Hanley D F, Feldman E, Borel C O, Rosenbaum A E, Goldberg A L
Department of Neurology, Johns Hopkins Medical Institution, Baltimore, Maryland.
Stroke. 1988 Jul;19(7):903-9. doi: 10.1161/01.str.19.7.903.
Two cases of complete sagittal sinus occlusion with multiple brain hemorrhages, elevated intracranial pressure, and disseminated intravascular coagulation are described. These patients were successfully managed using pentobarbital-induced coma to ameliorate intracranial pressure elevation. This therapy was combined with monitoring of intracranial pressure and intermittent drainage of cerebrospinal fluid to further control intracranial pressure elevations. Thrombus and coagulopathy resolved with pentobarbital alone in one patient and after pentobarbital plus heparin therapy in the second patient. It is suggested that cases of severe distal sagittal sinus thrombosis with brain hemorrhage and intracranial hypertension may benefit from combined pentobarbital coma and intraventricular drainage. This allows for stabilization of bleeding tendencies before instituting heparin therapy when necessary. Management of sagittal sinus thrombosis with barbiturates or ventricular drainage is best performed in an intensive care unit environment with continuous monitoring of intracranial pressure and substantial electrophysiologic and neuroradiologic support.
本文描述了两例矢状窦完全闭塞伴多发脑内出血、颅内压升高和弥散性血管内凝血的病例。这些患者通过戊巴比妥诱导昏迷成功控制了颅内压升高。该治疗方法联合颅内压监测和间歇性脑脊液引流，以进一步控制颅内压升高。其中一例患者单用戊巴比妥后血栓和凝血病得以缓解，另一例患者在戊巴比妥加肝素治疗后血栓和凝血病缓解。提示严重的远端矢状窦血栓形成伴脑出血和颅内高压患者可能从戊巴比妥昏迷和脑室内引流联合治疗中获益。这使得在必要时开始肝素治疗前出血倾向得以稳定。使用巴比妥类药物或脑室引流治疗矢状窦血栓形成，最好在重症监护病房进行，持续监测颅内压，并提供充分的电生理和神经放射学支持。
