单纯大脑皮层静脉血栓形成2例及文献回顾分析

目的总结分析单纯大脑皮层静脉血栓形成(isolated cortical vein thrombosis,ICoVT)的病例特点。方法报道2例ICoVT病例,并回顾文献报道的47例同类病例,分析其病因、临床影像学特征以及治疗预后。结果 49例患者多为中青年,女性多见;多为急性或亚急性起病;临床表现主要为癫痫发作33例(67.3%)、局灶性神经功能缺损症状22例(44.8%)、头痛19例(38.8%),首发症状以癫痫发作最多(21例,42.8%),大多数不伴有意识障碍和颅内高压症状;影像学检查可有不同程度地显示皮层静脉血栓的直接征象和间接征象;大多数患者经抗凝治疗后预后良好。结论 ICoVT临床和影像表现变异较大,仔细分析影像资料以及多种影像检查手段相结合可以提高诊断的准确率,临床上充分重视并给予抗凝治疗。     

Temporal Profile of CT and T2*-Weighted Gradient-Echo MRI in a Patient with Unilateral Thalamostriate Vein Thrombosis

Deep cerebral venous system thrombosis (DCVST) is an uncommon variety of thrombosis that accounts for 11% of cases of cerebral venous thrombosis. Thalamostriate vein (TSV) thrombosis is further rare among patients with DCVST. Although patients with cerebral venous thrombosis commonly have characteristic neurological deficits including headache, deterioration of consciousness, and seizures, patients with DCVST do not necessarily show such symptoms. Therefore, diagnose of DCVST is sometimes difficult. Here we report a case of TSV thrombosis with a unilateral basal ganglion lesion presenting with right-sided hemiparesis. A 61-year-old Japanese female was referred to our hospital. On neurological examination, she had no headache but presented with right facial paresis with dysarthria. Her right hemiparesis was present in the upper and lower extremities. We repeatedly performed brain computed tomography (CT) and T2*-weighted conventional gradient-echo (GRE) magnetic resonance imaging, and conclusively diagnosed as left TSV thrombosis. We firstly report a case of unilateral DCVST associated with TSV thrombosis in which a temporal profile of CT and T2*-weighted GRE images was obtained. Although DCVST is a rare clinical entity, physicians should be aware that repeated radiological observations can be useful for the diagnosis and early medical treatment for DCVST.     

Anticoagulation therapy in cerebral sinovenous thrombosis and ulcerative colitis in children

We describe four pediatric patients with ulcerative colitis and cerebral sinovenous thrombosis and review the pediatric and adult literature on the treatment of sinovenous thrombosis. All of our patients had headache as the initial complaint with onset during an ulcerative colitis flare. Evaluation for hypercoagulable states revealed heterozygosity for prothrombin gene mutation and increased homocysteine level in one patient and mild elevation of anticardiolipin antibodies in two patients. Treatment in the acute period included thrombolysis, heparin, and low-molecular-weight heparin. Chronic therapy included warfarin, low-molecular-weight heparin, and aspirin. Peripheral vein thrombosis occurred in two patients while not on antiplatelet or anticoagulation therapy. Neurologic outcome was positive in this series without complications of therapy, suggesting that aggressive therapy should be considered. Although anticoagulation therapy of sinovenous thrombosis is controversial, particularly in the context of intestinal hemorrhage, it can be beneficial given the possibility of an ongoing hypercoagulable state.     

脑静脉及静脉窦血栓形成16例临床分析

目的：探讨脑静脉及静脉窦血栓形成（CVST）的病因及临床特点。方法：回顾性调查16例CVST患者的临床资料。结果：侧窦血栓（87.5%）和上矢状窦血栓形成（37.5%）最常见,70%患者有2个以上部位血栓形成。最常见的症状为头痛14例（87.5%）,其次为癫癎、偏瘫、嗜睡及反应迟钝等。头颅CT有14例（87.5%）发现特征性改变,为枕部近颅板下或后纵裂条索状高密度影。头颅MRI结合MRV阳性率为94%。结论：头痛是CVST患者最常见的主诉,CT可作为一种诊断CVST有效的初始检查,MRI结合MRV有诊断价值。     

