颅内静脉窦血栓形成的危险因素及影像学表现

Risk factors and imaging features in patients with cerebral venous sinus thrombosis

目的分析颅内静脉窦血栓(CVST)形成的危险因素及影像学表现。方法回顾性纳入2016年2月至2020年12月安徽医科大学第一附属医院神经内科就诊的CVST病人,共入组95例病人,分析所有病人的起病形式、临床表现、CVST相关危险因素、实验室检查结果及影像学表现。结果与男性相比,女性CVST病人的主要危险因素包括妊娠/产褥期、小细胞低色素性贫血及肿瘤;与女性相比,男性CVST病人的主要危险因素包括各种非中枢神经系统感染及血栓形成倾向(凝血-纤溶系统异常、蛋白C/S异常)。肾病综合征等各种免疫相关疾病、中枢神经系统感染及高同型半胱氨酸血症也是CVST重要的危险因素。静脉梗死(19例,20.0%)及出血性梗死(13例,13.7%)是最多见的脑实质受损,另有58例病人无脑实质受损的影像学表现;87例(91.6%)病人多个静脉窦受累,累及最多的是横窦(82例,86.3%)和乙状窦(74例,77.9%)。结论CVST危险因素复杂多样,主要包括妊娠/产褥期、非中枢神经系统感染、血栓形成倾向、肾病综合征、小细胞低色素性贫血及近期手术等,且存在性别差异。脑实质受损病人影像学表现以静脉梗死及出血性梗死最多见,绝大多数病人累及横窦和乙状窦等多个静脉窦。

Objective To evaluate the risk factors and imaging features in patients with cerebral venous sinus thrombosis(CVST).Methods Ninety-five patients with CVST,who were treated in Department of Neurology,The First Affiliated Hospital of Anhui Medical University from February 2016 to December 2020,were retrospectively analyzed.Type of onset,clinical manifestations,risk factors for CVST,laboratory results and imaging features were evaluated.Results Compared with male patients,the main risk factors for female CVST patients were pregnancy/puerperium,hypochromic microcytic anemia and tumor.The main risk factors for male CVST patients were non-central nervous system infections and thrombophilia(abnormal coagulation and fibrinolysis system,protein C or S deficiency).Nephritic syndrome and other autoimmune diseases,central nervous system infections and hyperhomocysteinemia were also risk factors associated with CVST.Venous infarction(19 cases,20%)or hemorrhagic infarction(13 cases,13.7%)were the major forms of brain parenchymal lesions,and fifty-eight cases(61.1%)had no imaging findings of brain parenchymal lesions.Eighty-seven cases(91.6%)had multi-sinus involvement,and transverse sinus(82 cases,86.3%)and sigmoid sinus(74 cases,77.9%)were the most frequently involved venous sinus.Conclusions The risk factors for CVST are diverse,including pregnancy/puerperium,non-central nervous system infections,thrombophilia,nephritic syndrome,hypochromic microcytic anemia,recent surgery and so on.And there is gender difference in risk factors for CVST.The imaging findings of patients with brain parenchymal lesions mainly manifest as venous infarction and hemorrhagic infarction,and transverse sinus and sigmoid sinus are involved in the vast majority of CVST patients.