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中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (04) : 247 -251. doi: 10.3877/cma.j.issn.2095-3259.2021.04.012

病例报告

妊娠合并广泛颅内静脉窦血栓形成一例
刘志鹏1, 郭炜1, 章秋萍1, 钱东翔1,()   
  1. 1. 510150 广州医科大学附属第三医院神经外科
  • 收稿日期:2020-11-06 出版日期:2021-11-18
  • 通信作者: 钱东翔

A case of pregnancy complicated with extensive intracranial venous sinus thrombosis

Zhipeng Liu1, Wei Guo1, Qiuping Zhang1   

  • Received:2020-11-06 Published:2021-11-18
引用本文:

刘志鹏, 郭炜, 章秋萍, 钱东翔. 妊娠合并广泛颅内静脉窦血栓形成一例[J]. 中华产科急救电子杂志, 2021, 10(04): 247-251.

Zhipeng Liu, Wei Guo, Qiuping Zhang. A case of pregnancy complicated with extensive intracranial venous sinus thrombosis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(04): 247-251.

图1 妊娠早期合并颅内静脉窦血栓患者MRI影像图。A~B:静脉窦血栓急性期,上矢状窦内T1WI呈等信号、T2WI呈低信号(红色箭头示);C:MR增强相示上状窦的后三分之一处"空三角征"(黄色箭头示),为明显强化的充血静脉窦壁或侧支血管的高信号与腔内不强化的血栓低密度形成的对比;D~F:轴位、矢状位、冠状位MR增强扫描示双侧横窦、窦汇、上矢状窦、下矢状窦、直窦内不规则狭窄、闭塞、充盈缺损(蓝色箭头示);G:SWI可见上矢状窦条带状低信号影,梗阻静脉窦附近引流静脉扩张(绿色箭头示);H:大脑半球尚对称,脑回肿胀,双侧额顶叶脑沟内线状FLAIR高信号,考虑蛛网膜下腔出血(黑色箭头示);I~J:双侧额顶叶、右侧颞叶见散在斑点状、小片状异常信号影,边界欠清,DWI呈高信号,相应ADC图稍减低,考虑急性梗死灶(白色箭头示);K~L:MRV示颅内静脉窦未见显影,引流静脉扩张及侧支循环形成(橙色箭头示)
图2 妊娠早期合并颅内静脉窦血栓患者DSA动态变化影像图。A~B:溶栓取栓术前可见上矢状窦、下矢状窦、双侧乙状窦及横窦、直窦、窦汇未见显影(白色箭头示),静脉血液经两侧海绵窦引流至颈内静脉,大脑表面及静脉窦旁邻近静脉扩张及侧支循环形成(白色椭圆区域示),动静脉循环时间明显延长;C:溶栓取栓术中静脉窦开通情况,可见造影剂显影逐渐明显,上矢状窦及两侧横窦、乙状窦血流逐渐恢复。D~E:溶栓取栓术后并经系统抗凝治疗,复查DSA可见静脉窦基本恢复正常血流,大脑表面及静脉窦旁邻近静脉扩张较术前明显改善(D、E与A、B对比)
图3 妊娠早期合并颅内静脉窦血栓患者机械取栓术中的部分血栓斑块图
图4 妊娠早期合并颅内静脉窦血栓患者静脉接触性溶栓留置微导管图。上矢状窦-右侧乙状窦-右侧颈静脉内可见微导管置入(白色三角尖端示微导管行迹)
图5 妊娠早期合并颅内静脉窦血栓患者D-二聚体检测图。患者入院至出院的D-二聚体指标变化呈现先升高后降低的过程,于溶栓取栓术后第2天达到高峰,至患者出院前已降至正常。图中横坐标为检测时间精确到分钟,纵坐标为D-二聚体值
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