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目的探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)影像学中乳突异常对临床诊断的价值。方法回顾性研究北京大学第三医院2000-2012年收治的30例CVST患者,对其临床表现、影像学特点、治疗方式和治疗效果进行分析。结果 30例患者中14例为非感染性CVST,患者表现为不同程度的头痛、发热、癫痫、偏瘫及意识障碍;死亡4例;血栓部位在乙状窦和横窦;11例同时存在上矢状窦血栓;10例出现乳突充血改变,表现为头颅MRI平扫中乳突呈蜂窝样长T2信号改变,颞骨CT示乳突骨质无破坏。16例为感染性CVST,患者表现为高热、头痛、耳痛、耳流脓;血栓部位在乙状窦;经乳突根治术和乙状窦血栓清除术后预后良好;颞骨CT示乳突硬化型、胆脂瘤型中耳乳突炎。结论胆脂瘤型中耳乳突炎患者合并乙状窦血栓时,由于局部体征明显,通常能得到早期诊断并获得良好的预后。而非感染性CVST患者由于缺乏特异性的临床表现,早期诊断困难,乳突充血是重要的间接征象,需得到临床和放射科医师的重视。
Objective To investigate the clinical value of abnormal mastoid in the imaging of intracranial venous sinus thrombosis (CVST). Methods A retrospective study of 30 patients with CVST admitted in Peking University Third Hospital from 2000 to 2012 was conducted to analyze the clinical manifestations, imaging features, treatment modalities and therapeutic effects. Results Of the 30 patients, 14 were noninfectious CVST. The patients showed varying degrees of headache, fever, epilepsy, hemiparesis and disturbance of consciousness; 4 died; the thrombus was located in sigmoid sinus and transverse sinus; Sinusoid thrombus; 10 cases of papillae hyperemia changes, manifested as cranial MRI scan was honeycomb length T2 signal change, temporal bone CT showed no destruction of the bone mass. Sixteen patients were infected with CVST. The patients presented with fever, headache, earache, purulent ear, thrombus in the sigmoid sinus, good prognosis after radical mastoidectomy and sigmoid sinus thrombectomy, and temporal bone CT showed mastoid sclerosis Type, cholesteatoma type otitis media. Conclusions When cholesteatoma type otitis media is complicated by sigmoid sinus thrombosis, early diagnosis and good prognosis can usually be obtained because of obvious local signs. The non-infectious CVST patients due to the lack of specific clinical manifestations, early diagnosis difficulties, mastoid congestion is an important indirect signs, subject to clinical and radiologists attention.