【作者】 李杰；

【导师】 李猛；

【作者基本信息】 河北医科大学 ， 神经病学（专业学位）， 2023， 硕士

【摘要】 目的:通过回顾一例脑静脉系统血栓形成(cerebral vein and sinus thrombosis,CVST)患者的诊疗经过,分析该患者CVST的病因,为CVST早期临床诊断及优化治疗提供理论依据,减少并发症的发生。方法:回顾一例CVST患者的临床特征、影像学、血液学指标、病理检查结果,总结病例特点,并随访一年,分析CVST的病因。结合既往文献报道,分析该患者CVST的临床表现、影像学特征及治疗措施,总结和探讨CVST的早期临床诊断和治疗思路。结果:本例患者为青少年女性,既往溃疡性结肠炎病史,间断腹泻、便血,发病前出现发热、腹泻、便血次数增加。此次入院主要表现为头痛、恶心、呕吐等高颅压症状,逐渐出现精神差、睡眠增多、意识不清等高级皮层受损症状,病情逐渐进展,影像结果提示颅内静脉系统血栓形成,故诊断为脑静脉系统血栓形成。经过一般支持治疗、抗凝、降颅压、抗癫痫等综合治疗措施,病情明显好转。随诊一年,患者出院后未发生脑血管事件,预后良好。结论:1.多种因素共同作用导致CVST的发生,针对本病例,考虑缺铁性贫血、脱水、溃疡性结肠炎是该患者CVST发生的病因。2.本病例通过病因分析,结合实验室检查、影像学特征,实现早期诊断,为CVST的临床诊疗提供思路。3.尽管CVST死亡率高,在控制病因治疗的基础上,早期诊断、积极抗凝及处理并发症,可降低致残率和死亡率。更多还原

【Abstract】 Objective: To investigate the etiologies of cerebral vein and sinus thrombosis(CVST),provide theoretical basis for the early clinical diagnosis and optimal treatment of CVST,we systematically reviewed a patient with CVST treated in our hospital.Methods: The clinical characteristics,imaging,laboratory results,and pathology results of this case were retrospectively analyzed,with following up for one year,to investigate the etiologies of CVST.We then summarized the clinical manifestations,imaging findings and diagnostic progress according to the published literature to further explore early clinical diagnosis and optimal treatment of CVST.Results: The patient was a young female with diagnosis of CVST who suffered acute ulcerative colitis.The main manifestations were typical cranial hypertension symptoms: severe headache,nausea and vomiting.She then developed unresponsive and unconsciousness gradually.The neurological examination showed light coma,positive pathological sign and obvious meningeal irritation sign.Magnetic resonance imaging(MRI)brain showed sinus venous thrombosis in the deep venous system extending proximally to the vein of Galen and straight sinus,which supported the diagnosis of CVST.This patient had a history of ulcerative colitis,presenting with intermittent diarrhea and bloody stool.Before the onset of the disease,she suffered from fever,diarrhea,and severe bloody stool.She had good clinical functional outcomes after supportive care,anti-coagulation,treating anemia,reducing cranial pressure and anti-epilepsy.There were no cerebrovascular events occurring after discharge during the follow-up one year.Conclusions:1.CVST has complex clinical manifestations,etiologies and various risk factors.Iron deficiency anemia,dehydration and ulcerative colitis were the causes of this patient.2.Early diagnosis and prompt treatment according to the analysis of etiologies,risk factors,laboratory results and imaging,can provide the basis for the clinical diagnosis and treatment of the CVST.3.The mortality rate of CVST can be very high,but early initiation of anti-coagulation and prevention of complications are the key treatments for CVST to reduce disability and mortality rates.更多还原