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。     

脑静脉窦血栓形成53例诊治分析

目的 分析脑静脉窦血栓形成(CVST)的临床特征、诊断方法及疗效.方法 回顾性分析2003年8月至2008年5月北京天坛医院住院的53例CVST患者的发病年龄、发病形式、临床表现、影像学特征及治疗预后情况.结果 本组患者男22例,女31例;年龄(15～52)岁,平均(34.92±9.69)岁.多数为急性、亚急性起病.主要临床表现为头痛,伴有呕吐,视物不清,复视,抽搐,肢体活动障碍或意识障碍等.影像学表现为静脉窦闭塞及局灶性梗死灶,部分伴发渗血或血肿.治疗以脱水降颅压、抗凝治疗为主,根据情况可联合溶栓治疗或支架置入治疗.痊愈12例,好转37例,无效2例,脑疝形成自动出院2例.结论 认识CVST的临床特征并及时行MRV检查是正确诊断和及早治疗的关键,CVST的治疗以抗凝治疗为基础,根据情况可联合溶栓治疗或支架置入治疗.     

Neurological recovery after coma related to diffuse cerebral venous sinus thrombosis. Interest in thrombi-aspiration with Penumbra system

We report a young man with a history of deep coma secondary to an extensive superior sagittal sinus thrombosis despite full systemic anticoagulation. Endovascular treatment combining a 5 Max ACE reperfusion catheter (Penumbra) and Solitaire (Covidien) retrieval device permitted revascularization of the superior sagittal sinus with restoration of anterograde venous flow. This treatment led to the disappearance of cytotoxic edema on MRI and to a neurological improvement with a modified Rankin scale score of 2 after two months. Our experience shows that this technique provides a useful and safe tool after failure of anticoagulation in cerebral venous sinus thrombosis.     

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。     

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.

     

围产期颅内静脉窦血栓形成的临床与影像分析

目的 探讨围产期颅内静脉窦血栓形成的发病机制、临床表现、影像学特点及治疗。方法 回顾分析24例围产期颅内静脉窦血栓形成患者的临床与影像学资料。结果 围产期颅内静脉窦血栓形成患者多以急性或亚急性高颅压症状为主，以上矢状窦血栓形成多见。结论 对于围产期女性，不明原因出现颅内压增高、局限性神经症状、癫痫发作、突然意识障碍的患者，须行头颅MRI＋MRV检查。     

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。     

Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience

Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0–2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder.     

Successful treatment of cerebral venous sinus thrombosis by balloon venoplasty: a case report

Cerebral venous sinus thrombosis is a special cerebrovascular disease affecting young adult and middle-aged people. The clinical manifestations of cerebral venous sinus thrombosis are diverse and nonspecific; thus, imaging plays an important role in early diagnosis. Anticoagulation with heparin is the preferred treatment for cerebral venous sinus thrombosis. Endovascular treatment is also being increasingly used to achieve recanalization of the cerebral venous sinus. We herein describe a woman in her early 50s who was diagnosed with cerebral venous sinus thrombosis for which anticoagulation with heparin was ineffective. To improve her symptoms and prognosis, we selected balloon venoplasty to treat the right sigmoid sinus thrombosis. Her condition subsequently improved, and no recurrence was observed after several follow-ups.     

