脑静脉窦血栓形成65例临床与影像学分析

Clinical presentation and neuroimaging characteristics in 65 patients with cerebral venous sinus thrombosis

目的探讨脑静脉窦血栓形成(CVST)的病因、临床表现及影像学特点。方法回顾性分析65例CVST患者的临床表现、头颅CT、MRI、磁共振静脉血管造影及数字减影血管造影(DSA)特点。结果本组65例CVST患者中,25例(38%)患者仅表现为单纯颅高压;头面部局部或全身感染者13例(20%);贫血4例(6%);服用避孕药史4例(6%);结缔组织及相关疾病4例(6%)(Behcet's病2例,系统性红斑狼疮2例),蛋白C缺乏2例(3%)。9例急性患者的头颅CT平扫发现,2例存在"稠密三角征",3例存在"条带征"。亚急性患者头颅MRI显示,静脉窦内主要为T1、T2高信号(33%,4/12)。MRI发现急性、亚急性及慢性患者静脉性脑梗死的比例分别为38%(3/8)、33%(4/12)及18%(6/33)。在行MRV检查的12例患者中,均发现静脉窦充盈缺损或中断(100%)。DSA检查发现66%(40/61)累及2个或2个以上静脉窦,11%(7/61)累及大脑浅(深)静脉。结论CVST病因复杂,起病形式多样,临床表现主要为颅高压等一些非特异性症状及体征;头颅CT及MRI分别对急性,亚急性CVST静脉窦内的血栓有较高的敏感性与特异性;MRV可快速、无创地诊断CVST。若以上检查仍不能明确诊断,应尽快行DSA检查,尤其是大脑浅(深)静脉血栓形成患者。

Objective To investigate the etiologies, clinical manifestation and neuroradiological characteristics of the cerebral venous sinus thrombosis patients. Methods Records of 65 adults patients admitted with an angiography and （or） MRI diagnosis of cerebral venous sinus thrombosis from 1980 to 2006 were reviewed. Results Sixty-five patients （34 male, 31female） aged 20 to 60 years were identified. Twenty-five patient （38%） had a clinical picture of isolated intracranial hypertension. Local or systemic infection were the cause in 13 cases （20%） ;Other causes included anemia in 4 （6%）,oral contraceptives in 4 （6%）,connective tissue and allied disorders in 4 （6%）, （Behcet＇s disease in 2,systemic lupus erythematosus in 2）, protein C deficiency in 2 （3%）. In 9 acute CVST patients, there were 2 ＂dense triangle sign＂ and 3 ＂cord sign＂ found by unenhanced CT. In the subacute phase, the thrombosis became hyperintense in T1 -and T2 -weighted spin- echo images （33%,4/12）. Venous infarction were found in 38%（3/8） of acute CVST, 33%（4/12） of subacute and 18% （6/33） of chronic CVST patients. MRV showed filling defect or lack of flow in the sinus in 100% （12/12）. In 65% cases （34/61）, thrombosis affected two sinuses or more . Cerebral superficial（and or deep） veins were involved in 13%. Condusions The cause and onset of CVST were variable. The clinical manifestation was associated with intracranial hypertension and nonspecific. CT is a simple and effective method of diagnosis acute CVST. MRI is sensitive and special to diagnosis subacute CVST. MRV can evaluate venous and sinus thrombosis fast and invasively. If CT, MRI and MRV can not make clear the diagnosis, the patients should gotten the DSA inspection,especially for cortex and deep venous thrombosis.