脑静脉血栓形.ppt
,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：1215%；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%；发病中期：近一半患者有不同程度的醒觉水平下降。具有可逆性，但通常提示预后不佳。,脑静脉血栓形成的临床表现 意识及精神障碍,多见于炎性CVT。表现为不规则发热、寒颤、多汗、全身肌肉疼痛、皮下瘀血等感染和败血症征象。,脑静脉血栓形成的临床表现 全身症状,按部位CVT可分为：静脉窦血栓 大脑浅静脉(皮层静脉)血栓 大脑深静脉血栓 小脑静脉血栓 颈静脉血栓,各种脑静脉血栓的临床特点,上矢状窦血栓 侧窦(横窦 及乙状窦)血栓 岩上窦及岩下窦血栓 直窦血栓 海绵窦血栓,脑静脉窦血栓,其解剖特点决定了血栓易在此部位形成。此窦是脑皮层静脉循环和脑脊液回流的必经之路。,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,多种病因可引起SSST，其中非感染性原因更为多见。临床表现主要是颅内压增高、不同程度的意识障碍、癫痫发作、运动障碍以及括约肌功能障碍。,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,血栓的部位、累及范围和梗阻程度决定了损害情况。范围广泛，超过上矢状窦2/3以上 位于上矢状窦后方 局限于上矢状窦前段 累及到额叶前部静脉回流 波及到中央回静脉 影响到其它大脑浅静脉起病形式,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,脑静脉 窦血栓 上矢状窦血栓（superior sagittal sinus thrombosis，SSST）,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 lobeAn 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）,
