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。     

Intracranial hypertension in Beh?et's disease: demonstration of sinus occlusion with use of digital subtraction angiography

We describe two patients with Beh?et's disease who had symptomatic intracranial hypertension due to cerebral venous sinus thrombosis. The sinus thrombosis was demonstrated by digital subtraction angiography. In those patients with Beh?et's disease who have unexplained headaches, papilledema, and elevated cerebrospinal fluid pressure, venous digital subtraction angiography is an expedient, accurate, and safe procedure for demonstrating intracranial venous thrombosis.     

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...     

脑静脉窦血栓形成65例临床与影像学分析

目的 探讨脑静脉窦血栓形成(CVST)的病因、临床表现及影像学特点.方法 回顾性分析65例CVST患者的临床表现、头颅CT、MRI、磁共振静脉血管造影及数字减影血管造影(DSA)特点.结果 本组65例CVST患者中,25例(38%)患者仅表现为单纯颅高压;头面部局部或全身感染者13例(20%);贫血4例(6%);服用避孕药史4例(6%);结缔组织及相关疾病4例(6%)(Behcet's病2例,系统性红斑狼疮2例),蛋白C缺乏2例(3%).9例急性患者的头颅CT平扫发现,2例存在"稠密三角征",3例存在"条带征".亚急性患者头颅MRI显示,静脉窦内主要为T1、T2高信号(33%,4/12).MRI发现急性、亚急性及慢性患者静脉性脑梗死的比例分别为38%(3/8)、33%(4/12)及18%(6/33).在行MRV检查的12例患者中,均发现静脉窦充盈缺损或中断(100%).DSA检查发现66%(40/61)累及2个或2个以上静脉窦,11%(7/61)累及大脑浅(深)静脉.结论 CVST病因复杂,起病形式多样,临床表现主要为颅高压等一些非特异性症状及体征;头颅CT及MRI分别对急性,亚急性CVST静脉窦内的血栓有较高的敏感性与特异性;MRV可快速、无创地诊断CVST.若以上检查仍不能明确诊断,应尽快行DSA检查,尤其是大脑浅(深)静脉血栓形成患者.     

硬脑膜静脉窦血栓的影像学诊断对比研究

目的：探讨磁共振各序列及CT在诊断脑硬膜静脉窦血栓中的价值。方法：20例经MRI及MRV（其中15例曾行CT检查）诊断为脑静脉窦血栓的病人，着重观察静脉窦内异常信号、脑肿胀、脑实质内异常信号及有无乳突炎等。结果：15例行CT扫描病人中，7例可见脑内异常密度影，1例可见上矢状窦增宽，有高密度影充填，MRV显示上矢状窦血栓11例，上矢状窦合并横窦、直窦或乙状窦血栓7例，左横窦及乙状窦血栓1例，右侧乙状窦血栓1例。SE序列显示脑实质内异常信号8例。显示上矢状窦、横窦、乙状窦高信号影14例。结论：硬膜窦内高信号影可提示本病，而MRV与原始图像结合在诊断静脉窦血栓及随访观察中有极大的价值，T1WI在显示脑肿胀、出血等方面优于T2WI，但T2WI对于乳突炎的显示又明显优于其他序列。磁共振检查的优越性是CT及血管造影所不及的。     

SECONDARY HEADACHES

Background: The high pressures documented in the intracranial venous sinuses in idiopathic intracranial hypertension (IIH) could be the result of focal stenotic lesions in the lateral sinuses obstructing cranial venous outflow.
Objective: To explore the relation between venous sinus disease and IIH.
Methods: 12 patients with refractory IIH had dilatation and stenting of the venous sinuses after venography and manometry had shown intracranial venous hypertension proximal to stenoses in the lateral sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome.
Results: Intrasinus pressures were variably reduced by stenting. Five patients were rendered asymptomatic, two were improved, and five were unchanged.
Conclusions: The importance of venous sinus disease in the aetiology of IIH is probably underestimated. Lateral sinus stenting shows promise as an alternative treatment to neurosurgical intervention in intractable cases.
Comment: This is one of the hot topics, that is, whether idiopathic increased intracranial pressure is usually due to a cortical sinus thrombosis, stenosis, or other anomaly. When more advanced techniques in magnetic resonance venography become more widely available and utilized, answers on the frequency of secondary idiopathic intracranial hypertension should become available. SJT     

CT静脉血管成像诊断下肢深静脉血栓的应用进展

下肢深静脉血栓是在下肢深静脉内血液发生凝固、形成血栓的一种临床常见疾病.传统的静脉造影术和多普勒超声是以往临床常用的诊断下肢深静脉血栓的检查方法.近年来,随着MSCT的临床普及,CT静脉血管成像已成为诊断下肢深静脉血栓的有效方法.本文就CT血管成像技术在下肢深静脉血栓的临床诊断和评估方面的应用进展做一综述.     

