壹生资讯-颅内静脉窦血栓的介入干预指征？

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2022-12-02作者：论坛报沐雨经验

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作者：南京大学神经病学研究所刘锐

1. 临床恶化——我们将“临床恶化”定义为尽管进行了最佳的医疗管理，但出现以下任何一种或多种特征的复合终点，且排除了其他原因，如电解质紊乱、尿毒症、肝功能障碍：

（1）与入院时的评分相比，格拉斯哥昏迷评分下降（格拉斯哥昏厥评分<8或运动/言语/睁眼反应下降至少1分）

（2）恶化/新发局灶性神经功能缺损

（3）新发/复发性癫痫

2.颅内高压恶化——我们将“颅内高压恶化”定义为尽管进行了最佳医疗管理，但出现以下任何一种或多种特征的复合终点：

（1）颅内压升高的持续症状（头痛加剧、持续呕吐、心动过缓和高血压）

（2）ICU住院期间的重复成像显示静脉梗死继发的脑水肿/肿块效应恶化

3. 深静脉系统受累（直窦、盖伦静脉和大脑内静脉）

4. 全身抗凝的禁忌证，如严重血小板减少症（血小板<20000 cu mm，活动性全身出血或出血体质）

Clinical deterioration – We defined “clinical deterioration” as a composite end point of occurrence of any 1 or a combination of the following features despite optimal medical management, with other causes like dyselectrolytemia, uremia, hepatic dysfunction being excluded:

Drop in Glasgow Coma Score when compared with the score at admission (Glasgow Coma Score<8 or drop by at least 1 point in either motor/verbal/eye opening responses)
Worsening/new onset focal neurological deficits
New onset/recurrent seizures

Worsening intracranial hypertension – We defined “Worsening intracranial hypertension” as a composite endpoint of occurrence of any 1 or a combination of the following features despite optimal medical management:

Persistent symptoms of raised intracranial pressures (increased headache, protracted vomiting, bradycardia, and hypertension)
Repeat imaging during the course of ICU stay showing worsening cerebral edema/mass effect secondary to venous infarction

Involvement of deep venous system (straight sinus, vein of Galen, and internal cerebral veins)
Contraindication to systemic anticoagulation such as severe thrombocytopenia (platelets <20 000cu mm, active systemic bleeding or bleeding diathesis)