Rousseaux P, Bernard M H, Scherpereel B, Morel M, Guyot J F
Nouv Presse Med. 1977 Jun 4;6(23):2049, 2051-4.
The authors report 4 cases of thrombosis of the superior longitudinal sinus (SLS) in women taking oestroprogestational agents. This complication is very rare, only 25 cases existing in the literature. The clinical picture consists of premonitory headaches associated with neurological signs suggesting lesions affecting both hemispheres in alternation. In the absence of treatment, sudden deterioration on about the tenth day is to be feared. This picture is similar to that of puerperal thrombosis of the SLS. The diagnosis should be confirmed by carotid arteriography, which demonstrates the presence of collateral varices and the thrombosed sinus giving a "negative" image on the AP view. Cerebral scintigraphy shows one or more areas of uptake in the form of adjacent rounded shapes, corresponding to cerebral infarctions of venous origin. As far as the responsibility of oestro-progenstational agents is concerned, the role is suggested by the analogy with puerperal thromboses and also by the absence of cases in men (with the exception of head injury, infections of the face and haematological malignancies). The prognosis is grave (19 deaths out of 29 cases), but surviving patients are completely cured. This prognosis would seem to be essentially dependent upon the possibilities of venous callateral circulation, which are variable in each individual patient. Anticoagulants and thrombolytic risk, in effective doses, to transform the venous thrombosis into a cerebral haemorrhage. Treatment consists rather of methods to reduce cerebral volume, aimed at maximal use of collateral varices and assisting the patient to overcome to acute phase of the first 2 weeks. Headache would seem to be the principal presenting symptom. In our opinion, no biological test gives a reliable indication as to those women most at risk and contraindictions are in fact of a clinical character.
作者报告了4例服用雌孕激素制剂的女性发生上矢状窦血栓形成的病例。这种并发症非常罕见，文献中仅有25例。临床表现为前驱性头痛并伴有提示双侧半球交替性病变的神经体征。若不进行治疗，大约在第十天可能会突然恶化。这种表现与产后上矢状窦血栓形成相似。诊断应通过颈动脉造影来证实，其可显示侧支静脉曲张的存在以及血栓形成的上矢状窦在前后位片上呈现“阴性”影像。脑闪烁扫描显示一个或多个呈相邻圆形的摄取区域，对应于静脉源性脑梗死。就雌孕激素制剂的责任而言，通过与产后血栓形成的类比以及男性中无此类病例（头部受伤、面部感染和血液系统恶性肿瘤除外）提示了其作用。预后严重（29例中有19例死亡），但存活患者可完全治愈。这种预后似乎主要取决于静脉侧支循环的可能性，而每个患者的情况各不相同。抗凝剂和溶栓药物有导致静脉血栓转变为脑出血的风险，且剂量需有效。治疗主要包括减少脑容量的方法，旨在最大程度利用侧支静脉曲张并帮助患者度过最初两周的急性期。头痛似乎是主要的首发症状。我们认为，没有生物学检测能可靠地提示哪些女性风险最高，实际上禁忌证是基于临床特征的。
