颅内静脉窦血栓形成影像学表现.pdfVIP

颅内静脉窦血栓形成影像学表现 秦玲娣 概述 颅内静脉窦血栓形成(cerebral venous sinus thrombosis，CVST)是缺血性脑血管 病的一种少见类型，人群发病率约为2-7/百 万，约占全部脑血栓的3.5 ％，但其病死率 极高，文献报道CVST的病死率达20 ％～ 78%。 正常静脉窦解剖 绿色：上矢状窦浅蓝色：下矢状窦深紫：直窦橘色：汇合点深蓝色：横窦黄色： 乙状窦 Axial MR image series with a color overlay represents the major superficial cortical venous drainage territories according to Meder et al 21). Most of the superior cerebrum (green) is drained primarily into the superior sagittal sinus, which also receives drainage from the parasagittal cortical regions at lower levels. The sylvian veins drain blood from the peri-insular region (yellow) into the basal dural sinuses. The transverse sinuses receive blood from the temporal, parietal, and occipital lobes (blue). The Labbe´vein, if dominant, may drain much of this territory. Parenchymal abnormalities such as hemorrhage or edema in this territory may be indicative of thrombosis of the transverse sinus or Labbe´vein. Basal dural sinuses. Anteroposterior MIP image from contrast-enhanced MR venography, with the superficial and deep veins removed for better visualization, shows the cavernous sinus complex (1) and, connecting the lateral dural sinuses with the cavernous sinus, the superior petrosal sinuses (2), which arise from the junction of the transverse and sigmoid sinuses and extend along the petrous ridge, and the inferior petrosal sinuses (3), which arise from the distal portion of the sigmoid sinus or jugular bulb and extend along the clivus. Also visible are the superficial middle cerebral vein (sylvian vein) (4), which in this case extends into the cavernous sinus, and the emissary veins and occipital venous plexus complex (5) 病因  炎症性：继发于感染病灶，如颅内和局部感染  非炎症性： ①妊娠、围生期及口服避孕药； ②血液病和凝血因子异常，先天性或获得性凝血机制障碍； ③先天性或获得性心脏病；④ 自身免疫性炎性疾病； ⑤营养不良、脱水、癌症等消耗性疾病； ⑥类固醇治疗； ⑦外科手术及创伤； ⑧病因不明 临床表现 主要表现两大症候群 颅高压症状(栓塞发生于主要的静脉窦) 局灶性神经功能损害症状 。  CVST临床表现无特异性，多种体征混杂，