Clinical analysis of 68 patients with cerebral venous sinus thrombosis
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摘要: 目的 分析68例颅内静脉窦血栓形成(CVST)患者的临床表现、致病因素、治疗和预后,探讨该疾病的特点,提高临床医师的诊治水平。 方法 收集西安交通大学第二附属医院2011年1月—2018年5月诊断CVST患者共68例,采集记录患者临床表现、诱发因素、影像学资料、脑脊液检查、D-二聚体、个人史、家族史及预后。 结果 68例患者中,男性30例,女性38例,男∶女比为1∶1.27,平均发病年龄(35.5±12.4)岁。47例(69.1%)患者找到可能存在的诱因及病因。临床表现方面,首发症状为头痛者58例(85.3%)。影像学方面,14例(20.6%)有脑实质受累,54例(79.4%)患者发生2个及2个以上部位的静脉窦血栓。发生血栓部位最多的依次为:侧窦106个,上矢状窦30个,直窦12个,深静脉2个,4个累及颈内静脉。66例患者行腰穿脑脊液检查,64例(97.0%)颅内压增高,>300 mm H2O(1 mm H2O=9.8 Pa)者38例(57.6%)。68例患者中仅有26例(38.2%)患者D-二聚体增高。本组患者经抗凝、部分联合静脉窦内取栓或支架等治疗后均获得良好的预后,其中6例患者随访中复发,再次治疗后症状缓解。 结论 CVST好发于青年,头痛为主要的首发表现,侧窦(横窦、乙状窦)及上矢状窦最容易发生血栓,且多发生于多个部位,多数患者颅内压增高但不伴有脑实质受累,D-二聚体正常不能排除诊断,多数患者经过积极治疗获得良好的预后。Abstract: Objective To investigate the clinical presentations, pathogenic factors, treatment and prognosis of the 68 patients with cerebral venous sinus thrombosis. Methods The clinical data of 68 patients' diagnosis of cerebral venous sinus thrombosis from January 2011 to May 2018 was collected and analyzed retrospectively. Results Sixty-eight patients (30 male,38 female), were recorded with mean age of (35.5±12.4) year-old. Forty-seven out of 68 cases had causes with pregnancy, puerperium, and Long-term drinking, autoimmune disease et al. Headache attack (58 cases, 85.3%) is the most common first clinical sign. Neuroimaging data showed that there were 54 cases (79.4%) with more than one cerebral venous thrombosis, only 14 cases (20.6%) had brain lesion. Thrombosis occurred most frequently in the order of lateral sinus in 106 cases, superior sagittal sinus thrombosis in 30 cases, straight sinus thrombosis in 12 cases, 2 case of deep vein and 4 cases involving internal jugular vein. Sixty-four patients (97.0%) had increased intracranial pressure, and 38 patients (57.6%) had greater than 300 mm H2O(1 mm H2O=9.8 Pa). Only 26 of 68 patients (38.2%) had elevated D-dimer. The patients in our group received good prognosis after anticoagulation, partial combination of intravenous sinus thrombolysis and stenting, and 6 of them relapsed in follow-up and relieved after retreatment. Conclusions Cerebral venous sinus thrombosis mainly affects young female adults and headache attack is the most common first clinical sign. Neuroimaging shows that most common affected sites are lateral sinus and superior sagittal sinus. Most cases have more than one site of thrombosis, and have intracranial hypertension and no brain lesion. The diagnosis cannot be ruled out if D-dimer is normal. Most patients get good prognosis after active treatment.
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Key words:
- Cerebral venous sinus thrombosis /
- Clinical manifestations /
- Neuroimaging /
- D-dimer
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