颅内静脉窦血栓形成患者头痛表现的临床分析

目的分析不同发病形式的颅内静脉窦血栓形成(CVST)患者常见首发症状头痛的特征。方法回顾性收集2008年8月—2013年3月在西安交通大学第一附属医院、西安交通大学第二附属医院和西安高新医院住院的51例经MR静脉成像(MRV)或DSA确诊CVST患者的临床资料,包括主要临床表现及影像学检查结果。按发病时间将患者分为急性组(≤3周)32例;慢性组(3周)19例。结果 (1)51例患者首次发病年龄集中在20~40岁,且以女性多见。在诸多首发症状中,头痛居首位,占84.3%(43/51);以单纯头痛为首发症状占52.9%(27/51),以头痛伴有其他症状为首发症状(如眼科症状、偏瘫、失语等)占31.4%(16/51),以其他症状(如癫痫、偏瘫、眼科症状等)为首发症状占15.7%(8/51)。(2)急性组以单纯头痛为首发症状的构成比高于慢性组,差异有统计学意义(分别为65.6%和31.6%,P0.05),而慢性组以头痛合并其他症状为首发症状的构成比高于急性组(P0.05)。另外慢性组首发症状包括眼科症状的发生比例高于急性组(P0.01)。(3)对43例头痛患者进行分型,钝痛或胀痛者占72.1%(31/43),炸裂样痛占11.6%(5/43),其他性质痛占16.3%(6/43)。两组差异无统计学意义(P均0.01)。结论对年轻的既往无偏头痛病史患者,尤其是育龄期妇女,突发进行性加重或不典型头痛的患者,以及特发性颅内压增高的患者应提高警惕,应把CVST作为一个重要的诊断考虑。

Clinical analysis of headache in patients with cerebral venous sinus thrombosis

Objective To analyze the characteristics of the common first attack of headache in patients with cerebral venous sinus thrombosis （CVST）. Methods The clinical data of 51 patients who were diagnosed as CVST with MR venography （MRV）or DSA were collected retrospectively. The patients were divided into either a acute group （≤3 week,n= 32）or a chronic group （＆gt;3 weeks, n=19）. Results （1）The age of onset of symptoms in these patients was 20 to 40 years,and most of them were females. Of all the first symptoms,headache ranked first,accounting for 84. 3%（43/51 ）;headache only accounted for 52. 9%（27/51 ）,headache with other symptoms （ophthalmic symptoms, hemiplegia,and aphasia,etc. ）accounted for 31. 4%（16/51 ）,and other symptoms such as epilepsy, paralysis,and ophthalmic symptoms accounted for 15. 7%（8/51）. （2）The proportion of headache only as the first symptom in the acute group was higher than that in the chronic group （65. 6% vs. 31. 6%,P〈0. 05）, and the proportion of chronic headache with other symptoms as the first symptom in the chronic group was higher than that of the acute group （P〈0. 05）. In addition,the proportion of the first symptom including ophthalmic manifestations in the chronic group was higher than that of the acute group （P 〈0.01 ）.＆amp;nbsp;（3）Forty-three patients with headache,dull headache or distensible pain accounted for 72. 1%（31/43）, thunderclap headache accounted for 11. 6%（5/43）,and other kinds of headache accounted for 16. 3%（6/43）,however,there were no significant differences about the types of headache between the two groups （all P＆gt;0. 05 ）. Conclusion Young patients without previous history of migraine,especially women of childbearing age with sudden onset and progressive worsening headache,and the patients with idiopathic intracranial hypertension,CVST should be considered as an important possibility.