Sun Jing, He Zhidong, Nan Guangxian
Department of Neurology.
Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin 130000, China.
Medicine (Baltimore). 2018 Dec;97(50):e13476. doi: 10.1097/MD.0000000000013476.
Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) as the first presentation is extremely rare.
A 57-year-old woman presented with dizziness, nausea, and vomiting.
Neuroimaging confirmed a diagnosis of CVST.
The patient was treated with dehydration, scavenging free radicals, and nerve protection therapy.
After 4 weeks of systematic treatment, the patient resumed independent daily activities and was discharged with only slight non-fluent aphasia. She did not exhibit recurrent thrombosis at an 18-month follow-up point.
The usual treatment for sinus thrombosis is anticoagulation or local thrombolysis. Systemic anticoagulation is the first-line treatment for CVST, even in patients with cerebral hemorrhage or SAH. The present patient's hemorrhage clearly contraindicated heparin; therefore, no anticoagulants or thrombolytic agents were administered during the 4-week hospitalization. We discuss issues for consideration in similar cases and provide an example of determining an individualized approach to treatment.
多灶性脑出血是指由各种原因导致的脑内同时出现2个或更多病灶的脑出血，或在48小时内发生的脑出血，其起病急，死亡率高，临床治疗效果差。蛛网膜下腔出血（SAH）是由于脑底部或表面的病变血管破裂，血液直接流入蛛网膜下腔所致。脑静脉窦血栓形成（CVST）每百万人口中约有5人患病，约占所有卒中事件的1%。以SAH和多灶性脑出血（ICH）同时作为首发表现的CVST极为罕见。
一名57岁女性出现头晕、恶心和呕吐症状。
神经影像学检查确诊为CVST。
对患者进行了脱水、清除自由基和神经保护治疗。
经过4周的系统治疗，患者恢复了独立的日常活动，出院时仅有轻微的非流利性失语。在18个月的随访中，她未出现血栓复发。
窦血栓形成的常规治疗是抗凝或局部溶栓。全身抗凝是CVST的一线治疗方法，即使是脑出血或SAH患者也适用。本例患者的出血情况明确禁忌使用肝素；因此，在4周的住院期间未给予抗凝剂或溶栓剂。我们讨论了类似病例中需要考虑的问题，并提供了一个确定个体化治疗方法的实例。
