脑静脉窦血栓形成的临床与影像学特点

Clinical and imaging features of cerebral venous sinus thrombosis

目的探讨脑静脉窦血栓形成的临床与影像学特点。方法回顾性分析28例脑静脉窦血栓形成患者的临床资料。结果男8例(28.6%),女20例(71.4%);急性起病18例(64.3%),亚急性起病8例(28.6%),慢性起病2例(7.1%)。首发症状表现为头痛伴恶心、呕吐22例,发热伴视物模糊3例,发热伴精神异常2例,癫痫发作1例。主要临床表现为意识与认知功能障碍16例(57.1%),大脑皮质刺激症状5例(17.9%),运动功能障碍3例(10.7%),眼部症状6例(21.4%)。白细胞增高6例,淋巴细胞增高2例;C反应蛋白升高3例,血沉升高2例;凝血酶原时间缩短2例,D-二聚体升高4例。颅内压升高11例;CSF生化和细胞学检查异常4例。头颅CT平扫示条带征13例,头颅MRI平扫示实三角征14例,增强示空三角征7例,头颅磁共振静脉成像与数字减影血管造影均见血栓部位血流消失。经抗凝治疗,痊愈23例,好转4例,死亡1例。结论脑静脉窦血栓女性多见,主要首发症状为头痛伴恶心、呕吐,主要临床表现为意识与认知功能障碍。神经影像学特点为直接征像及间接征像。

Objective To explore the clinical and imaging features of cerebral venous sinus thrombosis （CVST）. Methods Clinical data of 28 CVST patients were analyzed retrospectively. Results Eight patients （28.6%） were male, and 20 patients （71.4%） were female. Acute onset was in 18 cases （64.3%） , subacute onset in 8 cases （28.6%） , chronic onset in 2 cases （7.1%）. The first symptoms was headache accompanied with nausea and vomited in 22 cases, fever accompanied with blurred vision in 3 cases, fever accompanied with mental anomaly in 2 cases, seizure disorder in 1 case. The main manifestations were consciousness disorders and cognitive dysfunction in 16 cases （57.1%）, cerebral cortex stimulation symptom in 5 cases （ 17.9% ） , motor dysfunction in 3 cases （ 10. 7% ） , and eye symptom in 6 cases （21. 4%）. Leukocyte increased was in 6 cases, lymphoeytes increased in 2 cases; c-reactive protein was increased in 3 cases, erythrocyte sedimentation rate increased in 2 cases; prothrombin time was decreased in 2 cases, D-dimer increased in 4 cases. Hypertension intraeranial was in 11 cases. Abnormal biochemistry and cytological examination of CSF was in 4 cases. Brain CT plain scan showed strap and cord sign in 13 cases. Brain MRI plain scan showed hyperintense triangular sign in 14 cases; and enhanced MRI showed hypointense triangular in 7 cases. Magnetic resonance vengioaphy and digital subtraction angiography showed the disappearance of blood flow in the thromboembolic area. After anticoagulant therapy, recovered was in 23 eases, improved in 4 cases, and 1 case was died. Conclusion CVST is common in women. The main first symptoms are headache accompanied with nausea and vomited; the main manifestations are consciousness disorders and cognitive dysfunction. The imaging features are direct signs and indirect signs.