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  • 龚洁芹,沈慧,李继珍.以孤立性头痛为主要表现的颅内静脉窦血栓形成的临床分析(附6例报告)[J].第二军医大学学报,2018,39(3):338-342    [点击复制]
  • GONG Jie-qin,SHEN Hui,LI Ji-zhen.Clinical analysis of cerebral venous sinus thrombosis with isolated headache as main manifestation: a report of 6 cases[J].Acad J Sec Mil Med Univ,2018,39(3):338-342   [点击复制]
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以孤立性头痛为主要表现的颅内静脉窦血栓形成的临床分析(附6例报告)
龚洁芹,沈慧,李继珍*
0
(上海交通大学医学院附属苏州九龙医院神经内科, 苏州 215028
*通信作者)
摘要:
目的 探讨以孤立性头痛为主要表现的颅内静脉窦血栓形成(CVST)患者的临床特点及早期诊断。方法 收集2012年1月至2016年12月在上海交通大学医学院附属苏州九龙医院住院的6例表现为孤立性头痛的CVST患者的临床资料,回顾性分析其临床特点、D-二聚体水平、头颅CT及头颅对比增强磁共振静脉血管成像(CE-MRV)。结果 6例患者均为青年,其中男性5例,女性1例,以急性起病的头痛为单一临床表现,头痛程度均为中重度,呈持续性进行性加重,部位以额颞部和枕部居多,性质多为胀痛或搏动性疼痛。6例患者中4例D-二聚体水平升高,2例正常。5例患者起病时头颅CT平扫可见横窦密度增高,入院后所有患者经头颅MRI+CE-MRV检查证实为CVST,受累静脉窦多为横窦、乙状窦。经抗凝治疗后6例患者头痛均缓解,预后良好。结论 以孤立性头痛为主要表现的CVST患者极为少见,因此,对初发的进行性加重的孤立性头痛患者需在临床上引起重视,即使D-二聚体检测正常,仍需尽早行头颅MRI+CE-MRV检查以明确诊断,避免漏诊、误诊,此类患者早期诊治预后良好。
关键词:  孤立性头痛  颅内静脉血栓形成  静脉窦  磁共振成像  早期诊断
DOI:10.16781/j.0258-879x.2018.03.0338
投稿时间:2017-07-27修订日期:2017-10-27
基金项目:
Clinical analysis of cerebral venous sinus thrombosis with isolated headache as main manifestation: a report of 6 cases
GONG Jie-qin,SHEN Hui,LI Ji-zhen*
(Department of Neurology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu, China
*Corresponding author)
Abstract:
Objective To discuss the clinical characteristics and early diagnosis of patients with cerebral venous sinus thrombosis (CVST) mainly presented as isolated headache. Methods The clinical data of 6 patients with CVST presented as isolated headache were collected, and they were hospitalized in the Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine from Jan. 2012 to Dec. 2016. The clinical features, D-dimer level, non-contrast cranial CT imaging and cranial contrast-enhanced magnetic resonance venography (CE-MRV) imaging of the patients were retrospectively analyzed. Results All the 6 patients were young, including 5 males and 1 female, with acute headache as a single clinical manifestation. The degrees of the headache were moderate to severe, and continuously became worse. The headaches were located in the frontotemporal and occipital areas, and the pains were mainly distending and throbbing. The levels of D-dimer were increased in 4 cases and normal in 2 cases. The non-contrast cranial CT imaging showed that the densities of transverse sinus were increased in 5 patients. CVST was finally confirmed by cranial MRI+CE-MRV in all the patients, and the most involved sinuses were transverse sinus and sigmoid sinus. All the 6 patients were relieved of headache after anticoagulant therapy, and the prognosis was good. Conclusion Patients with CVST mainly presented as isolated headache are extremely rare. Therefore, we need to pay attention to the patients with newly progressive isolated headache in clinc. These patients need early diagnosis by cranial MRI+CE-MRV to avoid misdiagnosis even if the D-dimer levels are normal, and then they can have good outcomes after early diagnosis and treatment.
Key words:  isolated headache  intracranial venous thrombosis  venous sinus  magnetic resonance imaging  early diagnosis