Vernet's Syndrome Associated with Internal Jugular Vein Thrombosis

Our objective is to present a case of Vernet's syndrome (cranial nerve (CN) IX, X, and XI palsy) associated with cerebral venous thrombosis (CVT) in an internal jugular vein. The patient presented with acutely developed dysphagia. The weakness of the left sternocleidomastoid and trapezius muscles was observed. The initial magnetic resonance imaging and computed tomography (CT) with contrast enhancement showed contrast-filling defect in the left internal jugular vein inside the jugular foramen. The magnetic resonance venography with contrast enhancement revealed a partial filling defect in the left sigmoid sinus and total occlusion of the left internal jugular vein. Under the diagnosis of CVT associated with CN IX, X palsy, anticoagulation therapy with low-molecular-weighted heparin was initiated. Despite the continued anticoagulation therapy for 3 months, neither the burden of thrombosis in the left sigmoid sinus and internal jugular vein on neck CT nor dysphagia symptoms improved. Clinicians need to be aware of internal jugular venous thrombosis as one of the differential diagnoses in Vernet's syndrome in patients in a hypercoagulable state. Further reporting of similar cases is needed to confirm the association between CVT and Vernet's syndrome.     

Familial hyperhomocysteinemia-related cerebral venous sinus thrombosis and pulmonary embolism: a case report

Elevated plasma homocysteine levels are associated with an increased risk of deep vein thrombosis. Herein we report a case of familial hyperhomocysteinemia-related cerebral venous sinus thrombosis and pulmonary embolism in a 21-year-old man who presented with severe headache over bilateral frontal areas. Neurological examination revealed no evidence of focal neurological deficit. Chest CT showed pulmonary thromboembolism in bilateral basal lung fields and brain MRI disclosed right transverse and sigmoid venous sinus thrombosis. Routine immunological tests, coagulation factors and occult tumor screening were normal, as were vitamin B12 and folate levels. The DIC profile was negative, The only risk factor we were able to identify was an elevated serum homocysteine level, namely 46.23 microM/L. Hyperhomocysteinemia was also noted in the patient's asymptomatic elder brother (68.0 microM/L) and, to a lesser extent, in his parents (father 12.5 microM/L; mother 11.7 microM/L). In conclusion, the cause of cerebral venous thrombosis and pulmonary embolism in this young patient was most likely related to familial hyperhomocysteinemia, with the thromboembolic events precipitated by a preceding systemic infection. After anticoagulation therapy; the patient recovered completely without any residual neurological deficit.     

脑静脉(窦)血栓的影像学特点与血管内治疗

目的探讨脑静脉(窦)血栓的影像学特点和经血管内治疗的疗效。方法对139例以顽固性头痛、头闷和颅内出血为主要症状的患者,采用头部MR和脑血管造影检查确立诊断,并施行经颈内动脉、静脉窦内接触性溶栓或静脉窦内支架血管成形术并协同长期抗凝治疗。结果治疗前MR检查显示颅内出血和静脉(窦)内血栓形成;脑血管造影检查可见脑静脉明显扩张、瘀滞,脑动脉至静脉窦间的血液循环时间显著延长(>11s),尤其静脉期(>5s)。治疗后130例患者临床症状迅速改善,治疗有效率达93.5%(130/139);并发症发生率0.7%(1/139);病死率2.2%(3/139)。对92例患者随访3个月～7年,1例死亡,91例疗效稳定,无明显复发。结论脑静脉(窦)血栓形成的主要病理表现为静脉回流障碍和血流动力学改变,通过脑血管造影检查可确定诊断;连续应用纤溶药物和长期抗凝治疗可获显著效果。     

脑静脉及静脉窦血栓形成的临床特点与影像学分析

目的 探讨脑静脉及静脉窦血栓形成（CVT）的临床表现、影像学特征以及诊断治疗方法。方法 回顾性分析52例CVT病例的临床特点及脑脊液、影像学特征,并结合文献复习其诊断治疗方法。结果 此病可见于各个年龄段,以中青年女性稍多,妊娠、感染、免疫性疾病等为常见病因,部分病例病因不明。以头痛为首发症状者多见（82.7％）,其次为癫发作（3.85%）或其他局灶性神经功能缺损（13.5%）。腰椎穿刺检查多数病例压力升高（86.7%）,脑脊液蛋白和白细胞数正常或轻度升高。典型病例颅脑CT可见到血栓局部条索状高密度影或伴有出血和水肿。MRI平扫可见病变静脉窦异常血栓信号。MRV和DSA可见病变静脉窦显影不良或不显影。经抗凝、降低颅内压等对症治疗,部分病例行溶栓治疗后,多数病例病情好转(86.5%),少数病例病情恶化(5.7%)。结论 中青年患者表现为头痛、呕吐、伴或不伴局灶性神经功能缺损,腰椎穿刺检查提示颅内压升高时应高度警惕CVT可能。围产期女性为高危人群。疑似病例应尽早行颅脑CT和MRI检查以明确诊断,DSA是CVT诊断的金标准并可指导溶栓路径。治疗上早期应用抗栓治疗,严重病例经动脉或静脉行局部溶栓治疗可以缓解临床症状,改善预后。此外还应根据病因进行针对性治疗。     

