罕见牙源性海绵窦血栓性静脉炎伴脑梗死1例并文献复习  

Rare odontogenic cavernous sinus thrombophlebitis combined with cerebral infarction:a case report and literature review

作　　者：赵稳 龚露瑶 苏巧珍 陈志光 郑春叶 ZHAO Wen;GONG Luyao;SU Qiaozhen;CHEN Zhiguang;ZHENG Chunye(The Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou510405,China;Department of Neurology,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广州中医药大学第二附属医院神经内科,广东广州510120

出　　处：《中国医药导报》2025年第5期189-193,共5页China Medical Herald

基　　金：国家中医药管理局全国中医临床优秀人才研修项目(国中医药人教函[2022]1号);广东省中医院名中医药专家学术经验传承工作室项目(中医二院[2014]89号)。

摘　　要：海绵窦血栓性静脉炎(CST)是脑静脉中非常严重且死亡率较高的疾病,起病迅速,变化多样。本文回顾性分析广东省中医院收治的1例罕见牙源性CST伴脑梗死,患者以发热、头痛、左侧肢体乏力和右眼不适为主要症状,眼眶增强磁共振成像提示多发血栓形成,邻近右侧颈内动脉受压、变窄,完善脑脊液病原体宏基因捕获测序技术后发现口腔厌氧菌存在,追问病史知有不当修牙史。牙源性CST相对罕见,临床首诊时极易出现漏诊、误诊等现象,检验、检查难以一步到位,眼眶增强磁共振成像可加强对海绵窦区识别,脑脊液检查帮助明确诊疗。因此,充分了解并提高对该类情况的认知,尽早干预,可防止感染蔓延,避免延治失治。Cavernous sinus thrombophlebitis(CST)is a very serious and high mortality rate disease in cerebral veins,with rapid onset,and diverse changes.This article retrospectively analyzes a rare case of odontogenic CST with cerebral infarction admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine.The patient presented with fever,headache,left limb weakness,and discomfort in right eye as the main symptoms.Enhanced magnetic resonance imaging of eye socket showes multiple thrombosis,adjacent right internal carotid artery is compressed and narrowed.After improving cerebrospinal fluid pathogen metagene capture sequencing technology,anaerobic bacteria is found in oral cavity.After questioning medical history,the patient has a history of improper tooth repair.Odontogenic CST is relatively rare,it is prone to misdiagnosis and missed diagnosis during initial clinical diagnosis.Testing and examination are difficult to complete in one step.Enhanced magnetic resonance imaging of eye socket can enhance the identification of cavernous sinus area,cerebrospinal fluid examination can help clarify diagnosis and treatment.Therefore,fully understanding and improving awareness of such situations,intervening as early as possible,can prevent the spread of infection and avoid delayed treatment.

关 键 词：海绵窦血栓性静脉炎 临床表现 病原体宏基因捕获测序技术 磁共振成像 

分 类 号：R543.6[医药卫生—心血管疾病]