脑静脉系统血栓形成合并硬脑膜动静脉瘘临床影像分析四例  

Clinical and imaging analysis of 4 cases of cerebral venous thrombosis accompanied by dural arteriovenous fistula

作　　者：曹宇泽 张君怡[1] 董立羚[1] 柳青[1] 郝红琳[1] 朱以诚[1] 倪俊[1] Cao Yuze;Zhang Junyi;Dong Liling;Liu Qing;Hao Honglin;Zhu Yicheng;Ni Jun(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院神经科,100730

出　　处：《中华脑血管病杂志（电子版）》2020年第5期268-274,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

摘　　要：目的总结分析脑静脉系统血栓形成合并硬脑膜动静脉瘘患者临床表现、诊疗过程及预后,以提高临床医师对二者合并病例的认识。方法回顾性分析北京协和医院2010年3月至2020年3月住院诊断为脑静脉系统血栓形成合并硬脑膜动静脉瘘病例,对其临床症状、头磁共振(包括磁共振成像、磁共振血管成像、磁共振静脉成像、磁敏感加权成像)及数字剪影血管造影(DSA)表现、治疗及转归进行分析总结。结果共确诊4例脑静脉系统血栓形成合并硬脑膜动静脉瘘患者,均为中青年男性,亚急性起病,其中3例患者明确诊断前病程迁延,临床表现包括视物模糊、癫痫发作、记忆力下降、性格改变等。影像学表现:3例患者以双侧丘脑病变为主异常信号,1例额顶叶皮层异常信号,4例患者头磁共振静脉成像均可见静脉或静脉窦显影异常,且DSA最终确诊为脑静脉系统血栓形成合并硬脑膜动静脉瘘。结论临床上中青年患者不明原因脑静脉系统血栓形成尤其血栓迁延不愈时,需警惕合并硬脑膜动静脉瘘可能;临床症状缺乏特异性,常与血栓形成及静脉回流障碍部位相关,双侧丘脑是最常见受累部位,针对性的影像学检查对于及时诊断治疗非常重要。Objective The clinical manifestations,diagnosis,treatment and prognosis of cerebral venous thrombosis accompanied by dural arteriovenous fistulas were summarized and analyzed,so as to improve the clinicians'knowledge of the combined cases.Methods The clinical symptoms,MR(including MRI,MRA,MRV,SWI)and DSA manifestations,treatment and outcome of cerebral venous thrombosis accompanied by dural arteriovenous fistula in Peking Union Medical College Hospital from March 2010 to March 2020 were analyzed retrospectively.Results Four cases of cerebral venous thrombosis accompanied by dural arteriovenous fistula were diagnosed in our hospital,all of whom were middle-aged men with subacute onset.The clinical manifestations included blurred vision,epileptic attack,memory decline,character change,etc.One patient had abnormal signal of frontal parietal cortex on MRI,and three patients had abnormal signal of bilateral thalamic lesions on MRI.The head MRV of 4 patients were abnormal.Four patients were diagnosed as cerebral venous thrombosis accompanied by dural arteriovenous fistula by DSA.Conclusion In clinic,young and middle-aged patients with cerebral venous thrombosis of unknown cause,especially those with protracted course of disease,need to be considered with dural arteriovenous fistula.There is not specific clinical which is often related to the location of thrombosis and venous reflux disorders.Bilateral thalamus is the most common affected area,and the targeted imaging examination is very important for the timely diagnosis and treatment.

关 键 词：脑静脉系统血栓形成 硬脑膜动静脉瘘 临床特征 

分 类 号：R743[医药卫生—神经病学与精神病学]