未成年人颅内静脉窦血栓形成的临床特点和治疗  

Clinical characteristics and treatment in young patients with cerebral venous sinus thrombosis

作　　者：侯宝军[1,2] 刘毅[1] 李思颉[1] 季泰令[2] 吉训明[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]潍坊医学院附属医院神经外科,261061

出　　处：《中国脑血管病杂志》2012年第12期643-647,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：“十一五”国家科技支撑计划项目(2011BAI08B07)

摘　　要：目的分析未成年人颅内静脉窦血栓(CVST)形成的原因、临床表现和治疗结果。方法回顾性分析21例经影像学确诊为CVST的未成年患者的临床表现、影像学特征、治疗方法及预后。其中11例患者仅接受抗凝治疗,10例患者接受抗凝联合血管内介入治疗。结果①在21例CVST患者中,16例存在明显病因,最多见的是感染病史10例(47.6%),其他病因包括头部外伤病史、早孕流产史、血液系统疾病等。②20例(95.2%)患者以头痛、呕吐等颅内压升高症状为首发症状,病程中可伴有癫痫发作、偏瘫、意识障碍、复视、视盘水肿等。③DSA显示受累静脉窦区均未显影,累及上矢状窦的12例,横窦16例,直窦4例,乙状窦12例,病变≥2个静脉窦的有17例(80.9%)。④经单纯抗凝药物治疗、血管内介入治疗后,痊愈7例,好转13例,死亡1例;3～6个月影像学随访,痊愈18例,好转1例。结论感染因素是本组未成年人CVST的主要病因,未成年人CVST累及≥2个静脉窦的比例较高。经抗凝和血管内治疗后,未成年人CVST的预后良好。Objective To retrospectively analyze the cause , clinical manifestation and treatment outcome in young patients with of cerebral venous sinus thrombosis （CVST）. Methods The clinical manifestations, imaging characteristics, treatment strategies and prognosis in 21 young patients with CVST diagnosed by imaging were studied and analyzed retrospectively. Eleven of them only received anti-coagulant therapy and the other 10 patients received anticoagulant therapy in combination with intravaseu-lar interventional treatment. Results ①In 21 patients with CVST, 16 had obvious causes. The most common one was history of infection （ n = 10, 47.6% ） , the others included head trauma,early abortion, and blood system diseases. ②The first symptoms in 20 patients （95.2%） were headache and vomiting. In the course of the diseases, they could be accompanied by seizures epilepsy, hemiplegia, conscious-ness disorders, diplopia, and papillary edema. ③DSA showed that the affected venous sinus areas did not develop. The superior sagittal sinus, transverse sinus, straight sinus, sigmoid sinus, and lesions ≥ 2 venous sini were affected in 12, 16, 4, 12, and 17 patients （80.9%）respectively. ④After anticoagu-lant or endovascular interventional treatment, 7 patients were cured, 13 improved, and 1 died. Follow-up imaging at 3 to 6 months, 18 patients were cured and 1 improved. Conclusion Infection is an impor-tant risk factor for young patients with CVST. The CVST involving two venous sini is common. The prog-nosis is good after aggressive treatment.

关 键 词：窦血栓形成 颅内 未成年人 疾病特征 治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]