影响颅内静脉窦和脑静脉血栓形成正确诊断的因素与诊断探讨

颅内静脉窦和脑静脉血栓形成是脑血管病的一种特殊类型。由于发病率低、病因多及症状各异 ,造成临床诊断困难。 1987年 2月至 1997年 12月我院神经内科收治的均经头颅ＣＴ、ＭＲＩ及脑血管造影 (ＤＳＡ)检查证实的颅内静脉窦血栓形成患者 2 4例和脑静脉血栓形成患者 2例。临床误诊为其他疾病 13例 ,误诊率 5 0 %。现对其临床误诊原因及早期诊断问题分析如下。资料和结果 :颅内静脉窦血栓形成患者 2 4例 ,脑静脉(大脑大静脉 )血栓形成患者 2例 ,男性 12例 ,女性 14例。年龄 18～ 49岁 ,平均 36岁。病程小于 2个月 5例 ,2～ 12个月15例 ,1年以…     

颅内静脉窦血栓形成11例分析

目的探讨颅内静脉窦血栓形成的诊治方法。方法本科1999年10月～2004年4月收治的11例经MRI、DSA确诊的颅内静脉窦血栓形成病例，其中9例进行了介入颈动脉内溶栓，2例进行了静脉溶栓，并同时进行了抗凝等治疗，现结合文献报道分析。结果采用介入颈动脉内溶栓治疗均获得良好效果．2例1周后复查脑血管造影大部分静脉窦再通，脑循环时间接近正常。治疗后2周颅内压降致250～300mm H2O。结论颈动脉内连续应用尿激酶溶栓并结合全身抗凝治疗颅内静脉窦血栓形成可能是目前较有效的方法。     

TCD动态监测静脉窦血栓形成五例

目的评价静脉窦血栓形成患者经颅多普勒超声(TCD)检测静脉侧枝的开放和再通情况以及颅内压变化。方法用TCD 2MHz探头检测5例静脉窦血栓形成患者的颅内静脉的血流速度以及动脉频谱形态的变化。结果 5例静脉窦血栓形成患者的颅内静脉(大脑中深静脉、基底静脉)的血流速度均明显增高(139cm/s,118 cm/s,99 cm/s,103 cm/s,58cm/s),动脉频谱呈高阻力,经过治疗,随着病情的好转,颅内静脉血流速度下降,颅内动脉频谱由高阻力型恢复正常。结论 TCD能可靠无创、准确地检测颅内静脉,在病程中通过多次的TCD检查,可以评价静脉窦血栓形成静脉侧枝的开放和再通情况以及颅内压变化。     

脑静脉及静脉窦血栓形成的诊断和血管内治疗

脑静脉及静脉窦血栓形成的临床症状和体征是因为脑循环受阻、脑脊液吸收障碍所继发的脑水肿、梗死、出血所致。颅内静脉窦血栓形成的常见症状有长期的渐进性头痛、头闷,并反     

脑小静脉疾病（连载2）

第二节单纯（孤立）皮层静脉血栓形成皮层静脉血栓形成可分为两种类型：（1）伴发于颅内静脉窦血栓形成：为颅内静脉窦血栓形成时，血栓逆行进展波及皮层静脉，多见。（2）单纯（孤立）皮层静脉血栓形成：没有静脉窦的参与，少见。因前者临床讨论较多，且本文主要讨论小静脉病变，故以下主要讨论单纯皮层静脉血栓形成。     

颅内静脉系统血栓形成后癫痫发作二例报道

正卒中后癫痫是成人常见的症状性癫痫病因,大约10%的卒中患者发生一次发作,取决于卒中的类型、部位和严重程度~([1])。颅内静脉系统血栓形成(cerebral vein and dural sinus thrombosis,CVST)是一种少见的脑血管病,属于卒中的一种特殊临床类型,主要是指颅内静脉窦血栓,脑静脉血栓形成较罕见,且多是静脉窦血栓形成延续所致。年发病率在新生儿和儿童为7/100万,成人约为(2~5)/100万~([2-4])。     

颅内静脉和静脉窦血栓形成患者的临床护理

颅内静脉系统包括静脉窦和脑静脉,颅内静脉系统血栓形成是脑血管病中的特殊类型,以往因诊断困难发现较少,近年随着影像学不断发展,临床确诊患者越来越多[1],但是由于静脉系统在颅内分布广泛,且静脉系统血栓的病因复杂,因此临床表现呈现多样化,护理的难度较大,对护理技术水平要求也较高.     

