自发性低颅压并发脑静脉血栓形成四例临床和影像学特征  

Clinical and neuroimaging features in patients with spontaneous intracranial hypotension and subsequent cerebral venous thrombosis

作　　者：毕涌[1] 龚洁芹[2] 王汉旻[1] 陈为安[1] 梁冬青[1] 陈国钱[1] 罗本燕[3] 张旭[1] 

机构地区：[1]温州医学院附属第一医院神经内科,浙江省温州市325000 [2]上海交通大学附属苏州九龙医院神经内科 [3]浙江大学附属第一医院神经内科

出　　处：《中华神经科杂志》2013年第12期796-800,共5页Chinese Journal of Neurology

基　　金：浙江省自然科学基金资助项目（Y2101091）;浙江省高校“十二五”神经生物学重点学科资助项目（204-071006）

摘　　要：目的 探讨自发性低颅压（SIH）并发脑静脉血栓形成（CVT）的临床和影像学特征.方法 回顾性分析4例SIH并发CVT患者的临床资料,分析其临床特征、影像学表现及药物治疗的效果.结果 4例患者均表现为直立性头痛、癫痫发作和颈强直,其中2例出现偏瘫.所有患者的影像学检查都存在SIH和CVT的表现,脑下垂、硬脑膜强化和硬膜下积液是其常见的特征性表现;其中并发皮质静脉血栓和上矢状窦静脉血栓各2例;所有患者经纠正低颅压和抗凝等治疗后病情好转.结论 SIH患者头痛性质发生变化或者出现新的症状和体征时,需高度警惕继发CVT的可能,行影像学检查可同时存在SIH和CVT的特征性表现,纠正低颅压和抗凝治疗有效.Objective To investigate the clinical and neuroimaging features in spontaneous intracranial hypotension （SIH） and subsequent cerebral venous thrombosis （CVT）. Methods To summary 4 cases of SIH who subsequently developed CVT, focusing on the clinical features, radiological appearances and treatment strategies. Results All patients had postural headaches, stiff neck and epilepsy. Among 4 patients, 2 had hemiplegia. Neuroimaging features of SIH and CVT coexisted in all patients. All patients had neuroimaging features of SIH and CVT, freguent features included downward displacement of the brain, subdural effusions and diffuse pachymeningeal gadolinium enhancement. Two patients had cerebral cortical venous thrombosis, and the other 2 patients had superior sagittal sinus thrombosis. All patients had recovered with redressed intracranial bypotension and anticoagulation therapy. Conclusions SIH may be associated with an increased risk of CVT. Clinicians treating patients with SIH must regard the developing CVT. We should consider appropriate imaging if the character of the headache changes, or if the patient develops new signs. Redressed intracranial hypotension and anticoagulation may be an effective method of treatment.

关 键 词：颅内低压 颅内血栓形成 静脉血栓形成 体层摄影术 X线计算机 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]