Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK.
Haemostasis Research Unit, University College London, London, UK.
Pract Neurol. 2020 Oct;20(5):356-367. doi: 10.1136/practneurol-2019-002415.
All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from 'conventional' stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research.
所有神经科医生都需要能够识别和治疗脑静脉血栓形成(CVT)。该病诊断困难,部分原因是其相对罕见,临床表现多样且各不相同(与“常规”中风不同,且常模仿其他急性神经系统疾病),并且通常难以获取和解释最佳和及时的脑部成像。尽管 CVT 可导致死亡或永久性残疾,但如果及早诊断和治疗,通常预后良好。因此,参与中风治疗的神经科医生也需要了解 CVT 的治疗方法(有不同程度的证据支持):主要方法是迅速抗凝,但尽管治疗仍恶化的患者可以考虑血管内治疗(血管内溶栓或血栓切除术)或神经外科手术(减压性颅骨切开术)。这篇综述总结了成人 CVT 的危险因素、诊断、治疗和预后的现有知识,并强调了一些未来研究的领域。