颅内静脉窦血栓形成的临床与影像学特点

摘要

Objective To explore the clinical and imaging features of cranial venous sinus thrombosis (CVST). Methods The clinical data of 17 patients with CVST were retrospectively analyzed. Results The average age of 17 CVST patients was 34.4 yeare old. There were 12 middle-aged or young patients (70.6% ) who is younger than 45 years old. The common clinical symptoms showed headache in 15 cases (88. 2% ), epilepsy in 5 cases (29.4% ). The physical signs showed neck resistance positive in 8 cases (47.1% ), papilloedema in 4 cases (23.5%). The lumber puncture examination of 16 patients showed CSF pressure increased in 15 patients, cell population of CSF slightly increased in 3 patients, protein quantity of CSF slightly increased in 4 patients. CT showed the direct signs of CVST in 3 cases (17.6% ), indirect signs of CVST in 10 cases (58.8% ). MRI showed the signs of CVST in 15 cases (88.2% ) ; MR venography (MK V) showed the lack or reduction of blood flow in intracranial venous sinus in 16 cases (94. 1% ). After treated with low molecular heparin to anticoagulation or combinedly treated with asprine and batroxobin, and with dehydration and anti-infection, 11 patients (64.7% ) recovered or improved, 4 patients (23.5% ) had no change, 2 patients (11.8%) died. Conclusions The incidence rate of CVST is high in middle-aged and young patients. The clinical manifestations are nonspecific. The diagnostic value of CT is poor for CVST, while the right rate of MRI and MRV to diagnose CVST is high. The occlusive venous sinus can be showed by MRI and MRV. The effect of anticoagulant treatment in CVST is very good.%目的 探讨颅内静脉窦血栓形成(CVST)的临床与影像学特点.方法 对17例CVST患者的临床资料进行回顾性分析.结果 本组17例CVST患者的平均年龄为34.4岁,≤45岁的中青年患者12例(70.6％).常见的临床症状:头痛15例(88.2％),癫痫发作5例(29.4％)；体征:颈抵抗(+)8例(47.1％),视盘水肿4例(23.5％).16例患者行腰穿CSF检查示压力增高15例,CSF细胞数和蛋白含量轻度增高分别为3例、4例.头颅CT检查显示CVST的直接征象3例(17.6％),间接征象10例(58.8％).MRI检查显示CVST的表现15例(88.2％)；MR静脉造影(MRY)检查有16例患者(94.1％)显示颅内静脉窦血流缺失或降低.经低分子肝素抗凝或合并肠溶阿司匹林、巴曲酶,以及脱水降颅压、抗感染等治疗后,基本痊愈+显著进步11例(64.7％),无变化4例(23.5％),死亡2例(11.8％).结论 CVST大多为中青年发病,临床表现无特异性.头颅CT对CVST的诊断价值较低；而MRI和MRV诊断CVST的准确性高,能显示颅内静脉窦闭塞的表现.本病抗凝治疗的效果较好.