非典型性颅内静脉窦血栓11例临床分析

Clinical study on atypical cerebral venous sinus thrombosis in 11 patients

目的分析非典型性颅内静脉窦血栓的临床特征及诊断方法,旨在加深对该病变的认识并探讨雌激素在其发病中的作用。方法对2000年3月～2002年8月诊断明确的11例男性颅内静脉系统血栓患者(平均年龄38.2岁)的临床表现、头部CT、MRI以及MRV等影像学资料进行回顾,分析其不同时期的影像学特点;并通过测定7例患者的血清雌激素水平探讨其发病原因。结果11例患者的阳性体征包括视乳头水肿(7例)、外展神经麻痹(4例)、肢体轻度瘫痪(3例)及脑膜刺激征(6例)。7例行血清雌激素检测者中,4例血清雌二醇水平及雌二醇与睾酮比值(E2/T)高于正常值。MR及MRV检查显示,单纯上矢状窦血栓3例,上矢状窦合并横窦血栓3例,上矢状窦合并横窦、直窦血栓5例;脑叶异常信号5例;脑叶合并基底节、丘脑异常信号1例。CT检查显示,3例呈现弥漫性脑水肿;3例脑叶见条索状高密度影;1例呈高密度三角征;蛛网膜下腔出血和顶叶出血各1例。结论对于无明确发病诱因的可疑颅内静脉系统血栓患者应及早行头部MR+MRV检查,以便于早期诊断。男性患者血清雌激素水平增高可能是发病的危险因素。

Objective To study the characteristics and diagnosis of atypical cerebral venous sinus thrombosis(ACVT)for improving the knowledge of this disorder and looking into the effect of estrogen on its pathogenesis.Meth ods The clinical manifestations of11male patients(average age38.2yrs)with ACVT definitely diagnosied during March2000and August2002as well as the data of CT,MRI,MRV were retro-spectively reviewed.The serum estrogen level of7cases were examinated for looking into its pathogenesis.Re sults The symptoms of these patients were papilloedema (n=7),abducent paralysis(n=4),mild paralysis of extremities(n=3)and meningeal irritaion(n=6).Of the7patients examinated the estrogen,there were abnor-mal higher level of estradiol(E 2 )and ratio of estradiol and testosterone(E 2 /T)in4cases.The MRI and MRV showed that there were thrombosis in superior saggital sinus(n=3),superior saggital sinus combined with transverse sinus(n=3),with straight sinus(n=5);abnormal signal of cerebral lobes(n=5),cerebral lobes com-bined with basal ganglia and thalamus(n=1).Signs of diffuse cerebral edema (n=3),high density streak image in cerebral lobes(n=3),high density of triangle sign(n=1),subarachnoid hemorrhage(n=1)and parietal hemor-rhage(n=1)were found in CT scanning.Con clu sion In patients suspected of cerebral venous sinus throm-bosis without precise predisposing cause,the scanning of MRI and MRV should be performed in time for es-tablishing early diagnosis.The elevating of serum estrogen level in male patients may be one of the risk fac-tors of this disorder.[