中华危重症医学杂志(电子版)
中華危重癥醫學雜誌(電子版)
중화위중증의학잡지(전자판)
CHINESE JOURNAL OF CRITICAL CARE MEDICINE ( ELECTRONIC EDITON)
2008年
1期
11-16
,共6页
孟强%张蕾%梅茸%赵忠%董曼丽%刘江%蒲传强%吴卫平%郎森阳%于生元%黄旭生
孟彊%張蕾%梅茸%趙忠%董曼麗%劉江%蒲傳彊%吳衛平%郎森暘%于生元%黃旭生
맹강%장뢰%매용%조충%동만려%류강%포전강%오위평%랑삼양%우생원%황욱생
脑静脉窦%血栓形成%影像学特点
腦靜脈竇%血栓形成%影像學特點
뇌정맥두%혈전형성%영상학특점
Cerebral venous sinus%Thrombosis%Neuroimaging characteristics
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.
目的 探討腦靜脈竇血栓形成(CVST)的病因、臨床錶現及影像學特點.方法 迴顧性分析65例CVST患者的臨床錶現、頭顱CT、MRI、磁共振靜脈血管造影及數字減影血管造影(DSA)特點.結果 本組65例CVST患者中,25例(38%)患者僅錶現為單純顱高壓;頭麵部跼部或全身感染者13例(20%);貧血4例(6%);服用避孕藥史4例(6%);結締組織及相關疾病4例(6%)(Behcet's病2例,繫統性紅斑狼瘡2例),蛋白C缺乏2例(3%).9例急性患者的頭顱CT平掃髮現,2例存在"稠密三角徵",3例存在"條帶徵".亞急性患者頭顱MRI顯示,靜脈竇內主要為T1、T2高信號(33%,4/12).MRI髮現急性、亞急性及慢性患者靜脈性腦梗死的比例分彆為38%(3/8)、33%(4/12)及18%(6/33).在行MRV檢查的12例患者中,均髮現靜脈竇充盈缺損或中斷(100%).DSA檢查髮現66%(40/61)纍及2箇或2箇以上靜脈竇,11%(7/61)纍及大腦淺(深)靜脈.結論 CVST病因複雜,起病形式多樣,臨床錶現主要為顱高壓等一些非特異性癥狀及體徵;頭顱CT及MRI分彆對急性,亞急性CVST靜脈竇內的血栓有較高的敏感性與特異性;MRV可快速、無創地診斷CVST.若以上檢查仍不能明確診斷,應儘快行DSA檢查,尤其是大腦淺(深)靜脈血栓形成患者.
목적 탐토뇌정맥두혈전형성(CVST)적병인、림상표현급영상학특점.방법 회고성분석65례CVST환자적림상표현、두로CT、MRI、자공진정맥혈관조영급수자감영혈관조영(DSA)특점.결과 본조65례CVST환자중,25례(38%)환자부표현위단순로고압;두면부국부혹전신감염자13례(20%);빈혈4례(6%);복용피잉약사4례(6%);결체조직급상관질병4례(6%)(Behcet's병2례,계통성홍반랑창2례),단백C결핍2례(3%).9례급성환자적두로CT평소발현,2례존재"주밀삼각정",3례존재"조대정".아급성환자두로MRI현시,정맥두내주요위T1、T2고신호(33%,4/12).MRI발현급성、아급성급만성환자정맥성뇌경사적비례분별위38%(3/8)、33%(4/12)급18%(6/33).재행MRV검사적12례환자중,균발현정맥두충영결손혹중단(100%).DSA검사발현66%(40/61)루급2개혹2개이상정맥두,11%(7/61)루급대뇌천(심)정맥.결론 CVST병인복잡,기병형식다양,림상표현주요위로고압등일사비특이성증상급체정;두로CT급MRI분별대급성,아급성CVST정맥두내적혈전유교고적민감성여특이성;MRV가쾌속、무창지진단CVST.약이상검사잉불능명학진단,응진쾌행DSA검사,우기시대뇌천(심)정맥혈전형성환자.
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%.Conclusions 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.
