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目的探讨颅内静脉窦血栓形成(CVST)的临床和影像学特点。方法回顾分析2008年1月-2013年12月收治的20例CVST患者的临床资料,包括临床表现、影像学资料及治疗转归等进行回顾分析。结果 20例患者中,10例患者有感染诱因,2例D-二聚体阳性,13例脑脊液压力增高,12例脑脊液红细胞升高。患者常见的临床症状包括:头痛16例,眼部症状12例,呕吐10例。3例患者CT平扫见直接阳性征像,6例MRI平扫见直接阳性征像。常见的血栓形成部位为:左横窦及乙状窦5例,上矢状窦5例,多个静脉窦受累5例。18例患者使用抗凝治疗,2例患者联合应用抗凝和介入溶栓治疗,治疗均有效。14例完全康复,6例遗留功能障碍。结论 CVST好发于育龄期女性,感染为常见诱因。该病临床症状复杂,临床表现缺乏特异性,确诊依赖于增强磁共振静脉成像或数字减影血管造影。抗凝和介入溶栓治疗CVST安全有效。CVST的早期诊断率仍有待提高。
Objective To investigate the clinical and imaging features of intracranial venous sinus thrombosis (CVST). Methods The clinical data of 20 patients with CVST admitted in our hospital from January 2008 to December 2013 were analyzed retrospectively, including clinical manifestations, imaging data and treatment outcome. Results Of the 20 patients, 10 had a predisposition to infection, 2 were positive for D-dimer, 13 were elevated in cerebrospinal fluid, and 12 were erythrocytes in cerebrospinal fluid. Common clinical symptoms include 16 cases of headache, 12 cases of ocular symptoms and 10 cases of vomiting. In the 3 patients, CT scan showed direct positive signs, 6 cases of MRI plain scan direct positive signs. Common thrombosis site: left transverse sinus and sigmoid sinus in 5 cases, 5 cases of superior sagittal sinus, multiple sinus involvement in 5 cases. Eighteen patients were treated with anticoagulant therapy and two patients were treated with anticoagulation and interventional thrombolysis, both of which were effective. Complete recovery in 14 cases, 6 cases of legacy dysfunction. Conclusions CVST occurs in women of childbearing age and infection is a common cause. The complex clinical symptoms of the disease, the lack of specificity of clinical manifestations, diagnosis depends on enhanced magnetic resonance venography or digital subtraction angiography. Anticoagulation and interventional thrombolytic therapy of CVST is safe and effective. The early diagnosis of CVST still needs to be improved.