刘彩燕硬脑膜动静脉瘘一例分析报告.ppt

结 论 诊断 GV+iCV+StS pressure elevated Bilateral basal gangalial and white matter lesions Dural arteriovenous fistula GV+iCV+StS thrombosis Figure 1. Distribution of parenchymal lesions in relationship to occluded venous sinuses. Each illustration is accompanied by a list of occluded sinuses. SSS indicates superior sagittal sinus; StS, straight sinus; TS, transverse sinus; SS, sigmoid sinus; vG, vein of Galen; iCV, isolated cortical vein; ICVs, internal cerebral veins. (Stroke. 2009;40:1509-1511.) Dural Arteriovenous Fistulaand CVST The relationship between the 2 entities is rather complex, because (1) dural fistulas can be a late complication of persistent dural sinus occlusion with increased venous pressure, (2) the fistula can close and cure if the sinus recanalizes, and (3) a preexisting fistula can be the underlying cause of CVT. The exact frequency of dural fistula after CVT is not known because there are no cohort studies with long-term angiographic investigation. 头MRV:大脑内静脉、Galen静脉、直窦未显影 头MRA:动静脉瘘 DSA证实 大脑内静脉、Galen静脉、直窦血栓形成 慢性进展病程 无颅压升高 无头痛 血D-dimer正常 硬脑膜动静脉瘘 ？ 诊断 GV+iCV+StS pressure elevated Bilateral basal gangalial and white matter lesions Dural arteriovenous fistula GV+iCV+StS thrombosis 治疗及随诊 治疗 动静脉瘘栓塞+华法令抗凝 随诊 病情稳定 文 献 复 习 1、DAVF的定义、分类 2、常见的临床表现 3、MRI的各种征象 4、本例的提示 DAVF的定义和分类 定义：由硬脑膜动脉供血，引流至静脉窦或脑膜静脉的动脉静脉畸形 分类： type I ：located in the main sinus with antegrade flow Type II: in the main sinus with reflux into the sinus(IIa), cortical veins(IIb),or both(IIa+IIb) Type III: with direct cortical venous drainage without venous ectasia Type IV: with direct cortical venous drainage with venous ectasia Type V: with spinal venous drainage ------ Radiology 1995;194:671-680 The commonly recognized initial symptoms of a DAVF tinnitus headache proptosis decreased cognitive function neurologic deficits associated with intracranial hemorrhage Various MRI findings in DAVF Flow void cluster Engorged ophthalmic vein/proptosis White matter hyperintensity