颅内深静脉血栓形成的临床诊治

目的　探讨颅内深静脉血栓形成（deep cerebral venous thrombosis，DCVT）的临床诊断与治疗策略。 方法　回顾性分析10年来影像学诊断为DCVT的5例患者的临床表现、影像学特征、治疗及预后情况。 结果　DCVT最常累及Rosenthal基底静脉、大脑内静脉、Galen静脉和直窦，其临床表现不典型，常见有头痛、意识障碍、复视、偏瘫等，常见诱发因素有口服避孕药、产褥期、妊娠期等。丘脑水肿为DCVT患者最常见的影像学征象。肝素抗凝治疗简单有效，大脑深静脉可恢复再通，临床症状缓解。 结论　DCVT患者临床症状缺乏特异性，早期诊断困难，特殊成像技术和特定影像学特征有助于其明确诊断，及时正确的抗凝治疗可获得良好的预后。

Clinical diagnosis and treatment of intracranial deep venous thrombosis

Objective　To investigate the clinical diagnosis and treatment strategy of deep cerebral venous thrombosis (DCVT).　 Methods　A total of 5 DCVT patients were enrolled during the past 10 years. The clinical manifestations, imaging features, treatment and prognosis were retrospectively analyzed.　Results　DCVT commonly was involved in the internal cerebral veins, vein of Galen, straight sinus, or basal vein of Rosenthal. However, the clinical manifestations of DCVT were atypical. Among patients seen in neurology clinics, headache, disturbance of consciousness, diplopia, and hemiplegia were common manifestations. Oral contraceptives, pregnancy, and puerperium were the common risk factors. Thalamic lesions were the common radiologic sign of DCVT. Heparin offered a simple and effective therapy to prevent blood clots in extended treatment after DCVT, leading to their gradual recovery, with recanalization of the deep venous system.　Conclusions　The clinical symptoms of DCVT patients are non-specific, and DCVT in the early stages is particularly hard to diagnose. Specific attention should be given to the specific imaging features which could help to diagnose DCVT. The DCVT patients will achieve a better outcome following timely anticoagulant treatment.