombosis was discussed in a state-of-the-art symposium. Since then, there have been many new developments on this topic. Tumors, through expression of tissue factor can activate coagulation. Furthermore, local peritumor activation of coagulation may have important effects on the biology of cancer. A randomized trial has been conducted which evaluated extensive screening to detect underlying malignancy vs. no screening in patients presenting with idiopathic VTE. No statistically significant difference was detected in cancer-related mortality between the two groups. A trial has evaluated extended prophylaxis in patients undergoing surgery for abdominal malignancy. There was a statistically significant reduction in venographically detected deep vein thrombosis in favor of 4 weeks of treatment. In contrast, there is clearly a need for more information on the use of thromboprophylaxis in medical cancer patients. Low molecular weight heparin (LMWH) has replaced unfractionated heparin as the first line treatment in the majority of patients with acute VTE. Many cancer patients with acute VTE can be treated safely at home with subcutaneous LMWH without admission to hospital. The results of a recent trial demonstrated that long-term low molecular weight heparin administered over a 6-month period substantially reduced the rate of recurrent VTE compared with oral anticoagulant therapy with no increase in bleeding. Finally, the first trial specifically designed to evaluate the anticancer effect of long-term LMWH in cancer patients has been conducted and will no doubt stimulate future research.     

Superior vena cava thrombosis secondary to Hickman catheter and complete resolution after fibrinolytic therapy

We present a case of acute-onset vena cava syndrome produced by thrombosis of the vena cava superior in a patient receiving adjuvant chemotherapy through a Hickman catheter. After angiographic diagnosis fibrinolytic therapy was administered, which brought about complete resolution. We also present a brief review of the literature.     

孤立性小腿深静脉血栓的超声诊断

目的　探讨孤立性小腿深静脉血栓的声像图特点及超声诊断方法。方法　应用彩色多普勒超声检查小腿肌肉内深静脉 (比目鱼肌静脉、腓肠肌静脉 )、胫后静脉、腓静脉、胫前静脉 ,以及静脉以上近端深静脉是否有血栓形成。结果　检出的 13例孤立性小腿深静脉血栓中 ,77%为小腿肌肉内深静脉受累 ,少数为腓静脉及胫后静脉受累 ,未发现胫前静脉单独受累者 ;比目鱼肌内的单支静脉血栓为最常见的类型 ,且半数合并近端深浅静脉返流。结论　超声检查能够有效地检出孤立性小腿深静脉血栓病变 ,小腿深静脉特别是肌肉内深静脉应包括在下肢深静脉检查常规之中。     

Polymorphisms in coagulation factor genes and their impact on arterial and venous thrombosis

Arterial and venous thromboses, with their clinical manifestations such as stroke, myocardial infarction (MI), or pulmonary embolism, are the major causes of death in developed countries. Several studies in twins and siblings have shown that genetic factors contribute significantly to the development of these diseases. Since the advent of molecular genetics in medicine, it has been a focus of interest to elucidate the role of mutations in various candidate genes and their impact on hemostatic disorders such as arterial and venous thromboses. In this article, we review the current knowledge of the contribution of polymorphisms in coagulation factors to the development of thrombotic diseases. We show that in arterial thrombosis, results are controversial. Only for factor XIII 34Leu a protective effect on the development of myocardial infarction has been demonstrated in several studies. No other single polymorphism in a coagulation factor could be confirmed as a relevant risk factor, although there is evidence for a role of factor V Arg506Gln, factor VII Arg353Gln, and vWF Thr789Ala polymorphisms in patient subgroups. Further studies will be necessary to confirm the value of testing for genetic polymorphisms in arterial thrombosis. A large body of data is available on the role of factor V Arg506Gln and the prothrombin G20210A mutation in venous thrombosis. Some papers already recommend diagnosis and treatment strategies. We will discuss these recent publications on venous thrombosis in our review.     

Macrothrombosis and stroke in patients with mild Covid‐19 infection

Coronavirus disease 2019 (COVID‐19) is a pandemic disease currently affecting millions of people worldwide. Its neurological implications are poorly understood, and further study is urgently required. A hypercoagulable state has been reported in patients with severe COVID‐19, but nothing is known about coagulopathy in patients with milder disease. We describe cases of patients in New York City presenting with stroke secondary to large vessel thrombosis without occlusion, incidentally found to have COVID‐19 with only mild respiratory symptoms. This is in contrast to the venous thrombosis and microangiopathy that has been reported in patients with severe COVID‐19. Our cases suggest that even in the absence of severe disease, patients with COVID‐19 may be at increased risk of thrombus formation leading to stroke, perhaps resulting from viral involvement of the endothelium. Further systematic study is needed because this may have implications for primary and secondary stroke prevention in patients with COVID‐19.     

股浅静脉与股深静脉血栓形成差异的超声研究

目的 探讨股浅静脉与股深静脉在血栓形成上存在差异的血流动力学机制.方法 选择144例下肢深静脉血栓患者为研究对象,共观察下肢深静脉148条,统计分析股浅静脉血栓与股深静脉血栓在发病率及闭塞程度上是否存在差异.结果 148条下肢深静脉血栓中,股浅静脉完全闭塞及部分闭塞分别为139条及9条,股深静脉完全闭塞及部分闭塞分别为92条及47条,股浅静脉较股深静脉血栓发病率高(P<0.01),股浅静脉血栓形成导致血管闭塞程度较股深静脉重(P<0.01).结论 股浅静脉较股深静脉易患血栓且闭塞程度重与其距小腿较远,小腿肌肉收缩形成具有一定速度的血流在股浅静脉血流速度明显减低有关.