脑深静脉血栓形成12例临床及影像分析

摘要/Abstract

摘要：

目的探讨脑深静脉血栓形成（deep cerebral venous thrombosis，DCVT）的临床及影像学特点。方法回顾性分析2004年12月～2013年5月在北京协和医院神经内科住院的经数字减影血管造影（digital subtraction angiography，DSA）或者磁共振静脉成像（magnetic resonance venography，MRV）确诊的12例DCVT患者的临床表现、影像学特征、治疗及预后情况。结果 12例DCVT患者中男性7例，女性5例，年龄24.5（19.75，33.5）岁。临床表现：头痛11例［11/12 （92%）］；不同程度意识障碍5例［5/12（42%）］，其中1例为昏迷；抽搐发作5例［5/12（42%）］；其他局灶体征（单侧肢体无力）2例［2/12（17%）］。影像表现：累及直窦和大脑大静脉最多见，分别为 11例［11/12（92%）］及8例［8/12（67%）］，累及大脑内静脉3例［3/12（25%）］，基底静脉1例［1/12 （8%）］，所有患者均合并其他静脉窦受累。8例患者行头颅计算机断层扫描（computed tomography，CT）和（或）磁共振成像（magnetic resonance imaging，MRI）检查，其中丘脑病灶4例［4/8（50%）］，基底节区病灶2例［2/8（25%）］，额或顶叶病灶3例［3/8（38%）］，其中病灶内合并出血者2例［2/8 （25%）］。治疗预后：12例患者中除1例因感染性休克死亡，未能接受抗凝治疗外，其余11例均给予抗凝治疗，最终症状体征基本消失，复查影像学病灶明显好转或消失。结论意识障碍及双侧丘脑病变是DCVT的常见临床及影像表现，需注意识别；大脑大静脉及直窦为常见受累深静脉（窦），且常并存其他静脉窦受累；DCVT虽急性期症状凶险，如及早诊断及治疗，预后可相对较好。

文章导读： 脑深静脉血栓形成病情凶险，极易误诊，结合临床与影像，及早诊断和治疗可改善预后。

关键词: 脑深静脉血栓形成; 丘脑病变; 预后

Abstract:

Objective To discuss the clinical and imaging features of deep cerebral venous thrombosis (DCVT). Methods The clinical and imaging features, treatments as well as outcomes of 12 patients with DCVT confirmed by magnetic resonance venography (MRV) or digital subtraction angiography (DSA) were analyzed retrospectively. All patients were admitted to Peking Union Medical College Hospital between December 2004 and May 2013. Results Seven of 12 patients were male, 5 were female. The median age of all 12 patients was 24.5 (19.75, 33.5) years. Clinical presentations:headache (11/12, 92%), reduced consciousness (5/12, 42%), seizures (5/12, 42%), other focal neurological signs (2/12, 17%). Imaging findings:Within the deep venous system (DVS), the straight sinus and Galen vein were affected most frequently in 11 (11/12 [92%]) and 8 (8/12 [67%]) patients respectively, internal cerebral veins were affected in 3 (3/12, 25%), whereas basal veins were less frequently involved (1/12, 8%). All patients were associated with thrombosis of other sinuses. Among the eight patients who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) examination, the parenchymal findings included thalamic lesions (4/8, 50%), basal ganglia lesions (2/8, 25%), and frontal or parietal lobe lesions (3/8, 38%). Intracerebral hemorrhage was seen in two patients (2/8, 25%). Treatment and outcome:All patients received anticoagulation therapy except one who was diagnosed septic shock and died finally. Eleven of the 12 patients had excellent outcome on discharge. The parenchymal lesions improved or disappeared in the follow-up image series. Conclusion Consciousness impairment and bilateral thalamic lesions were the common clinical and parenchymal MRI presentations in patients with DCVT. The straight sinus and Galen vein were affected most frequently. DCVT was usually in association with thrombosis of other sinuses. Early diagnosis and timely treatment may improve prognosis despite the severe manifestations on acute stage.

Key words: Deep cerebral venous thrombosis; Thalamic lesions; Prognosis

周雁，倪俊，朱以诚，周立新，姚明，关鸿志，彭斌，崔丽英. 脑深静脉血栓形成12例临床及影像分析[J]. 中国卒中杂志, 2014, 9(10): 814-818.

ZHOU Yan, NI Jun, ZHU Yi-Cheng, ZHOU Li-Xin, YAO Ming, GUAN Hong-Zhi,. Clinical and Imaging Features in Deep Cerebral Venous Thrombosis:an Analysis of 12
Cases[J]. Chinese Journal of Stroke, 2014, 9(10): 814-818.

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