颅内静脉窦血栓形成课件

DiagnosisandManagementofCerebralVenusThrombosisAstatementforHealthcareProfessionalsFromTheAmericaStrokeAssociation刘娟丽颅内静脉窦血栓形成CerebralVenusThrombosisBackground

1Purpose2Anatomy3Diagnosisandmanagement5Riskfactors4Treatmentoptions6颅内静脉窦血栓形成BackgroundCVTrepresents0.5%-1%ofallstrokeCVTusuallyaffectingyoungindividualsDiversityofcausesandpresentingscenarios颅内静脉窦血栓形成PurpousToprovideanovereviewofcerebralvenoussinusthrombosisToproviderecommendationforitsdiagnosismanagementtreatment颅内静脉窦血栓形成Anatomay脑静脉吻合支较动脉丰富得多颅内静脉窦血栓形成Anatomaythesuperiorsagittalsinus(green),inferiorsagittalsinus(lightblue),straightsinus

(darkpurple),confluenceofthesinuses(orange),transversesinuses(darkblue),sigmoidsinuses(yellow).frontopolarveins[1],anteriorfrontal

veins[2],posteriorfrontalveins[3]anteriorparietalveins[5]Trolardvein[4];superficialmiddlecerebralvein][6],theLabbe´vein[7].颅内静脉窦血栓形成CerebralVenousSinusesA.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.下矢状窦颅内静脉窦血栓形成CerebralVenousSinuses颅内静脉窦血栓形成FactorsPriormedicalcondition:thrombophiliasIBSTransientsituation:

pregnancy、infectiondehydrationSelectedmedications：substanseabuse、oralcontraceptivesUnpredictable

events:head

trauma颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成ClinicalfeaturesSeizures40%Bilateralbraininvolvement,deepvenus

drainagesystemeg:bilateralthalamicinvolvementSlowlyprogressivesymptoms颅内静脉窦血栓形成superiorsagittalsinusthrombosis，SSSTΔ颅内静脉窦血栓形成SSST颅内静脉窦血栓形成SSST颅内静脉窦血栓形成transverseandsigmoidsinusthrombosisCaption:A23-year-oldfemalewithheadache.CTscandemonstratesasubtlerighttransversesinusthrombosiswithhighattenuation(arrows).MRvenographydemonstratesabsentflowintherighttransversesinus,sigmoidsinus,andinternaljugularvein.颅内静脉窦血栓形成(transverseandsigmoidsinusthrombosis)

A32-year-oldpostpartumpatientwithheadaches.AxialCTimageshowsahypodenselefttemporallobevenousinfarct.Atriangularhigh-attenuationfocus(arrows)posterolateraltotheareaofinfarctionrepresentsthrombuswithinthelefttransversesinus.AxialMRvenogramdemonstratesocclusionofthelefttransversesinus,sigmoidsinus,andinternaljugularvein.颅内静脉窦血栓形成transverseandsigmoidsinusthrombosisCTscandemonstrates:aleftposteriortemporalhematomaina38-year-oldwomanonoralcontraceptives.Contrast-enhancedMRIshowinglackoffillingoflefttransversesinus.AxialviewofMRvenogramdemonstratinglackofflowintransversesinusCoronalviewofMRvenogramdemonstratinglackofflowinthelefttransverseandsigmoidsinuses.颅内静脉窦血栓形成superiorandinferiorpetrosalsinusthrombosis颅内静脉窦血栓形成straightsinusthrombosis颅内静脉窦血栓形成cavernoussinuses颅内静脉窦血栓形成脑浅深静脉血栓颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成分型

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。颅内静脉窦血栓形成LaboratoryfindingsRountinebloodwork颅内静脉窦血栓形成D-Dimer颅内静脉窦血栓形成CommomPitfallsIntracranialHemorrahage颅内静脉窦血栓形成CommomPitfallsIsolatedHeadache/IdiopathicIntracranialHypertension颅内静脉窦血栓形成IsolatedMentalStatusChange颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成颅内静脉窦血栓形成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—肯定抗凝颅内静脉窦血栓形成溶栓治疗●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？颅内静脉窦血栓形成溶栓治疗

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