颅内静脉系统血栓形成的临床特征与疗效分析

目的探讨颅内静脉系统血栓形成的临床特征以及治疗原则。方法分析14例颅内静脉系统血栓形成患者的发病年龄、发病形式、临床表现、影像学特征、脑脊液检查结果，并比较阿加曲班和低分子肝素对神经功能改善程度及预后的影响。结果颅内静脉系统血栓形成可见于任何年龄段，中青年女性多见，以妊娠、感染、免疫性疾病等为常见发病原因。急性或亚急性发病，主要表现为头痛（10例）、癫痼发作（5例）和肢体无力（3例），大部分患者脑脊液压力明显升高。影像学表现为脑静脉及静脉窦闭塞的特征性变化，同时伴有脑实质损害。阿加曲班和低分子肝素治疗总有效病例分别为7例和5例（Z=-0．067，P=0．950），两组患者治疗前后神经功能缺损程度美国国立卫生研究院卒中量表（NIHSS）评分]比较，差异有统计学意义（P=0．007）。结论对急性起病且临床主要表现为头痛、呕吐等颅内高压症状，且头部CT检查显示皮质对称性梗死而无常见脑卒中危险因素的患者，应高度怀疑颅内静脉系统血栓形成。虽然脑血管造影检查为金标准，但大部分患者可通过早期MRI联合MRV检查明确诊断。阿加曲班和低分子肝素疗效无差异，早期积极抗凝治疗患者获益更大。

Analysis on the clinical characteristics and treatment of intracranial venous and sinus thrombosis

Objective To explore the clinical characteristics and treatment of intraeranial venous and sinus thrombosis. Methods Fourteen patients （2 males and 12 females） with intraeranial venous and sinus thrombosis were divided into 2 groups, and were treated with argatroban （argatroban group, n = 8） and heparin （heparin group, n = 6）, respectively. Age, pattern of onset, clinical manifestations, imaging characteristics and result of cerebrospinal fluid （CSF） examination were analysed. The improvement of neural function and outcome was compared between 2 groups. Results Intracranial venous and sinus thrombosis could be seen in all age, but especially often occurred in young and middle-agnd women. The common causes were pregnancy, infection, immunological disorders, etc. Acute or subacute clinical characteristics were headache （71.43%, 10/14）, seizure （35.71%, 5/14）, asthenia （21.43%, 3/14）, and CSF pressure was significantly high in most patients. The imaging findings were cerebral venous and sinus occlusion and cerebral parenchymal impairment （infarction, hemorrhage, brain edema）. There were 7 and 5 effective cases in argatroban group and heparin group, respectively （Z =- 0.067, P = 0.950）. In both group, the neural function National Institute of Health Stroke Scale （NIHSS） score] was significantly improved after treatment （P = 0.007）. Conclusion Intracranial venous and sinus thrombosis should be highly suspected in patients who have no common risk factors for stroke, but with acute intracranial hypertensive symptoms such as headache, vomiting, and cortex symmetric infarction on CT scanning. Although cerebral angiography is the golden standard for the diagnosis of intraeranial venous and sinus thrombosis, most patients can be early diagnosed by magnetic resonance imaging （MRI） and magnetic resonance venography （MRV）. The difference in curative effect is not significant between argatroban and heparin. The patient with intracranial venous and sinus thrombosis may get more benefit, when anticoagulant therapy is given earlier and actively.