颅内静脉窦血栓形成的临床分析  

Clinical Analysis of Cranial Venous Sinus Thrombosis

作　　者：唐宇凤[1] 张杉杉[1] 张芸[1] 都泓材 李肇坤[1] 张献文[1] 段劲峰[1] 

机构地区：[1]绵阳市中心医院神经内科,四川绵阳621000

出　　处：《华西医学》2015年第10期1849-1852,共4页West China Medical Journal

基　　金：四川省卫生厅科研课题(130446);绵阳市科技局课题(14S-ZC-03)~~

摘　　要：目的探讨颅内静脉窦血栓形成(CVST)的临床和影像学特点。方法回顾分析2008年1月-2013年12月收治的20例CVST患者的临床资料,包括临床表现、影像学资料及治疗转归等进行回顾分析。结果 20例患者中,10例患者有感染诱因,2例D-二聚体阳性,13例脑脊液压力增高,12例脑脊液红细胞升高。患者常见的临床症状包括:头痛16例,眼部症状12例,呕吐10例。3例患者CT平扫见直接阳性征像,6例MRI平扫见直接阳性征像。常见的血栓形成部位为:左横窦及乙状窦5例,上矢状窦5例,多个静脉窦受累5例。18例患者使用抗凝治疗,2例患者联合应用抗凝和介入溶栓治疗,治疗均有效。14例完全康复,6例遗留功能障碍。结论 CVST好发于育龄期女性,感染为常见诱因。该病临床症状复杂,临床表现缺乏特异性,确诊依赖于增强磁共振静脉成像或数字减影血管造影。抗凝和介入溶栓治疗CVST安全有效。CVST的早期诊断率仍有待提高。Objective To explore the clinical and imaging features of cranial venous sinus thrombosis（CVST）. Methods The clinical data of 20 patients with CVST treated between January 2008 and December 2012 were retrospectively analyzed, including the clinical manifestations, neuroimaging characters and treatment outcomes. Results Among the 20 patients, there were 10 infected cases; D-dimer was detected positively in only 2 cases; cerebrospinal fluid pressure increased in 13 patients; and red blood cell population of cerebrospinal fluid increased in 12 patients. The common clinical symptoms included headache in 16 cases, eye symptoms in 12 cases, and vomiting in 10 cases. CT showed the direct signs of CVST in 3 cases, and MRI showed the direct signs of CVST in 6 cases. The common disease regions were in left transverse sinus and sigmoid sinus in 5 cases, superior sagittal sinus in 5 cases, and multiple venous sinus in 5 cases. Eighteen patients only received anticoagulation, and 2 received anticoagulation and local thrombolytic treatment. Fourteen cases recovered fully, 6 had dysfunctions. Conclusions The clinical manifestations of CVST are nonspecific. This disorder predominantly affects childbearing women. Infection is a common cause of CVST. The occlusive venous sinus can be confirmed by enhanced magnetic resonance venography or digital subtraction angiography. Anticoagulation and local thrombolytic therapy are both proved to be safe and effective in the treatment of CVST. The early diagnosis rate of CVST remains to be improved.

关 键 词：颅内静脉窦血栓形成 症状 抗凝 溶栓 影像学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]