Zhongguo cuzhong zazhi (Jan 2018)
以视力障碍为主要表现静脉窦血栓临床特点分析 Clinical Manifestations Analysis of Venous Sinus Thrombosis with Main Manifestations of Visual Disturbance
Abstract
目的 分析以视力障碍为主要表现的静脉窦血栓形成患者的临床特点，为此类静脉窦血栓形成患 者的诊治提供新思路。 方法 收集2004年1月-2016年7月以“视力障碍”住院的静脉窦血栓形成患者34例。对患者的人口学 资料、临床表现、实验室检查及影像学特征进行归纳总结。 结果 本组34例患者中男性18例（52.9%），女性16例（47.1%），平均发病年龄（36.1±12.9）岁，亚 急性起病11例（32.4%），慢性发病23例（67.6%）。34例患者中感染引发疾病的有5例（14.7%）；非 感染因素29例（85.3%）。临床症状中视力下降29例（85.3%）（双眼视力下降23例，单眼视力下降6 例），阵发性黑蒙8例（23.5%），复视1例（2.9%）。伴随头痛9例，眼痛1例，颈痛1例，耳鸣2例，头晕1 例，症状性癫痫2例。主要体征为视盘水肿29例（双眼视盘水肿27例，单眼视盘水肿2例）；静态视 野检查中仅6例（17.6%）正常，18例（52.9%）表现为弥漫性视野缺损或全视野缺损，其中双眼受累11 例（32.4%），单眼受累7例（20.6%）。33例患者行腰穿检查，颅内压<180 mm H2O者1例（3.0%），颅内 压180～330 mm H2O者14例（42.4%），颅内压﹥330 mm H2O者18例（54.5%）。34例患者均行影像学检查， 有7例（20.6%）仅累及1个部位静脉窦，26例（76.5%）累及2个或2个以上部位静脉窦，有12例（35.3%） 出现脑实质或脑膜病变，而多达22例（64.7%）无新发脑实质损害。 结论 以视力障碍为主要表现的脑静脉窦血栓好发于中青年，多隐匿起病，主要临床表现为高颅压， 近一半患者静态视野损害重，血栓好发于横窦和乙状窦，且好发于多个部位静脉窦，多数无明显的 脑实质损害。 Abstract: Objective To investigate the clinical characteristics of patients with cerebral venous sinus thrombosis and visual disorders as main manifestations, so as to provide a new thought for diagnosis and treatment. Methods The clinical data of 34 patients with venous sinus thrombosis and visual impairment as the manifestation who were admitted into the department of Neurology in Tongren hospital during Jan. 2004 to July 2016 were collected. The demographic data, clinical manifestations, laboratory tests and imaging characteristics were analyzed and summarized. Results Among 34 patients, 18 (52.9%) were male and 16 (47.1%) were female, with mean age of (36.1±12.9) year-old.There were 11 cases (32.4%) with sub-acute onset and 23 cases (67.6%) with chronic onset.There were 5 cases (14.7%) caused by infection, and other 29 cases (85.3%) caused by no-infection. Visual disturbance (n =29, 85.3%) and headache (n =9, 26.5%) were the first common clinical sign. Impaired vision included binocular vision loss (n =23), monocular vision loss (n =6),paroxysmal amaurosis (n =8, 23.5%), and 1 (2.9%) diplopia. Other accompanied symptoms were 9 cases of headache, 1 case of eye pain, 1 case of neck pain, 1 case of tinnitus, 1 case of dizziness and 2 cases of symptomatic epilepsy. The main sign of 29 cases was optic disc edema, including both eyes in 27 cases and one eye in 2 cases. Severe visual field defect means diffuse visual field defect or whole visual field defect. There were 18 (52.9%) cases which had severe visual field defect, including both eyes in 11 cases (32.4%) and one eye in 7 cases (20.6%). Lumbar puncture were performed in 33 cases. There were 1 case (3.0%) of intracranial pressure less than 180 mm H2O, 14 cases (42.4%) of 180-300 mm H2O, and 18 cases (54.5%) more than 330 mm H2O. All 34 patients underwent neuroimaging. The data showed that there were 7 cases (20.6%) with 1 cerebral venous thrombosis and 26 cases (76.5%) with more than 1 cerebral venous thrombosis.There were 12 cases (35.3%) who had brain lesion or dural lesion, and 22 cases (64.7%) who had no brain lesion. Conclusion Venous sinus thrombosis with visual impairment as the main manifestation mainly occurs young adults and most cases don’t have explicit causes.Intracranial hypertension is the most common clinical manifestation.In addition, about half of cases had severe static vision field loss. Neuroimaging showed that the most common affected sites were sigmoid sinus and bilateral transverse sinus. Most cases had more than one site of thrombosis and no brain lesion.
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