背景和目的目前的脑静脉血栓形成(cerebral venous thrombosis, CVT)诊断和治疗指南是欧洲神经病学学会联盟在2010年发布的,本文旨在通过更为通俗易懂和循证的方法对先前的指南进行更新。方法我们遵循推荐意见分级评估、制定和评价(Grading of.Recommendations, Assessment, Development and Evaluation, GRADE)系统,提出相关诊断和治疗问题、进行系统评价并根据现有的科学证据质量制定推荐意见。结果我们建议通过磁共振血管造影或CT血管造影对CVT进行确诊,但不建议对CVT患者常规进行血栓形成倾向或癌症筛查。我们推荐对急性CVT进行胃肠外抗凝治疗,并进行减压手术以避免因脑疝而引起死亡。我们建议在急性期优先选用低分子肝素而非直接口服抗凝药。我们不建议使用类固醇和乙酰唑胺来降低死亡或生活依赖风险。我们建议对早期有癫痫发作以及幕上病变的患者应用抗癫痫药来预防进一步的早期癫痫发作。关于急性期后抗凝治疗的疗程、溶栓和(或)机械血栓切除术、治疗性腰椎穿刺以及利用抗癫痫药预防远期癫痫发作,我们无法提出推荐意见。我们建议既往有CVT史的女性应避免使用含有雌激素的避孕药。患CVT之后妊娠是安全的,但建议应在整个妊娠期和产褥期考虑预防性使用低分子肝素。结论需要多中心观察性和实验性研究来提高支持CVT诊断和治疗推荐意见的证据水平。
COVID-19 is a new challenge in clinical medicine. Although typical presentations include f.ver and pneumonia, we describe a case of.COVID-19 presenting with neurological symptoms of.encephalitis and inf.ctious-related...
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COVID-19 is a new challenge in clinical medicine. Although typical presentations include f.ver and pneumonia, we describe a case of.COVID-19 presenting with neurological symptoms of.encephalitis and inf.ctious-related syndrome of.inappropriate anti-diuretic hormone secretion. Because of.the epidemic health problems, it is crucial to identif. these patients as early as possible to f.llow the isolation procedures. We suggest that unclear neurological clinical presentations of.patients should be considered f.r COVID-19.
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