20例脑静脉(窦)血栓形成的早期诊断与治疗分析

目的：分析脑静脉窦血栓形成（CVT）的早期诊断及治疗方法。方法：回顾分析20例（男性11例，女性9例）CVT病人的发病年龄、可能病因、临床表现、影像学特征、脑脊液检查结果与治疗方法。结果：（1）年龄多在20-40岁；（2）多数病例为急性起病，病情逐渐进展；（3）病因多样；（4）早期表现为头痛（85％）、呕吐（60％），伴或不伴局灶性神经功能缺损或癫痫发作；（5）影像学表现为静脉窦闭塞及静脉性梗死灶（40％）；（6）脑脊液压力明显升高（83．3％），白细胞及蛋白含量正常或升高；（7）对因及脱水治疗基础上行抗凝治疗14例、溶栓1例，5例重症患者预后不佳。结论对临床急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的年轻病人，应高度怀疑CVT，及时行MRI及磁共振静脉血管造影（MRv）联合检查，早期明确诊断，尽可能地检查和控制潜在病因，尽早开始抗凝治疗。对重症及经肝素治疗无效的病例建议局部静脉窭内溶栓治疗。

Analysis on the Early Diagnosis and Treatment of Cerebral Venous Sinus Thrombosis in 20 Cases

Objective:To analyse the early diagnosis and treatment of cerebral venous sinus thrombosis (CVT). Methods:The onset age. possible etiology, clinical manifestations, imaging characteristics, changes of cerebrospinal fluid (CSF) and treatment in 20 patients (male 11 and female 9) with CVT were retrospectively analyzed. Results:The clinical cause of our cases was varied considerably. The CVT was most commonly seen in people of 20-40 years old, and the onset was acute in roughly 70% of cases. The first and most common symptoms included headache(85%) and vomit(60%), with or without focal deficits and/or seizures. Neuroimaging findings showed 40% Parenchymal focal infarction and cerebral venous and sinus occlusions. As for CSF examination, pressure increased remarkably(83. 3%), with WBC and protein normal or increased slightly. Based on dehydration and etiologic treatment, anticoagulation, local thrombolysis treatment were utilized in 15 patients,5 severe cases had poor outcomes. Conclusion: Headache, vomit with or without focal deficits and /or seizures as initial presentation should raise the suspicion of CVT, Neuroimaging examination (combination of MRI and MRV) make diagnosis for certain. We might have to examine and control the underlying disease thoroughly. Early administration of anticoagulation is recommended as first-line treatment of CVT. Where this fails, and in severe cases, endovascular approaches, involving direct infusion of thrombolytic agents, have been used.