Wall Jacob, Enblad Per
Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.
Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.
J Clin Neurosci. 2018 Dec;58:83-88. doi: 10.1016/j.jocn.2018.10.003. Epub 2018 Oct 16.
The aim was to review the neurointensive care (NIC) of cerebral venous sinus thrombosis patients with haemorrhage during a 15-year period. This is a severe condition with substantial mortality caused by increased intracranial pressure (ICP) and studies are lacking describing the complex picture of the NIC, which offers a large treatment arsenal for intracranial hypertension. Patients treated 2000-2015 were investigated. Data regarding patient characteristics, symptoms, imaging, ICP-treatment, NIC-treatment intensity, and outcome were collected and analysed. Twenty-four patients (13 women) were studied, mean age 46 (range 16-75). Twenty patients were in Glasgow coma scale motor score 6 (obeys), 2 in score 5 (localizes) and 2 in score 2 (extension) on admission. Mean haemorrhage volume was 17 ml (range 1-70). Twenty patients (83%) received unfractionated heparin and 3 (13%) low molecular weight heparin. Haemorrhagic progression occurred in 10 patients (42%). In 9 patients (38%), 4-6 of the treatment options mechanical ventilation, hyperventilation, ICP-monitoring, cerebrospinal fluid-drainage, osmotherapy, barbiturates or surgery were used. In 3 patients mechanical ventilation only was used (hyperventilation in 1). Twelve patients were not managed with any of those treatment options. At follow up, 15/24 patients (62%) had favourable outcome (4 missing). The study shows that many patients needed multiple actions to treat intracranial preassure but more than 60% achieved favourable clinical outcome. Preferably, patients with cerebral venous sinus thrombosis and haemorrhage who are awake should have fast access to NIC because it appears difficult to predict who will deteriorate and promptly need NIC treatment.
目的是回顾15年间脑静脉窦血栓形成伴出血患者的神经重症监护（NIC）情况。这是一种由颅内压（ICP）升高导致死亡率很高的严重病症，目前缺乏对NIC复杂情况的研究描述，而NIC为颅内高压提供了大量治疗手段。对2000年至2015年期间接受治疗的患者进行了调查。收集并分析了有关患者特征、症状、影像学、ICP治疗、NIC治疗强度和预后的数据。研究了24例患者（13名女性），平均年龄46岁（范围16 - 75岁）。入院时，20例患者格拉斯哥昏迷量表运动评分为6分（能听从指令），2例为5分（能定位），2例为2分（伸展反应）。平均出血量为17毫升（范围1 - 70毫升）。20例患者（83%）接受了普通肝素治疗，3例（13%）接受了低分子肝素治疗。10例患者（42%）出现出血进展。9例患者（38%）使用了4 - 6种治疗方法，包括机械通气、过度通气、ICP监测、脑脊液引流、渗透性疗法、巴比妥类药物或手术。3例患者仅使用了机械通气（其中1例还进行了过度通气）。12例患者未采用上述任何一种治疗方法。随访时，15/24例患者（62%）预后良好（4例失访）。该研究表明，许多患者需要采取多种措施来治疗颅内压，但超过60%的患者获得了良好的临床预后。对于清醒状态的脑静脉窦血栓形成伴出血患者，最好能迅速获得神经重症监护，因为似乎很难预测谁会病情恶化并急需神经重症监护治疗。
