脑静脉血栓形成的临床特点及预后分析

目的:探讨脑静脉血栓形成(cerebral venous thrombosis,CVT)的诊断要点、治疗及预后.方法:回顾性分析22例CVT患者的发病年龄、起病形式、临床表现、影像学特征、治疗方法及预后.结果:(1)发病年龄15～58(33.0±8.8)岁;(2)男女比为1:1.4,育龄期女性占总数的41%;(3)多为急性起病,大部分可以找到相关病因(59%),各种因素导致的血液高凝状态为最常见原因;(4)首发症状多为头痛呕吐等颅高压表现(86%),伴或不伴局灶性神经功能缺损及癫痫发作,严重者可出现意识障碍;(5)脑脊液压力明显升高,白细胞及蛋白含量可正常或升高;(6)头颅CT,MRI,磁共振血管造影(mag-netic resonance angiography,MRA)及数字减影血管造影(digital subtraction angiogrophy,DSA)等影像学检查结果示患者均有不同程度的颅内静脉或静脉窦受累,其中上矢状窦受累程度最严重(82%);(7)应用脱水、抗凝、皮质激素及病因治疗等,22例患者中9例症状好转,7例基本痊愈,2例无变化,1例继发脑出血,3例死亡.结论:有血液黏滞度增高、感染等危险因素的中青年患者出现急起头痛、呕吐和(或)局灶性神经功能缺损及癫痫发作时,应高度怀疑CVT.MRI和MRA是早期诊断的有效手段.早期正确诊断及尽早使用肝素抗凝治疗是取得良好预后的关键.

Clinical features and prognosis of cerebral venous thrombosis

OBJECTIVE: To explore the diagnosis,therapy and prognosis of cerebral venous thrombosis (CVT). METHODS: Twenty-two CVT patients were reviewed. The onset age, clinical manifestations, imaging, treatment, and prognosis were analyzed. RESULTS: Their age ranged from 15 to 58 (mean 33.0+/-8.8) years. Nine were males and 13 were females (1:1.4), 41% of whom were women of childbearing age.This disease occurred rapidly, and the relative pathogeny could be found in most patients (59%), and the hypercoagulative state was the commonest one.The clinical manifestations were variable. Most patients had symptoms and signs of intracranial hypertension(86%), accompanied with or without focal neurological dysfunction and seizures. Disorders of consciousness were found in some sever conditions.The cerebrospinal fluid (CSF) pressure was significantly increased, and the quantity of proteins or white blood cells in CSF was nearly normal.The occluded dural sinus and the clot could be visualised directly by means of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) or digital subtraction angiogrophy (DSA).After dehydration,anticoagulation,application of adrenal cortex hormone and etilogical treatment,9 patients improved,7 nearly cured, 2 had no changes,1 had cerebral hemorrhage, and 3 died. CONCLUSION: CVT should be suspected when patients show manifestation of intracranial hypertension and/or focal neurological dysfunction and seizures. MRI and MRA are efficient choices for the early diagnosis of CVT. Early diagnosis and anticoagulation with heparin are keys to good prognosis.