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目的探讨颅内静脉窦血栓患者头部MRI及其脑实质病灶的表现和预后。方法回顾性分析41例颅内静脉窦血栓患者的临床表现及影像学资料。根据头部MRI,将患者分为脑实质病灶阳性组21例和阴性组20例,分析两组患者的临床表现及受累静脉窦的差异。结果阳性组发生脱水、癫痫、运动障碍和精神症状的比率高于阴性组,分别为28.6%(6例)比0%(0例)、57.1%(12例)比15.0%(3例)、47.6%(10例)比5.0%(1例)、33.3%(7例)比5.0%(1例),差异均有统计学意义(均P<0.05)。阳性组发生上矢状窦血栓的比率低于阴性组[47.6%(10例)比80.0%(16例),P=0.031]。出院时阳性组完全恢复(改良Rankin评分0~1分)的比率低于阴性组[71.4%(15例)比100%(20例),P=0.032]。结论颅内静脉窦血栓患者脑实质病灶阴性患者的临床症状比阳性者相对轻微,预后较好,血栓累及上矢状窦居多。
Objective To investigate the manifestations and prognosis of head MRI and brain parenchyma in patients with intracranial venous sinus thrombosis. Methods The clinical manifestations and imaging data of 41 patients with intracranial venous sinus thrombosis were retrospectively analyzed. According to the head MRI, the patients were divided into 21 cases of positive parenchymal lesions and 20 cases of negative ones. The clinical manifestations and the differences of sinusoids involved in the two groups were analyzed. Results The positive rates of dehydration, epilepsy, dyskinesia and psychiatric symptoms in the positive group were significantly higher than those in the negative group (28.6% vs 0%, 57.1% vs 12.3%, respectively) 47.6% (10 cases), 5.0% (1 case), 33.3% (7 cases) and 5.0% (1 case), the differences were statistically significant (all P <0.05). The percentage of upper sagittal sinus thrombi in the positive group was lower than in the negative group [47.6% (10 cases) vs 80.0% (16 cases), P = 0.031]. The rate of complete recovery (modified Rankin score 0-1) at the time of discharge was lower in the positive group than in the negative group [71.4% (15 cases) vs 100% (20 cases), P = 0.032]. Conclusion The clinical symptoms of patients with negative brain parenchyma in patients with intracranial venous sinus thrombosis are relatively mild and the prognosis is better than those with positive. The thrombus is involved in the majority of the superior sagittal sinus.