脑静脉血栓形成的临床与MRI表现

【目的】探讨脑静脉血栓形成(CVT)的临床与磁共振成像(MRI)特征。【方法】收集42例脑静脉血栓形成患者资料,详细分析其临床表现和MRI特征。【结果】90.5%的病人有头痛、呕吐等颅高压表现,50%的病人伴有局灶神经功能缺损如肢体无力、癫痫发作、视力下降等,21.4%的病人有精神异常,38.1%的病人仅表现为颅内压增高;MRI和磁共振静脉成像(MRV)能直接显示脑静脉闭塞及其血栓栓子。【结论】MRI和MRV对脑静脉血栓形成诊断起着重要作用。     

脑静脉窦血栓形成致肌张力障碍康复1 例报道

目的探讨脑静脉窦血栓形成所致肌张力障碍的临床特点及康复方法。方法报道1 例脑静脉窦血栓形成患者,并结合文献分析。结果和结论经过抗凝治疗,神经功能缺损症状主要表现为左侧肢体活动不灵伴变形性肌张力障碍,经过康复训练、背肌局部治疗肉毒素后运动功能改善。     

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: a Case Report

Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present the case of a man with CVT of the right transverse sinus who presented with a SAH in the right parietal sinus. In this case, we describe a hyper-homocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance of identifying possible causes that could be reversed with an appropriate treatment, and the controversy about the timing for starting anticoagulation therapy in such cases.     

Severe Subarachnoid Hemorrhage Associated with Cerebral Venous Thrombosis in Early Pregnancy: A Case Report

Background

Cerebral venous thrombosis (CVT) rarely induces subarachnoid hemorrhage (SAH). During late pregnancy and puerperium, CVT is an uncommon but important cause of stroke. However, severe SAH resulting from CVT is extremely rare during early pregnancy.

Objective

We report on a rare case of severe SAH due to CVT, and discuss the potential pitfalls of CVT diagnosis in early pregnancy.

Case Report

A 32-year-old pregnant woman (9th week of pregnancy) presented with slight head dullness. Initial magnetic resonance imaging (MRI) revealed focal, abnormal signal intensity in the left thalamus. Nine days later, the patient developed a generalized seizure and severe SAH was detected with computed tomography (CT) scan. MRI and cerebral angiography revealed a completely thrombosed superior sagittal sinus, vein of Galen, straight sinus, and right transverse sinus. Transvaginal sonography indicated a missed abortion. The day after admission, the patient presented again with a progressive loss of consciousness and signs of herniation. The patient underwent emergency decompressive craniotomy, followed by intrauterine curettage. Two months later, she made an excellent recovery except for a slight visual field defect.

Conclusions

A rare case of severe SAH due to CVT is reported, with emphasis on the potential pitfalls of CVT diagnosis in early pregnancy.     

产后颅内静脉窦血栓形成介入治疗1例报告并文献复习

目的：探讨产后颅内静脉窦血栓形成（CVST）的诊断与血管内碎栓治疗。方法：回顾总结产后CVST患者的诊疗资料,复习近期国内外相关文献。结果：对1例产后CVST患者进行血管内机械取栓及接触性溶栓治愈。随访3个月无复发。结论：产后CVST早期诊断极其重要,介入治疗可取得良好效果。     

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。     

12例脑深静脉血栓影像表现分析

目的探讨脑深静脉血栓（DCVT）的影像学表现及其诊断价值。方法回顾性分析12例临床诊断为DCVT的CT（12例）、MRI平扫（12例）、MR静脉成像（MRV,3D-时间飞跃法,8例）及数字减影血管造影（DSA,8例）表现,评估其直接征象（静脉异常）及间接征象（脑实质表现）,4例进行了MRI及MRV复查。结果CT表现为正常3例,深静脉“绳索征”9例,深静脉回流区（丘脑、基底节区及脑深部白质）梗塞3例。12例MRI显示脑深静脉血栓T1WI及T2WI呈等或高信号,深静脉回流区水肿、梗塞或出血性梗塞8例,8例MRV及8例DSA显示与MRI一致。4例MRI复查显示了深静脉的再通。结论CT平扫脑深静脉“绳索征”可以提示DCVT。MRI对DCVT的直接征象及间接征象均很敏感,结合MRV可以准确地作出DCVT的诊断。     

脑静脉血栓形成影像学诊断与误诊原因分析(附27例报告)

目的探讨计算机体层摄影(CT)、磁共振成像(MR)及数字减影血管造影术(DSA)对脑静脉血栓形成的诊断价值。方法 对我院2000～2010年经CT、MR、DSA和病理学诊断证实的27例脑静脉血栓形成临床资料进行回顾性分析。27例均行头部MRI检查,19例行MRV检查,21例行CT检查,15例行DSA检查。结果本组19例首次影像学检查确诊,8例误诊。误诊病例中7例行MRV或DSA检查确诊,1例死亡后尸检确诊。本组单纯脑深静脉血栓5例,单纯静脉窦血栓14例,脑深静脉血栓并静脉窦血栓8例。影像学直接征象为脑静脉内血栓,间接征象主要为水肿及静脉性梗死。结论 CT、MR及DSA检查对脑静脉血栓形成有一定诊断价值,需各检查结合,仔细分析鉴别,提高诊断率。     

头臂干血栓致脑栓塞1 例报道

目的讨论头臂干血栓致脑栓塞的临床特点及诊治策略。方法报道1 例头臂干血栓所致急性脑栓塞患者的临床表现、影像学特征及诊治方法。结果同时存在右侧前后脑循环区域多发急性脑梗死;胸主动脉超声提示头臂干处存在随心动周期活动的血栓团块;抗凝药物是其主要治疗方法。结论对急性右侧前后脑动脉循环多发脑梗死患者需积极进行胸主动脉超声检查以观察头臂干部位血管状况,对存在头臂干血栓者应立即采用抗凝治疗。     

