颅内静脉窦血栓形成眼科误诊分析与影像学检查

Misdiagnosis Analysis in Ophthalmology Department and MRI Characteristics of Cranial Venous Sinus Thrombosis

目的探讨眼科临床工作中颅内静脉窦血栓(CVST)患者的临床及磁共振成像(MRI)特点。方法回顾性分析21例眼科误诊的CVST患者的临床资料与MRI影像特点。结果本组以头痛为首发症状者4例,头痛伴视物模糊4例,一过性黑朦2例,视力下降9例,视物变形1例,眼前黑影飘动1例。本组21例眼底检查均表现为视盘水肿。其中首诊时17例分别误诊为视神经乳头炎、视盘血管炎、视神经网膜炎、屈光不正、弱视、缺血性视神经病变和视盘玻璃膜疣。4例没有明确诊断。MRI检查:急性期2例表现T1加权像等信号和T2加权像低信号,亚急性期3例,T1、T2加权像均为高信号。慢性期16例表现T1加权像上出现高或等信号,T2加权像上出现不一致的信号。结论对CVST的眼科临床特征和MRI认识的深入是眼科临床工作中CVST在早期确诊的重要因素。

Objective To analyze the MRI character and misdiagnosed causes of cranial venous sinus thrombosis in ophthalmologic clinical practice. Methods The clinical data and the magnetic resonance imaging （MRI） characteristics of 21 patients with cranial venous sinus thrombosis were analyzed retrospectively. Results The initial clinical manifestations in this series mainly included headache in 4 cases, blurred vision in 6 cases, headache companied with blurred vision in 4 cases, transient black dim in 2 cases, vision descend in 9 cases, dysmorphopsia in 1 case and shadow float front of eyes in 1 case. Ocular fundus examination of the 21 cases all showed papilloedema. Among the 21 cases,17 were misdiagnosed as papillitis, optic disc vasculitis,neuroretinitis, ametropia/amblyopia,ischemic optic neuropathy and drusen of the optic disc ,4 cases only diagnosed as papilloedema. MRI was performed within 1 weeks of onset, Isosignal on T1 - weighted sequence and low - intensity signal on T2 - weighted sequence in 2. MRI was performed within 2 weeks of onset. High - intensity signal on T1 - and T2 - weighted sequence in 3. MRI was performed over 2 weeks after onset. Isosignal on T1 - weighted sequence and heterogeneous - intensity signal on T2 -weighted sequence. Conclusion The main misdiagnosed cause of cranial venous sinus thrombosis in ophthalmologic clinical practice is that some ophthalmologists lack profound understanding on the ophthalmologic clinical features and MRI characteristics of the disease.