颅内静脉及静脉窦血栓形成的临床特点及误诊分析 .docVIP

　　颅内静脉及静脉窦血栓形成的临床特点及误诊分析 马斌武，黄李雅，杜彦辉，陈桂生，李勇军，侯晓霖 【摘要】 　　目的 探讨脑静脉及静脉窦血栓形成(CVST)的临床特点和误诊原因，提高对CVST诊治的认识。方法 采用回顾性分析的方法对58例CVST患者的病因、临床表现、腰椎穿刺检查、影像学特征、误诊情况及治疗转归，结合文献进行分析。结果 CVST在青壮年中发生率较高且女性居多，常见病因有妊娠和围产期、感染、严重脱水、脑外伤、凝血机制异常、口服避孕药、自身免疫性疾病、遗传性疾病及肿瘤等。临床表现复杂多样，以头痛为首发症状者居多占72.41%，其次为癫痫发作者占12.07%，其他局灶性神经功能缺损者占12.07%。腰椎穿刺检查多数病例压力升高占91.18%，脑脊液检查蛋白和白细胞轻度增高或正常。CT早期诊断CVST难度较大，44.00%表现正常，MRI和MRV相结合使CVST诊断敏感性增高，达到94.12%。误诊14例(24.14%)，其中7例(12.07%)误诊为颅内感染，最多见，其次误诊为脑出血和脑梗死各2例(3.45%)，误诊为颅内肿瘤、良性颅高压和神经性头痛各1例(1.72%)。经抗凝、降颅压等对症治疗，大部分患者好转。结论 CVST临床表现多样，缺乏特异性，早期容易误诊和漏诊，肝素抗凝治疗为CVST的一线治疗，可改善预后。 【关键词】 颅内静脉；静脉窦血栓形成；诊断；误诊 　　Clinical Characters and Misdiagnosis Analysis in Patients bosis 　　Abstract：Objective To explore the clinical manifestation and misdiagnosis reasons in patients bosis, as isdiagnosis rate. Methods The cause, clinical symptoms, examination of lumbar puncture, imaging characteristics, misdiagnosis reason, treatments and prognosis CVST, particularly in young and middleaged en. Pregnancy, infection, cerebral trauma, contraceptive, immunological disorders, hereditary disease, tumor ain causes. Headache(72.41%)ost mon onset symptom, then pairment (12.07%).Increased intracranial pressure ost patients(91.18%),ostly normal or increased slightly. It al in 44.00% CVST patients.The diagnosis rate of CVST ination. 14 patients isdiagnosed and meningitis(12.07%) ost mon misdiagnosis, then orrhage(3.45%) and cerebral thrombosis(3.45%). Most patients improved after the treatment ptomatic treatment. Conclusion The symptoms and clinical course of CVST are very different and nonspecific. It is helpful for increase of the diagnosis rate and decrease of the misdiagnosis rate of CVST to develop radiological technology and improve doctors diagnosed ability. Anticoagulation is the best treatment of CVST. 　　Key bosis；diagnosis； misdiagnosis 　　脑静脉及静脉窦血栓形成(cerebral vein and sinus thrombosis，CVST)是临床上较少见的一种脑血管病，临床、腰椎穿刺检查和影像学表现多样，缺乏特异性，容易误诊和漏诊，有报道称误诊率高达50%以上〔1〕。CVST病因复杂，早期诊断困难，预后不良，病死率高达30%～50%〔2〕。近年