高度疑似胶质瘤的颅内静脉-静脉窦血栓形成临床实践与研究附1例报告并相关文献复习

Clinical Practice and Study of Cerebral Vein-Venous Sinus Thrombosis That Highly Resembles Cerebral Glioma

目的 总结高度疑似胶质瘤的颅内静脉 静脉窦血栓形成的临床实践和研究体会。方法 采用形态学检查和功能学研究相结合的原则 ,选择颅脑磁共振成像平扫和磁共振成像增强扫描后 ,对高度疑似脑胶质瘤的临床案例进行研究。在阐述背景资料基础上 ,着重就患者的临床表现和影像学特征进行临床诊断辨析 ,再有针对性地进行特殊的实验室检查 ,包括 :磁共振成像弥散加权成像、局部脑氟脱氧葡萄糖代谢显像、数字减影血管造影术 ,并在相应的康复措施 (包括抗炎、抗凝用药和高压氧、血液磁极化疗法等 )前后 ,就磁共振成像所见和脑循环动力学指标进行动态的对照观察。结果 治疗后 ,患者的意识、精神状态等恢复正常 ,脑循环动力学指标明显改善 ,原脑内的疑似病灶接近消失。明确诊断为 :①颅内静脉 静脉窦血栓形成 ;②全身性血栓性静脉炎。结论 以直窦为主及其引流静脉血栓形成的影像学表现可酷似脑胶质瘤样改变 ;熟悉有关本病的危险因素 ,并以科学的思维方法进行临床诊断辨析是避免贻误诊断的关键所在。

Objective To summarize the clinical practice and experie nce about the cerebral vein-venous sinus thrombosis that highly resemble s cerebra l glioma.Methods One case with suspected cerebral glioma by gener al and contract enhancement scanning of the magnetic resonance imaging (MRI) was selected for study. The clinic expression and imaging features includi ng the po sitron emission tomography (PET),the digital subtraction angiography (DSA) and the cerebrovascular dynamics index (CVDI) were analyzed. Around the mea sures of clinical rehabilitation, the MRI features and the CVDI of the patient were obser ved. Results The state of the consciousness and mental attitude were recovered after the therapy. The CVDI was improved distinctly; the origina l focuses in brain nearly disappeared. The clinical final diagnoses were: ① cerebral vein-venous sinus thrombosis; ② general thromboangi itis of the veins. Conclusion The thrombosis of the straight sinus and its d rain veins highly re-sembles the cerebral glioma in the imaging feature. A careful anglysis should be performed before correct diagnosis is made.