脑静脉及静脉窦血栓形成16例临床分析

目的：探讨脑静脉及静脉窦血栓形成（CVST）的病因及临床特点。方法：回顾性调查16例CVST患者的临床资料。结果：侧窦血栓（87.5%）和上矢状窦血栓形成（37.5%）最常见,70%患者有2个以上部位血栓形成。最常见的症状为头痛14例（87.5%）,其次为癫癎、偏瘫、嗜睡及反应迟钝等。头颅CT有14例（87.5%）发现特征性改变,为枕部近颅板下或后纵裂条索状高密度影。头颅MRI结合MRV阳性率为94%。结论：头痛是CVST患者最常见的主诉,CT可作为一种诊断CVST有效的初始检查,MRI结合MRV有诊断价值。

Clinical and Radiological Analysis of Cerebral Venous Sinus Thrombosis:A Review of 16 Cases

Aim：To study the clinical and imaging characteristics of cerebral venous sinus thrombosis （CVST）.Methods：16 cases of CVST（mean age of 40 years,9 men：7 women） presenting to the 6th People＇ s Hospital of Shanghai between 2005 and 2009 were retrospectively reviewed.Results：The study showed that the trasverse sinus（87.5%） and the superior sagittal sinus（37.5%） are the commonest sites of thrombosis,and multiple sites of thrombosis（70%） are more frequent than a single site.The common symptoms were headache （87.5%）,seizure（25%）,paresis（25%）,conscious disturbance（18.7%）,visual impairment（12.5%）,papilledema （25%）.Lumber puncture showed an increased intracranial pressure in most patients（81.8%,9/11）.14 cases （87.5%） had characteristic direct signs of CT scan,such as trabs-like high dense signal at occipital or posterior longitudinal fission area.In addition to the abnormal signals of thrombus,MRI revealed many indirect signs, including cerebral edema（cellular or vascular edema）,infarction and haemorrhage.MRV demonstrated loss of signal in the thrombosed sinus.Most patients had good prognosis after treatment,4 patients died in hospital. Conclusion：Young patient with complaint of acute or subacute headache and with or without seizure,paresis or other focal neurological impairment should prompt the physician to consider the diagnosis of CVST. Unenhanced brain CT is a valid initial radiological examination in the diagnosis of CVST.MRI and MRV are required to confirm the diagnosis.Systemic anticoagulation（low molecular heparin） seemed to be safe and beneficial in this study.