Department of Neurology and Stroke Center, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany,
Curr Neurol Neurosci Rep. 2014 Jan;14(1):417. doi: 10.1007/s11910-013-0417-5.
Cerebral venous and sinus thrombosis is a still underdiagnosed cause of stroke, with an incidence of about 2.8 events per 100,000 person-years in young women and about 1.3 events per 100,000 person-years in the general population. Puerperium, oral hormonal contraception, and coagulation disorders remain the most frequently identified risk factors. Initial treatment with heparin is the only proven therapy, although the evidence is based on only two randomized placebo-controlled trials which together included 79 patients. In the case of clinical deterioration under anticoagulation, local thrombolysis and mechanical thrombectomy may be considered, but clinical efficacy is supported only by case reports. Patients with imminent lateral herniation due to large hemorrhagic infarctions should be treated with prompt surgical decompression. Following the acute phase, oral anticoagulation is recommended for 3-12 months, and only patients suffering from a severe coagulopathy or with recurrent cerebral venous and sinus thrombosis should be considered for long-term anticoagulation. Only insufficient experience is available for novel anticoagulants such as thrombin inhibitors or factor Xa antagonists.
脑静脉和静脉窦血栓形成是一种仍未被充分诊断的卒中病因，在年轻女性中的发病率约为每 10 万人年 2.8 例，在普通人群中约为每 10 万人年 1.3 例。产褥期、口服激素避孕药和凝血障碍仍然是最常确定的危险因素。肝素初始治疗是唯一被证实的治疗方法，尽管这一证据仅基于两项纳入 79 例患者的随机安慰剂对照试验。在抗凝治疗下临床恶化的情况下，可以考虑局部溶栓和机械血栓切除术，但仅通过病例报告支持临床疗效。由于大的出血性梗死而即将出现外侧疝的患者应进行及时的手术减压。在急性期后，建议进行 3-12 个月的口服抗凝治疗，只有患有严重凝血障碍或反复发生脑静脉和静脉窦血栓形成的患者才应考虑长期抗凝治疗。新型抗凝剂如凝血酶抑制剂或因子 Xa 拮抗剂的经验有限。