脑静脉窦血栓形成的诊断及治疗

目的:探讨脑静脉窦血栓形成(CVST)的临床特点。方法:对20例CVST患者的一般情况、病因、临床表现、脑脊液特点、影像学特征、治疗及预后等资料进行回顾性分析。结果:20例患者多表现为头痛,可伴有癫疒间发作和各种神经功能缺损的症状体征,脑脊液压力明显升高,白细胞数和蛋白质定量可正常或升高,头颅CT示静脉窦高密度改变及脑实质异常信号,MRI示静脉窦异常信号,MRV示静脉窦闭塞或充盈缺损,DSA示静脉窦狭窄、血流中断或不显影。治疗以脱水、抗凝、溶栓为主,19例好转,1例死亡。结论:对于高颅压伴或不伴神经、精神障碍的患者,须高度警惕CVST,应尽早行MRV或DSA检查,治疗以抗凝、溶栓为主。     

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。     

Magnetic resonance black-blood thrombus imaging can confirm chronic cerebral venous thrombosis: a case report and literature review

BackgroundCerebral venous thrombosis (CVT) is easily missed or misdiagnosed in clinical settings because of its high variability in terms of symptoms and radiological findings. Herein, we aimed to explore a promising modality for confirming presumed CVT in the hope to uncover its superior diagnostic performance to conventional imaging modalities.Case presentation: The patient complained of intolerable pain in her forehead and left eye. Her lumbar puncture opening pressure was 140 mmH₂O, and her cerebrospinal fluid composition was normal. No marked abnormalities were observed in routine brain images, including non-contrast computed tomography, magnetic resonance imaging, and contrast-enhanced magnetic resonance venography. However, chronic mural thrombi in the lumen of the left cortical veins, transverse/sigmoid sinus, and superior sagittal sinus were identified in magnetic resonance black-blood thrombus imaging (MRBTI) maps.ConclusionsMRBTI can be used to directly and non-invasively visualize thrombi, and may thus be a promising tool over alternative routine techniques for confirming the diagnosis of CVT.     

颅内静脉窦血栓形成20例临床分析

目的:探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特点、影像学检查和诊治方法,为临床提供经验。方法:回顾分析20例CVST患者的临床资料,分析其发病原因、临床特点、实验室检查、影像学表现、治疗方案等。结果:20例患者均为中青年,大多为急性或亚急性起病,临床表现主要为高颅压综合征或局灶性神经功能缺损,出现头痛17例、视力障碍8例、肢体乏力麻木10例、癫痫发作6例。CVST的诊断主要依靠影像学表现。根据19例患者的磁共振静脉血管成像(magnetic resonance renography,MRV)或数字成影血管造影(digital subtraction angiography,DSA)检查结果(去除1例无效数据)发行,血栓累及2个或2个以上静脉窦15例(78.9%),累及上矢状窦9例、橫窦15例、乙状窦14例;脑实质损伤8例(40%)。经抗凝、降颅压和抗癫痫等对症治疗后,治疗有效(症状完全消失/缓解)17例(85%),无效3例(15%),病死2例。结论:CVST发病率低,容易漏诊和误诊,头痛、视力障碍、癫痫和肢体感觉运动障碍为常见临床表现,孤立性头痛和孤立性视乳头水肿(视物模糊/黑朦)患者需警惕CVST;D-二聚体检查阴性不足以排除CVST诊断;CT和MRI检查对CVST有重要提示作用,经静脉造影检查(MRV或DSA)发现血管腔内血栓是CVST确诊的关键;早期诊断,规范的抗凝治疗和积极的对症治疗有助于改善预后。     

脑静脉窦血栓形成的CT、MRI诊断

目的:探讨CT、MRI及MRV对脑静脉窦血栓形成(CVST)的诊断价值。材料与方法:回顾性分析15例脑静脉窦血栓形成的头颅CT、MRI及MRV表现。结果:所有患者均行头颅CT和MRI平扫,其中5例行CT增强扫描,3例行MRI增强扫描,11例行MRV检查。CT平扫显示静脉窦密度增高,急性7例(7/9),亚急性3例(3/6);MRI平扫显示13例静脉窦内有异常信号,CT及MRI增强扫描均见"空三角征"或"充盈缺损征",11例MRV均表现为受累静脉窦不显影或充盈缺损。结论:头颅CT是诊断急性CVST的重要方法;MRI对亚急性CVST具有更高敏感度与特异性;MRV可快速、无创地评价CVST。     

MRI和MRV在脑静脉窦血栓形成中的诊断价值探讨

目的:探讨磁共振成像(MRI)和磁共振静脉成像(MRV)对脑静脉窦血栓形成的诊断价值。方法:对20例脑静脉窦血栓形成患者,其中急性期(<1周)脑静脉窦血栓形成3例,亚急性期(1～2周)13例,慢性期(>2周)4例,作MRISE序列平扫,10例有TOF法MRV,3例有MRIGd-DTPA增强,13例有平扫CT对照。结果:20例脑静脉窦血栓形成中,MRISE序列扫描确诊19例,1例急性期早期MRI平扫漏诊,后经MRV确定。13例CT平扫均未能确定脑静脉窦血栓的诊断。急性期脑静脉窦血栓MRI信号复杂,T1WI呈低、中等或稍高信号,T2WI呈明显低信号。亚急性期呈短T1和长T2信号表现典型;慢性期由高信号到低信号,最后血栓吸收,静脉窦再通。MRV表现为静脉窦闭塞或静脉窦内充盈缺损。结论:MRI和MRV是诊断和随访静脉窦血栓形成的有效手段,对脑静脉窦血栓的诊断优于CT,可替代创伤性的DSA检查。     

