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1.
脑静脉及静脉窦血栓形成的临床特点与影像学分析   总被引:1,自引:0,他引:1  
目的 探讨脑静脉及静脉窦血栓形成(CVT)的临床表现、影像学特征以及诊断治疗方法。方法 回顾性分析52例CVT病例的临床特点及脑脊液、影像学特征,并结合文献复习其诊断治疗方法。结果 此病可见于各个年龄段,以中青年女性稍多,妊娠、感染、免疫性疾病等为常见病因,部分病例病因不明。以头痛为首发症状者多见(82.7%),其次为癫发作(3.85%)或其他局灶性神经功能缺损(13.5%)。腰椎穿刺检查多数病例压力升高(86.7%),脑脊液蛋白和白细胞数正常或轻度升高。典型病例颅脑CT可见到血栓局部条索状高密度影或伴有出血和水肿。MRI平扫可见病变静脉窦异常血栓信号。MRV和DSA可见病变静脉窦显影不良或不显影。经抗凝、降低颅内压等对症治疗,部分病例行溶栓治疗后,多数病例病情好转(86.5%),少数病例病情恶化(5.7%)。结论 中青年患者表现为头痛、呕吐、伴或不伴局灶性神经功能缺损,腰椎穿刺检查提示颅内压升高时应高度警惕CVT可能。围产期女性为高危人群。疑似病例应尽早行颅脑CT和MRI检查以明确诊断,DSA是CVT诊断的金标准并可指导溶栓路径。治疗上早期应用抗栓治疗,严重病例经动脉或静脉行局部溶栓治疗可以缓解临床症状,改善预后。此外还应根据病因进行针对性治疗。  相似文献   

2.
颅内静脉窦血栓形成的早期诊断与治疗   总被引:2,自引:0,他引:2  
目的 探讨颅内静脉窦血栓形成(CVT)的早期临床特点及治疗方法.方法 回顾性分析11例CVT病人的发病年龄、发病形式、首发症状、临床表现、影像学特征及脑积液检查结果.结果 (1)年龄多在20~40岁;(2)急性起病;(3)临床表现无特异性,早期表现有头痛(91%)、呕吐(60%)伴或不伴局灶性神经功能缺埙;(4)影像学表现为静脉窦闭塞及局限性梗死灶等;(5)脑积液压力明显升高,白细胞及蛋白含量正常或稍高;(6)应用脱水、抗凝、局部溶栓及病因治疗等.结论 对临床急性起病的头痛、呕吐伴或不伴局灶性神经功能缺损的年轻病人,应高度怀疑CVT,及时行头颅CT、MRI、MRA及数字减影脑血管造影(DSA)检查,明确诊断.一旦明确诊断应尽快治疗,肝素或低分子肝素为治疗首选方法,可小剂量静脉溶栓或经股静脉介入溶栓.  相似文献   

3.
脑静脉窦血栓形成的早期诊断与治疗   总被引:16,自引:1,他引:15  
目的探讨脑静脉窦血栓形成的早期临床特点及治疗方法。方法回顾性分析16例脑静脉窦血栓形成患的发病年龄、发病形式、首发症状、临床表现、影像学特征及脑脊液等检查结果与治疗方法。结果发病年龄以20~60岁多见,多数患为急性发病,早期临床表现为头痛、呕吐,伴或不伴局灶性神经功能缺损或癫痫发作。影像学检查表现为静脉窦闭塞及局限性梗死灶。脑脊液压力明显增高,白细胞数及蛋白质含量正常或增高,但感染性或癌性脑静脉窦血栓形成除外。应用脱水、抗凝、局部溶栓及病因治疗等方法后,16例患中6例基本痊愈,7例症状好转,1例无变化,2例死亡。结论脑静脉窦血栓形成的临床表现复杂多样,无特异性,对临床急性发病的头痛、呕吐、伴或不伴局灶性神经功能缺损及乏癫痫发作的年轻患,应高度怀疑脑静脉窦血栓形成,及时行磁共振成像(MRI)及磁共振血管造影(MRA)联合检查,以明确诊断。确诊后应尽早开始治疗。  相似文献   

