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目的 总结高度疑似胶质瘤的颅内静脉 静脉窦血栓形成的临床实践和研究体会。方法 采用形态学检查和功能学研究相结合的原则 ,选择颅脑磁共振成像平扫和磁共振成像增强扫描后 ,对高度疑似脑胶质瘤的临床案例进行研究。在阐述背景资料基础上 ,着重就患者的临床表现和影像学特征进行临床诊断辨析 ,再有针对性地进行特殊的实验室检查 ,包括 :磁共振成像弥散加权成像、局部脑氟脱氧葡萄糖代谢显像、数字减影血管造影术 ,并在相应的康复措施 (包括抗炎、抗凝用药和高压氧、血液磁极化疗法等 )前后 ,就磁共振成像所见和脑循环动力学指标进行动态的对照观察。结果 治疗后 ,患者的意识、精神状态等恢复正常 ,脑循环动力学指标明显改善 ,原脑内的疑似病灶接近消失。明确诊断为 :①颅内静脉 静脉窦血栓形成 ;②全身性血栓性静脉炎。结论 以直窦为主及其引流静脉血栓形成的影像学表现可酷似脑胶质瘤样改变 ;熟悉有关本病的危险因素 ,并以科学的思维方法进行临床诊断辨析是避免贻误诊断的关键所在。
Objective To summarize the clinical practice and research experience of intracranial venous sinus thrombosis in highly suspected gliomas. Methods According to the principle of combination of morphological examination and functional study, the clinical cases of highly suspected glioma were studied after the brain MRI scan and the magnetic resonance imaging enhanced scan were selected. On the basis of expatiating on the background information, we focus on the clinical diagnosis and differentiation of the clinical manifestations and imaging features of patients, and then carry out special laboratory tests, including: diffusion weighted imaging of magnetic resonance imaging, local cerebral fluorodeoxyglucose metabolism was significantly Such as digital subtraction angiography, and dynamic MRI findings and cerebral circulation dynamics before and after appropriate rehabilitation measures (including anti-inflammatory, anticoagulant medication and hyperbaric oxygenation, blood magnetic therapy, etc.) Control observation. Results After treatment, the patient’s consciousness, mental status returned to normal, significantly improved brain circulatory dynamics, the original brain lesions near the disappearance of suspected. Clearly diagnosed as: ① intracranial venous sinus thrombosis; ② systemic thrombophlebitis. Conclusions The imaging manifestations of mainly straight sinus and its drainage venous thrombosis may resemble glioma-like changes. Being familiar with the risk factors of this disease and using scientific thinking methods for clinical diagnosis is the key to avoiding the delaying diagnosis .