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目的探讨颅内静脉系统血栓形成(CVT)的临床表现、影像学特征以及诊断治疗方法。方法回顾性分析长春市中心医院16例CVT患者的临床特点及脑脊液、影像学特征与治疗方法。结果CVT发病年龄以青中年居多,多数急性或亚急性起病,早期表现为头痛、呕吐、伴或不伴有局灶性神经功能缺损或癫痫发作。脑脊液压力明显增高,白细胞及蛋白含量正常或升高。影像学表现为静脉窦闭塞、局限性梗死灶及伴有滲血或血肿。治疗方法在降颅压的同时给予抗凝和溶栓治疗。结论静脉系统血栓形成临床缺乏特异性,误诊率高。对临床急性起病的头痛、呕吐,伴或不伴有局灶性神经功能缺损或癫痫发作的青中年人,应高度怀疑CVT,及时行MRI及MRA或DSA联合检查,可明确诊断。该病一经诊断,应尽早开始治疗。抗凝和溶栓治疗为CVT的首选治疗方法。
Objective To investigate the clinical manifestations, imaging features and diagnosis and treatment of intracranial venous thrombosis (CVT). Methods The clinical features, cerebrospinal fluid (CSF), imaging characteristics and treatment of 16 patients with CVT in Changchun Central Hospital were analyzed retrospectively. Results The age of onset of CVT was mostly young and middle-aged, with most acute or subacute onset. The early symptoms of CVT were headache, vomiting, with or without focal neurological deficits or seizures. Cerebrospinal fluid pressure was significantly increased, white blood cells and protein levels were normal or elevated. Radiographic manifestations of sinus occlusion, focal infarction and associated with bleeding or hematoma. Treatment of intracranial pressure at the same time give anticoagulant and thrombolytic therapy. Conclusion The clinical manifestations of venous thrombosis lacks specificity and the rate of misdiagnosis is high. For acute onset of clinical headache, vomiting, with or without focal neurological deficits or seizures in young middle-aged people, should be highly suspected CVT, timely MRI and MRA or DSA joint examination, can confirm the diagnosis. Once the disease is diagnosed, treatment should begin as soon as possible. Anticoagulation and thrombolytic therapy are the preferred treatment for CVT.