Swerdlow R H, Hanna G R
Department of Neurology, University of Virginia Health Sciences Center, Charlottesville 22906, USA.
Headache. 1996 Feb;36(2):115-8. doi: 10.1046/j.1526-4610.1996.3602115.x.
The standard evaluation of patients with intracranial hypertension frequently does not reveal a discrete pathophysiologic process, leading in these cases to classification of the syndrome as "benign." We present a 35-year-old woman with a recent diagnosis of pseudotumor cerebri who presented with headache, emesis, and blurring of vision. Her symptoms were progressive despite two lumbar punctures that revealed normal cerebrospinal fluid under high pressure. Contrast and noncontrast CT scans were normal; both the cerebrospinal fluid and CT neuroimaging were thus consistent with benign intracranial hypertension. An MRI, however, supported the presence of sagittal sinus thrombosis, a finding which was confirmed by MR venography. Further workup for an underlying cause of sinus thrombosis disclosed symptoms and signs fulfilling the diagnostic criteria for Behcet's disease. Cerebral venous (or sinus) thrombosis should be considered in the differential diagnosis of intracranial hypertension. Behcet's disease, while extremely rare, should be considered as a potential cause of cerebral venous thrombosis. Magnetic resonance venography can serve as a useful diagnostic study in situations where confirmation or exclusion of sinus thrombosis is required.
对颅内高压患者的标准评估常常无法揭示明确的病理生理过程，在这些病例中导致该综合征被归类为“良性”。我们报告一名35岁女性，近期诊断为假性脑瘤，表现为头痛、呕吐和视力模糊。尽管进行了两次腰椎穿刺，结果显示脑脊液在高压下正常，但她的症状仍在进展。增强和非增强CT扫描均正常；脑脊液和CT神经影像学结果因此均符合良性颅内高压。然而，磁共振成像（MRI）显示存在矢状窦血栓形成，磁共振静脉血管造影（MRV）证实了这一发现。对窦血栓形成潜在病因的进一步检查发现了符合白塞病诊断标准的症状和体征。在颅内高压的鉴别诊断中应考虑脑静脉（或窦）血栓形成。白塞病虽然极为罕见，但应被视为脑静脉血栓形成的潜在病因。在需要确认或排除窦血栓形成的情况下，磁共振静脉血管造影可作为一项有用的诊断检查。
