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[脑静脉和硬脑膜窦血栓形成的诊断与治疗中的当前争议]

[Current controversies in the diagnosis and management of cerebral venous and dural sinus thrombosis].

作者信息

Schwarz S, Daffertshofer M, Schwarz T, Georgiadis D, Baumgartner R W, Hennerici M, Groden C

机构信息

Neurologische Universitätsklinik, Klinikum Mannheim, Mannheim.

出版信息

Nervenarzt. 2003 Aug;74(8):639-53. doi: 10.1007/s00115-003-1526-1.

Abstract

Over the last few years, the results from clinical studies and innovative radiological approaches have significantly altered the management of patients with cerebral venous thrombosis. In contrast to previously held beliefs, cerebral venous thrombosis is considered to be a relatively benign disease with an overall favourable prognosis. Mortality is <10%, and the vast majority of patients recover completely. Although the efficacy of heparin has not been unequivocally proven, it is employed in most centres as the standard therapy. There are not sufficient data supporting long-term anticoagulation. In patients with a proven hypercoagulability syndrome, anticoagulation therapy is generally recommended for a period of 6 months. Whether patients with idiopathic thrombosis should also be treated remains controversial. Non-invasive MR and CT angiography techniques have largely replaced conventional angiography for initial evaluation and follow-up examinations. Both methods have a high sensitivity for cerebral venous thrombosis. Local fibrinolytic therapy or other aggressive recanalizing methods can not be generally recommended.

摘要

在过去几年中,临床研究结果和创新性放射学方法显著改变了脑静脉血栓形成患者的治疗方式。与先前的认知相反,脑静脉血栓形成现在被认为是一种相对良性的疾病,总体预后良好。死亡率低于10%,绝大多数患者可完全康复。尽管肝素的疗效尚未得到明确证实,但在大多数中心它被用作标准治疗方法。目前尚无足够数据支持长期抗凝治疗。对于已证实存在高凝综合征的患者,一般建议进行为期6个月的抗凝治疗。特发性血栓形成的患者是否也应接受治疗仍存在争议。非侵入性磁共振血管造影(MR)和计算机断层血管造影(CT)技术在很大程度上已取代传统血管造影用于初始评估和随访检查。这两种方法对脑静脉血栓形成均具有较高的敏感性。一般不推荐局部纤溶治疗或其他激进的再通方法。

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