摘要
目的探讨脑静脉及静脉窦血栓形成(CVT)的临床表现、影像学特征以及诊断治疗方法。方法回顾性分析52例CVT病例的临床特点及脑脊液、影像学特征,并结合文献复习其诊断治疗方法。结果此病可见于各个年龄段,以中青年女性稍多,妊娠、感染、免疫性疾病等为常见病因,部分病例病因不明。以头痛为首发症状者多见(82.7%),其次为癫发作(3.85%)或其他局灶性神经功能缺损(13.5%)。腰椎穿刺检查多数病例压力升高(86.7%),脑脊液蛋白和白细胞数正常或轻度升高。典型病例颅脑CT可见到血栓局部条索状高密度影或伴有出血和水肿。MRI平扫可见病变静脉窦异常血栓信号。MRV和DSA可见病变静脉窦显影不良或不显影。经抗凝、降低颅内压等对症治疗,部分病例行溶栓治疗后,多数病例病情好转(86.5%),少数病例病情恶化(5.7%)。结论中青年患者表现为头痛、呕吐、伴或不伴局灶性神经功能缺损,腰椎穿刺检查提示颅内压升高时应高度警惕CVT可能。围产期女性为高危人群。疑似病例应尽早行颅脑CT和MRI检查以明确诊断,DSA是CVT诊断的金标准并可指导溶栓路径。治疗上早期应用抗栓治疗,严重病例经动脉或静脉行局部溶栓治疗可以缓解临床症状,改善预后。此外还应根据病因进行针对性治疗。
Objective To explore the clinical manifestation, radiological feature, diagnosis and treatment of cerebral vein and sinus thrombosis(CVT). Methods Clinical feature, cerebral spinal fluid (CSF) and radiological manifestation of 52 patients with CVT were analyzed retrospectively, and we also discussed the diagnosis and treatment of CVT by reviewing the literature. Results All age groups would suffer from CVT, particularly the young and middle-aged women. Pregnancy, infection, immunological disorders were main causes, while some were unknown. Headache(82.7%)was the most common on-set symptom, then was epilepsy(3.85%) and other focal neurological impairment(13.5%). Increased intracranial pressure was found in most patients(86.7%), while the protein concentration and white blood cell count in CSF were mostly normal or increased slightly. High density like trabs was found by CT scan in typical case and some with edema or hemorrhage. Abnormal signals of thrombus were always found on magnetic resonance imaging(MRI) of brain. Poor visualization or nonvisualization of venous sinus were found on magnetic resonance venography (MRV) and digital subtraction angiography(DSA). Most patients(86.5%) improved and few of them(5.7%) deteriorated after the treatment with anticoagulant, decreasing the intracranial pressure, other symptomatic treatment and some thrombolysis. Conclusion Young patients with headache, vomiting, with or without other focal neurological impairment, and increased intracranial pressure should be highly suspected as CVT, especially women in perinatal stage. CT and MRI exams should be undertaken as early as possible to definite the diagnosis, DSA is the gold standard for diagnosis, and also can instruct thrombolysis. Antithrombotic treatment should be given early and thrombolysis is suggested for severe cases. In addition, etiological treatment should also be carried out simultaneously.
出处
《中国卒中杂志》
2007年第9期734-737,共4页
Chinese Journal of Stroke
关键词
脑静脉
窦血栓形成
诊断
治疗
影像学
Cerebral venous sinus thrombosis
Diagnosis
Treatment
Radiology