11例颅内静脉血栓形成的临床诊断及治疗转归分析

目的 总结分析颅内静脉血栓形成的临床表现、影像学特征及治疗方法,为该疾病的诊断和治疗提供参考. 方法 对自2002年至2007年湘雅医院神经内科收治的11例颅内静脉血栓形成患者的临床表现、实验室资料、影像学特征、治疗经过及预后进行回顾性分析. 结果 10例患者临床表现为非特异性的头痛,其次为呕吐、肢体偏瘫、脑膜刺激征、抽搐等.确诊前有2例曾分别诊断为脑出血、蛛网膜下腔出血.11例患者均行头颅CT和(或)MRI,8例行MRV检查,1例行DSA,明确诊断为静脉血栓形成者10例.所有患者均行降颅压治疗,10例患者进行抗凝/抗血小板治疗,9例好转,1例加重,1例死亡. 结论 颅内静脉血栓形成l临床表现缺乏特异性,误诊率高,确诊有赖于影像学检查,早期抗凝治疗是一种安全有效的方法.     

外伤性脑静脉窦血栓形成

目的 探讨外伤性颅内静脉窦血栓形成（CVST）的特点及治疗策略。方法 对11例外伤所致CVST的诊断、治疗进行回顾性分析。结果 11例CVST患者4例继发于颅骨未骨折的闭合性脑损伤，7例继发于颅骨线形骨折；以头部胀痛、视力下降、癫痫发作为其主要临床表现；头颅MRI及MRV和脑血管造影检查为该病提供确诊依据；11例患者中4例行抗凝治疗，7例行血管内治疗；治疗后6例患者痊愈，4例好转，1例无效，无严重并发症发生。本组中9例病人接受门诊和电话随访6个月至3年，疗效稳定，无一例复发。结论 颅脑损伤后不明原因颅内压增高，尤其是并发颅骨骨折时，应警惕CVST发生，尽早行神经影像学检查以明确诊断，血管内治疗协同抗凝治疗可提高其疗效。     

硬脑膜静脉窦血栓形成的血管内介入治疗

目的 探讨硬脑膜静脉窦血栓形成(DVST)的血管内介入治疗。方法 11例由CT、MRI、DSA确诊的硬脑膜静脉窦血栓形成患者经皮股动、静脉穿刺给予介入治疗；围手术期规范抗凝、抗血小板聚集等综合治疗。结果 2例患者临床症状戏剧性改善，10例患者临床症状消失或好转，1例无变化；术后影像学均有不同程度的改善；1例机械辅助溶栓患者介入治疗时发生导丝断裂；1例机械辅助溶栓后置人支架未成功；术中、术后无其它相关并发症发生。出院时临床痊愈5例，显效3例，好转2例，无效1例。随访9例患者3～6月无复发。结论 多种介入方法联合治疗DVST的方法是可行的且安全有效。是值得在临床推广的治疗DVST的方法，其远期效果尚需观察。     

Thrombosis of deep cerebral veins in form adults: clinical features and diagnostic approach

Thrombosis of deep cerebral veins is a rare condition, and is associated with a poor prognosis. We report four new cases observed between 1994 and 1997. All four cases were women, aged less than 45 years. Initial symptoms associated alteration of consciousness, change in mental status, progressive headache and vomiting. We observed also uni or bilateral signs of long tract injury. In three cases, diagnosis initially suspected by CT scan was confirmed with encephalic MRI. For the last patient, conventional angiography was needed. Thrombosis affected straight sinus, vein of Galien and internal cerebral veins in all patients. Basilar veins were also affected in one patient, without dural sinuses extension. Lateral sinus was involved in two others cases, and superior sagittal in the last patient. Etiology remains undetermined in one patient, associated with post-partum, use of oral contraceptive pill, and familial protein S deficiency, one case each. Outcome was favorable in all four cases with anticoagulation therapy. Precocity of diagnosis is determinant and MRI is usefull in this issue. These observations show that evolution of deep veins thrombosis can be favorable, without needing fibrinolytic therapy.     

