Jacobs K, Moulin T, Bogousslavsky J, Woimant F, Dehaene I, Tatu L, Besson G, Assouline E, Casselman J
Department of Neurology, Algemeen Ziekenhuis St.-Jan, Brugge, Belgium.
Neurology. 1996 Aug;47(2):376-82. doi: 10.1212/wnl.47.2.376.
Cortical vein thrombosis without sinus involvement is rarely diagnosed, although it may commonly be overlooked. We report four cases of cerebral venous thrombosis limited to the cortical veins. The diagnosis was made on surgical intervention in one patient and by angiography in three patients. Together with a survey of the published cases, the clinical and neuroimaging patterns of our patients allow delineation of several features suggestive of cortical venous stroke. Focal or generalized seizures followed by hemiparesis, aphasia, hemianopia, or other focal neurologic dysfunction in the absence of signs of increased intracranial pressure should suggest this possibility. Neuroimaging (CT, MRI) shows an ischemic lesion that does not follow the boundary of arterial territories and often has a hemorrhagic component, without signs of venous sinus thrombosis. Conventional angiography demonstrates no arterial occlusion but may show cortical vein thrombosis corresponding to the infarct, although these may also be nonspecific findings. The role of MR angiography, which is well-established in sinus thrombosis, remains to be assessed in patients with brain ischemia due to isolated cortical vein occlusion.
不伴有静脉窦受累的皮质静脉血栓形成很少被诊断出来，尽管它可能常常被忽视。我们报告了4例仅限于皮质静脉的脑静脉血栓形成病例。其中1例患者通过手术干预确诊，3例患者通过血管造影确诊。结合已发表病例的调查，我们患者的临床和神经影像学表现有助于勾勒出一些提示皮质静脉卒中的特征。在没有颅内压升高迹象的情况下，局灶性或全身性癫痫发作后出现偏瘫、失语、偏盲或其他局灶性神经功能障碍，应考虑到这种可能性。神经影像学检查（CT、MRI）显示的缺血性病变并不沿动脉供血区边界分布，且常伴有出血成分，无静脉窦血栓形成的迹象。传统血管造影未显示动脉闭塞，但可能显示与梗死灶对应的皮质静脉血栓形成，尽管这些表现也可能不具有特异性。磁共振血管造影在静脉窦血栓形成中的作用已得到充分证实，但在孤立性皮质静脉闭塞导致脑缺血的患者中，其作用仍有待评估。
