Smadja D, Raynaud M, Mehdaoui H, Poey C, Drault J N, Ridarch A, Tixier F, Vernant J C, Mas J L
Service de Neurologie, CHU Fort-de-France, Martinique.
Rev Neurol (Paris). 1997 May;153(4):271-4.
A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic treatment was then performed using transvenous catheterization and instillation of Urokinase (2.6 MU over 4 days). A near complete repermeabilization of the sinuses was obtained and the patient improved dramatically in a few days. The only adverse effect of Urokinase was hematuria. Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relatively safe procedure. This treatment should be considered in a patient with extensive dural sinus thrombosis which fails to respond to heparin treatment.
一名37岁男性头痛10天，随后因广泛的脑静脉血栓形成出现一次强直阵挛性发作并昏迷。尽管使用全剂量肝素治疗7天，但临床症状仍恶化，同时CT扫描显示水肿加重。随后通过经静脉导管插入术并注入尿激酶（4天内注入260万单位）进行直接溶栓治疗。窦道几乎完全再通，患者在数天内显著好转。尿激酶唯一的不良反应是血尿。根据我们的经验以及对包括之前26例病例的文献回顾，直接溶栓治疗似乎是一种相对安全的方法。对于广泛硬脑膜窦血栓形成且对肝素治疗无反应的患者，应考虑这种治疗方法。
