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脑静脉血栓形成
Cerebral Venous Thrombosis


Allan H. Ropper ... 心脑血管疾病 • 2021.07.01
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脑静脉血栓形成是目前广受关注的罕见脑血管疾病,受到关注的部分原因是与某些COVID-19疫苗相关的罕见病例。脑静脉血栓形成所致脑梗死的特点不同于动脉闭塞导致的一般类型的缺血性卒中。这篇简短综述回顾了自2005年本刊发表关于这一主题的综述以来,基于临床和影像学特征形成的脑静脉血栓诊断流程和现有治疗方法1

 

解剖学和病理生理学


硬脑膜窦血栓形成指的是硬脑膜大静脉内形成血凝块,皮质静脉血栓形成指的是皮质表面静脉闭塞。脑静脉血栓形成包括硬脑膜血凝块和皮质静脉闭塞。最重要的硬脑膜静脉通道是上矢状窦,它向后流入横窦(侧窦),然后进入两侧的颈内静脉。上矢状窦和横窦由皮质表面许多大小和位置不同的分支静脉流入;在每一侧,这些静脉中最大的被称为Trolard静脉(垂直地位于顶叶上并流入上矢状窦的静脉)和Labbé静脉(水平地位于颞叶上并流入横窦的静脉)。静脉内血凝块从硬脑膜窦开始并向心脏方向延伸(propagate)到皮质静脉的情况常见;根据文献综述中的报道,单纯皮质静脉血栓形成仅见于116例患者2。血栓也独立发生于深静脉结构内(直窦、盖伦静脉、下矢状窦、引流丘脑的大脑内静脉和罗森塔尔基底静脉),导致局限于受累静脉的综合征。

如本刊之前的综述所总结,脑静脉血栓形成引起两种具有不同病理生理特征的疾病:皮质静脉梗死伴局灶性神经系统综合征,以及颅内压升高1。这些临床综合征(单独或一起)通常在数小时或数日内形成,但也可以在数周内持续进展。





作者信息

Allan H. Ropper, M.D., and Joshua P. Klein, M.D., Ph.D.
From the Department of Neurology, Brigham and Women’s Hospital, Boston.

 

参考文献

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