Rousseaux P, Bernard M H, Scherpereel B, Guyot J F
Neurochirurgie. 1978;24(4):197-203.
The authors report 22 cases of intracranial venous sinus thrombosis and study what is new about that old pathology. Sagittal superior sinus is still the most touched one, followed by the lateral sinuses. Half of the cases are traumatic: their clinical picture consists either of benign intracranial hypertension, either of intracranial hypertension and neurological signs. Puerperal thrombosis of the sinuses have quite disappeared and have been replaced by thrombosis in women taking oestro-progestional agents, whose clinical picture is absolutely the same. Infectious thrombophlebitis are quite less frequent than intracranial abcesses, whose diagnosis must be made first. About diagnosis, the certitude is still given by bilateral carotid arteriography which demonstrates the thrombosed sinus, whereas cerebral scintigraphy shows whether their is an adjacent infarction of venous origin or not. Treatment is a medical one. It consists rather of methods to reduce cerebral volum, aiming at maximal use of collateral varices. Heparin should be used only if there is no cerebral infarction of venous origin. Total mortality is 27% and among survivals there are few sequels. Prognosis depends on the thrombosed sinus, on the rapidity for clinical signs to appear and especially on the anastomotic venous collateral ability demonstrated by carotid angiography.
作者报告了22例颅内静脉窦血栓形成病例,并研究了这种古老病症的新情况。上矢状窦仍是最常受累的部位,其次是横窦。半数病例为创伤性:其临床表现要么是良性颅内高压,要么是颅内高压伴神经体征。产褥期窦血栓形成已相当少见,取而代之的是服用雌激素 - 孕激素制剂的女性发生的血栓形成,其临床表现完全相同。感染性血栓性静脉炎比颅内脓肿少见得多,颅内脓肿的诊断必须首先进行。关于诊断,双侧颈动脉造影仍能确诊,可显示血栓形成的静脉窦,而脑闪烁扫描则显示是否存在相邻的静脉源性梗死。治疗采用内科方法。主要包括减少脑容量的方法,旨在最大限度地利用侧支静脉曲张。仅在不存在静脉源性脑梗死时才应使用肝素。总死亡率为27%,存活者中后遗症较少。预后取决于血栓形成的静脉窦、临床体征出现的速度,尤其是颈动脉造影显示的吻合静脉侧支能力。