脑静脉窦血栓形成的临床和影像学分析

目的 通过对24例脑静脉窦血栓形成（CVST）患者的临床和影像学资料分析,揭示CVST的临床特点.方法 回顾性总结24例CVST患者的临床资料,从病因、临床特点和影像学特点三个方面进行分析.影像学特点作为重点讨论部分,包括MRI、MRV和DSA表现.结果 24例CVST患者中16例的病因分别为凝血机制异常（33.3%）、产褥期（12.5%）,高同型半胱氨酸血症（8.3%）、雌激素水平异常（4.2%）、贫血（4.2%）、肿瘤（4.2%）,另8例病因不明;24例患者起病症状包括：头痛、复视、抽搐发作、肢体无力和视力障碍.体征包括：视乳头水肿、偏瘫、脑膜刺激征和意识障碍.影像学特点：MRI 18例有异常改变,其中12例显示静脉窦部分或全部节段性流空消失,代之以短T1长T2信号;MRV 23例相应静脉窦不同程度显影缺失.DSA检查,每例患者均见一处或多处静脉窦狭窄、充盈缺损和显影不良.结论 CVST多数伴有头痛、视乳头水肿、颅压升高,影像学窦腔或浅静脉有异常,临床应想到CVST,确诊需要DSA检查.

Clinic and imaging analysis of cerebral venous sinus thrombosis

Objective To investigate the common characteristics of cerebral venous sinus thrombosis （CVST） by analyzing the clinic and imaging features of 24 patients with the disease. Methods Twenty four patients were included, 9 males and 15 females, average age of （32±12）years old,disease time 8 day - 7 years, mean time （59± 62） days. Observation parameters included the causes, clinical manifesta- tion, and imaging data from cranial CT,MRI,MRV and DSA. Results The causes of disease： puerperi um was found in 3 patients,hyperhomocysteinaemia in 2 ,abnormal hormonal level in 1 ,amenia in 1, clotting mechanism abnormality in 8,and tumor in 1 patient. Symptoms： headache was recorded in 22 patients,diplopia in 1,and meningeal irritation sign in 3 patients. Clinical signs： papilledema was observed in 19 patients, impaired vision in 6, weakness in 5, Babinski sing （Jr）in 5, seizure in 5, amaurosis in 3, disturbance of comsciousness in 1 patient,and Veins thrombosis of lower extremity in 2 patients. Imaging： MRI tests abnormal in 18 patients,12 of them were detected disappearance of part or all of the venous sinus flow vacancy phenomenon, which was replaced with short T1 and long T2 signals. 23 MRV tests showed poor development of venous sinus in different degrees. DSA test revealed some abnormality of cerebral venous sinus in all the patients. Conclusions Most of CVST patients are companied by headache ,papilledema,high CSF pressure and abnormality of cerebral venous sinus. DSA is essential for the definite diagnosis of CVST.