脑静脉血栓形成
Utrecht, the Netherlands
脑静脉血栓形成可以影响一个或多个大脑静脉窦、皮层静脉或深静脉，诊断通常很困难。第一，临床特征复杂：头痛(有时突然发作)、局灶性神经功能缺损、痫性发作或意识障碍，具有各种不同的组合症状和不同程度的严重性。神经系统检查对确诊几乎没有帮助，除非脑脊液压力升高(上矢状窦血栓形成)，已经引起视神经乳头水肿，展神经麻痹，或二者同时发生，才有可能作出诊断。第二，CT扫描很少显示静脉窦血栓形成的直接证据(致密窦征，空δ征)，更常见的是不典型梗塞形式的间接证据。少见的方面是定位(矢状窦旁区域、背侧丘脑、颞叶、双侧大脑半球损伤或幕上和幕下的联合损伤)和出血性梗塞的程度(有时出血密集，足够提示原发性脑出血)。为了确诊，MR扫描是必不可少的，除了血栓的证据外，MR应该显示一个或多个静脉窦无充盈的影像。
表中列举了大量的病因，最常见的是凝血疾病(占70%)。有20%的患者病因不能确定。治疗大概包括抗凝药物(苄丙酮香豆素钠衍生物)。随机试验遗留了一些关于抗凝治疗疗效的疑问，但至少显示抗凝治疗是安全的。血管内溶栓治疗和通过经静脉的导管抽吸治疗已经应用，但是没有对照研究。有时原发病因，例如乳突炎，必须单独治疗。预后同样依赖于初始状态和治疗。完全恢复的比例在不同的病历系列中不同，范围从 50-80%。据报道，最多有10%的患者复发。
, http://www.100md.com
Cerebral venous thrombosis
J. van Gijn MD FRCP FRCP(Edin)
Utrecht, the Netherlands
Cerebral venous thrombosis may affect one or more cerebral sinuses, cortical veins, or deep veins. The diagnosis is often difficult. Firstly, the clinical features are heterogeneous: headache (sometimes with sudden onset), focal deficits, epileptic seizures or impairment of consciousness, in a variety of combinations and with different degrees of severity. The neurological examination will rarely help to make the diagnosis, except when raised CSF pressure (with thrombosis of the superior sagittal sinus) has caused papilloedema, VIth nerve palsies, or both. Secondly, CT scanning rarely shows direct evidence of sinus thrombosis (dense sinus sign, empty delta sign); more often there are indirect signs in the form of atypical infarction. The unusual aspects are the location (parasagittal regions, thalamus, temporal lobes, lesions in both hemispheres or a combination of supratentorial and infratentorial lesions) and the degree of haemorrhagic infarction (sometimes dense enough to suggest primary intracerebral haemorrhage). For a definitive diagnosis MR scanning is indispensable: this should show non-filling of one or more sinuses as well as evidence of thrombus.
, 百拇医药
The list of causal factors is extensive; most frequent are disorders of coagulation (70%). In 20% of patients no contributing factors can be identified. Treatment mostly consists of anticoagulant drugs (coumadin derivatives); randomised trials leave some doubt about the efficacy of this treatment but have at least shown that it is safe. Endovascular treatment by thrombolysis and suction through a transvenous catheter has been performed but not in controlled studies. Sometimes primary causes such as mastoiditis have to be treated separately. The prognosis depends as much on the initial state as on treatment; the proportion with complete recovery ranges from 50-80% in different case series. Recurrences are reported in at most 10% of patients., 百拇医药
脑静脉血栓形成可以影响一个或多个大脑静脉窦、皮层静脉或深静脉，诊断通常很困难。第一，临床特征复杂：头痛(有时突然发作)、局灶性神经功能缺损、痫性发作或意识障碍，具有各种不同的组合症状和不同程度的严重性。神经系统检查对确诊几乎没有帮助，除非脑脊液压力升高(上矢状窦血栓形成)，已经引起视神经乳头水肿，展神经麻痹，或二者同时发生，才有可能作出诊断。第二，CT扫描很少显示静脉窦血栓形成的直接证据(致密窦征，空δ征)，更常见的是不典型梗塞形式的间接证据。少见的方面是定位(矢状窦旁区域、背侧丘脑、颞叶、双侧大脑半球损伤或幕上和幕下的联合损伤)和出血性梗塞的程度(有时出血密集，足够提示原发性脑出血)。为了确诊，MR扫描是必不可少的，除了血栓的证据外，MR应该显示一个或多个静脉窦无充盈的影像。
表中列举了大量的病因，最常见的是凝血疾病(占70%)。有20%的患者病因不能确定。治疗大概包括抗凝药物(苄丙酮香豆素钠衍生物)。随机试验遗留了一些关于抗凝治疗疗效的疑问，但至少显示抗凝治疗是安全的。血管内溶栓治疗和通过经静脉的导管抽吸治疗已经应用，但是没有对照研究。有时原发病因，例如乳突炎，必须单独治疗。预后同样依赖于初始状态和治疗。完全恢复的比例在不同的病历系列中不同，范围从 50-80%。据报道，最多有10%的患者复发。
, http://www.100md.com
Cerebral venous thrombosis
J. van Gijn MD FRCP FRCP(Edin)
Utrecht, the Netherlands
Cerebral venous thrombosis may affect one or more cerebral sinuses, cortical veins, or deep veins. The diagnosis is often difficult. Firstly, the clinical features are heterogeneous: headache (sometimes with sudden onset), focal deficits, epileptic seizures or impairment of consciousness, in a variety of combinations and with different degrees of severity. The neurological examination will rarely help to make the diagnosis, except when raised CSF pressure (with thrombosis of the superior sagittal sinus) has caused papilloedema, VIth nerve palsies, or both. Secondly, CT scanning rarely shows direct evidence of sinus thrombosis (dense sinus sign, empty delta sign); more often there are indirect signs in the form of atypical infarction. The unusual aspects are the location (parasagittal regions, thalamus, temporal lobes, lesions in both hemispheres or a combination of supratentorial and infratentorial lesions) and the degree of haemorrhagic infarction (sometimes dense enough to suggest primary intracerebral haemorrhage). For a definitive diagnosis MR scanning is indispensable: this should show non-filling of one or more sinuses as well as evidence of thrombus.
, 百拇医药
The list of causal factors is extensive; most frequent are disorders of coagulation (70%). In 20% of patients no contributing factors can be identified. Treatment mostly consists of anticoagulant drugs (coumadin derivatives); randomised trials leave some doubt about the efficacy of this treatment but have at least shown that it is safe. Endovascular treatment by thrombolysis and suction through a transvenous catheter has been performed but not in controlled studies. Sometimes primary causes such as mastoiditis have to be treated separately. The prognosis depends as much on the initial state as on treatment; the proportion with complete recovery ranges from 50-80% in different case series. Recurrences are reported in at most 10% of patients., 百拇医药