脑血管介入评估脑静脉窦与特发性颅内压增高相关性

目的 探讨采用脑血管内介入方法评估脑静脉窦与特发性颅内压增高(ⅡH)的相关性.方法 回顾性分析13例临床诊断ⅡH患者资料.完善相关临床症状、体征、实验室、MR静脉成像(MRV)等检查.局部麻醉下作全脑血管DSA造影,同时超选至静脉窦作矢状窦、横窦、乙状窦、颈静脉分段测压.结果 脑血管DSA检查显示,13例患者中静脉窦狭窄或闭塞10例(76.9％),其中横窦6例,乙状窦3例,横窦和乙状窦同时受累l例.静脉窦超选测压显示,10例患者静脉窦狭窄两端压力差达120～580 mmH2O;8例(61.5％,8/13)静脉窦闭塞/狭窄可能与ⅡH相关,2例(15.4％,2/13)静脉窦狭窄可能继发于ⅡH,3例(23.1％,3/13)静脉窦狭窄可能与ⅡH无关.结论 脑血管内介入造影结合静脉窦超选测压,能够良好地辨别ⅡH与静脉窦的关系.     

股静脉入路脑静脉窦内支架成形术治疗特发性颅内高压伴静脉窦狭窄13例

【摘要】 目的 评价股静脉入路脑静脉窦内支架成形术治疗特发性颅内压增高（IIH）伴脑静脉窦狭窄（CVSS）的安全性和有效性。 方法 回顾性分析13例确诊为IIH伴局限性CVSS患者的临床资料。所有患者均接受全脑血管造影检查,并在逆行性脑静脉窦内微导管测压后经股静脉行静脉窦内支架成形术。术后均行腰椎穿刺术复测颅内压力,并复查眼底照相评估视神经乳头水肿改善情况。随访期间观察患者临床症状改善情况,有无并发症,脑静脉窦是否通畅。 结果 13例患者均成功完成脑静脉窦内支架成形术。狭窄病变两端压力差由术前平均（20.67±5.63） mmHg（1 mmHg=0.133 kPa）降至术后平均（4.72±1.87） mmHg（P＜0.001）,颅内压由术前平均（371.5±84.7） mmH2O（1 mmH2O=0.009 8 kPa）降至术后平均（225.6±45.7） mmH2O（P＜0.001）。术后所有视神经乳头水肿均明显改善或消失。随访3～33个月,2例耳鸣患者症状消失,12例头痛患者、8例视物模糊患者症状明显好转,2例视力下降患者症状改善不明显。所有患者均无不适症状,原症状无复发,CTV或DSA复查提示支架开放良好,无支架内再狭窄。 结论 脑静脉窦内微导管测压指导股静脉入路支架成形术治疗IIH伴CVSS患者安全、有效。     

Assessment of CSF dynamics and venous flow in the superior sagittal sinus by MRI in idiopathic intracranial hypertension: a preliminary study

A velocity-sensitive magnetic resonance imaging (MRI) phase-mapping method was used for noninvasive study of cerebrospinal fluid (CSF) flow in the cerebral aqueduct, for indirect calculation of supra-tentorial CSF production, and for measurement of blood flow in the superoor sagittal sinus (SSS). We examined 12 patients with idiopathic intracranial hypertension (HH; pseudotumour cerebri), and 10 healthy volunteers. The peak caudal and rostal CSF flow in the aqueduct during the cardiac cycle did not differ significantly between the patients and the volunteers. A significant correlation was found between the CSF volume flow amplitude and the resistance to cerebrospinal fluid out-flow in the patients (p<0.05). The calculated mean supratentorial CSF production rate was 0.79 ml/min in the patients and 0.70 ml/min in the controls, but this difference was not statistically significant. However, the MRI measurements suggested CSF hypersecretion in three patients, whereas increased transependymal passage of CSF could have been the cause of negative calculated CSF production rates in two others. A tendency towards lower mean blood flow in the SSS (mean 345 ml/min) in the patients than in the controls (mean 457 ml/min) was found, and in two patients showed very low values. We showed that MRI phase-mapping may be used to study the relative importance of the pathophysiological factors thought to play a role in the development of IIH.     