磁敏感加权成像及T_2*梯度回波序列在颅内静脉血栓形成中的应用

目的分析大脑静脉系统血栓形成(cerebral venous thrombosis,CVT)的临床及影像学特点,主要是磁敏感加权成像及T_2*梯度回波序列。方法收集我院11例大脑静脉系统血栓形成病例(6例皮质静脉血栓,4例静脉窦血栓,1例皮质静脉合并静脉窦血栓),分析其病因及影像学特点。结果 11例CVT女3例,男8例,平均年龄(40±21)岁。头部CT及MRI示不同脑叶出血性梗死、窦汇高密度、横窦束带征、静脉窦高信号等。MRV和全脑血管造影术(digital subtraction angiography,DSA)示静脉窦血栓形成,皮质静脉血栓或横窦乙状窦先天发育不良。头部MRI的SWI和T_2*序列示静脉窦血栓或皮质静脉区血栓,2例未发现异常。6例SWI和T_2*序列显示静脉血栓一致。2例SWI和T_2*序列阴性病例通过MRV或DSA诊断。结论 CVT是颅内静脉系统的血栓栓塞性疾病,多见于中青年,头部MRI的SWI像和T_2*序列对于皮质静脉血栓诊断非常重要,对于静脉窦血栓形成病例有很大帮助。T_2*和SWI序列可作为颅内静脉血栓形成的常规检查。     

脑静脉及静脉窦血栓形成的临床表现及诊断的研究进展

脑静脉系统血栓形成(cerebral vein and sinus thrombosis,CVT)是指颅内静脉及静脉窦的血栓形成,是由于感染性或非感染性原因导致静脉系统形成血栓而造成静脉回流障碍     

MRI不同成像方法对颅内静脉窦血栓的诊断价值

目的探讨MRI不同成像方法对颅内静脉窦血栓(IVST)的诊断价值。方法回顾性分析综合评价近期证实且资料齐全的IVST患者10例,并对CE-MRI和MRV成像方法在血栓部位、范围、窦腔闭塞、侧支静脉以及颅内静脉的整体形态显示方面进行比较。结果血栓位于上矢状窦、横窦各4例,窦汇、横窦及乙状窦同时受累各1例。在血栓范围、窦腔闭塞方面,CE-MRI均优于MRV,侧支静脉、颅内静脉的整体显示MRV优于CE-MRI(P均<0.05),两种检查方法均准确显示血栓部位。结论对颅内静脉窦血栓的诊断,多种成像方法互为补充,相互印证,联合应用才能准确诊断。     

《中国颅内静脉系统血栓形成诊断和治疗指南2015》解读

颅内静脉系统血栓形成是特殊类型的脑血管病,由于其临床表现无特异性,临床易误诊和漏诊。近年此类疾病的诊断与治疗均取得较大进展,为此中华医学会神经病学分会脑血管病学组修订《中国颅内静脉系统血栓形成诊断和治疗指南2015》。为了指导临床医师更好地理解和使用指南,本文对指南进行解读。     

Individual propensity for thrombosis: comparison of venous and arterial circulations

Introduction

The pathogenesis of venous thrombosis has been attributed to complex interaction between environmental and inherited variables. A basal predisposition for venous thrombophilia independent of environmental variables has not been previously defined experimentally. Both to address the existence of an individual propensity to venous thrombosis and to establish an animal model in which variables governing this propensity could be tested, we provoked venous thrombi in a cohort of pigs of uniform size and age. We furthermore sought to determine whether the thrombotic propensity in the venous circulation is associated with similar propensity for arterial thrombosis.

Materials and methods

Bilateral iliac venous stents were deployed and 2 h later, thrombi were harvested and weighed. The thrombotic response was compared to carotid arterial thrombi generated by crush injury within the same pig. Venous and arterial thrombus platelet deposition were measured by scintillation detection of autologous ¹¹¹In-platelet content.

Results

In a cohort of 27 pigs, venous thrombus weights and platelet content varied over greater trrhan 10-fold range from least to greatest responders. There was strong intra-individual correlation of thrombus platelet deposition (r = 0.86; p = 0.008) and thrombus weights (r = 0.68; p = 0.015) between stented iliac vein pairs. Venous thrombosis correlated with whole blood platelet counts but not carotid platelet-rich thrombus formation.

