直窦血栓形成并硬脑膜动静脉瘘致双侧丘脑病变:附1例报告及文献分析  

Bilateral Thalamic Lesions Caused by Straight Sinus Thrombosis and Dural Arteriovenous Fistula:1 Case Report and Literature Analysis

作　　者：杨红 臧卫周[2] 张杰文[2] 代全德[1] Yang Hong;Zang Weizhou;Zhang Jiewen(Stroke Unit,Shangqiu First People’s Hospital,Shangqiu,Henan,476000,China)

机构地区：[1]商丘市第一人民医院卒中单元,河南商丘476000 [2]河南省人民医院神经内科,河南郑州450000

出　　处：《黑龙江医学》2023年第16期1960-1965,共6页Heilongjiang Medical Journal

摘　　要：目的:探讨直窦血栓形成并硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的临床表现、影像学特点、治疗及预后,以提高临床医师对二者合并病例的认识。方法:结合文献,回顾性分析直窦血栓形成并致双侧丘脑病变患者的年龄、性别、临床症状、影像学特点、治疗及预后。结果:通过中国知网、万方、维普和PubMed数据库检索到国内外发表的关于直窦血栓形成并硬脑膜动静脉瘘致双侧丘脑病变,并本文中1例,共36例。其中男性32例,女性4例,平均年龄56.7岁。临床共同点为不同程度的认知功能下降,MRI通常表现为双侧丘脑T2或FLAIR高信号。25例接受血管内栓塞治疗,其中4例行2次或以上治疗;4例行外科手术夹闭;其中3例血管内栓塞不完全,联合外科手术夹闭;3例给予脱水降颅压联合抗凝药物保守治疗;1例单纯脱水降颅压。32例行手术治疗的患者中,3例症状改善,28例症状明显好转,1例死亡;保守治疗患者中3例失访,1例出院时稍好转。结论:以双侧丘脑受累的疾病种类众多,经积极治疗仍缓解不明显患者,且MRI提示双侧丘脑肿胀者,需考虑直窦血栓形成并硬脑膜动静脉瘘,尽早完善全脑血管造影检查明确诊断,条件允许者尽快完善各种手术治疗,逆转受损的神经功能。Objective:To investigate the clinical manifestations,imaging features,treatment and prognosis of straight sinus thrombosis with dural arteriovenous fistula(DAVF)in order to improve clinicians’understanding of the combined cases of both.Methods:Combined with the literature,age,sex,clinical symptoms,imaging features,treatment and prognosis of patients with straight sinus thrombosis with resultant bilateral thalamic lesions were retrospectively analyzed.Results:A total of 36 cases were retrieved from domestic and foreign publications on straight sinus thrombosis with dural arteriovenous fistulae causing bilateral thalamic lesions and 1 case in this paper through China Knowledge Network,Wanfang,Vipshop and PubMed databases.There were 32 male cases and 4 female cases with a mean age of 56.7 years.The clinical common denominator is varying degrees of cognitive decline,with MRI usually showing bilateral thalamic T2 or FLAIR high signal.25 cases were treated with endovascular embolization,of which 4 cases were treated twice or more,4 cases were surgically clamped,3 cases had incomplete endovascular embolization combined with surgical clamping,3 cases were treated conservatively with dehydration and cranial pressure reduction com⁃bined with anticoagulants,and 1 case was treated with dehydration and cranial pressure reduction alone.Of the 32 patients treated surgically,3 had improved symptoms,28 had significantly improved symptoms,1 died,and 3 of the conservatively treated patients were lost to follow-up and 1 was slightly improved at discharge.Conclusion:There are many kinds of diseases with bilateral thalamic involvement,and patients who do not have significant remission even after active treatment and whose MRI suggests bilateral thalamic swelling need to consider straight sinus thrombosis and dural arteriovenous fistula,and complete whole brain angiography as soon as possible to clarify the diagnosis,and improve various surgical treatments as soon as conditions allow to reverse the damaged neurological functions.

关 键 词：直窦血栓 硬脑膜动静脉瘘 双侧丘脑病变 认知障碍 

分 类 号：R543.31[医药卫生—心血管疾病]