综合治疗颅内静脉窦血栓形成

颅内静脉窦血栓形成是脑血管病的一种特殊类型 ,其临床表现以高颅压为主 ,须通过全脑血管造影 (ＤＳＡ)、磁共振成像 (ＭＲＩ)方能确诊。1　临床资料1 1　一般资料　 40例患者中 ,男性 17例 ,女性 2 3例 ,年龄 18～ 6 3岁 ,平均 38岁。患者大多以间断头痛和额眶部胀痛并进行性视力下降及高颅压就诊。血常规检查 :13例ＷＢＣ >10× 10 9/Ｌ ,Ｎ >0 77。 5例有近期发热病史。 40例患者中 ,临床主要症状分别以头痛、呕吐、复视、癫痫、视力障碍 ,视乳头水肿、眼底出血和锥体束损害为主 ,行腰穿检查 ,脑脊液压力均高于正常 1 98～ 4 0ｋＰａ(2 …     

颅内静脉窦血栓形成的MRI诊断

目的 探讨颅内静脉窦血栓形成的磁共振成像(MRI)表现及其对本病的诊断价值。方法 搜集8例经临床确诊的颅内静脉窦血栓形成的MRI资料，回顾性分析其MR影像学表现。结果 颅内静脉窦血栓形成的MRI表现有如下特点：(1)常为多处静脉窦同时受累；(2)形成血栓的静脉窦增粗、流空效应消失，呈现等或短、混杂T1、短或长T2信号影，典型表现为“白三角”征；(3)在急性期做增强扫描可见“黑三角”征；(4)MR静脉成像显示：栓堵的静脉窦影缺失。结论 颅内静脉窦血栓形成有比较典型的MR影像学特点；MRI检出本病优于CT，且能作出早期诊断；MRI增强扫描及MR静脉成像在本病的早期诊断及鉴别诊断中具有重要意义。     

MR imaging of idiopathic intracranial hypertension

We report the case of a 9-year-old male patient with idiopathic intracranial hypertension without papilledema for which MR imaging of the optic nerves and pituitary gland provided important clues for the diagnosis of idiopathic intracranial hypertension and showed a return to normal appearance after normalization of CSF pressure.     

特发性颅内高压的影像学研究

目的研究特发性颅内高压（IIH）的可靠影像学征象及与临床症状的关系,提高对该病的认识。方法研究2008年7月～2012年12月有完整临床、影像学资料的20例IIH患者,并以同期20例正常志愿者作为对照组。由2位有经验的神经放射医生共同评价影像学异常,包括垂体及蝶鞍形态、脑室形态及视神经鞘形态。结果空蝶鞍/部分空蝶鞍和视神经鞘扩张都具有较高的敏感性（分别为75％、80％和75％）和特异性（分别为95％、75％和80％）;2组之间Evans指数、双侧麦氏腔长宽比及OND均无统计学差异（P〉O．05）,垂体腺高度及深度、双侧ONSD均有统计学显著性差异（Pd0．01）。结论空蝶鞍和视神经鞘扩张是IIH的可靠影像学征象。正确认识IIH的影像学表现对其早期诊断和治疗具有重要价值。     

脑静脉窦血栓形成的介入治疗

目的 研究血管内介入治疗颅内静脉窦血栓形成的疗效和安全性.方法 对10例临床抗凝治疗无效的颅内静脉窦血栓形成患者行血管内介入治疗,全部患者均接受经静脉插管接触性溶栓联合机械性碎栓治疗,其中4例在接受经静脉途径溶栓后又接受了经动脉溶栓.术后继续抗凝治疗6个月,随访12～29个月,平均21个月.结果 8例患者的临床症状和体征得到缓解或部分缓解,其中6例头痛消失,2例存在轻度头痛.1例症状无明显改善,1例病稃较长的患者残留语言功能障碍.所有患者腰椎穿刺脑脊液压力均恢复正常,未再发生血栓形成和新的神经功能症状.所有患者术中和术后均未发生与操作相关的颅内或全身出血并发症.结论 血管内介入治疗颅内静脉窦血栓是安全、有效的治疗手段.     

