静脉窦血栓2—培训课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） This 58 year-old man complained of a severe headache 12 hours after taking part in the London marathon. He attended the general casualty but no cause was found. He was discharged with a diagnosis of possible migraine. However, the pain persisted and he re-attended the casualty 2 days later. He was found to have bilateral optic disc swellings and an urgent MRI scan was requested. Full blood count revealed high platelet count (thrombocythemia) but otherwise all the other tests were normal 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） Clinical History: 17-year-old female who presents with a four day history of headaches and a seizure immediately prior to admission. There is no significant past medical history. Findings: An axial noncontrasted CT image through the brain demonstrates cerebral edema within the left frontal lobe and deep gray matter. In addition, there is hyperattenuation within the region of the straight sinus. Petechial hemorrhage as well as edema is seen within the left frontal lobe An angiogram demonstrates occlusion of the anterior one half of the superior sagittal sinus as well as occlusion of the deep venous system bilaterally. 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） ●预后： 单纯上矢状窦血栓在数周或数月后可再通，颅内压恢复正常，预后良好。 如果累及到其他脑静脉窦或脑静脉，而未能得到及时有效的治疗，其颅压高将持久存在，严重者可造成死亡。 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） ●视乳头水肿 CVT 视乳头水肿出现率差异较大 年轻患者更见，45岁以下约33% 亚急性或慢性患者达60%，急性者为6% 脑静脉血栓形 成的临床表现 颅内压增高 ●癫痫 ◆发病初期：12~15%；病程中：40% ◆最常见病灶部位：前中央沟区域 ◆发作类型：局灶型，全身型。两种类 型常同时出现。 脑静脉血栓形 成的临床表现 大脑半球受损 ●局灶性神经功能缺损 ◆发病初期：15%；病程中：60%。 ◆以运动障碍和感觉障碍为主，下肢为著。 ◆颅神经麻痹：可提示一些特殊部位的血栓， III、IV、VI颅神经麻痹对应于海绵窦血栓； IX、X颅神经损害对应于颈静脉血栓。 ◆其它：失语、视觉障碍、小脑体征等。 脑静脉血栓形 成的临床表现 大脑半球受损 ●发病初期少见，约有4%；