自发性颅内低压并发脑静脉血栓形成的临床特征及治疗效果分析(附四例报道)  

Clinical characteristics and therapeutic efficacy of spontaneous intracranial hypotension complicated with cerebral venous thrombosis:an analysis of four cases

作　　者：祝清勇[1] 宋承汝[2] 滕军放[1] Zhu Qingyong;Song Chengru;Teng Junfang(Department of Neurology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Magnetic Resonance Imaging,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经内科,郑州450052 [2]郑州大学第一附属医院磁共振科,郑州450052

出　　处：《中华神经医学杂志》2021年第9期892-901,共10页Chinese Journal of Neuromedicine

摘　　要：目的探讨自发性颅内低压(SIH)并发脑静脉血栓形成(CVT)的临床特征及治疗效果。方法回顾性报道郑州大学第一附属医院神经内科自2014年3月至2020年4月收治的4例SIH并发CVT患者的临床资料,并通过文献检索(数据库为PubMed及中国知网、万方,检索时限为建库至2020年12月31日)纳入35例同类患者的临床资料进行汇总分析。结果4例患者的首发表现均为直立性头痛,其中例1头痛缓解后再发直立性头痛,余3例加重为持续性头痛并癫痫发作;例1为上矢状窦及皮质静脉血栓形成,例3为上矢状窦血栓形成,例2和例4为孤立性皮质静脉血栓形成。26例文献病例描述了头痛特征改变,其中加重为持续性头痛和仍保持直立性头痛者均为12例(46.15%),头痛消失2例(7.69%);最常见的新发症状为癫痫(17例,48.57%)和肢体无力(10例,28.57%)。31例患者(4例收治病例+27例文献病例)记录了治疗后出血变化情况,其中17例行单纯抗凝治疗患者中出血变化发生比例较14例行其他治疗患者明显增高(7/17 vs.1/14),差异有统计学意义(P<0.05);行硬膜外血贴联合抗凝治疗的5例患者均没有出血变化。结论SIH并发CVT的头痛特征多样,头痛性质的改变并非可靠的症状标志。SIH病程中若出现痫性发作、肢体无力等新发症状,需警惕CVT的发生。对于SIH并发CVT,应重视SIH的病因治疗和关注抗凝治疗后的出血风险。Objective To investigate the clinical characteristics and therapeutic efficacy of spontaneous intracranial hypotension(SIH)complicated with cerebral venous thrombosis(CVT).Methods The clinical data of 4 patients with SIH complicated with CVT admitted to our hospital from March 2014 to April 2020 were retrospectively analyzed.And the clinical data of 35 patients with SIH complicated with CVT were included for summary analysis through literature retrieval(the databases included PubMed,CNKI and Wanfang;retrieval period was from database construction to December 31,2020).Results These 4 patients were with onset of orthostatic headache;one was with recurred orthostatic headache after relief,and the other 3 developed persistent headache and epileptic seizure;case 1 was with superior sagittal sinus and cortical vein thrombosis,case 3 was with superior sagittal sinus thrombosis,and other 2 patients were with isolated cortical vein thrombosis.Twenty-six documented cases demonstrated headache changes:12 patients(46.15%)developed persistent headache,12 patients(46.15%)showed orthostatic headache persistently,and 2 patients(7.69%)had disappeared headache.The most common new symptoms were epilepsy in 17 patients(48.57%)and limb weakness in 10 patients(28.57%).Totally,these 31 patients(4 patients from our hospital+27 patients from literature retrieval)had hemorrhage after treatment;the percentage of patients having hemorrhage changes in the 17 patients accepted anticoagulant therapy was significantly increased as compared with that in 14 patients accepted other treatments(7/17 vs.1/14,P<0.05);there were no bleeding changes in 5 patients accepted epidural blood patch and anticoagulant therapy.Conclusions The clinical features of SIH complicated with CVT are various,and the change of headache is not a reliable marker.In the course of SIH,it is necessary to be alert to the occurrence of CVT if there are new symptoms such as epileptic attack or limb weakness.The etiological treatment of SIH is essential and the hemorrhage risk aft

关 键 词：自发性颅内低压 脑静脉血栓形成 直立性头痛 硬膜外血贴 抗凝治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]