4.
目的 探讨脑静脉及脑静脉窦血栓形成(CVT)的诊断及治疗策略.方法 对23例确诊为脑静脉及脑静脉窦血栓形成的患者的病因、临床表现、影像学特征、治疗方法及预后进行回顾性分析.结果 23例患者中,经降颅压、抗炎及抗凝等对症及支持治疗后,19例好转出院,3例死亡,1例自动出院.结论 脑静脉及脑静脉窦血栓病因复杂,临床表现无特异性,确诊须行MRL/MRV或DSA检查.早期给予抗凝及溶栓治疗可获得较好效果.  相似文献   

5.
脑静脉窦血栓形成的早期诊断与治疗   总被引:86,自引:2,他引:84  
目的 探讨脑静脉窦血栓形成(CVT)的早期临床特点及治疗方法。方法 回顾性分析69例(男34例,女26例)CVT病人的发病年龄、发病形式、首发症状、临床表现、影像学特征及脑脊液等检查结果。结果 (1)年龄多在20-40岁;(2)多数为急性起病;(3)早期表现为头痛(87%)、呕吐(61%),伴或不伴局灶性神经功能缺损或癫痫发作;(4)影像学表现为静脉窦闭塞及局限性梗死灶(51%),其中39%伴有渗血或血肿;(5)脑脊液压力明显升高,白细胞及蛋白含量正常或升高(感染性或癌性CVT除外);(6)应用脱水、抗凝、局部溶栓及病因治疗等,60例病人中,26例症状好转,24例基本痊愈,死亡6例。结论 对临床急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的年轻病人,应高度怀疑CVT,及时行MRI及磁共振血管造影(MRA)联合检查,明确诊断。一旦明确诊断,应尽早开始治疗。剂量调节性静脉肝素或低分子肝素(其后口服抗凝药物3-6个月)为治疗CVT的首选治疗方法。  相似文献   

6.
目的探讨脑静脉窦血栓形成(CVT)的早期临床特点及治疗方法.方法回顾性分析16例CVT病人的发病年龄、发病形式、首发症状、临床表现、影像学特征及脑脊液等检查结果及治疗.结果发病年龄多在26~60岁;多数为急性起病;早期表现为头痛、呕吐,伴或不伴局灶性神经功能缺损或癫癇发作;影像学表现为静脉窦闭塞及局限性梗死灶;脑脊液压力明显升高,白细胞及蛋白含量正常或升高(感染性或癌性CVT除外);应用脱水、抗凝、局部溶栓及病因治疗等,16例病人中,7例症状好转,6例基本痊愈,1例无变化,2例死亡.结论CVT临床表现复杂多样,无特异性,对临床急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫癇发作的年轻病人,应高度怀疑CVT,及时行MRI及磁共振血管造影(MRA)联合检查,明确诊断.一旦明确诊断,应尽早开始治疗.  相似文献   

7.
目的:总结脑静脉和静脉窦血栓形成(CVT)的临床及辅助检查特征,探讨CVT的早期诊断方法。方法:回顾性分析48例CVT患者的临床表现、影像学特征、脑电图及脑脊液等检查结果。结果:CVT最常见的首发症状为头痛(83%),其次为局灶性神经功能缺损、癫痫、意识障碍和精神症状;影像学表现为脑静脉系统血流中断、局灶性梗死或水肿,其中28%伴有出血;脑部MR/显示的异常病灶与局灶性脑电图异常相符率为97.3%,但是有7例脑部MRI正常患者早期出现了脑电图局灶性或弥漫性改变;脑脊液压力明显升高,压颈试验阳性率为75%。结论:对于持续而严重的头痛、伴或不伴局灶性神经功能缺损、癫痫、意识障碍及精神症状等患者,应高度怀疑CVT,脑部MRI+MRV是目前诊断CVT的最佳手段,对不典型CVT的早期诊断,脑电图、颅内压及压颈试验等有一定的临床价值,但应尽早行DSA检查。  相似文献   

