Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.
Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.
World Neurosurg. 2020 Jul;139:215-218. doi: 10.1016/j.wneu.2020.03.220. Epub 2020 Apr 15.
The American Stroke Association and the European Stroke Organization have established guidelines on cerebral venous thrombosis (CVT); however, questions remain when an individual case does not fall within the inclusion criteria on which these guidelines are based. This is relevant when considering the use of anticoagulation in cases of CVT regarding whether or not associated hemorrhage is present and whether the hemorrhage is currently expanding.
A 16-year-old right-handed female G2P2 (gravidity 2 [2 pregnancies] and parity 2 [2 live births after at least 24 weeks) presented 8 days postpartum with complaints of slurred speech, right facial droop, and right upper extremity numbness that had progressed over the course of 4 hours before presentation. On imaging the patient had a CVT with associated hemorrhage progressing in size at serial 6-hour stability computed tomography scans for 24 hours post arrival. At 24 hours the patient went into disseminated intravascular coagulation and demonstrated signs of herniation. The patient underwent an emergency hemicraniectomy along with a right frontal external ventricular drain for intracranial pressure monitoring. Most recently, the patient had a Glasgow Coma Scale score of 15 and had a modified Rankin Scale score of 4 and was ultimately discovered to have antiphospholipid syndrome.
This case of CVT demonstrates the need for critically reading guidelines, as in this case the time to anticoagulation treatment was shorter than in cases included in guideline construction and repeated computed tomography examination demonstrated expansion suggesting it is unsuitable for immediate anticoagulation. Certain cases may fall outside of the study parameters on which guidelines are constructed, and clinicians should be aware of these exceptions.
美国卒中协会和欧洲卒中组织已经制定了关于脑静脉血栓形成（CVT）的指南；然而，当个别病例不符合这些指南所依据的纳入标准时，仍存在一些问题。当考虑在 CVT 中使用抗凝剂时，这一点尤其相关，无论是否存在相关出血以及出血是否正在扩大。
一名 16 岁的右利手女性，G2P2（妊娠 2 次[2 次妊娠]，活产 2 次[至少 24 周后分娩]）在产后 8 天出现言语不清、右侧面部下垂和右侧上肢麻木的症状，这些症状在就诊前 4 小时内逐渐加重。在影像学检查中，患者出现 CVT 伴相关出血，在到达后 24 小时内连续 6 小时稳定 CT 扫描中出血逐渐扩大。在 24 小时时，患者出现弥漫性血管内凝血并出现脑疝迹象。患者接受了紧急开颅手术和右侧额部外引流术，以进行颅内压监测。最近，患者格拉斯哥昏迷量表评分为 15 分，改良 Rankin 量表评分为 4 分，最终被诊断为抗磷脂综合征。
本例 CVT 表明需要仔细阅读指南，因为在本例中，抗凝治疗的时间短于指南制定中包含的病例，并且重复 CT 检查显示出血扩大，表明不适合立即抗凝。某些病例可能不符合指南构建所依据的研究参数，临床医生应注意这些例外情况。
