以慢性头痛为主要表现的颅内静脉窦部分血栓形成

目的探讨以慢性头痛为主要表现的颅内静脉窦部分血栓形成的发病原因。方法回顾分析1例以慢性头痛为主要表现的颅内静脉窦部分血栓形成的临床资料。结果患者因头痛10余年,加重1年入院。头痛与月经来潮有关,曾在外院诊断为原发性慢性头痛及焦虑状态。近1年月经周期缩短至20 d左右,且经期延长,月经量明显增多,查血红蛋白99.00 g/L,血清铁5.41μmol/L;头颅磁共振静脉成像(MRV)检查示右侧横窦、双侧乙状窦及上矢状窦、直窦内部分血栓形成。确诊为颅内静脉窦部分血栓形成。月经间期予活血化瘀中药治疗,同时予补铁、止血等对症支持治疗,头痛症状减轻。随访6个月,患者头痛症状明显缓解。结论颅内静脉窦部分血栓形成可能为慢性头痛的病因,而女性患者因月经量增多所致缺铁性贫血可能是导致颅内静脉窦部分血栓形成的原因之一。     

以颅内静脉窦血栓为首发表现的急性单核细胞白血病1例报告并文献复习

回顾性分析1例儿童儿童急性单核细胞白血病伴发颅内静脉窦血栓的临床表现、实验室检查、治疗经过及预后,并结合文献复习进行分析。儿童急性单核细胞白血病以颅内静脉窦血栓为首发表现缺乏特异性,在积极抗凝抗血栓治疗的同时应尽早找出原发病避免漏诊和误诊。     

误诊为颈椎病的颅内静脉窦血栓形成1例

患者,男,31岁,因突发颈后痛19天、于2007年8月31日入院.发病前2周内无感冒、感染史,患者于2007年8月12日无明显诱因突发劲后痛,恶心、呕吐,呕吐物为胃内容物,非喷射状,后出现头晕、双手麻木,坐起时症状加重,平躺好转,无意识障碍,无饮水呛咳,无二便失禁等症状.     

颅内静脉窦血栓误诊1例分析

对颅内静脉窦血栓误诊1例分析如下。男,43岁。因“右下肢麻木无力1个月,头晕头痛1d”于2008—08—06入我院。患者入院前1个月坐位起立时自觉右侧肢体麻木无力,以右下肢为重,无头痛及头晕,就诊于地方医院,疑为“脑血栓形成”,予改善循环治疗,无明显好转。入院前1d晨起后无明显诱因出现烦躁不安,易激惹．双手舞动,前胸部抓伤,伴头痛头晕及恶心,未呕吐,无发热。既往体健。     

脑静脉窦血栓形成作为首发的神经白塞病1例报告并文献复习

神经白塞病(Neuro-Behcet's disease,NBD)指的是白塞病(Behcet's disease,BD)患者神经系统受累.NBD中枢神经系统表现分为实质型和非实质型,脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)为NBD非实质型中主要表现.CVST是BD患...     

颅内静脉窦血栓形成60例分析

目的：增进对CVST的认识,提高诊治水平。方法：对60例CVST患者的临床资料进行回顾性分析总结。结果：病因明确者46例,主要表现为头痛,经头颅MRI、MRA、DSA等确诊,经抗凝、溶栓、降颅压、抗炎等治疗,22例基本治愈,18例好转,10例偏瘫,4例无变化,6例死亡。结论：CVST病因复杂,临床表现无特异,确诊有赖影像学检查,抗凝、降颅压治疗可能安全有效。     

脑静脉窦血栓形成误诊1例分析并文献复习

目的:分析脑静脉窦血栓形成误诊原因及治疗方法。方法:应用核磁共振脑静脉造影(MRV)确定诊断,通过临床诊治过程,结合文献对脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的病理学特征、临床类型、误诊原因及治疗进行探讨。结果:CVST是一种特殊类型的脑血管疾病,病因复杂、起病形式多样,临床表现缺乏特异性,头部CT特异性和敏感性不高,脑脊液检查正常,易造成误诊及漏诊。结论:CVST发病急、进展快、死亡率较高,MRV是诊断脑静脉窦血栓形成并检测疗效的首选影像学检查方法,抗凝治疗是一种安全有效的方法。     

产后颅内静脉窦血栓形成介入治疗1例报告并文献复习

目的：探讨产后颅内静脉窦血栓形成（CVST）的诊断与血管内碎栓治疗。方法：回顾总结产后CVST患者的诊疗资料,复习近期国内外相关文献。结果：对1例产后CVST患者进行血管内机械取栓及接触性溶栓治愈。随访3个月无复发。结论：产后CVST早期诊断极其重要,介入治疗可取得良好效果。     

