脑静脉窦血栓形成的临床特点  

Clinical features of cerebral venous sinus thromsis

作　　者：张菁[1] 孟然[1] 

机构地区：[1]北京世纪坛医院神经内科,100038

出　　处：《临床神经病学杂志》2011年第3期161-163,共3页Journal of Clinical Neurology

基　　金：国家自然科学基金项目(30770741);首都发展基金重点项目(20052050)

摘　　要：目的探讨脑静脉窦血栓形成的临床特点。方法回顾性分析17例脑静脉窦血栓形成患者的临床资料。结果本组男9例,女8例;平均年龄32岁。13例(76.5%)为急性起病,3例(17.6%)亚急性起病,1例(5.9%)慢性起病。起病原因:3例(17.6%)为感染因素,12例(70.6%)为非感染因素,2例(11.8%)不明。首发症状:头痛16例(94.1%),癫发作4例(23.5%),意识障碍2例(11.8%),头晕及精神症状各1例(5.9%)。神经系统体征:视盘水肿8例(47.1%),偏身感觉障碍3例(17.6%),偏瘫2例(11.8%),面瘫及复视各1例(5.9%)。15例行腰穿脑脊液检查的患者中,10例(66.7%)脑脊液压力增高。8例血浆D-二聚体水平检测均增高。头颅CT示脑梗死或出血4例(23.5%),静脉高密度和条索征3例(17.6%);14例磁共振静脉成像(MRV)均显示受累静脉窦部分或广泛血流信号缺失;5例数字减影血管造影(DSA)均显示受累静脉窦不规则狭窄、充盈缺损。结论脑静脉窦血栓形成多为急性起病,出现颅内压增高的表现,少数患者有局灶性神经系统损害的表现,但缺乏特异性;MRV及DSA检查可以确诊。Objective To explore the clinical features of cerebral venous sinus thromsis （CVT）. Methods The clinical data of 17 CVT patients were analyzed retrospectively. Results The average age of the 17 patients （9 males and 8 females） was 32 years old. The onset was acute in 13 eases（76.5% ）, sub-acute in 3 cases（ 17.6% ） and chronic in 1 ease（5.9% ）. Predisposing factor was infection in 3 cases （ 17.6% ）, non-infection in 12 cases （70.6%） , unknown in other 2 cases（ 11.7% ）. The first symptoms were headache in 16 cases （94.1%） ; epileptic attack in 4 cases （23.5%）, disorder of consciousness in 2 cases （ 11.8% ） , dizziness and psychical symptom in 1 case （5.9%） respectively. Neurological sign： papilloedema in 8 cases （47. 1% ）, hemidysesthesia in 3 cases （ 17.6% ） , hemiparalysis in 2 cases （ 11.8% ） , faeioplegia and diplopia in 1 case （5.9%） respectively. The eerebrospinal fluid examination in 15 cases showed that the eerebrospinal fluid pressure was increased in 10 cases （66. 7% ） , the level of plasma D-dimer was detected in 8 cases and the results in all of them were increased. The cerebral infarction or hemorrhage were found out in 4 cases （23.5%） , venous high-density and the trabs sign in 3 eases （ 17.6% ） by skull CT. Magnetic resonamee venography （MRV） was applied in 14 eases and showed that the normal high-blood-flow signals were partly or completely disappeared in the involved venous sinuses, digtial subtraction angiography （DSA） was applied in 5 cases and showed that the abnormality stenosis and the filling defect in the target venous sinuses. Conclusions The onset of CVT mostly is acute. The symptoms are intracranial hypertension, and in few patients have local neurological disfunction, but has no specificity. MRV and DSA can make diagnosis.

关 键 词：脑静脉窦血栓形成 临床特点 磁共振静脉成像 

分 类 号：R743.32[医药卫生—神经病学与精神病学]