脑静脉系统血栓形成的临床特点

目的探讨脑静脉血栓形成(CVT)的临床特点。方法回顾性分析27例CVT患者的临床资料。结果本组患者中25例有发病诱因(包括妊娠或产褥期18例,高热、腹泻5例等),平均年龄(29.7±9.3)岁;多以急性(7例,25.9%)、亚急性(19例,70.4%)起病。以头痛为首发症状23例(91.7%),伴呕吐21例,12例出现意识障碍,均出现不同部位的神经功能缺损表现。腰穿CSF压力增高21例。血常规检查异常22例(81.5%),凝血功能异常13例(48.2%)。影像学检查CT、MRI、MR静脉血管成像(MRV)]显示,均有不同程度的颅内静脉或静脉窦受累,其中上矢状窦受累最多(77.8%)。24例采用肝素抗凝治疗,2例用溶栓治疗。17例痊愈,4例好转,6例死亡(其中4例并发出血性梗死,2例伴大脑大静脉血栓形成)。结论 CVT继发于循环血液不足及血液高凝状态,以急性或亚急性起病,主要表现为颅内压增高综合征,死亡率较高;MRI和MRA是早期诊断的有效手段,早期肝素抗凝治疗可取得良好疗效。

Clinical features of cerebral venous thrombosis

Objective To explore the clinical features of cerebral venous thrombosis(CVT).Methods The clinical data of 27 CVT patients were retrospectively analyzed.Results There were 25 cases having inducement including pregnancy and puerperum in 18 cases,fever and diarrhea in 5 cases,etc.The average age was(29.7±9.3) years old.Most of them onset was acute(7 cases,25.9%) and subacute(19 cases,70.4%).The onset symptom was headache in 23 cases(91.7%),and combined with vomiting in 21 cases.There was disturbance of consciousness in 12 cases.There was neurologic impairment in the different part in all the cases.There were 21 cases with high CSF pressure.Blood routine in 22 cases(81.5%) and blood clotting in 13 cases(48.2%) were abnormal.The imaging examination (CT,MRI,MR venography(MRV)] showed that intracranial venous or venous sinus were involved in different degree,and the mostly of them was superior longitudinal sinus(77.8%).Twenty-four cases received heparin anticoagulant therapy,and 2 cases received thrombolytic therapy.Seventeen cases were cured,4 cases were improved,and 6 cases were died(including 4 cases complicated with hemorrhagic brain infarction and 2 cases complicated with cerebral great vein thrombosis).Conclusions CVT is often secondary to insufficient circulating blood volume and high blood coagulation state.The onset is acute or subacute mostly.The main manifestations is increased intracranial pressure syndrome.The mortality is higher.MRI and MRV are sensitive and efficient methods for the early diagnosis.Early application of heparin may acquire better curative effect.