颅内静脉窦血栓形成(9例临床报道)

Cerebral Venous Thrombosis Report and Literature Review From 9 Cases

目的:探讨脑静脉血栓形成(CVT)的临床特点与影像学表现。方法:回顾性分析本院9例CVT的临床及影像学资料。结果:①临床表现:头痛(77%)、癫样抽搐(66%)、局灶性神经功能缺失(66%)、视乳头水肿(44%)、不同程度意识障碍(22%)。②影像学资料及治疗转归:1例头颅CT示弥漫性脑水肿,蛛网膜下隙出血合并多发出血性脑梗死,因颅内压持续增高,予外科手术行去骨板减压术,见大脑表面浅静脉怒张呈绳索状并多数点片状出血灶。8例行头颅MRI和MRV,显示直接征像8例、间接征像6例。其中2例同时行DSA,均显示多个静脉和静脉窦充盈缺损。静脉血栓部位:上矢状窦合并浅静脉血栓1例,上矢状窦合并侧窦及多处静脉受累7例,直窦血栓1例。7例行肝素抗凝等对症治疗、1例行血管内局部溶栓、1例行矢状窦手术取栓并抗凝治疗。症状缓解至痊愈7例,病死2例。结论:首诊时诊断不明确,可先作头颅CT,排除颅内非CVT性病变,临床已拟诊CVT时,应首选MRI+MRV,进行综合判断是目前诊断和随访CVT的最好方法,婴幼儿CVT常表现为癫发作起病,提示CVT是婴幼儿重要的未被识别的性发作原因之一。

Aim： To investigate the clinical characteristics and MR image manifestations of cerebral venous thrombosis （CVT）. Methods： 9 cases of CVT were retrieved. Results： The principal symptoms of 9 patients had headache（77%）, papilloedema（44%）, focal deficit（66%）, conscious disturbance（22%）and seizures（66%）. CT, MRI and MRV of neuroimaging findings included direct signs in 8 cases and indirect signs in 9 cases, two patients with DSA at the same time, discovered filling defect of veins and sinus, 1 case comfirmed by pathology. Superior sagittal sinus（SSS） thrombosis alone or together with other venous （sinus） more than the other lateral sinus. Conclusion： The MRI and MRV composite decisions to diagnose and follow up CVT are the best approach. The onset with epileptic seizure in baby and young children should rule out the CVT.