血管内介入治疗颅内静脉窦血栓形成

目的 探讨血管内介入方法治疗颅内静脉窦血栓形成的疗效和安全性.方法 对27例抗凝治疗无效的颅内静脉窦血栓形成患者行血管内介入治疗,其中19例行局部静脉窦溶栓及机械性破栓治疗,5例行局部静脉窦溶栓、机械性破栓及动脉溶栓治疗,3例行静脉窦支架置入术.结果 23例患者的症状、体征明显改善,其中头痛消失18例,视力改善12例;3例症状无改善,出院前22例患者测脑脊液压力正常,血管造影等检查证实21例患者静脉窦主干通畅,皮层静脉和深静脉恢复正常;3例部分再通,皮层静脉和深静脉部分代偿.结论 血管内介入治疗是颅内静脉窦血栓形成安全、有效的治疗手段.     

颅内静脉窦血栓形成的个体化介入治疗

目的 探讨个体化介入治疗颅内静脉窦血栓形成(CVST)的疗效和安全性.方法 对12例临床抗凝治疗无效的CVST患者根据发病的严重程度及病程特点行个体化介入治疗.以患者临床症状及体征、脑脊液压力及脑动静脉循环时间为疗效观察和随访指标.12例患者均接受经静脉插管接触性溶栓联合机械性碎栓治疗,其中3例在接受经静脉途径溶栓后又接受了经动脉溶栓.术后继续抗凝治疗6个月;随访12～24个月,平均(18±4)个月.结果 术后,12例患者中2例仍存在轻度头痛,但较治疗前明显减轻.1例遗留轻度偏瘫,3例遗留复视或视物模糊,腰椎穿刺脑脊液压力从术前的28～38 cm H2O(1 cm H2O=0.098 kPa),平均(32.4±3.0)cm H2O,均降至26 cm H2O以下,脑血管造影显示脑动静脉循环时间从术前的11～20 s恢复至10 s以内,未再发生血栓形成和新的神经功能缺失症状.除1例患者出现股静脉穿刺部位皮下渗血外,其余患者均未发生与操作相关的颅内或全身出血并发症.结论 个体化介入治疗颅内静脉窦血栓是安全、有效的治疗手段.     

Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report

We report what we believe to be the first case of restenosis of the sigmoid sinus after stenting, in a 42-year-old man with an arteriovenous malformation with progressive right hemiparesis secondary to venous hypertension. Angiography revealed severe stenosis of the left sigmoid sinus, which was dilated with a self-expandable stent. Six months after the procedure, however, the sinus was again severely stenosed. Intravascular sonography revealed intimal proliferation in the stented sinus. It was dilated percutaneously, and the venous pressure decreased from 51 to 33 mmHg. On sonography, the intimal tissue decreased in thickness and the diameter of the stent enlarged a little.     

MR imaging of pituitary morphology in idiopathic intracranial hypertension

The aim of this study was to investigate the morphologic changes of the pituitary gland in patients with the clinical diagnosis of idiopathic intracranial hypertension (IIH). Qualitative and quantitative analyses of pituitary morphology were performed in normal subjects (n = 23), patients with the clinical diagnosis of IIH (n = 40), and patients with acute increased intracranial pressure (AICP; n = 37) caused by acute head trauma. The loss of pituitary height (concavity) on the sagittal T1-weighted image was classified into five categories: I = normal, II = superior concavity that was mild (<(1/3) the height of the sella), III = moderate (between (1/3) and (2/3) concavity of height of sella), IV = severe (>(2/3) concavity of height of sella), and V = empty sella. The area ratio of pituitary gland to sella turcica measured in the midsagittal plane was quantified. Clinical records were retrospectively reviewed to correlate with magnetic resonance (MR) findings. Using moderate concavity (>(1/3)) as the minimum criterion for abnormality, IIH patients had an 85% incidence of morphologic changes with 80% sensitivity and 92% specificity. Empty sella (almost complete concavity of the sella) was found in only 2.5% of patients with IIH. Quantitative analysis of the pituitary gland/sella turcica area ratio showed a significant decrease in patients with IIH (P < 0.0001) but no significant difference between the normal subjects and AICP patients. A posterior deviation of the pituitary stalk was seen in 43% of patients. No enlargement of the ventricles or sulcal effacement was seen in IIH patients. Routine brain MR examination of patients with IIH frequently shows morphologic changes of the pituitary gland ranging from various degrees of concavity to (rarely) the extreme case of an empty sella. The etiology is unknown and may be related to the severity and duration of elevated CSF pressure. Such findings may be useful to facilitate the diagnosis of IIH, particularly in patients with equivocal clinical findings or when IIH is not suspected. J. Magn. Reson. Imaging 2000;12:808-813.     