平扫静脉窦CT值对诊断急性脑静脉窦血栓的价值

目的探讨脑静脉窦平扫CT值对判断急性脑静脉窦血栓的参考价值。方法回顾性分析28例急性脑静脉窦血栓患者(病例组)CT及临床资料,并与对照组A(28例血红蛋白和红细胞压积正常者)及对照组B(28例血红蛋白和红细胞压积升高者)的颅脑CT平扫资料进行比较,分别测各组脑静脉窦CT值。将病例组分别与对照组A、B所测得静脉窦最高CT值进行比较,采用独立样本t检验。对病例组及对照组B最高CT值行ROC曲线分析,统计三组静脉窦CT值的差异。结果病例组CT平扫静脉窦最高CT值范围62~86 HU,平均(76.21±5.90)HU;对照组A静脉窦最高CT值范围37~56 HU,平均(44.14±3.99)HU;对照组B静脉窦最高CT值范围51~69 HU,平均(62.61±4.71)HU。病例组与对照组A静脉窦最高CT值有极显著性差异(t=9.740、P0.001);病例组与对照组B静脉窦最高CT值也有极显著性差异(t=24.400、P0.001)。病例组病变区静脉窦的平扫CT值明显较非发病人群高,即使是血红蛋白升高的人群其静脉窦CT值也低于急性静脉窦血栓病例的水平。ROC分析结果当静脉窦CT值为68.50 HU时,诊断急性静脉窦血栓的曲线下面积0.966,敏感度为92.9%,特异度96.4%。按此CT值可有效初步筛除急性静脉窦血栓的患者。结论采用静脉窦平扫CT值用于初步判断急性脑静脉窦血栓具有一定参考价值,当静脉窦最高CT值超过68.5 HU时,应积极排查静脉窦血栓的可能。     

以孤立性头痛为主要表现的颅内静脉窦血栓1例并文献复习

目的 探讨本病的病因、临床表现、影像学特征、治疗方法.方法 回顾性分析1例以反复孤立性头痛为主要表现的颅内静脉窦血栓病例,并复习相关文献.结果 患者男性,28岁,主因头痛10天,加重4天入院.头部MRI平扫+增强提示左侧乙状窦及横窦充盈缺损,T1及Flair呈高信号.数字减影血管造影证实为左侧横窦、乙状窦血栓.经抗感染...     

机械性碎栓联合接触性溶栓治疗颅内静脉窦血栓的护理

颅内静脉窦血栓形成发病率低,容易误诊或漏诊,增加该病的致残率和致死率,文献报道死亡率达6％～15％[1].早期诊断,迅速疏通闭塞的静脉窦有助于减少该病的并发症,降低致残率和致死率.2005年2月～2010年6月我科运用机械性碎栓联合接触性溶栓治疗颅内静脉窦血栓形成(CVST) 12例,取得较好的临床疗效,现将护理体会报告如下.     

16层螺旋CT静脉血管成像对脑静脉窦血栓形成诊断价值的初步探讨

目的 探讨16层螺旋CT静脉血管成像对脑静脉窦血栓形成的诊断价值.方法 回顾分析6例诊断为脑静脉窦血栓病例的16层螺旋CT表现特点.结果 2例可见高密度索条征,2例可见脑组织水肿、局灶性静脉性梗塞,2例脑室扩大,1例脑室缩小,1例脑血循环时间延长.6例均可见Delta征,CT静脉血管成像三维重建均可见静脉窦内充盈缺损.结论 16层螺旋CT静脉血管成像是诊断脑静脉窦血栓形成的可靠、有效的检查方法.     

脑静脉窦血栓合并脑实质损害的MRI影像学特征

目的探讨MRI在脑静脉窦血栓（cerebralvenoussinusthrombosis,CVST）合并脑实质损害的诊断和评价中的作用。方法回顾性分析北京大学深圳医院2003年5月-2010年8月期间收治的38例CVST患者的相关临床资料及影像学资料。全部病例经临床资料及随访证实,所有病例均作常规MRI的T1WI、T2WI序列及MRV．MRV采用三维对比增强法,分析、探讨脑静脉窦血栓合并脑实质损害的MRI表现。结果本组38例经MRI及MRV检查均提示颅内静脉窦血栓存在,14例患者并发脑实质损害,其中脑梗塞9例,脑出血5例。结论MRI可显示脑静脉窦血栓直接征象．同时能较好的显示脑梗塞、脑出血、脑水肿等并发症,综合应用常规T。wI、’r2wI序列及MRV可无创诊断CVST,同时为CVST的病情评估提供重要信息。     

Optic neuropathy,a warning for cerebral venous sinus thrombosis and underlying dural arteriovenous fistulae

