Rosa Sara, Fragata Isabel, Aguiar de Sousa Diana
Neuroradiology Department, Lisbon Central University Hospital - ULS São José.
Faculdade de Medicina, Universidade de Lisboa.
Curr Opin Neurol. 2025 Feb 1;38(1):18-28. doi: 10.1097/WCO.0000000000001329. Epub 2024 Oct 21.
This review intends to systematize the diagnostic and treatment approach to cerebral venous thrombosis (CVT), highlighting key studies that have been recently published.
In light of the recent pandemic, new risk factors for CVT have emerged. Contrast-enhanced MRI and susceptibility-weighted imaging have been shown to offer increased sensitivity for detecting cortical vein thrombosis.Dabigatran seems to be as effective and well tolerated as warfarin for long-term anticoagulation. Partial venous recanalization often occurs in patients treated with anticoagulation only, as early as 8 days after treatment onset. For patients with CVT and impending brain herniation, two-thirds of those who undergo decompressive craniectomy survive, with one-third being functionally independent 6 months after diagnosis.
CVT is an unusual type of cerebrovascular disease that mostly affects women of fertile age. Risk factors should be identified and addressed. Diagnosis relies on confirmation of venous sinus and/or vein thrombosis, usually by CT venography or MRI. Anticoagulation is the cornerstone of treatment. Despite the lack of high-quality evidence, endovascular treatment is often considered in severe cases. Special populations require tailored approaches. About 80% achieve mRS 0-1, but residual symptoms often affect quality of life and the ability to return to work.
本综述旨在系统阐述脑静脉血栓形成（CVT）的诊断和治疗方法，重点介绍近期发表的关键研究。
鉴于近期的大流行，CVT出现了新的危险因素。对比增强磁共振成像（MRI）和磁敏感加权成像已被证明在检测皮质静脉血栓形成方面具有更高的敏感性。达比加群在长期抗凝治疗中似乎与华法林一样有效且耐受性良好。仅接受抗凝治疗的患者通常早在治疗开始后8天就会出现部分静脉再通。对于患有CVT且即将发生脑疝的患者，三分之二接受减压颅骨切除术的患者存活，三分之一在诊断后6个月功能独立。
CVT是一种不常见的脑血管疾病，主要影响育龄女性。应识别并处理危险因素。诊断通常依靠CT静脉造影或MRI确认静脉窦和/或静脉血栓形成。抗凝是治疗的基石。尽管缺乏高质量证据，但在严重病例中常考虑血管内治疗。特殊人群需要量身定制的方法。约80%的患者改良Rankin量表（mRS）评分为0 - 1，但残留症状常影响生活质量和重返工作岗位的能力。