CTA/V detection of bilateral sigmoid sinus dehiscence and suspected idiopathic intracranial hypertension in unilateral pulsatile tinnitus

Purpose

This aimed to evaluate the prevalence and extent of bilateral sigmoid sinus dehiscence (SSD) and to explore the presence of idiopathic intracranial hypertension (IIH) in patients with unilateral pulsatile tinnitus (PT) with CTA/V.

Methods

Sixty PT patients (52 females; 40.4 ±?11.6 years [20–72]) who underwent CTA/V and 30 non-PT patients (27 females; 38.4 ±?14.7 years [12–62]) were enrolled in this study. The primary outcome measure was the radiographic presence of SSD. The index of transverse sinus stenosis (ITSS) was obtained by multiplying the stenosis scale values for each transverse sinus, and once was ≥?4, the presence of IIH was suspected.

Results

The prevalence and extent of SSD on symptomatic side (78%; maximum transverse diameter, MTD 0.49?±?0.23; maximum vertical diameter, MVD 0.50?±?0.26 cm) were significantly higher and larger than those on asymptomatic side (50%, P?<?0.001; MTD 0.35?±?0.18, P?= 0.006; MVD 0.30?±?0.15 cm, P?<?0.001) in the study group and those (20%, P?<?0.001; MTD 0.36?±?0.18, P?= 0.073; MVD 0.30?±?0.22 cm, P?<?0.048) in the control group. The presence of SSD showed significant correlation with both PT (logistic regression analysis, OR 4.167 [1.450–11.97]; P?=?0.008) and suspected IIH (OR 16.25 [1.893–139.5]; P?=?0.011).

Conclusion

In PT patients, SSD has a significant correlation with PT and a potential correlation with IIH.

     

颅内静脉窦血栓形成的MRI和MRV表现

目的探讨颅内静脉窦血栓形成的MRI和MRV（磁共振静脉成像）表现特点。方法回顾分析20例颅内静脉窦血栓形成患者的MRI和MRV表现。20例均行常规MRI,10例行MRI增强,15例行MRV检查（2DTOF）。结果20例常规MRI榆查中,12例静脉窦内正常流空效应消失,T1WI,T2WI和FLAIR静脉赛内见等、高或低信号,3例静脉宴内未见明屁异常信号但伴有腑组织水肿、出血、梗死及脑积水。5例海绵窦区T1WI见稍低或等信号,T2WI见高信号并可见强化．15例MRV见静脉窦高信号缺失、静脉窦粗细不规则、静脉窦内充盈缺损。结论MRI和MRV相互结合可有助于对顿内静咏窦血栓形成的早期作出正确诊断。     

Vascular hydraulics associated with idiopathic and secondary intracranial hypertension

BACKGROUND AND PURPOSE: The radiologic diagnosis of idiopathic intracranial hypertension (IIH) is one of exclusion, with no reproducible positive features described in the imaging literature. Because MR venography is prone to flow artifacts, diagnosis of secondary intracranial hypertension (SIH) can also be problematic. Vascular hydraulics can be useful for diagnosis of these conditions when measured by invasive or sonographic means. The purpose of this study was to measure vascular flow and pulsatility characteristics with a noninvasive MR imaging method. METHODS: Twelve patients with clinical and lumbar puncture findings of IIH or SIH and 12 control subjects were examined with MR venography and MR flow quantification studies of the cerebral arteries and veins. Total cerebral, superior sagittal sinus (SSS), and straight sinus blood flows were measured. Pulsatility indices from the arterial and venous flow for all patients were compared using the Student t test. RESULTS: MR venography confirmed that seven of the 12 patients had venous outflow obstruction, and thus, SIH. The remaining five patients had IIH. All patients showed reduced sinus pulsatility compared with that of the control group; reductions of 42% in the SSS and 32% in the straight sinus were noted (P =.0001 and.005, respectively). In the IIH group, total blood flow was 46% higher than that in the control group (P =.0002), and SSS flow was normal. In the SIH group, total blood flow was normal; however, SSS flow was reduced by 25% (P =.003). CONCLUSION: Reduced venous sinus pulsatility is a marker of intracranial hypertension secondary to raised venous sinus pressure. When suspicion of IIH or SIH exists and the MR venogram is difficult to interpret, raised total blood flow indicates IIH, whereas reduced SSS flow indicates SIH.