非神经科住院患者颅内静脉窦血栓形成临床和影像特征分析并文献复习

目的:探讨非神经科住院患者颅内静脉窦血栓形成(CVST)发生的病因、临床和影像学特征,提高临床医生对CVST的识别和诊断能力.方法:回顾性分析因非神经科疾病于其他科室接受住院治疗,并于住院期间确诊的CVST患者的临床和影像学资料,同时结合相关文献进行回顾性分析.结果:共纳入6例确诊的CVST患者,其原发性疾病分别为肾小...     

磁共振成像对脑静脉窦血栓形成的诊断

目的:探讨脑静脉窦血栓形成的MRI表现和成像特点。方法:回顾性分析2003年12月~2005年1月经临床确诊的13例脑静脉窦血栓形成患者的MRI表现,所有患者均行超导MRI检查,多平面图像采集,磁共振静脉造影(MRV)采用2D-TOF技术。结果:MRI特征性表现为平扫脑静脉窦内正常的流空信号消失,代之以异常的等信号或高信号。病变最常累及上矢状窦和横窦。MRV表现为受累的静脉窦的闭塞呈充盈缺损或再通后的模糊影,病变部位和范围与MRI相对应?熏 侧枝血管形成,深部静脉明显扩张或其他引流静脉显现。结论:MRI和MRV能准确诊断脑静脉窦血栓形成,而且可以用于病例的随诊观察。     

脑静脉（窦）血栓形成的MRI和MRV诊断价值

目的探讨脑静脉血栓（CVT）和静脉窦血栓（CVST）形成磁共振成像（MRI）和磁共振静脉系成像（MRV）的特征。方法回顾性分析经磁共振诊断和临床治疗的58例脑静脉（窦）血栓病人的资料。全部有MRI平扫,其中39例有2DPC法MRV成像,观察脑静脉窦、脑静脉内和脑实质内信号改变。结果脑静脉窦血栓49例：单独静脉窦血栓31例,8例合并浅静脉血栓,其中3例合并出血;4例合并脑深静脉血栓;6例同时合并深、浅静脉血栓。单独脑深静脉血栓9例。结论 MRI结合MRV是诊断脑静脉（窦）血栓首选和最有效而又无损伤的检查方法。     

3D-CE-MRA在脑静脉血栓影像学诊断中的价值

目的:探讨运用三维对比增强MR血管造影技术(3D-CE-MRA)的MRV在脑静脉血栓(CVT)的各种影像学诊断中的价值。方法:回顾22例经MRI、MRV及DSA检查CVT的病例,重点观察分析各种影像学表现。结果:MRI(SE序列)检查共显示脑实质继发改变10例;显示上矢状窦、横窦及直窦血栓共13例;MRV检查显示上矢状窦血栓6例;下矢状窦血栓1例;上矢状窦合并直窦2例;上矢状窦合并横窦、乙状窦3例;横窦合并乙状窦血栓3例;海绵窦血栓1例;大脑大静脉及大脑内静脉血栓1例;大脑上静脉及吻合静脉血栓1例。全部病例均经DSA检查证实。结论:MRI与3D-CE-MRA成像技术的MRV相结合可以全面、准确地显示CVT,为CVT检出的最佳方法。     

Cerebral Venous Thrombosis: An Uncommon Cause of Papilledema on Bedside Ocular Ultrasound

Background

Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confused for more common and less debilitating or life-threatening diagnoses such as migraine, seizure, or idiopathic intracranial hypertension.

Distinguishing dural sinus thrombosis from benign intracranial hypertension

Dural sinus thrombosis (DST) is a life threatening illness and is often overlooked but it must be considered in the differential diagnosis of a patient presenting with a significant headache. DST presents similarly to benign intracranial hypertension (BIH) with intracranial hypertension and headache. A case of a 23 year old woman with DST is described that was initially diagnosed as BIH. A Medline search to determine the examination of a patient with suspected BIH or DST yielded several articles on this topic but only two brief case reports in the emergency medicine literature. Any patient with suspected DST or BIH must have a confirmatory magnetic resonance imaging and magnetic resonance venography study. Treatment of DST seems to be effective, considerably different from BIH, and lack of treatment may lead to increased morbidity and mortality.     

Diagnostic approach to deep venous thrombosis and pulmonary embolism in the critical care setting

Considerable progress has been made during the last 30 years in the prevention, diagnosis, and therapy of venous thromboembolism. This article discusses the epidemiology, pathophysiology, and clinical presentation of the disease as well as the diagnostic uncertainty that exists in the critical care setting. Diagnostic approaches for deep venous thrombosis and pulmonary embolism are considered, including clinical prediction rules, D-dimer, contrast venography, duplex ultrasonography, computed tomographic angiography and venography, magnetic resonance imaging, ventilation–perfusion scanning, chest radiograph, arterial blood gases, electrocardiography, and echocardiography.