颅内静脉及静脉窦血栓形成的临床特点及误诊分析  

Clinical Characters and Misdiagnosis Analysis in Patients with Cerebral Vein and Sinus Thrombosis

作　　者：马斌武[1] 黄李雅[2] 杜彦辉[1] 陈桂生[1] 李勇军[1] 侯晓霖[1] 

机构地区：[1]宁夏医学院附属医院神经内科,银川750004 [2]宁夏医学院附属医院消化内科,银川750004

出　　处：《宁夏医学院学报》2008年第6期717-719,共3页Journal of Ningxia Medical College

摘　　要：目的探讨脑静脉及静脉窦血栓形成(CVST)的临床特点和误诊原因,提高对CVST诊治的认识。方法采用回顾性分析的方法对58例CVST患者的病因、临床表现、腰椎穿刺检查、影像学特征、误诊情况及治疗转归,结合文献进行分析。结果CVST在青壮年中发生率较高且女性居多,常见病因有妊娠和围产期、感染、严重脱水、脑外伤、凝血机制异常、口服避孕药、自身免疫性疾病、遗传性疾病及肿瘤等。临床表现复杂多样,以头痛为首发症状者居多占72.41%,其次为癫痫发作者占12.07%,其他局灶性神经功能缺损者占12.07%。腰椎穿刺检查多数病例压力升高占91.18%,脑脊液检查蛋白和白细胞轻度增高或正常。CT早期诊断CVST难度较大,44.00%表现正常,MRI和MRV相结合使CVST诊断敏感性增高,达到94.12%。误诊14例(24.14%),其中7例(12.07%)误诊为颅内感染,最多见,其次误诊为脑出血和脑梗死各2例(3.45%),误诊为颅内肿瘤、良性颅高压和神经性头痛各1例(1.72%)。经抗凝、降颅压等对症治疗,大部分患者好转。结论CVST临床表现多样,缺乏特异性,早期容易误诊和漏诊,肝素抗凝治疗为CVST的一线治疗,可改善预后。Objeetive To explore the clinical manifestation and misdiagnosis reasons in patients with Cerebral Vein and Sinus Thrombosis, as well as to increase the early diagnosis rate and decrease the misdiagnosis rote. Methods The cause, clinical symptoms, examination of lumbar puncture, imaging characteristics, misdiagnosis reason, treatments and prognosis were retrospectively reviewed in 58 CVST patients. Results All age group would suffer from CVST, particularly in young and middle-aged women. Pregnancy, infection, cerebral trauma, contraceptive,immunological disorders, hereditary disease, tumor were main causes. Headache（72.41% ）was the most common on-set symptom, then was epilepsy（ 12.07% ） and other focal neurological impairment （ 12.07% ）. Increased intracranial pressure was found in most patients（91.18% ）, while the protein concentration and white blood cell count in CSF were mostly normal or increased slightly. It was ditiqcult by CT scan to diagnose CVST and CT scan were normal in 44.00% CVST patients.The diagnosis rate of CVST was to 94.12% by MRI and MRV examination. 14 patients was misdiagnosed and meningitis（12.07%） was the most common misdiagnosis, then was intracerebral hemorrhage（3.45% ） and cerebral thrombosis（3.45 % ）. Most patients improved after the treatment with anticoagulant, decreasing intracranial pressure and other symptomatic treatment. Conclusion The symptoms and clinical course of CVST are very different and nonspecifie. It is helpful for increase of the diagnosis rate and decrease of the misdiagnosis rate of CVST to develop radiological technology and improve doctors＇ diagnosed ability. Antieoagulation is the best treatment of CVST.

关 键 词：颅内静脉 静脉窦血栓形成 诊断 误诊 

分 类 号：R743.3[医药卫生—神经病学与精神病学]