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目的:总结脑静脉和静脉窦血栓形成(CVT)的临床及辅助检查特征,探讨CVT的早期诊断方法。方法:回顾性分析48例CVT患者的临床表现、影像学特征、脑电图及脑脊液等检查结果。结果:CVT最常见的首发症状为头痛(83%),其次为局灶性神经功能缺损、癫癎、意识障碍和精神症状;影像学表现为脑静脉系统血流中断、局灶性梗死或水肿,其中28%伴有出血;脑部MRI显示的异常病灶与局灶性脑电图异常相符率为97.3%,但是有7例脑部MRI正常患者早期出现了脑电图局灶性或弥漫性改变;脑脊液压力明显升高,压颈试验阳性率为75%。结论:对于持续而严重的头痛、伴或不伴局灶性神经功能缺损、癫癎、意识障碍及精神症状等患者,应高度怀疑CVT,脑部MRI+MRV是目前诊断CVT的最佳手段,对不典型CVT的早期诊断,脑电图、颅内压及压颈试验等有一定的临床价值,但应尽早行DSA检查。
Objective: To summarize the characteristics of clinical and laboratory examinations of cerebral venous and sinus venous thrombosis (CVT) and to explore the early diagnosis of CVT. Methods: The clinical manifestations, imaging features, electroencephalogram and cerebrospinal fluid examination results of 48 patients with CVT were retrospectively analyzed. RESULTS: The most common first symptom of CVT was headache (83%), followed by focal neurological deficits, epilepsy, disturbance of consciousness and psychiatric symptoms. Imaging findings were disruption of the cerebral venous system, focal infarction or edema , Of which 28% were associated with hemorrhage. The abnormalities of brain MRI showed a consistent rate of 97.3% with focal EEG abnormalities. However, there were 7 cases of early brain MRI with focal or diffuse EEG Change; cerebrospinal fluid pressure was significantly increased, pressure neck test positive rate was 75%. CONCLUSIONS: CVT should be highly suspected in patients with persistent and severe headache with or without focal neurological deficits, epilepsy, impaired consciousness, and psychiatric symptoms. MRI + MRV of the brain is the best means of diagnosing CVT at present, Of atypical CVT early diagnosis, EEG, intracranial pressure and cervical compression test has some clinical value, but DSA should be performed as soon as possible.