脑静脉系统血栓形成伴颅内出血的临床特征及治疗

目的 探讨脑静脉及静脉窦血栓形成（CVST）伴颅内出血的临床特征及治疗效果。方法 回顾性分析2012年1月至2020年9月收治的35例CVST伴颅内出血的临床资料。27例接受抗凝治疗，其中单纯抗凝治疗13例，术后抗凝治疗9例，介入治疗后抗凝治疗5例；8例未接受抗凝治疗。治疗4周采用GOS评分评估预后。结果 手术并抗凝治疗的9例中，5例GOS评分4~5分，2例2~3分，2例死亡；接受介入机械取栓及溶栓治疗并抗凝治疗的5例中，4例GOS评分4~5分，1例2分；单纯抗凝治疗的13例中，9例GOS评分4~5分，4例2~3分；未接受抗凝治疗的8例中，3例死亡，3例GOS评分2~3分，1例4分，1例5分。结论 伴颅内出血的CVST临床表现多样且无明显特征性，抗凝为治疗基础，部分病人可根据情况选择介入治疗，出血较多及脑疝病人可考虑开颅手术减压，大多病人预后尚可，出血较多、广泛静脉窦血栓形成及脑疝形成病人预后较差。

Clinical characteristics and treatment of cerebral vein and dual sinus thrombosis associated with intracranial hemorrhage

Objective To explore the clinical features and treatment of cerebral vein and dural sinus thrombosis (CVST) associated with intracranial hemorrhage (ICH). Methods A retrospectiv analysis was performed on the clinical data of 35 patients with CVST associated with ICH who admitted to our hospital from January 2012 to September 2020. Anticoagulant therapy was administered in 27 patients of whom 13 received simple anticoagulant therapy, 9 received anticoagulant therapy after the operation and 5 received anticoagulant therapy after intervention treatment. Eight patients did not receive anticoagulant therapy. GOS score was sued to assess the prognosis 4 weeks after the treatment. Results Of 9 patients received anticoagulant therapy after the operation, 5 patients had GOS score of 4~5, 2 had GOS score of 2~3 and 2 had GOS score of 1. Of 5 patients received anticoagulant therapy after intervention treatment, 4 had GOS score of 4~5 and 1 had GOS score of 2. Of 13 patients received simple anticoagulant therapy, 9 patients had GOS score of 4~5 and 4 had GOS score of 2~3. Of 8 patients who did not receive anticoagulant therapy, 3 patients died, 3 patients had GOS score of 2~3, 1 had GOS score of 4 and 1 had GOS score of 5. Conclusions The clinical manifestations of CVST patients associated with ICH are diverse and have no obvious characteristics. Anticoagulant treatment is the basic treament for CVST patients associated with ICH. Certain patients can choose interventional mechanical thrombectomy and thrombolytic therapy according to their condition. Those patients with heavy bleeding, cerebral hernia should consider surgical decompression. Most patients can achieved good prognosis after appropriate treatment. The prognoses are poor in the patients with heavy bleeding, extensive venous sinus thrombosis and cerebral hernia.