脑静脉窦血栓形成的临床与影像学特点

摘要

目的 探讨脑静脉窦血栓形成的临床与影像学特点.方法 回顾性分析28例脑静脉窦血栓形成患者的临床资料.结果 男8例(28.6％),女20例(71.4％)；急性起病18例(64.3％),亚急性起病8例(28.6％),慢性起病2例(7.1％).首发症状表现为头痛伴恶心、呕吐22例,发热伴视物模糊3例,发热伴精神异常2例,癫痫发作1例.主要临床表现为意识与认知功能障碍16例(57.1％),大脑皮质刺激症状5例(17.9％),运动功能障碍3例(10.7％),眼部症状6例(21.4％).白细胞增高6例,淋巴细胞增高2例；C反应蛋白升高3例,血沉升高2例；凝血酶原时间缩短2例,D-二聚体升高4例.颅内压升高11例；CSF生化和细胞学检查异常4例.头颅CT平扫示条带征13例,头颅MRI平扫示实三角征14例,增强示空三角征7例,头颅磁共振静脉成像与数字减影血管造影均见血栓部位血流消失.经抗凝治疗,痊愈23例,好转4例,死亡1例.结论 脑静脉窦血栓女性多见,主要首发症状为头痛伴恶心、呕吐,主要临床表现为意识与认知功能障碍.神经影像学特点为直接征像及间接征像.%Objective To explore the clinical and imaging features of cerebral venous sinus thrombosis (CVST).Methods Clinical data of 28 CVST patients were analyzed retrospectively.Results Eight patients (28.6％) were male,and 20 patients (71.4％) were female.Acute onset was in 18 cases (64.3％),subacute onset in 8 cases (28.6％),chronic onset in 2 cases (7.1％).The first symptoms was headache accompanied with nausea and vomited in 22 cases,fever accompanied with blurred vision in 3 cases,fever accompanied with mental anomaly in 2 cases,seizure disorder in 1 case.The main manifestations were consciousness disorders and cognitive dysfunction in 16 cases (57.1％),cerebral cortex stimulation symptom in 5 cases (17.9％),motor dysfunction in 3 cases (10.7％),and eye symptom in 6 cases (21.4％).Leukocyte increased was in 6 cases,lymphocytes increased in 2 cases ; c-reactive protein was increased in 3 cases,erythrocyte sedimentation rate increased in 2 cases ; prothrombin time was decreased in 2 cases,D-dimer increased in 4 cases.Hypertension intracranial was in 11 cases.Abnormal biochemistry and cytological examination of CSF was in 4 cases.Brain CT plain scan showed strap and cord sign in 13 cases.Brain MRI plain scan showed hyperintense triangular sign in 14 cases; and enhanced MRI showed hypointense triangular in 7 cases.Magnetic resonance vengioaphy and digital subtraction angiography showed the disappearance of blood flow in the thromboembolic area.After anticoagulant therapy,recovered was in 23 cases,improved in 4 cases,and 1 case was died.Conclusion CVST is common in women.The main first symptoms are headache accompanied with nausea and vomited; the main manifestations are consciousness disorders and cognitive dysfunction.The imaging features are direct signs and indirect signs.