8.
目的 探讨和研究脑静脉窦血栓形成(CVT)的早期诊断和治疗方法。方法 回顾性分析,15例CVT病人的临床资料,就其临床表现、影像学特征、脑脊液检查、治疗与预后,结合文献进行分析。结果 (1)年龄在19~52岁;(2)急性或亚急性起病;(3)早期表现为头痛(87%)、呕吐(60%)、视力障碍(33%),伴或不伴局灶性神经功能缺损;(4)影像学表现为静脉窦闭塞及局限性脑梗死(67%),其中20%伴有出血;(5)颅压明显升高,脑脊液白细胞及蛋白定量正常或升高;(6)病因治疗及脱水、抗凝、溶栓等治疗效果好。结论 对临床以颅内压增高为主要表现、伴或不伴有脑局灶性症状、体征的年轻病人,应考虑到CVT,及时行MRI或MRA检查,早期明确诊断,尽早治疗,抗凝治疗为其首选方法。  相似文献   

9.
脑静脉窦血栓形成15例分析   总被引:2,自引:0,他引:2  
目的探讨和研究脑静脉窦血栓形成(CVT)的早期诊断和治疗方法。方法回顾性分析,15例CVT病人的临床资料,就其临床表现、影像学特征、脑脊液检查、治疗与预后,结合文献进行分析。结果(1)年龄在19~52岁;(2)急性或亚急性起病;(3)早期表现为头痛(87%)、呕吐(60%)、视力障碍(33%),伴或不伴局灶性神经功能缺损;(4)影像学表现为静脉窦闭塞及局限性脑梗死(67%),其中20%伴有出血;(5)颅压明显升高,脑脊液白细胞及蛋白定量正常或升高;(6)病因治疗及脱水、抗凝、溶栓等治疗效果好。结论时临床以颅内压增高为主要表现、伴或不伴有脑局灶性症状、体征的年轻病人.应考虑到CVT,及时行MRI或MRA检查,早期明确诊断,尽早治疗.抗凝治疗为其首选方法。  相似文献   

10.
目的 对脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的发病特点进行综合分析并评估其治疗效果。方法 回顾性分析北京天坛医院和青岛即墨市人民医院神经内科收治的脑静脉窦血栓患者的临床资料。结果 2006~2010年两院共收治确诊的脑静脉窦血栓患者48例,24例(50.0%)患者为亚急性起病,主要表现为高颅压综合征,8例(16.7%)患者伴肢体活动障碍或肢体抽搐,8例(16.7%)患者有意识障碍。颅脑磁共振静脉血管成像(magnetic resonance venography,MRV)均表现为不同程度的脑静脉窦闭塞。治疗以病因治疗、抗凝治疗、对症支持治疗为主,部分患者联合介入溶栓治疗。痊愈15例(占31.3%),好转30例(占62.5%),无效3例(占6.25%)。结论 CVST临床表现缺乏特异性,及时行颅脑磁共振检查是正确诊断和及时治疗的关键,抗凝治疗是CVST的主要治疗方法,治疗后该病预后相对良好。  相似文献   

11.
脑静脉窦血栓形成的诊断与血管内治疗   总被引:2,自引:0,他引:2  
目的 探讨脑静脉窦血栓形成的诊断和血管内溶栓治疗。方法 对8例以顽固性头痛、呕吐伴或不伴局灶性神经功能缺损或癫发作为主要表现的患者,采用颅脑MRI和脑血管造影检查确定诊断,并施行经颈内动脉、静脉窦内接触性溶栓或静脉窦内支架成形术协同抗凝治疗。结果 MRI显示相应脑静脉窦区出现长T2WI,短T1WI信号,DSA显示脑静脉窦闭塞、静脉侧支循环建立和脑动静脉循环时间延长。治疗后静脉窦完全或部分再通,脑循环时间接近正常,临床病情显著缓解。结论 血管内介入治疗可能是脑静脉窦血栓形成最有效的治疗方法之一,有待大样本研究证实。  相似文献   

