脑深静脉血栓形成:病例系列研究

Deep cerebral vein thrombosis:a case series study

目的探讨脑深静脉血栓形成(deep cerebral vein thrombosis,DCVT)的临床和影像学特点。方法回顾性纳入南京鼓楼医院2006年12月至2019年12月经影像学确诊的DCVT住院病例,分析患者的临床表现、影像学检查、治疗及转归。结果共纳入11例DCVT患者,男性7例,女性4例,平均发病年龄41.6岁。最常见的临床表现为急性或亚急性起病的头痛(11/11,100%)、意识障碍(5/11,45.5%)和癫痫发作(4/11,36.4%)。11例患者均累及直窦,9例累及大脑大静脉,5例累及大脑内静脉,1例累及基底静脉。所有患者均合并其他静脉窦血栓,3例合并皮质浅静脉血栓形成。8例(72.3%)早期CT平扫(发病1周内)可显示大脑大静脉高密度点征或直窦条索征。头颅MRI显示90.9%(10/11)的患者出现脑实质损害,以丘脑受累(5/11,45.5%)最常见,其次为深部白质(4/11,36.4%)。1例患者接受尿激酶介入溶栓治疗,发病第6天死亡。其余10例接受抗凝治疗后好转,随访4个月至13年显示,4例遗留轻至中度残疾(改良Rankin量表评分1~3分),6例恢复正常。结论头痛、意识障碍和癫痫发作是DCVT的常见临床表现,影像学检查显示丘脑或深部白质受累时需警惕DCVT的可能。需重视早期CT平扫显示的高信号血栓点征和条索征。合并皮质静脉血栓形成的DCVT患者急性期进展迅猛,转归较差。

Objective To investigate the clinical and imaging characteristics of deep cerebral vein thrombosis(DCVT).Methods From December 2006 to December 2019,patients with DCVT admitted to Nanjing Drum Tower Hospital were enrolled retrospectively.The clinical manifestations,imaging examinations,treatment and prognosis of the patients were analyzed.Results A total of 11 patients with DCVT were enrolled in the study,including 4 females and 7 males.Their average age of onset was 41.6 years.Their most common clinical manifestations were acute or subacute onset headache(11/11,100%),disturbance of consciousness(5/11,45.5%),and seizures(4/11,36.4%).All 11 patients involved straight sinus,9 involved the great cerebral vein,5 involved the internal cerebral vein,and 1 involved the basilar vein.All patients were complicated with other venous sinus thrombosis,and 3 were complicated with superficial cortical venous thrombosis.Early CT plain scan(within 1 week of onset)of 8 patients(72.3%)showed high-density point sign of great cerebral vein or cord sign of straight sinus.Head MRI showed that 90.9%(10/11)of patients had brain parenchymal damage,thalamic involvement(5/11,45.5%)was the most common,followed by deep white matter(4/11,36.4%).One patient received urokinase interventional thrombolysis and died on the 6th day of onset.The remaining 10 patients improved after receiving anticoagulant therapy.Follow up of 4 months to 13 years showed that 4 patients left with mild to moderate disability(the modified Rankin scale score 1-3),and 6 returned to normal.Conclusions Headache,disturbance of consciousness and seizures are common clinical manifestations of DCVT.Imaging examination shows that the possibility of DCVT should be warned when the thalamus or deep white matter is involved.It is necessary to pay attention to the high-density thrombus spot sign and cord sign on early CT plain scan.DCVT patients with cortical venous thrombosis progressed rapidly in the acute phase,and the outcomes were poor.