Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
Am J Emerg Med. 2021 Sep;47:24-29. doi: 10.1016/j.ajem.2021.03.040. Epub 2021 Mar 16.
Cerebral venous thrombosis (CVT) is an uncommon neurologic emergency associated with significant morbidity and mortality that can be difficult to differentiate from other conditions. It is important for the emergency clinician to be familiar with this disease as it requires a high index of suspicion, and early diagnosis and management can lead to improved outcomes.
This narrative review provides an evidence-based update concerning the presentation, evaluation, and management of CVT for the emergency clinician.
CVT is due to thrombosis of the cerebral veins resulting in obstruction of venous outflow and increased intracranial pressure. Early recognition is important but difficult as the clinical presentation can mimic more common disease patterns. The most common patient population affected includes women under the age of 50. Risk factors for CVT include pregnancy, medications (oral contraceptives), inherited thrombophilia, prior venous thromboembolic event, malignancy, recent infection, and neurosurgery. CVT can present in a variety of ways, but the most common symptom is headache, followed by focal neurologic deficit, seizure, and altered mental status. Imaging studies such as computed tomography (CT) venography or magnetic resonance (MR) venography should be obtained in patients with concern for CVT, as non-contrast CT will be normal or have non-specific findings in most patients. Treatment includes anticoagulation, treating seizures and elevated ICP aggressively, and neurosurgical or interventional radiology consultation in select cases.
CVT can be a challenging diagnosis. Knowledge of the risk factors, patient presentation, evaluation, and management can assist emergency clinicians.
脑静脉血栓形成（CVT）是一种少见的神经急症，与较高的发病率和死亡率相关，且较难与其他疾病相鉴别。由于该病需要高度怀疑，早期诊断和治疗可改善预后，因此急诊临床医生对此病应较为熟悉。
本文对 CVT 的临床表现、评估和管理进行了循证综述，为急诊临床医生提供最新信息。
CVT 是由于脑静脉血栓形成导致静脉回流受阻和颅内压升高所致。早期识别很重要，但较难，因为其临床表现可能与更常见的疾病模式相似。最常受影响的患者人群包括年龄在 50 岁以下的女性。CVT 的危险因素包括妊娠、药物（口服避孕药）、遗传性血栓形成倾向、既往静脉血栓栓塞事件、恶性肿瘤、近期感染和神经外科手术。CVT 可表现为多种形式，但最常见的症状是头痛，其次是局灶性神经功能缺损、癫痫发作和意识状态改变。对于疑似 CVT 的患者，应进行 CT 静脉造影或磁共振（MR）静脉造影等影像学检查，因为大多数患者的非增强 CT 可能正常或存在非特异性发现。治疗包括抗凝治疗、积极治疗癫痫发作和颅内压升高，以及在某些情况下请神经外科或介入放射学会诊。
CVT 的诊断具有挑战性。了解危险因素、患者的临床表现、评估和管理有助于急诊临床医生进行诊断和治疗。
