脑静脉血栓形课件.ppt

1、脑静脉血栓形发病初期：发病初期：1215%；病程中：40%最常见病灶部位：最常见病灶部位：前中央沟区域发作类型：发作类型：局灶型，全身型。两种类 型常同时出现。发病初期：发病初期：15%；病程中：；病程中：60%。以运动障碍和感觉障碍为主，下肢为著。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，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；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。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。其它：失语、视觉障碍、小脑体征等。按部位按部位CVT可分为：可分为

2、：静脉窦血栓静脉窦血栓 大脑浅静脉大脑浅静脉(皮层静脉皮层静脉)血栓血栓 大脑深静脉血栓大脑深静脉血栓 小脑静脉血栓小脑静脉血栓 颈静脉血栓颈静脉血栓 上矢状窦血栓上矢状窦血栓 侧窦侧窦(横窦横窦 及乙状窦及乙状窦)血栓血栓 岩上窦及岩下窦血栓岩上窦及岩下窦血栓 直窦血栓直窦血栓 海绵窦血栓海绵窦血栓 其解剖特点决定了血栓易在此部位形成。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。此窦是脑皮层静脉循环和脑脊液回流的必经之路。多种病因可引起多种病因可引起SSST，其中非感染性原因更为多见。，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

3、、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。癫痫发作、运动障碍以及括约肌功能障碍。血栓的部位、累及范围和梗阻程度决定了损害情况。血栓的部位、累及范围和梗阻程度决定了损害情况。起病形式起病形式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

4、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

5、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

6、 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.预后：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。