颅内静脉窦血栓诊断治疗4例分析

颅内静脉窦血栓引起的颅压高综合征临床并非多见 ,我院自 1988～ 1998年共收治良性颅压高 112例 ,其中仅 4例患者是由于静脉窦血栓引起 ,而且均表现为头痛及双眼底视乳头水肿 ,视力下降 ,视野缺损 ,既往有中耳炎和上颌窦炎病史 ,采用保守及导管溶栓治疗 ,症状缓解 ,现报告如下。1　临床资料本组女 3例 ,男 1例 ,平均年龄 33.7岁。临床表现为颅内压增高症状、头痛、恶心、双眼视力下降 ,视乳头水肿 ,视野缺损 ,3例保守治疗 ,1例行导管溶栓 ,效果满意。典型病例例 1　女 ,38岁。阵发性头痛 1a,恶心伴复视 0 .5 a,双眼视力下降 2周 ,既往有慢性…     

颅内静脉窦血栓形成早期易误诊的临床分析

目的探讨颅内静脉窦血栓形成（cerebralvenoussinusthrombosis,CVST）的临床特点及早期误诊的原因。方法回顾性分析我院2004年3月至2013年4月误诊的15例CVST患者的临床资料,总结误诊的原因。结果共纳入60例患者,其中有15例早期误诊,误诊率为25％,分别误诊为：脑出血4例,脑梗死2例,蛛网膜下腔出血2例,中枢神经系统感染5例,颅内占位病变1例,血管性头痛1例。结论CVST患者临床表现多变,影像学改变不典型,早期容易误诊。临床医生应提高对疾病的认识,对疑诊病例及早行MRI＋MRV检查,必要时行DSA检查,以降低误诊率。     

Stenting for acute cerebral venous sinus thrombosis in the superior sagittal sinus

Endovascular treatment for superior sagittal sinus (SSS) thrombosis is not always successful because of difficult access and long thrombus lesions. We report the first two cases of patients with acute cerebral venous sinus thrombosis at the SSS that was not recanalized by anticoagulation, mechanical thrombectomy, or thrombolysis, but was successfully treated by stent placement. Case 1 was a 37-year-old woman with bilateral subdural hematomas. Digital subtraction angiography showed obstruction of the sinus from the SSS to the right transverse sinus. Recanalization was achieved by selective thrombolysis using urokinase followed by balloon angioplasty, but re-occlusion occurred on the next day of treatment. Repeated endovascular treatment including balloon angioplasty, thrombus aspiration and thrombolysis using recombinant tissue plasminogen activator failed to achieve recanalization. We thus placed intracranial stents in the SSS, which did achieve recanalization. Case 2 was a 69-year-old woman with a small infarction in the left parietal lobe. Digital subtraction angiography showed sinus obliteration from the SSS to the bilateral transverse sinuses. Recanalization was not achieved by balloon angioplasty, thrombus aspiration and selective thrombolysis. We thus placed intracranial stents in the SSS, which did achieve recanalization. Postoperative course was uneventful in both cases and venous sinus patency was confirmed by venography >1.5 years after treatment. When conventional endovascular strategies have been unsuccessful, placement of intracranial stents, which can easily gain access to the distal part of the SSS as compared with carotid stents, may be a useful treatment option for the acute sinus thrombosis in this region.     

颅内静脉窦和脑静脉血栓形成的临床和影像学诊断探讨

目的探讨诊断颅内静脉窦和脑静脉血栓形成的方法。方法对 6例颅内静脉窦和脑静脉血栓形成的临床及影像学资料进行分析。结果患者多表现颅内高压征象 ,伴有全脑症状或局灶神经功能异常。头颅MRI及磁共振静脉成像 (MRV)诊断颅内静脉窦和脑静脉血栓形成有肯定的价值 ,而血管数字减影 (DSA)是诊断该病的最可靠手段。结论根据临床表现及影像学检查可确诊颅内静脉窦和脑静脉血栓形成。     

颅内静脉窦血栓形成2例并文献复习

目的：总结颅内静脉窦血栓形成(CVST)的临床特点,提高对该病的早期诊断和治疗水平。方法分析2例 CVST 的临床特点、影像学和实验室检查资料及治疗效果。结果2例患者均为男性,分别为48岁、63岁。1例有眼球感染,另1例无明显诱因。2例均有头痛等神经系统症状,病情迅速加重。2例头颅 CT 检查均出现两侧大脑半球肿胀,局部出血灶和明显占位效应,1例数字减影血管造影(DSA)示局部静脉、静脉窦不显影。1例腰椎穿刺颅内压升高,呈血性脑脊液。2例患者经抗凝等综合治疗均获得良好疗效。结论 CVST 以头痛等症状为主要表现,病情进展迅猛,头颅 CT 表现为两侧大脑半球肿胀,局部出血,占位效应明显,早期诊断及治疗效果好。     