Cerebral venous sinus thrombosis (CVST) typically presents as headache, papilledema, and seizures. A dural arteriovenous fistula (DAVF) is a rare intracranial vascular malformation, and common symptoms include headache, pulsatile tinnitus, and stroke. The occurrence of CVST as a complication of DAVF is infrequent. Moreover, optic neuropathy presenting as the initial symptom of CVST and secondary DAVF is also unusual. We present a case of a patient with optic neuropathy and persistent intracranial hypertension who underwent head magnetic resonance imaging, which indicated CVST. She received normative anticoagulant and dehydration therapy; however, a repeated lumbar puncture showed dramatically increased intracranial pressure. Further digital subtraction angiography revealed an intracranial DAVF. The patient was finally diagnosed with a DAVF and secondary CVST. This case indicates that intractable optic neuropathy could be an uncommon indicator for CVST and secondary DAVF. Early diagnosis and early treatment are essential for visual rehabilitation and prognosis improvement.     

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。     

脑静脉窦及脑静脉血栓CT平扫表现及影像学诊断策略

目的：分析脑静脉窦/脑静脉血栓形成（CVST/CVT）CT平扫的影像学表现特征，以便提高CT平扫对CVST/CVT的早期认识，优化诊断方法，减少误诊。材料与方法：搜集拟诊为CVST/CVT病例25例的平扫及部分增强病例，经与MR与DSA等对照。重点回顾会诊前后血栓本身的CT平扫的直接征象及间接征象并进行对照，比较两者的结果。结果：CT平扫初诊血栓的直接征象的阳性率为13/25，阴性率为12/25，其中假阳性3例，假阴性8例。会诊后血栓阳性征象为21/25，阴性率为4/25，经统计学分析两者差别有显著性。而脑实质改变，会诊前检查的阳性率为20/25，阴性为5/20，而会诊后影像学阳性率为21/25，阴性为4/25，经统计学分析两者的差别无显著性。同时分析了CT平扫误诊原因及正确进行影像学检查的策略。结论：CVST/CVT CT初次平扫，大多都有血栓的直接征象及间接征象，正确认识这些征象，可以提示CVST/CVT的存在，并推荐立即行CTV检查来证实CT平扫的初步意见。     

妊娠和产褥期脑静脉窦栓塞的诊断与治疗

脑静脉窦栓塞在年轻女性中是比较少见的疾病,然而,在妊娠和产褥期,脑静脉窦血栓形成的发病率增加。脑静脉窦血栓形成、局部缺血性卒中/颅内出血的发病和死亡的频率和危险增加。本文将讨论妊娠和产褥期脑静脉窦血栓形成的诊断与治疗。     

脑静脉窦血栓形成的影像学特征分析

目的探讨脑静脉窦血栓(CVST)形成的电子计算机断层扫描(CT)及磁共振成像(MRI)表现特征。 方法回顾性分析2014年11月至2018年3月,江苏省丰县人民医院神经内科收治的14例CVST患者的临床及影像学资料。所有患者均行CT及MRI平扫,3例行MRI增强扫描,5例行磁共振静脉血管成像(MRV),2例行磁共振动脉血管成像(MRA)。观察CVST累及区域范围及周围情况、平扫密度或信号特征及颅内伴发病变等。 结果全部患者均累及2个以上静脉窦,7例患者CT平扫见受累静脉窦明显高密度,MR平扫10例患者可见受累静脉窦T1WI明显高信号或混杂信号,T2WI及FLAIR均可见受累静脉窦高信号。3例行MRI增强扫描患者中,受累及静脉窦呈完全强化2例,部分性强化1例。CT及MRI提示左颞叶出血性梗死1例,矢状窦旁占位2例,丘脑出血性梗死1例,皮层蛛网膜下腔出血2例。MRV均可见受累静脉窦显影不规则、狭窄或完全不显影及侧支代偿血管形成。 结论MRI平扫可显示CVST的特征,CT平扫部分患者显示CVST的特征,CT及MRI平扫均可显示CVST的颅内伴发病变。识别CVST的静脉窦CT及MRI平扫特征及可能的颅内继发病变影像学表现,并结合MRV检查有助于准确诊断。