脑静脉血栓形成合并颅内出血的特征分析  

Clinical features and radiographic characteristics of cerebral venous thrombosis with intracranial haemorrhage

作　　者：顾双双[1] 李瑾[1] 高凤娟[1] 范国峰[1] 王军[1] GU Shuang-shuang;LI Jin;GAO Feng-juan;FAN Guo-feng;WANG Jun(Department of Emergency Medicine,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院急诊科,南京210008

出　　处：《医学研究生学报》2021年第5期500-504,共5页Journal of Medical Postgraduates

摘　　要：目的早期积极的抗凝治疗可改善静脉血栓形成(CVT)合并颅内出血(ICH)患者的神经系统预后。文中分析CVT合并ICH患者的临床和影像学特征,为提升早期诊断率提供参考。方法回顾性分析2015年1月至2020年6月期间于以ICH为首发表现的CVT患者的临床表现、影像学资料、治疗及预后情况。结果48例患者纳入研究,其中女30例、男18例,年龄14~68岁,平均(33.9±12.3)岁。患者以不同程度的头痛起病,其中22例有癫痫发作,局灶性神经系统缺损症状者16例,意识障碍者6例。44例CT平扫表现为不同部位脑叶出血,4例表现为孤立性脑凸面蛛膜下腔出血。血栓累及横窦38例、上矢状窦34例、乙状窦28例、直窦6例,累及皮质静脉6例、脑深静脉2例。46例予抗凝治疗,2例行去骨瓣减压术,4例行介入手术,随访44例预后良好。结论头痛和癫痫发作是CVT合并ICH患者的常见临床表现。对于影像学显示脑叶出血及凸面蛛网膜下腔出血年轻患者,应关注患者是否存在CVT发生的高危因素,尽早行颅脑磁共振静脉造影或数字减影血管造影检查。明确诊断后应积极地予个体化抗凝治疗,总体预后良好。Objective To summarize and analyse clinical features and radiographic characteristics of patients diagnosed as cerebral venous thrombosis(CVT)with intracranial hemorrhage(ICH)as the first presentation,to improve the early diagnosis rate.Methods Patients diagnosed as CVT complicated with intracranial hemorrhage from January 2015 to June 2020 were selected and their clinical manifestations,imaging features,treatment and prognosis were analyzed retrospectively.Results A total of 48 patients from 14 to 68 years old were included in the study,including 30 females and 18 males,with an average age of 33.9 years.All of them were presented with different degrees of headache.Seizures and focal neurologic deficits were observed in 22 and 16 patients,respectively.6 cases had disturbance of consciousness.CT plain scan of 44 cases showed cerebral lobe hemorrhage,and 4 cases were presented with isolated convexal subarachnoid hemorrhage(cSAH).CVT involved transverse sinus in 38 patients,superiorsagittal sinus in 34,sigmoid sinus in 28 and straight sinus in 6.Cortical veins and deep cerebral vein thrombosis were involved in 6 and 2 patients.46 patients accepted anticoagulant therapy,of which 2 patients underwent decompressive craniectomy,4 patients underwent endovascular intervention.44 patients were with good outcome.Conclusion Headache and seizure are common clinical manifestations of CVT combined with ICH.For young patients with lobar hemorrhage or cSAH,more attention should be paid to the existence of high risk factors of CVT.MRV or DSA examination should be performed as soon as possible in order to make a definite diagnosis.Individual anticoagulant therapy should be given after definite diagnosis and overall prognosis is good.

关 键 词：脑静脉血栓形成 颅内出血 临床特征 

分 类 号：R743.34[医药卫生—神经病学与精神病学]