Cerebral venous sinus thrombosis

Summary

The cerebral venous system is an unusual site of thrombosis, with a particularly high incidence in young adults. This incidence has increased in past decades because of the improvement of neuroradiological techniques. Risk factors for cerebral venous sinus thrombosis overlap with those of other venous thromboembolism sites; however, some are specific for this particular anatomical district. Prognosis is favorable in most cases if diagnosis is made rapidly and treatment is promptly initiated, even if acute complications or chronic invalidity still occur in a quarter of patients. The mainstay of treatment is anticoagulation, which is necessary in order to block clot propagation and obtain recanalization. Intracranial bleeding does not contraindicate anticoagulation. Endovascular procedures are reserved for patients with a particularly severe presentation or rapidly declining neurological symptoms despite appropriate anticoagulation, although data from clinical trials are lacking. Specifically, this review addresses the epidemiology, clinical presentation and course, risk factors, and treatment of cerebral venous sinus thrombosis, with a special focus on the pediatric population.

     

Changing pattern of headache pointing to cerebral venous thrombosis after lumbar puncture and intravenous high-dose corticosteroids

OBJECTIVE: To emphasize the diagnostic importance of change in the headache pattern which pointed to cerebral venous thrombosis in two patients after lumbar puncture and high-dose intravenous methylprednisolone for suspected multiple sclerosis. RESULTS: Both patients had a diagnostic lumbar puncture for suspected multiple sclerosis and were treated with high-dose intravenous methylprednisolone. Both developed a postlumbar puncture headache that was initially postural, typical of low cerebrospinal fluid pressure. Three days later, the headache became constant, lost its postural component, and was associated with bilateral papilledema. Magnetic resonance imaging of the brain disclosed superior sagittal and lateral sinuses thrombosis. The diagnostic difficulties of such cases and the potential role of lumbar puncture and corticosteroids as risk factors for cerebral venous thrombosis are discussed. CONCLUSIONS: When a typical postdural puncture headache loses its postural component, investigations should be performed to rule out cerebral venous thrombosis, particularly in the presence of other risk factors.     

脑静脉窦血栓形成的CT与MRI

目的：探讨脑静脉窦血栓形成（CVST）的CT与MRI表现特点。方法：回顾分析35例CVST患者的头颅CT、MRI及MRV表现。结果：15例血栓位于上矢状窦，8例位于下矢状窦和直窦，7例累及横窦-乙状窦，5例为多窦受累，7例患者伴有皮质引流静脉及脑深部大静脉受累；10例急性病例，CT见直接和/或间接征象；MRI示32例典型病例表现为脑静脉窦内正常流空效应消失，代之以异常等信号或高信号影，MRV示受累静脉窦全程或节段性闭塞。结论：对急性CVST，头颅CT是一种简单、有效的诊断方法；而对于亚急性和慢性者，常规MRI及MRV的表现具有特征性，其是诊断CVST可靠的手段。     

脑静脉窦血栓形成12例临床分析

目的探讨脑静脉窦血栓形成(CVST)的病因,早期临床特点、影像学特征及治疗方法。方法回顾性分析12例脑静脉窦血栓形成患者的病因,临床表现,实验室资料,影像学特征,治疗经过及预后。结果早期的主要表现是,头痛11例,头痛伴呕吐5例,伴视力减退5例。能查找到病因的7例(58.3%)。11例患者行头颅磁共振成像(MR I)及磁共振血管显影(MRA)检查,诊断为静脉窦血栓形成者10例,阳性率83%。2例行数字减影血管显影检查(DSA),均确诊为静脉窦血栓形成。所有患者均行抗凝治疗,部分患者脱水降颅压治疗,2例脑疝形成患者开颅手术治疗。其中9例好转,1例无变化,2例死亡,死亡率16.7%。结论脑静脉窦血栓形成病因复杂,临床表现缺乏特异性,确诊有赖于影像学检查。抗凝,降颅压治疗安全有效。     

Transverse sinus thrombosis presenting with acute hydrocephalus: a case report

We report on a 32-year-old woman who presented with headache of a 10-day duration, due to acute hydrocephalus. This was a result of a tumefactive lesion of the posterior fossa, which was later proven to be a cerebellar venous infarct caused by unilateral transverse sinus thrombosis. Cerebral dural sinus thrombosis should be considered in the differential diagnosis of new onset of headache.