颅内静脉窦血栓形成11例误诊分析  

Misdiagnosis Analysis of 11 Cases of Cranial Venous Sinus Thrombosis

作　　者：何达 肖杰[1] 冉忠营 马骏 尹浩 熊云彪[1] 刘窗溪[1] HE Da;XIAO Jie;RAN Zhong-ying;MA Jun;YIN Hao;XIONG Yun-biao;LIU Chuang-xi(Guizhou Medical University Department of Neurosurgery,Affiliated People's Hospital of Guizhou Medical University,Guiyang 550002,China)

机构地区：[1]贵州医科大学,贵州医科大学附属人民医院神经外科,贵阳550002

出　　处：《临床误诊误治》2018年第7期67-71,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特点及误诊原因。方法回顾性分析贵州医科大学附属人民医院收治的11例CVST误诊病例资料。结果本组急性起病6例,亚急性起病1例,慢性起病4例。首发症状为头痛8例,意识障碍3例;2例伴癫痫大发作,1例伴颈部胀痛。查体示:脑膜刺激征阳性2例,面部皮肤感觉及听力减退、混合性失语、双下肢Babinski征阳性各1例。入院误诊为蛛网膜下腔出血7例,后交通动脉瘤2例,颅内占位性病变性质待查和双侧顶枕叶出血各1例。11例均行数字减影血管造影(DSA)确诊CVST,发现上矢状窦显影不良7例,下矢状窦未显影2例,横窦未显影及乙状窦充盈缺损各1例。本组误诊时间4~7 d。本组明确诊断后均予抗凝治疗,其中3例行机械取栓+接触溶栓治疗,2例好转出院,于外院行康复治疗,1例失访;余8例予药物保守治疗均好转出院。结论CVST病因、临床表现多样,一般影像学检查鉴别诊断困难,确诊需行DSA检查。临床医师应加强对CVST临床表现及诊断手段的认识,以减少误诊。Objective To investigate the clinical features and misdiagnosis of cranial venous sinus thrombosis(CVST).Methods Retrospective analysis was performed on 11 cases of misdiagnosed CVST who were admitted to People's Hospital of Guizhou Medical University.Results In this group,the number of patients who had acute,subacute and chronic onset was 6,1 and 4,respectively.The initial symptoms included headache in 8 patients,and disturbance of consciousness in 3.In addition,there were 2 patients with grand mal epilepsy and 1 with neck pain.Two cases with positive meningeal irritation sign,as well as 1 case with facial skin sensation and hearing loss,1 with mixed aphasia,and 1 with positive Babinski sign in lower extremities were recorded.After admission,the condition was misdiagnosed as subarachnoid hemorrhage in 7 cases,posterior communicating aneurysm in 2,as well as intracranial space-occupying lesions to be investigated in 1 and bilateral occipital occipital cerebral hemorrhage in 1.All the 11 cases underwent digital subtraction angiography(DSA)to confirm the diagnosis of CVST.It was found that the superior sagittal sinus was poorly developed in 7 cases,the inferior sagittal sinus was not visualized in 2 cases,the transverse sinus was not developed in 1 case and sigmoid sinus filling defect was found in 1.Duration of misdiagnosis in this group was 4 to 7 days.This group was treated with anticoagulant therapy.Among them,3 patients received mechanical embolectomy+contact thrombolysis,and 2 patients were discharged after the condition was improved.Rehabilitation treatment was performed after discharge.One patient was lost to follow-up;8 patients were all improved and discharged home.Conclusion Due to diversified etiology and clinical manifestations of CVST,the condition is difficult to differentiate and diagnose with general imaging examination,thus,DSA examination is required for a confirmed diagnosis.Clinicians should strengthen their understanding of clinical manifestations and diagnostic methods of CVST,thereby reducin

关 键 词：窦血栓形成 颅内 误诊 蛛网膜下腔出血 动脉瘤 

分 类 号：R743.33[医药卫生—神经病学与精神病学]