大脑大静脉及直窦血栓形成18例临床研究.docVIP

大脑大静脉及直窦血栓形成18例临床研究【摘要】 目的 总结大脑大静脉与直窦血栓形成的早期诊断和治疗方法。方法 回顾性总结本院收治的18例大脑大静脉与直窦血栓形成的临床表现、实验室资料、脑脊液检查、影像学特征、治疗经过和预后，并结合文献进行回顾性分析。结果 10例患者为急性起病，5例为亚急性起病，3例慢性起病。主要临床表现为头痛、呕吐、视乳头水肿、癫痫、意识障碍，局灶性神经功能障碍。腰穿显示16例患者颅压明显升高。影像学检查提示，18例患者均有异常征象，其中3例合并上矢窦，2例合并海绵窦血栓形成。上述患者予以应用脱水、抗凝、局部溶栓及对症治疗，死亡2例，痊愈16例。结论 大脑大静脉与直窦血栓形成表现多样，多伴颅内压增高。及时影像学检查有助于早期诊断。治疗以降颅内压和抗凝治疗为首选。 【关键词】 脑静脉窦；血栓形成 Clinical analysiswith galen vein and straight sinus thrombosis WEN Chang-ming,ZHANG Bao-chao.The Center Hospital of Nanyang City，Henan 473009,China 【Abstract】 Objective To summarize the diagnosis and treatment for patients with Galen vein and straight sinus thrombosis.Methods The clinical and image data of eighteen patients diagnosed as Galen vein and straight sinus thrombosis were collected and analyzed restrospectively.Results In all eighteen cases, ten patients were in an acute episode, five caese in subacute episode, and three cases in an chronic episode. The clinical presentations included headache, vomiting, papilla edema, seizure, loss of conciousness, and local neurological deficits. All patients had abnormal signs in CT, MRI, MRV, and DSA. Superior sagittal sinus thrombosis was found in three cases and capillary sius thrombosis in two cases. Increased intracranial pressure was found in sixteen patients by lumbar puncture. Dehydration, anticoagulation, local thrombolysis, and support treatment were used for these patients. Sixteen cases recoverd and 2 cased dead.Conclusion Patients with Galen vein and straight sinus thrombosis had a spectrum of clinial signs andmost cases with increased intracranial pressure. Early image information may help for diagnosis. Dehydration and anticoagulation treatment should be used. 【Key words】 Cerebral venous sinus；Thrombosis 脑静脉窦血栓形成（cerebral venous sinus thrombosis，CVST）是脑血管疾病中的少见类型，估计年发病率为3~4/100万。大脑大静脉（又称Galen静脉）与直窦（staight sinus）是脑静脉系统的重要组成部分，主要引流大脑深部的静脉血流，有报道该部位血栓形成的发生率约占脑静脉系统血栓形成的15%［1-2］。由于其解剖和生理方面的特殊性，该部位血栓形成的发生、发展及诊治方面较之其他部位病变有着不同的特征［3］。现将南阳市中心医