Conclusions

The wide variation in venous thrombotic response to a standardized injury appears to represent an intrinsic propensity of the individual. The poor correlation with arterial thrombosis implies unique mechanisms responsible for this propensity in arteries and veins.     

Dural sinus thrombosis: a mechanism-based classification and review of 42 cases

Cranial venous outflow obstruction due to dural sinus thrombosis may result in venous hypertension, cerebral infarction, cerebral haemorrhage or impaired cerebrospinal fluid (CSF) absorption with consequent pseudotumour syndrome. We propose a mechanism based classification of dural sinus thrombosis from these four outcomes. Forty two cases of dural sinus thrombosis presenting to Royal Prince Alfred Hospital between 1986-1997 were retrospectively reviewed. These cases were classified according to mechanism of presentation and relevance of this to site of thrombosis, treatment and prognosis. This study shows that the superior sagittal sinus and transverse sinus are the commonest sites of thrombosis, and multiple sites of thrombosis (69%) are more frequent than a single site. Magnetic resonance imaging (MRI) with venous flow studies is the investigation of first choice for diagnosis but angiography remains the gold standard. A pseudotumour syndrome is the commonest presentation (43%) followed by cerebral haemorrhage (31%). The overall prognosis for sinus thrombosis is good, with 71% of cases recovering to normal function.     

Antiphospholipid antibodies and thrombosis

Antiphospholipid syndrome is an autoimmune disease which combines vascular thrombosis and/or pregnancy complications with the presence of antiphospholipid antibodies. It could be a devastating and sometimes life-threatening condition. As vascular thrombosis presents as typical venous or arterial thromboembolism diagnosis is based on laboratory data. Therefore proper performance and interpretation of laboratory tests is crucial. Broader knowledge about clinical and laboratory aspects of the syndrome and their associations are essential for proper evaluation and management of the patients.     

The antithrombotic effect of aspirin and dipyridamole in relation to prostaglandin synthesis

The antithrombotic effect of aspirin (ASA) and dipyridamole (DIP) was evaluated in rabbits in which platelet thromboxane A2 (TXA2) and arterial prostacyclin (PGI2) were measured. An intracarotid cannula thrombosis model previously shown to be sensitive to antiplatelet agents was used. Prostaglandins were determined by radioimmunoassays for thromboxane B2 (TXB2) and 6-keto-prostaglandin PGF1 alpha, the stable metabolites of TXA2 and PGI2. In the aspirin-treated animals, reduction in thrombosis was seen only in rabbits which received a low-dose (1-2 mg/kg), and was related to a selective suppression of platelet TXA2. In contrast, higher doses of ASA (10 or 100 mg/kg), which suppressed both TXA2 and PGI2, were not associated with thrombus inhibition. DIP alone had a lesser antithrombotic effect which was augmented by low-dose ASA but not by high-dose ASA. It is concluded that 1) the antithrombotic effect of ASA in this animal model is dependent on selective TXA2 suppression; 2) ASA has no antithrombotic properties beyond its inhibition of prostaglandin synthesis by platelets; 3) selective suppression of TXA2 in vivo can be achieved in rabbits by a single dose of ASA but only over a narrow dose-range; 4) DIP may have an antithrombotic effect additive to that of low-dose ASA; 5) measurement of serum TXB2 may be used to determine the minimal ASA dose necessary to suppress TXA2 and therefore be most likely to spare PGI2.     

