中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
8期
635-638
,共4页
王宪玲%杨延辉%王向波%李存江
王憲玲%楊延輝%王嚮波%李存江
왕헌령%양연휘%왕향파%리존강
丘脑%静脉性梗死%静脉血栓形成%硬脑膜动静脉瘘
丘腦%靜脈性梗死%靜脈血栓形成%硬腦膜動靜脈瘺
구뇌%정맥성경사%정맥혈전형성%경뇌막동정맥루
Thalamus%Venous infarction%Venous thrombosis%Dural arteriovenous fistula
目的 提高对丘脑静脉性梗死的临床及影像学表现的认识.方法 回顾性分析首都医科大学宣武医院神经内科2009-2013年确诊的4例丘脑静脉性梗死病例的临床特征及影像学表现.结果 4例患者均经全脑数字减影血管造影(DSA)确诊.4例患者均为急性或亚急性起病,临床表现主要为头痛、记忆力减退及睡眠增多.3例伴有恶性,呕吐等症状.神经系统体检主要表现为意识障碍,记忆力下降和锥体束征.腰椎穿刺显示脑脊液压力不同程度升高(200～ 310 mmH2O,1 mmH2O =0.009 8 kPa),脑脊液蛋白不同程度升高(650 ～920 mg/L).头颅MRI均显示为双侧丘脑为主的病变,主要为丘脑水肿,1例伴渗血;MRI表现为长T1长T2异常信号,1例病灶有强化.除丘脑病变外,2例还同时累及基底节区,2例累及中脑,1例累及胼胝体.丘脑静脉性梗死的原因:3例为静脉窦血栓形成,位于横窦、直窦,其中2例同时累及大脑深静脉,经抗凝治疗后好转,此3例具有深静脉或静脉窦血栓形成的危险因素,其中合并怀孕1例,JAK2基因V617F点突变阳性的原发性血小板增多症1例,缺铁性贫血1例;另1例为硬脑膜动静脉瘘,引流静脉为基底静脉,经硬脑膜动静脉瘘栓塞治疗后好转.结论 临床上遇到急性或亚急性起病的睡眠增多、意识障碍和记忆力下降的病例,MRI显示双侧丘脑病变时应考虑到有无静脉性梗死的可能,必要时进行DSA等检查明确诊断.
目的 提高對丘腦靜脈性梗死的臨床及影像學錶現的認識.方法 迴顧性分析首都醫科大學宣武醫院神經內科2009-2013年確診的4例丘腦靜脈性梗死病例的臨床特徵及影像學錶現.結果 4例患者均經全腦數字減影血管造影(DSA)確診.4例患者均為急性或亞急性起病,臨床錶現主要為頭痛、記憶力減退及睡眠增多.3例伴有噁性,嘔吐等癥狀.神經繫統體檢主要錶現為意識障礙,記憶力下降和錐體束徵.腰椎穿刺顯示腦脊液壓力不同程度升高(200～ 310 mmH2O,1 mmH2O =0.009 8 kPa),腦脊液蛋白不同程度升高(650 ～920 mg/L).頭顱MRI均顯示為雙側丘腦為主的病變,主要為丘腦水腫,1例伴滲血;MRI錶現為長T1長T2異常信號,1例病竈有彊化.除丘腦病變外,2例還同時纍及基底節區,2例纍及中腦,1例纍及胼胝體.丘腦靜脈性梗死的原因:3例為靜脈竇血栓形成,位于橫竇、直竇,其中2例同時纍及大腦深靜脈,經抗凝治療後好轉,此3例具有深靜脈或靜脈竇血栓形成的危險因素,其中閤併懷孕1例,JAK2基因V617F點突變暘性的原髮性血小闆增多癥1例,缺鐵性貧血1例;另1例為硬腦膜動靜脈瘺,引流靜脈為基底靜脈,經硬腦膜動靜脈瘺栓塞治療後好轉.結論 臨床上遇到急性或亞急性起病的睡眠增多、意識障礙和記憶力下降的病例,MRI顯示雙側丘腦病變時應攷慮到有無靜脈性梗死的可能,必要時進行DSA等檢查明確診斷.
목적 제고대구뇌정맥성경사적림상급영상학표현적인식.방법 회고성분석수도의과대학선무의원신경내과2009-2013년학진적4례구뇌정맥성경사병례적림상특정급영상학표현.결과 4례환자균경전뇌수자감영혈관조영(DSA)학진.4례환자균위급성혹아급성기병,림상표현주요위두통、기억력감퇴급수면증다.3례반유악성,구토등증상.신경계통체검주요표현위의식장애,기억력하강화추체속정.요추천자현시뇌척액압력불동정도승고(200～ 310 mmH2O,1 mmH2O =0.009 8 kPa),뇌척액단백불동정도승고(650 ～920 mg/L).두로MRI균현시위쌍측구뇌위주적병변,주요위구뇌수종,1례반삼혈;MRI표현위장T1장T2이상신호,1례병조유강화.제구뇌병변외,2례환동시루급기저절구,2례루급중뇌,1례루급변지체.구뇌정맥성경사적원인:3례위정맥두혈전형성,위우횡두、직두,기중2례동시루급대뇌심정맥,경항응치료후호전,차3례구유심정맥혹정맥두혈전형성적위험인소,기중합병부잉1례,JAK2기인V617F점돌변양성적원발성혈소판증다증1례,결철성빈혈1례;령1례위경뇌막동정맥루,인류정맥위기저정맥,경경뇌막동정맥루전새치료후호전.결론 림상상우도급성혹아급성기병적수면증다、의식장애화기억력하강적병례,MRI현시쌍측구뇌병변시응고필도유무정맥성경사적가능,필요시진행DSA등검사명학진단.
Objective To explore the clinical and radiological features of bilateral thalamus venous infarction.Methods The cases definitely diagnosed as thalamus venous infarction were collected and the corresponding clinical and radiological data were retrospectively analyzed.Results Four cases confirmed as thalamus venous infarction by digital substraction angiography (DSA) were collected.Bilateral thalamus lesions were detected in all cases by brain MRI scans which mainly presented as thalamus edema with high T1 and T2 signals with partial enhancement.Mild hemorrage was also shown in one case.Acute or subacute onset with clinical manifestations of headache,hypomnesia and hypersomnia were reported in all cases.The neurological examination showed conscious disturbance,memory impairment and positive Babinski sign.The venous thrombi were formed mainly in the transverse and the straight sinuses in 3 cases with the deep cerebral venous involved in 2 cases.All patients were improved after the anticoagulation therapy.Dural arteriovenous fistula was found in the other case drained by the Rosenthal's vein,and the symptoms were ameliorated after the embolotherapy.Conclusions As the thalamus is drained by the thalamostriate vein and the lateral thalamic vein towards the internal cerebral vein with the caudate portion drained particularly by the Rosenthal's vein,venous thrombosis or fistula drainage into these veins would probably disturb the normal drainage of the thalamus and result in further edema and infarction.Thus,the venous infarction should be taken into consideration whenever bilateral thalamus lesions are encountered in clinical practice and DSA is necessary to confirm the diagnosis.
