摘要
目的探讨颅内静脉窦血栓形成（cerebral venous sinus thrombosis,CVST）的临床表现以及常规电子计算机体层扫描（CT）、磁共振成像（MRI）与磁共振静脉造影（MRV）对CVST的诊断价值,并文献复习。方法收集35例CVST患者的临床表现以及CT、MRI、MRV资料,并以患者主诉有神经学症状的发病时间为起点,分别在发病急性期（0~5 d）、亚急性期（6~15 d）以及慢性期（〉15 d）检查MRI,结合相关文献进行回顾性临床病例研究。结果 35例患者中,头痛24例（68.6%）,视乳头水肿10例（28.6%）,脑膜刺激征8例（22.9%）,发热5例（14.2%）,运动和（或）感觉障碍5例（14.2%）,癫痫发作3例（8.6%）,意识障碍1例（2.8%）,精神异常1例（2.8%）。影像学表现为上矢状窦血栓形成16例,左侧横窦血栓形成8例,右侧横窦血栓形7成例,左侧乙状窦血栓形成12例,右侧乙状窦血栓形10成例,直窦血栓形成4例。10例单支静脉窦受累,12例2支静脉窦受累,10例3支静脉窦受累,3例4支静脉窦受累,5支静脉窦受累病例未发现。CVST急性期（0~5 d）MRI纵向弛豫（T1WI）上呈等信号,横向弛豫（T2WI）、液体衰减反转恢复序列（T2FLAIR）、弥散加权成像（DWI）上均呈低信号;亚急性期（6~15 d）T1WI、T2WI、T2FLAIR、DWI均呈高信号;慢性期（〉15 d）T1WI等信号,T2WI、T2FLAIR、DWI呈高信号或等信号。结论 CVST临床表现复杂多变,缺少特异性,对起病较急的高颅压患者须警惕CVST,应尽早行影像学检查,颅内静脉窦血栓形成的MRI表现与血栓形成的时间有重要关系。
Objective To investgate clinic characteristic of cerebral venous sinus thrombosis （CVST）, and to investgate value of computerized tomography （ CT）, magnetic resonance imaging （ MRI）, magnetic resonance venography （MRV） in diagnosing CVST and literature review. Methods The clinic and CT, MRI, MRV data of 35 patients with CVST were col- lected. Time of onset in patients presenting with neurological symptoms as a starting point, respective, in the acute stage （0 - 5 d）, subacute （6 - 15 d）, chronic phase （ 〉 15 d）, check MRI, and were retrospectively analyzed with review of the lit- erature. Results Among the 35 CVST cases,headache was found in 24 cases,papillary edema in 10 cases,meningeal ir- ritation sign in 8 cases, fervescence in 5 cases,motor and sensory feficits in 5 cases,epilepsy in 3 cases, unconsciousness in 1 case, psychosis in 1 case. Image analysis showed that superior sagittal sinus thrombosis in 16 cases,left transverse si- nus thrombosis in 8 cases,right transverse sinus thrombosis in 7 cases,left sigmoid sinus thrombosis in 12 cases, right sig- moid sinus thrombosis in 10 cases, straight sinus thrombosis in 4 cases. One venous sinus was involved in 10 patients,2 in 12 patients,3 in 10 patients,4 in 3 patients,5 were not found. In the acute phase of CVST（0 -5 d） ,TIWI showed same signal, T2 WI, T2 FLAIR, DWI showed low signal. In the subacute phase （ 6 - 15 d）, T1WI, T2 WI, T2 FLAIR, DWI showed high signal;In the chronic phase（ 〉 15 d） ,T1WI showed same signal ,T2WI, T2FLAIR, DWI showed high signal or same signal. Conclusion The clinical manifestations of CVST are identified as independent nonspecific. The patients of high tntracranical pressure should be alert to CVST. Imaging examination should be performed as early as possible. There was important relationship between MRI and thrombus formation time.
出处
《中华全科医学》
2015年第6期893-895,1026,共4页
Chinese Journal of General Practice
关键词
颅内静脉窦血栓形成
磁共振成像
临床表现
Cerebral venous sinus thrombosis
Magnetic resonance imaging
Clinical manifestation