Lipopolysaccharide augments venous and arterial thrombosis in the mouse

BACKGROUND: Animal models of diseases are essential for therapeutic target validation, drug discovery and development. Increasing evidence has demonstrated the importance of inflammation in thrombosis. Here, murine models of vena cava thrombosis and carotid arterial thrombosis augmented by lipopolysaccharide (LPS) were established and characterized to study the association between inflammation and thrombosis. MATERIALS AND METHODS: Murine (C57BL/6 mice) models of ferric chloride (FeCl(3))-induced carotid arterial and vena cava thrombosis were established. Thrombus formation was measured indirectly by Doppler blood flow (i.e., clot functional interference with blood flow) in the arterial thrombosis model and directly by protein content of the clot in the venous thrombosis model. An optimal concentration of FeCl(3) was defined to induce thrombus formation and used to study the effects of LPS (i.e., a well-known inflammatory stimulus under these conditions). Real-time polymerase chain reaction (PCR) was used to examine the effect of LPS on TNFalpha and IL-1beta mRNA expression in thrombus formation. RESULTS: Dose-dependent analysis demonstrated that 2 mg/kg, i.p., LPS provided a maximal prothrombotic effect in 2.5% ferric chloride-induced vena cava thrombosis, with a 60% increase in thrombus size (n=8, p<0.05) compared to vehicle treatment. In contrast, 2 mg/kg LPS had no significant effect on thrombus formation in a more severe, 3.5% FeCl(3)-induced vena cava thrombosis. A similar prothrombotic effect was observed for LPS in 2.5% FeCl(3)-induced carotid arterial thrombosis model. Treatment of 2 mg/kg LPS significantly augmented arterial thrombosis immediately (between 5-30 minutes) following FeCl(3) injury as assessed by change of Doppler blood flow (n=8, p<0.05). Real-time PCR demonstrated significant induction of TNFalpha and IL-1beta mRNA expression in the thrombus formation in the vessels in response to LPS challenge. CONCLUSION: These data demonstrate that LPS augments thrombus formation in acute vascular injury and that LPS-augmented thrombosis might be a useful tool to study the relationship between inflammation and thrombosis.     

脑静脉窦血栓的综合血管内治疗

目的评价综合应用颈动脉溶栓、静脉窦置管溶栓及静脉窦支架置入术治疗脑静脉窦血栓的疗效。方法对我科1997年7月～2005年6月收治的99例脑静脉窦血栓患者进行综合血管内治疗,其中5例患者接受静脉窦置管溶栓合并静脉窦支架置入术(方案1),38例患者接受颈动脉溶栓合并静脉窦置管溶栓(方案2),56例患者接受单纯颈动脉溶栓(方案3),观察3组患者的临床疗效。结果经治疗,99例患者中有94例颅内压降至300 mm H_2O, 75例患者静脉窦实现再通,93例患者循环时间降至11 s以下。结论综合应用颈动脉溶栓、静脉窦置管溶栓及静脉窦支架置入术等方法治疗脑静脉窦血栓是一种安全、有效的手段。     

经血管内溶栓并支架成形术治疗侧窦血栓形成

目的观察静脉窦内溶栓并支架成形术治疗侧窦血栓形成的效果。方法对21例诊断明确的侧窦血栓形成患者施行经静脉窦内留置微导管连续尿激酶溶栓治疗,并辅以肝素钠全身抗凝治疗,其中9例溶栓效果欠佳者采用静脉窦内自膨式支架(Wallstent或Smart)成形术。结果经静脉窦内直接溶栓及窦内支架成形术治疗后,21例中静脉窦完全再通者11例,部分再通9例,1例未通。其中8例静脉侧支循环明显改善,建立以海绵窦代偿性引流、椎静脉丛引流以及头皮静脉代偿引流等3种方式。手术后所有患者颅内压均降至≤200mmH2O(2kPa),8例于手术后7d内再次出现不同程度颅内压水平升高,经持续肝素钠抗凝治疗后恢复至正常值水平。随访3个月～6年,20例患者症状持续缓解,未复发。结论静脉窦内持续尿激酶溶栓并支架成形术治疗侧窦血栓形成、促进静脉窦血液回流、降低颅内压安全可靠,手术后继续应用抗凝药物可以维持长期疗效。     

Interobserver agreement in the magnetic resonance location of cerebral vein and dural sinus thrombosis

The interobserver variation in the magnetic resonance (MR) location of cerebral vein and dural sinus thrombosis (CVT) has not been previously reported. Four independent observers rated a convenience sample of 40 MR/MR angiographies to assess whether or not each dural sinus and major cerebral veins were occluded. Interobserver reliability was measured using κ statistics. Interobserver agreement was comparable between the six pairs of raters. Agreement was excellent for thrombosis of the deep cerebral venous system ( κ  = 1.00), cerebellar veins ( κ  = 1.00), superior saggital sinus ( κ range: 0.82–1) and right jugular vein ( κ range: 0.84–0.95); good to excellent for the right transverse/sigmoid sinus ( κ range: 0.75–0.90) and the left jugular vein ( κ range: 0.65–0.85); moderate to excellent for the left lateral sinus ( κ range: 0.59–0.78) and the straight sinus ( κ range: 0.59–0.92); poor to good for the cortical veins ( κ range: 0.02–0.65). Agreement between observers varies with the location of CVT. It is good or excellent for most of the occluded sinus and veins, except for the cortical veins. This study suggests that information on the location of CVT can be reliably collected and used in multicentre studies.