脑静脉窦血管内治疗脑静脉窦血栓形成临床研究

目的对比静脉肝素抗凝与脑介入治疗脑静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析我院14例脑静脉窦血栓患者,按治疗方法分为介入组(脑静脉窦血管内治疗)和抗凝组(静脉肝素抗凝),每组7例,比较2组平均住院时间、血管完全再通率、mRS及并发症发生率。结果脑静脉窦介入组住院时间较抗凝组短,血管完全再通率高于抗凝组,mRS平均评分低于抗凝组,差异均有统计学意义(P0.05)。2组并发症发生率无显著差异(P0.05)。结论脑静脉窦血管内治疗可改善CVST患者的转归,疗效优于静脉肝素溶栓保守治疗。     

Cerebral venous thrombosis in COVID-19-associated coagulopathy: A case report

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China in December 2019, and is ongoing pandemic. While a majority of patients with SARS-CoV-2 infection shows asymptomatic or mild disease, hospitalized patients can develop critical condition, such as pneumonia, sepsis, and respiratory failure. Some cases deteriorate into sever systemic disease and multiorgan failure. Many patients of severe COVID-19 show hypercoagulable state and complicate with venous thromboembolism and atrial thrombosis. We herein reported a case of COVID-19 who developed cerebral venous thrombosis (CVT) co-incidence with pulmonary thromboembolism (PTE). A 56-year-old Japanese man was presented with fever and malaise and diagnosed with COVID-19. He was treated with ciclesonide and azithromycin, but his respiratory condition deteriorated. Thus, systemic corticosteroids and favipiravir were initiated and these treatments resulted in afebrile state, improving malaise and respiratory failure. However, he suddenly developed severe headache and vomiting with increased concentration of D-dimer. Brain CT and MRI showed typical images of CVT in the left transvers sinus and CT pulmonary angiography showed PE. Administration of unfractionated heparin followed by edoxaban treatment reduced the levels of D-dimer and improved his clinical presentation and thrombosis. Monitoring coagulopathy is important in COVID-19 patients and in case of venous thromboembolism, including cerebral venous system, appropriate anticoagulant therapy should be initiated.     

颅内静脉系统血栓形成的临床和影像学分析

目的探讨颅内静脉系统血栓形成的临床和影像学表现以及治疗和预后,为该病的临床诊断和治疗提供依据。方法选取我院就诊的颅内静脉和静脉窦血栓形成患者71例,收集人口学资料、临床症状和体征、影像学表现、生化等实验室检查、病因,以及治疗方案和预后,并进行统计学分析。结果 71例患者中,常见的临床表现为颅高压症状(头痛、恶心、呕吐)、癫痫、视物模糊或视力下降等。D-二聚体升高67例(94.4%)。横窦血栓形成34例(47.9%),乙状窦血栓形成25例(35.2%),上矢状窦血栓形成44例(62.0%),深部脑静脉血栓形成(直窦或Galen静脉)9例(12.7%),同时累及2个或以上静脉窦者52例(73.2%)。结论 CVST的临床表现缺乏特异性,临床上对于头部CT未见明显异常的不明原因的头痛患者、产褥期或口服避孕药或合并自身免疫性疾病的女性头痛患者,需考虑CVST可能性,并积极行影像学检查,早期识别,早期诊断。     

产褥期颅内静脉系统血栓形成临床分析

目的 探讨产褥期颅内静脉血栓形成的发病机制、临床表现及治疗对策。方法 回顾性分析2000年1月～2011年12月收治的46例产后颅内静脉血栓形成患者的临床资料,并进行归纳总结。结果 产后颅内静脉血栓形成患者以高颅内压及局灶性脑损伤为主要临床表现,经低分子肝素抗凝及对症治疗,患者症状均有改善。结论 对于存在静脉血栓形成风险的产褥期女性,应尽快完成相关检查,早诊断、早治疗,以期改善患者预后。     

