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目的:探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特征、影像特点及治疗。方法:分析34例脑静脉窦血栓形成病因、临床表现、影像特征及治疗。结果:本组病因依次为产褥期(58.8%)、感染(23.5%)、脱水(2.9%)、血液病(2.9%)、外伤(2.9%);头痛、恶心、呕吐为首发症状,查体视乳头水肿89.4%,癫痫发作44.1%,脑膜刺激征阳性35.3%,意识障碍26.5%,轻偏瘫5.9%,眼球突出伴活动障碍5.9%;头MRI、MRV均显示脑静脉窦血栓形成,2例行DSA检查发现双侧横窦血栓形成;本组在应用降颅压、抗感染等药物的同时,应用低分子肝素5000u,12小时一次,疗效显著,治愈25例(73.5%),好转3例,死亡6例。结论:产褥期、感染、脱水是CVST常见原因; CVST患者主要表现为高颅压症状;头MRI和MRV能清楚显示血栓形成部位;抗凝治疗是脑静脉窦血栓形成痊愈的关键。
Objective: To investigate the clinical features, imaging characteristics and treatment of cerebral venous sinus thrombosis (CVST). Methods: Etiology, clinical manifestations, imaging features and treatment of 34 cases of cerebral venous sinus thrombosis were analyzed. Results: The causes of this group were puerperium (58.8%), infection (23.5%), dehydration (2.9%), hematological disease (2.9%) and trauma (2.9%); headache, nausea and vomiting were the first symptoms. Papillary edema 89.4%, epileptic seizures 44.1%, 35.3% positive meningeal irritation, 26.5% disturbance of consciousness, mild hemiplegia 5.9%, highlighting with movement disorders 5.9%; head MRI, MRV showed cerebral venous sinus thrombosis, 2 cases DSA examination found bilateral transverse sinus thrombosis; the application of intracranial pressure, anti-infection and other drugs, the application of low molecular weight heparin 5000u, 12 hours once, the effect was significant, cured in 25 cases (73.5%), improved in 3 cases, 6 died. Conclusions: Puerperium, infection and dehydration are the common causes of CVST. The symptoms of intracranial hypertension are mainly manifested in patients with CVST. The head MRI and MRV can clearly show the thrombosis site. The anticoagulant therapy is the key to heal thrombosis of cerebral venous sinus.