颅内静脉及静脉窦血栓形成的临床特点及误诊分析

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1、颅内静脉及静脉窦血栓形成的临床特点及误诊分析作者：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12.0

2、7%，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，

3、可改善预后。【关键词】颅内静脉；静脉窦血栓形成；诊断；误诊13　　ClinicalCharactersandMisdiagnosisAnalysisinPatientswithCerebralVeinandSinusThrombosis　　Abstract：ObjectiveToexploretheclinicalmanifestationandmisdiagnosisreasonsinpatientswithCerebralVeinandSinusThrombosis,aswellastoincreasetheearlydiagnosisrateand

4、decreasethemisdiagnosisrate.MethodsThecause,clinicalsymptoms,examinationoflumbarpuncture,imagingcharacteristics,misdiagnosisreason,treatmentsandprognosiswereretrospectivelyreviewedin58CVSTpatients.ResultsAllagegroupwouldsufferfromCVST,particularlyinyoungandmiddleagedwomen.Pregna

5、ncy,infection,cerebraltrauma,contraceptive,immunologicaldisorders,hereditarydisease,tumorweremaincauses.Headache(72.41%)wasthemostcommononsetsymptom,thenwasepilepsy(12.07%)andotherfocalneurologicalimpairment(12.07%).Increasedintracranialpressurewasfoundinmostpatients(91.18%),whi

6、letheproteinconcentrationandwhitebloodcellcountinCSFweremostlynormalorincreasedslightly.ItwasdifficultbyCTscantodiagnoseCVSTandCTscanwerenormalin44.00%CVSTpatients.ThediagnosisrateofCVSTwasto94.12%byMRIandMRVexamination.1314patientswasmisdiagnosedandmeningitis(12.07%)wasthemostco

7、mmonmisdiagnosis,thenwasintracerebralhemorrhage(3.45%)andcerebralthrombosis(3.45%).Mostpatientsimprovedafterthetreatmentwithanticoagulant,decreasingintracranialpressureandothersymptomatictreatment.ConclusionThesymptomsandclinicalcourseofCVSTareverydifferentandnonspecific.Itishelp

8、fulforincreaseofthediagnosisrateanddecre