127例颅内静脉窦血栓形成的回顾性分析

doi:10.6040/j.issn.1671-7554.0.2019.1453

摘要/Abstract

摘要： 目的探讨颅内静脉窦血栓形成(CVST)的相关诱发因素、临床特点、影像学表现及治疗预后。方法回顾性分析2012年2月至2019年4月就诊于山东大学齐鲁医院神经内科的127例CVST患者的临床资料。结果 (1)诱发因素及临床表现:没有发现明确诱发因素或病因者较少(43例,33.86%), 发现常见诱因或病因者居多(84 例,66.14%);首发症状以头痛(97例,76.38%)最为常见,常见伴发症状有恶心呕吐(78例,61.42%)、视乳头水肿(30例,23.62%)、偏瘫(28例,22.05%)、癫痫发作(26例,20.47%)等;(2)实验室检查:共82例CVST患者行腰椎穿刺检查,脑脊液压力范围70~330 mmH₂O(正常值参考范围80~180 mmH₂O), 200~300 mmH₂O者23例(28.05%),≥300 mmH₂O者49例(59.76%);(3)影像学检查:所有患者均行头颅CTV、MRV和/或DSA检查,累及部位以横窦(103例,81.10%)、乙状窦(87例,68.50%)、上矢状窦(77例,60.63%)、直窦(29例,22.83%)、窦汇(10例,7.87%)为主;(4)治疗与预后:2例并发脑疝自动出院, 125例患者中大部分患者临床症状得到明显改善,预后良好。结论根据发病因素及症状,结合实验室及影像学检查可提高CVST诊断的准确率,尽早启动抗凝治疗可有效改善患者预后。

关键词: 颅内静脉窦血栓形成, 临床表现, 影像学, 治疗及预后

Abstract: Objective To elucidate the inducing factors, clinical manifestations, imaging features, treatment and prognosis of patients with cerebral vein sinus thrombosis(CVST). Methods Clinical data of 127 CVST cases treated in Qilu Hospital of Shandong University during Feb. 2012 and Apr. 2019 were retrospectively analyzed. Results (1) Inducing factors and clinical manifestations: 43 cases(33.86%)had no explicit inducing factors, and 84 cases(66.14%)had common etiologies. Headache was the initial symptom in 97 cases(76.38%). Other common concomitant symptoms included nausea and vomiting in 78 cases(61.42%), optic nipple edema in 30 cases(23.62%), hemiplegia in 28 cases(22.05%), and seizures in 26 cases(20.47%). (2) Laboratory results: 82 patients underwent lumbar puncture, the cerebrospinal fluid pressure ranging from 70 to 330 mmH₂O. The cerebrospinal fluid pressure was 200-300 mmH₂O in 23 cases(28.05%), and ≥300 mmH₂O in 49 cases(59.76%). (3) Imaging results: all patients underwent head CTV, MRV, and/or DSA. The lesions involved transverse sinus in 103 cases(81.10%), sigmoid sinus in 87 cases(68.50%), superior sagittal sinus in 77 cases(60.63%), straight sinus in 29 cases(22.83%), and torcular in 10 cases(7.87%). (4) Treatment and diagnosis: 2 patients complicated with cerebral hernia were discharged automatically, and the other 125 patients had significantly improved clinical symptoms and good prognosis. Conclusion The diagnostic accuracy of CVST can be improved by combining laboratory and imaging examinations, inducing factors and symptoms. Early anticoagulant therapy can effectively improve the prognosis of patients.

Key words: Cerebral vein sinus thrombosis, Clinical manifestation, Imaging, Treatment and prognosis

中图分类号:

R743.9

李海云,乔珊,崔才三. 127例颅内静脉窦血栓形成的回顾性分析[J]. 山东大学学报 (医学版), 2020, 58(5): 77-81.

LI Haiyun, QIAO Shan, CUI Caisan. A retrospective clinical analysis of 127 cases with cerebral vein sinus thrombosis[J]. Journal of Shandong University (Health Sciences), 2020, 58(5): 77-81.

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