Tsai F Y, Wang A M, Matovich V B, Lavin M, Berberian B, Simonson T M, Yuh W T
Department of Radiology, University of Missouri-Kansas City School of Medicine 64108, USA.
AJNR Am J Neuroradiol. 1995 May;16(5):1021-9.
To correlate parenchymal brain changes, venous sinus pressure measurements, and outcome in 29 patients with acute dural sinus thrombosis.
A retrospective review of 29 patients with angiographically proved acute dural sinus thrombosis was made from January 1989 to December 1993. MR examinations were performed on either a 0.5- or 1.5-T superconductive scanner in multiple planes. Direct dural sinus venography, cerebral angiography, and MR venography were performed. Venous sinus pressure measurements were obtained in 11 of 29 patients.
We identified five distinct stages of brain parenchymal changes; each stage correlated with increasing intradural sinus pressure. The pressures measured in this study ranged from 20 to 50 mm Hg. Brain parenchymal changes were reversible up to stage III if thrombolytic treatment was performed. Beyond stage III, there were some residual changes, even after thrombolysis. All stage V patients died.
Acute dural sinus thrombosis leads to distinct stages of parenchymal changes, the severity of which depends on the degree of venous congestion, which, in turn, is closely related to intradural sinus pressure. As intradural sinus pressure increases, progression from mild parenchymal change to severe cerebral edema and/or hematoma may occur if thrombolysis is delayed.
探讨29例急性硬脑膜窦血栓形成患者的脑实质改变、静脉窦压力测量值与预后之间的关系。
回顾性分析1989年1月至1993年12月期间经血管造影证实为急性硬脑膜窦血栓形成的29例患者。在0.5T或1.5T超导扫描仪上进行多平面磁共振成像（MR）检查。同时进行直接硬脑膜窦静脉造影、脑血管造影和MR静脉造影。29例患者中有11例进行了静脉窦压力测量。
我们确定了脑实质改变的五个不同阶段；每个阶段与硬脑膜窦内压力升高相关。本研究中测量的压力范围为20至50毫米汞柱。如果进行溶栓治疗，脑实质改变在III期之前是可逆的。超过III期，即使在溶栓后仍有一些残留改变。所有V期患者均死亡。
急性硬脑膜窦血栓形成导致脑实质改变的不同阶段，其严重程度取决于静脉充血程度，而静脉充血程度又与硬脑膜窦内压力密切相关。随着硬脑膜窦内压力升高，如果溶栓延迟，可能会从轻度脑实质改变发展为严重脑水肿和/或血肿。
