脑静脉血栓的影像学特点与临床处理

目的 :探讨脑静脉血栓的发病原因 ,影像学特点与评价临床和处理的效果。材料和方法 :32例以顽固性头痛、头闷和颅内出血为主要症状 ,采用脑MRI和DSA检查确立诊断 ,并施以降低血粘度 ,扩容和 2年抗凝治疗。结果 :MRI检查无明确的异常发现 ;但脑DSA表现明显的皮层静脉缺如 ,小静脉扩张和淤滞 ,脑动脉至静脉间的循环时间在静脉期显著延长达 11s以上。在应用纤溶药物和抗凝等治疗后 ,临床症状迅速改善 ;随访 6个月～ 4年 ,无明显复发。结论 :脑静脉血栓形成可能是以小静脉内的血流动力学梗塞为主要病理基础 ,通过脑DSA检查确定诊断 ;应用纤溶和抗凝治疗可获显著效果。

Imaging Features and Clinical Management of Cerebral Venous Thrombosis

Purpose: To investigate the imaging features and effects of clinical management in cerebral venous thrombosis. Materials and Methods: In 32 cases, the main symptoms of the patients were intractable headache, sense of oppression and hemorrhage. The diagnosis was confirmed by the MRI and DSA examination. The therapy were composed of the blood viscidity reduction with dextran, blood volume extending, fibrinolysis with urokinase, and anticoagulation with warfarin for two years. Results: There was no positive finding on MRI. The DSA showed the distinct dilatation and blood silt in venula,as well as the depletion in cortex vein. The circulating term from cerebral artery to vein sinus was remarkably prolonged for over 11 seconds. After using fibrinolysis and anticoagulation therapy,the clinical symptoms were improved rapidly. There was no evidence of recurrence in follow up of 6 months to 4 years. Conclusion: The main pathologic foundation of thrombus in cerebral vein is related with hemodynamic infarction in venula. DSA has been showed to be a good diagnostic method and the thrombolysis and anticoagulation therapy may have the good effects.