成人缺铁性贫血合并脑静脉血栓形成的临床特点及诊治

目的 探讨成人缺铁性贫血合并脑静脉血栓形成的临床特点及诊治。方法 对成人缺铁性贫血合并脑静脉血栓形成的临床特点及诊治进行回顾分析,并复习相关文献。结果 本研究报道的4例缺铁性贫血合并脑静脉血栓形成的患者均为女性,年龄33～47岁,缺铁性贫血的原因均为月经过多,其中1位33岁女性同时合并节食。4例患者否认肿瘤、凝血异常、自身免疫病、甲状腺功能异常病史,否认近期服用避孕药物、近期胃肠手术史及相关家族史等,筛查肿瘤、凝血功能、自身免疫、甲状腺功能等检查未见异常。4例患者均补铁治疗,2例患者经抗凝治疗后症状缓解,1例患者行支架治疗,1例患者经抗凝治疗后视力下降无缓解,予静脉支架置入术后症状未再进展。4例患者经补铁,抗凝或支架治疗后除1例抗凝治疗效果不佳未及时行支架术的患者预后差外,余3例均预后良好,未遗留神经系统症状。结论 缺铁性贫血为脑静脉血栓形成的可能原因之一,对于缺铁性性贫血患者,特别是女性患者如出现头痛,视物模糊等症状时,需注意并发脑静脉血栓形成的可能,如果能早期诊断,积极治疗,预后良好     

颅内静脉窦血栓形成13例

目的探讨颅内静脉窦血栓形成(CVST)的临床特点与治疗方法。方法分析13例CVST患者的临床、影像学特征及治疗方法。结果 13例多为中青年患者,临床表现头痛12例(92.3%),癫痫发作8例(61.5%)。11例腰穿显示脑脊液压力增高。头颅CT显示脑静脉窦异常5/13例(38.5%);MRI显示脑静脉窦异常7/13例(53.8%);MRV显示脑静脉窦异常7/12例(58.3%);DSA显示脑静脉窦异常6/6例(100%)。患者均应用脱水和抗凝治疗,部分予溶栓治疗,13例中5例基本痊愈,6例明显好转,2例遗留有不同程度的偏瘫、癫痫等症状。结论 CVST的临床特点是中青年人发生率高,以头痛、呕吐等颅高压症状为主要表现;MRI+MRV及DSA确诊率高;一旦确诊应及时予抗凝治疗,重症患者可行溶栓治疗。     

脑静脉窦血栓形成的临床与治疗

目的:探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的临床特征、影像特点及治疗。方法:分析34例脑静脉窦血栓形成病因、临床表现、影像特征及治疗。结果:本组病因依次为产褥期(58.8%)、感染(23.5%)、脱水(2.9%)、血液病(2.9%)、外伤(2.9%);头痛、恶心、呕吐为首发症状,查体视乳头水肿89.4%,癫痫发作44.1%,脑膜刺激征阳性35.3%,意识障碍26.5%,轻偏瘫5.9%,眼球突出伴活动障碍5.9%;头MRI、MRV均显示脑静脉窦血栓形成,2例行DSA检查发现双侧横窦血栓形成;本组在应用降颅压、抗感染等药物的同时,应用低分子肝素5000u,12小时一次,疗效显著,治愈25例(73.5%),好转3例,死亡6例。结论:产褥期、感染、脱水是CVST常见原因; CVST患者主要表现为高颅压症状;头MRI和MRV能清楚显示血栓形成部位;抗凝治疗是脑静脉窦血栓形成痊愈的关键。     

脑内静脉窦血栓形成三例报告及文献复习

目的 探讨脑内静脉窦血栓形成（CVST）的临床表现、诊断和治疗。方法 回顾性分析3例经影像学检查诊断为CVST的患者，均行抗凝治疗和脑室-腹腔分流，随访1～2年。结果 CVST主要症状为外伤、感染后头痛，颅内压增高，视力减退，精神症状；神经影像学表现为CT增强扫描后可见静脉窦内“空三角征”，MRI示静脉窦正常流空影的形态消失，出现长T2、短T1信号；MRV示静脉窦血流不连续或缺失，梗阻远端侧支循环血管建立或其他引流静脉异常扩张；3例患者经抗凝及脑室-腹腔分流后症状均有不同程度的缓解。结论 对临床急性起病的颅高压征，伴或不伴局灶性神经功能缺损病人，应高度怀疑CVST，及时行MRI及MRV或DSA检查，明确诊断，尽早治疗。抗凝和溶栓治疗为治疗CVST的首选治疗方法，对于经济有困难的CVST患者，行抗凝及脑室-腹腔分流短期内疗效满意，不失为一种治疗方法的选择。