Einhäupl K, Bousser M-G, de Bruijn S F T M, Ferro J M, Martinelli I, Masuhr F, Stam J
Department of Neurology, Charité, Humboldt-University Berlin, Germany.
Eur J Neurol. 2006 Jun;13(6):553-9. doi: 10.1111/j.1468-1331.2006.01398.x.
Cerebral venous and sinus thrombosis (CVST) is a rather rare disease which accounts for <1% of all strokes. Diagnosis is still frequently overlooked or delayed due to the wide spectrum of clinical symptoms and the often subacute or lingering onset. Current therapeutic measures which are used in clinical practice include the use of anticoagulants such as dose-adjusted intravenous heparin or body weight-adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis, and symptomatic therapy including control of seizures and elevated intracranial pressure. We searched MEDLINE (National Library of Medicine), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library to review the strength of evidence to support these interventions and the preparation of recommendations on the therapy of CVST based on the best available evidence. Review articles and book chapters were also included. Recommendations were reached by consensus. Where there was a lack of evidence, but consensus was clear we stated our opinion as good practice points. Patients with CVST without contraindications for anticoagulation should be treated either with body weight-adjusted subcutaneous LMWH or dose-adjusted intravenous heparin (good practice point). Concomitant intracranial haemorrhage related to CVST is not a contraindication for heparin therapy. The optimal duration of oral anticoagulation after the acute phase is unclear. Oral anticoagulation may be given for 3 months if CVST was secondary to a transient risk factor, for 6-12 months in patients with idiopathic CVST and in those with 'mild' hereditary thrombophilia. Indefinite anticoagulation (AC) should be considered in patients with two or more episodes of CVST and in those with one episode of CVST and 'severe' hereditary thrombophilia (good practice point). There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate anticoagulation and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without intracranial haemorrhage (good practice point). There are no controlled data about the risks and benefits of certain therapeutic measures to reduce an elevated intracranial pressure (with brain displacement) in patients with severe CVST. Antioedema treatment (including hyperventilation, osmotic diuretics and craniectomy) should be used as life saving interventions (good practice point).
脑静脉窦血栓形成（CVST）是一种相当罕见的疾病，在所有中风中占比不到1%。由于临床症状范围广泛且发病往往呈亚急性或迁延性，其诊断仍经常被忽视或延误。临床实践中目前使用的治疗措施包括使用抗凝剂，如剂量调整的静脉肝素或体重调整的皮下低分子肝素（LMWH），溶栓治疗，以及对症治疗，包括控制癫痫发作和颅内压升高。我们检索了医学文献数据库（美国国立医学图书馆）、Cochrane系统评价中心注册库（CENTRAL）和Cochrane图书馆，以评估支持这些干预措施的证据强度，并根据现有最佳证据编写关于CVST治疗的建议。综述文章和书籍章节也被纳入。通过共识达成建议。在缺乏证据但共识明确的情况下，我们将我们的意见作为良好实践要点陈述。无抗凝禁忌的CVST患者应接受体重调整的皮下LMWH或剂量调整的静脉肝素治疗（良好实践要点）。与CVST相关的颅内出血不是肝素治疗的禁忌证。急性期后口服抗凝的最佳持续时间尚不清楚。如果CVST继发于短暂性危险因素，口服抗凝可给予3个月；特发性CVST患者以及患有“轻度”遗传性血栓形成倾向的患者，口服抗凝时间为6 - 12个月。有两次或更多次CVST发作的患者以及有一次CVST发作且患有“严重”遗传性血栓形成倾向的患者应考虑长期抗凝（AC）（良好实践要点）。没有足够的证据支持在CVST患者中使用全身或局部溶栓治疗。如果患者在充分抗凝治疗后仍病情恶化且已排除其他恶化原因，在某些选定病例中，可能是那些无颅内出血的病例，溶栓可能是一种治疗选择（良好实践要点）。对于严重CVST患者，关于某些降低颅内压（伴脑移位）治疗措施的风险和益处，尚无对照数据。抗水肿治疗（包括过度通气、渗透性利尿剂和颅骨切除术）应用作挽救生命的干预措施（良好实践要点）。