痉挛型脑性瘫痪MRI研究

目的探讨颅脑MRI与脑瘫类型、患儿胎龄之间的关系。方法回顾性分析224例痉挛型脑瘫患儿的MRI检查和临床资料。结果224例患儿痉挛型偏瘫27例、双瘫149例、四肢瘫48例；MRI异常201例（89.7%），其中偏瘫、双瘫、四肢瘫的异常率分别为100%、87.2%和91.7%。痉挛型双瘫以脑室周围白质软化（PVL）最常见，发生率79.2%，其他类型脑损伤少见。痉挛型四肢瘫脑损伤多种多样，以PVL、足月儿类型脑损伤、先天发育畸形为主要表现，发生率分别为45.8%、20.8%和18.8%。足月儿痉挛型偏瘫以半侧损伤为主，临床表现为一侧肢体运动障碍，上肢重，下肢轻；未成熟儿痉挛型偏瘫表现为单侧或双侧PVL，临床表现为下肢重、上肢轻的偏瘫。152例PVL患儿中，发生于未成熟儿108例（71.1%）、足月儿44例（28.9%）。足月儿类型脑损伤22例，发生于足月儿20例（90.9%）。未成熟儿脑损伤类型主要为PVL，主要见于未成熟儿脑瘫，也可发生于足月儿脑瘫。足月儿类型脑损伤主要见于足月儿脑瘫，未成熟儿少见。结论颅脑MRI表现与脑瘫的类型、出生胎龄密切相关。     

An Unusual Case of Cerebral Venous Sinus Thrombosis in a Pediatric Patient

Background: Cerebral venous sinus thrombosis (CVST) is a rare, but potentially devastating illness. It is important for emergency physicians to be aware of the classic and most common risk factors leading to this illness, including genetic and acquired prothrombotic states, infection, inflammatory conditions, and certain drugs. Objectives: The objectives of this article are to discuss a case of CVST and describe the signs and symptoms of CVST as well as the radiologic modalities used to diagnose this disease. Finally, we will discuss the causes and risk factors that lead to this potentially devastating diagnosis. Case Report: An 11-year-old girl was found unconscious and without pulses in an apparent drug overdose. Emergency Medical Services responders and Emergency Department personnel resuscitated the patient to a return of spontaneous circulation. The patient was intubated and admitted to the intensive care unit. As part of an altered mental status work-up, a magnetic resonance imaging scan of the head was performed and showed a cerebral venous sinus thrombosis. This was thought to be due to the drug overdose and the low-flow state that occurred during loss of circulation. After anticoagulation therapy and antibiotic treatment for sinusitis, the patient had a full recovery. Conclusion: Rapid diagnosis of CVST was essential to the appropriate care of this patient. Being aware of signs, symptoms, and risk factors leading to CVST will assist the emergency physician in making this diagnosis.     

Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension

Background and Objective.— The occurrence of cerebral venous thrombosis has been reported among patients with spontaneous intracranial hypotension, but a causal relationship has not been clearly established. We reviewed our experience with spontaneous intracranial hypotension and cerebral venous thrombosis and we reviewed the relevant literature to evaluate the relationship between these 2 entities. Methods.— We reviewed the medical records and imaging studies of a consecutive group of patients with spontaneous intracranial hypotension evaluated at a tertiary care center between 1/1/2001 and 12/31/2007. The main search strategy was a systemic review of journal articles in MEDLINE (1966 to January 2008). Results.— Among 141 patients with spontaneous intracranial hypotension, 3 (2.1%) were also diagnosed with cerebral venous thrombosis. Among these 3 patients and the 17 reported in the literature there were 11 men and 9 women with a mean age of 39.5 years. Radiographic or clinical evidence for spontaneous intracranial hypotension preceding cerebral venous thrombosis was found in most patients, while there was no evidence for cerebral venous thrombosis preceding spontaneous intracranial hypotension in any patient. Eight (40%) of the 20 patients were found to have a change in their headache pattern believed to be due to the development of cerebral venous thrombosis. Complications of cerebral venous thrombosis, eg, cerebral venous infarction, occurred in 8 patients (40%). Conclusions.— Spontaneous intracranial hypotension is a risk factor for cerebral venous thrombosis, but cerebral venous thrombosis is found in only about 2% of patients with spontaneous intracranial hypotension. A change in headache pattern is not a reliable predictor of the development of cerebral venous thrombosis in patients with spontaneous intracranial hypotension.     

脑静脉及静脉窦血栓形成的预后研究

目的 考察脑静脉及静脉窦血栓形成（CVST）的远期预后，并探索与不良结局相关的预测因素。方法 本研究采用前瞻性登记的方法，对纳入的脑静脉及静脉窦血栓形成患者进行连续性随访。研究的初级终点指标是发病6个月时的死亡／残疾（改良Rakin评分〉2）。采用多因素logistic回归模型考察与预后独立相关的因素。结果 研究共纳入了52例脑静脉及静脉窦血栓形成患者。6个月复发率和病死率分别为13．5％和7．7％，6个月时的死亡／残疾率为29．9％。多因素logistc回归分析显示，伴有颅内实质病灶[OR=14．62．，95％CI（2．36，90．36）]，确诊延迟〉16天[OR=13．14，95％CI（1．90，90．84）]与CVST患者6个月的结局独立相关。结论 脑静脉及静脉窦血栓形成在我国仍是一种致死致残性疾病，远期预后较国外报道差，原因可能与本组患者确诊时间晚，延误了早期治疗有关。