12.
Little is known of the natural history and rate of sinus recanalisation after cerebral venous thrombosis (CVT). Although acute anticoagulation is effective, the duration of therapy remains speculative. We aimed to determine the relationship between sinus recanalisation and clinical outcome. We studied 12 consecutive patients with aseptic CVT with evidence of sinus thrombosis on initial magnetic resonance imaging, followed up 5-68 months after onset, using 15 repeat magnetic resonance scans in 9 of the patients to assess recanalisation. All patients initially had one or more thrombosed sinuses and were treated with anticoagulants for at least 6 months, including 3 with haemorrhagic infarction. Residual neurological deficits were present in only one patient. No patient had a recurrent thrombosis. Recanalisations was incomplete in 6 of the 9 cases. Sinus recanalisation after cerebral venous thrombosis does not correlate with clinical outcome. Although empirical, the general recommendation of 6 months anticoagulant therapy is appropriate.  相似文献   

13.
目的 探讨颅内静脉系统血栓形成的临床特征以及治疗原则.方法 分析14例颅内静脉系统血栓形成患者的发病年龄、发病形式、临床表现、影像学特征、脑脊液检查结果,并比较阿加曲班和低分子肝素对神经功能改善程度及预后的影响.结果 颅内静脉系统血栓形成可见于任何年龄段,中青年女性多见,以妊娠、感染、免疫性疾病等为常见发病原因.急性或...  相似文献   

14.
93例脑静脉及静脉窦血栓的临床分析   总被引:1,自引:1,他引:0  
目的 探讨脑静脉及静脉窦血栓(cerebral venous thrombosis,CVT)的危险因素、临床及影像学表现、治疗及预后影响因素。方法 回顾性分析93例CVT病例的临床资料,包括患者的一般情况、病程及起病方式、危险因素、首发症状、腰椎穿刺结果、影像学表现、治疗及预后等,并比较急性起病及慢性病程患者在危险因素及首发症状方面的不同。结果 93例CVT患者中,急性起病者(1周之内)45例,慢性病程逐渐加重者48例。两组最常见的危险因素为血液系统异常,除此之外,急性起病者危险因素构成为围产期、口服避孕药、病毒感染、大量失水,慢性病程者为中耳乳突炎、恶性肿瘤等。两组均以高颅压为首发症状,但慢性病程者较少出现意识障碍、癫发作等全脑受损的表现。37例行腰椎穿刺检查,脑脊液压力升高、正常、低于正常者分别占70.3%(26/37),24.3%(9/37),5.4%(2/37)。影像学方面,CT、磁共振静脉成像(magnetic resonancevenography,MRV)、全脑血管造影(digital subtraction angiography,DSA)的阳性率分别为44.1%(41/93),92.9%(79/85),96.9%(31/32)。所有患者一经诊断,均给予常规治疗,共有15例患者接受介入治疗,其中14例临床症状有不同程度改善,有8例在术后6个月复查DSA,提示闭塞的静脉窦部分或完全再通。结论 急慢性CVT患者的危险因素及首发症状存在区别,临床表现缺乏特异性,只有依据症状、腰椎穿刺检查结果、影像学等进行综合分析才能够避免漏诊或误诊。疾病早期应尽快行MRV或DSA检查以明确诊断,情况允许可给予介入治疗,可望获得良好预后  相似文献   

15.
Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease that can occur at any age, including in neonates, and it accounts for 0.5% of all stroke. The widespread use of neuroimaging now allows for early diagnosis and has completely modified our knowledge on this disorder. CVT is more common than previously thought and it is recognised as a non-septic disorder with a wide spectrum of clinical presentations, numerous causes, and usually a favourable outcome with a low mortality rate. MRI with T1, T2, fluid-attenuated inversion recovery, and T2* sequences combined with magnetic resonance angiography are the best diagnostic methods. D-dimer concentrations are raised in most patients but normal D-dimers do not rule out CVT, particularly in patients who present with isolated headache. Heparin is the first-line treatment, but in a few cases more aggressive treatments, such as local intravenous thrombolysis, mechanical thrombectomy, and decompressive hemicraniectomy, may be required.  相似文献   

