颅内静脉窦血栓形成.ppt

DiagnosisandManagementofCerebralVenusThrombosis,AstatementforHealthcareProfessionalsFromTheAmericaStrokeAssociation,CerebralVenusThrombosis,Treatmentoptions,6,Background,CVTrepresents0.5%-1%ofallstrokeCVTusuallyaffectingyoungindividualsDiversityofcausesandpresentingscenarios,Purpous,ToprovideanovereviewofcerebralvenoussinusthrombosisToproviderecommendationforitsdiagnosismanagementtreatment,Anatomay,脑静脉吻合支较动脉丰富得多,Anatomay,thesuperiorsagittalsinus(green),inferiorsagittalsinus(lightblue),straightsinus(darkpurple),confluenceofthesinuses(orange),transversesinuses(darkblue),sigmoidsinuses(yellow).,frontopolarveins1,anteriorfrontalveins2,posteriorfrontalveins3anteriorparietalveins5Trolardvein4;superficialmiddlecerebralvein6,theLabbevein7.,CerebralVenousSinuses,A.上矢状窦B.Galen静脉C.眼静脉D.面静脉E.海绵窦F.下岩窦G.颈静脉H.乙状窦I.上岩窦J.橫窦K.直窦L.下矢状窦,CerebralVenousSinuses,Factors,Priormedicalcondition:thrombophiliasIBSTransientsituation:pregnancy、infectiondehydrationSelectedmedications：substanseabuse、oralcontraceptivesUnpredictableevents:headtrauma,Clinicalfeatures,Seizures40%Bilateralbraininvolvement,deepvenusdrainagesystemeg:bilateralthalamicinvolvementSlowlyprogressivesymptoms,superiorsagittalsinusthrombosis，SSST,SSST,SSST,transverseandsigmoidsinusthrombosis,Caption:A23-year-oldfemalewithheadache.CTscandemonstratesasubtlerighttransversesinusthrombosiswithhighattenuation(arrows).MRvenographydemonstratesabsentflowintherighttransversesinus,sigmoidsinus,andinternaljugularvein.,(transverseandsigmoidsinusthrombosis),A32-year-oldpostpartumpatientwithheadaches.AxialCTimageshowsahypodenselefttemporallobevenousinfarct.Atriangularhigh-attenuationfocus(arrows)posterolateraltotheareaofinfarctionrepresentsthrombuswithinthelefttransversesinus.AxialMRvenogramdemonstratesocclusionofthelefttransversesinus,sigmoidsinus,andinternaljugularvein.,transverseandsigmoidsinusthrombosis,CTscandemonstrates:aleftposteriortemporalhematomaina38-year-oldwomanonoralcontraceptives.,Contrast-enhancedMRIshowinglackoffillingoflefttransversesinus.,AxialviewofMRvenogramdemonstratinglackofflowintransversesinus,CoronalviewofMRvenogramdemonstratinglackofflowinthelefttransverseandsigmoidsinuses.,superiorandinferiorpetrosalsinusthrombosis,straightsinusthrombosis,cavernoussinuses,脑浅深静脉血栓,分型,1、进行性颅内压增高2、突然发生的神经系统局灶性损害，酷似动脉性卒中，常无癫痫发作。3、神经系统局灶性损害，有或无癫痫发作及颅内压增高，病情常在数日内进展。4、神经系统局灶性损害，有或无癫痫发作及颅内压增高，病情常在数周或数月内进展。5、突然出现的头痛，类似蛛网膜下腔出血或短暂性脑缺血发作，此型较少见。,Laboratoryfindings,Rountinebloodwork,D-Dimer,CommomPitfalls,IntracranialHemorrahage,CommomPitfalls,IsolatedHeadache/IdiopathicIntracranialHypertension,IsolatedMentalStatusChange,抗凝治疗,治疗效果有分歧bienfait(62例)不肯定Diaz(203)治疗组：91%非治疗组：36%Einhaupl肯定,抗凝,溶栓治疗,治疗时间窗无严格的时间窗。血栓机化延迟。但应遵循愈早愈好的原则伴有出血的CVT是否能溶栓？溶栓的危险性？,溶栓治疗,i