16.
目的 总结分析颅内静脉血栓形成的临床表现、影像学特征及治疗方法,为该疾病的诊断和治疗提供参考. 方法 对自2002年至2007年湘雅医院神经内科收治的11例颅内静脉血栓形成患者的临床表现、实验室资料、影像学特征、治疗经过及预后进行回顾性分析. 结果 10例患者临床表现为非特异性的头痛,其次为呕吐、肢体偏瘫、脑膜刺激征、抽搐等.确诊前有2例曾分别诊断为脑出血、蛛网膜下腔出血.11例患者均行头颅CT和(或)MRI,8例行MRV检查,1例行DSA,明确诊断为静脉血栓形成者10例.所有患者均行降颅压治疗,10例患者进行抗凝/抗血小板治疗,9例好转,1例加重,1例死亡. 结论 颅内静脉血栓形成l临床表现缺乏特异性,误诊率高,确诊有赖于影像学检查,早期抗凝治疗是一种安全有效的方法.  相似文献   

17.
Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variations to be detected in the cortical vein and venous sinus. Diagnosis of thromboses in the venous system should not depend entirely on angiography of undeveloped veins or venous sinus. Currently, the combination of magnetic resonance imaging and magnetic resonance venography is the gold standard for diagnosing cerebral venous sinus thrombosis, rather than digital subtraction angiography. This article summarizes clinical manifestations, results from computed tomography and magnetic resonance imaging in two cases of isolated cortical venous thrombosis, analyzed relevant literature, and discussed the clinical and imaging characteristics of isolated cortical venous thromboses.  相似文献   

18.
BACKGROUND:Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variations to be detected in the cortical vein and venous sinus. Diagnosis of thromboses in the venous system should not depend entirely on angiography of undeveloped veins or venous sinus. Currently, the combination of magnetic resonance imaging and magnetic resonance venography is the gold standard for diagnosing cerebral venous sinus thrombosis, rather than digital subtraction angiography. This article summarizes clinical manifestations, results from computed tomography and magnetic resonance imaging in two cases of isolated cortical venous thrombosis, analyzed relevant literature, and discussed the clinical and imaging characteristics of isolated cortical venous thromboses.  相似文献   

19.

Purpose

The aim of the present study is to provide a clinical and etiological analysis of cerebral venous thrombosis (CVT) in the Tunisian population.

Methods

This is a prospective monocentric study including 26 patients referred to the Neurology Department of the Military Hospital of Tunis between January 2005 and January 2008. The diagnosis of CVT was confirmed in all patients by magnetic resonance imaging (MRI) and angiography. The clinical and biological risk factors of cerebral venous thrombosis were analyzed. The average follow-up was 18 months (range six to 30). The outcome was assessed clinically with the modified Rankin scale and with MRI.

Results

Mean age was 38.26 years, predominantly females (sex-ratio 4.2). The clinical onset was acute in 88.46% of the cases. Headache was the most common inaugural sign (84.6%). Lateral and superior longitudinal sinuses were the most commonly involved with equal frequency (61.53%). Parenchymal lesions were frequently noted (77%), especially hemorrhagic infarcts (46.15%). The causes of CVT were variable and usually combined (85%). Specifically, thrombophilia and obstetric-gynecological causes were predominant with a prevalence of 61.5 and 42.3%, respectively. Septic causes (38.46%) are also frequent, mainly oral infections (27%). Outcome was favorable in 77% of patients given heparin therapy, followed by oral anticoagulants and antibiotics as needed.

Conclusion

Our Tunisian population presented distinct clinical features compared with previous studies, including a high frequency of thrombophilia and gyneco-obstetrical disorders as well as infectious causes.  相似文献   

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