脑膜癌伴颅内静脉窦血栓形成病例分析及文献回顾

发布时间：2018-06-11 17:50

本文选题：脑膜癌伴颅内静脉窦血栓形成 + 临床表现　；参考：《兰州大学》2014年硕士论文

【摘要】：目的：探讨脑膜癌伴颅内静脉窦血栓形成的临床表现及诊断。方法：回顾性分析一例脑膜癌伴颅内静脉窦血栓形成的病历资料并结合文献复习。设计：病例报告病例：患者中年女性,于入院前2月出现间断性头痛,以两侧颞叶为著,呈跳动样疼痛,持续约5分钟后缓解；于入院前1周,头疼症状渐加重伴头晕、恶心、呕吐；于入院前2天,上述症状加重,伴发作性意识丧失1次,持续约10秒后意识转清；结合外院头颅CT示：颅内无明显异常；头颅MRI+MRA+MRV及头颅MRI增强提示：左侧横窦近端发育细小；行腰椎穿刺术提示：压力350mmH20；脑血管造影提示：颈内动脉、椎动脉及颅内动脉分支走形正常,血流减慢,脑循环时间明显延迟,上矢状窦形态良好,窦汇及左侧横窦显影欠佳,可见造影剂滞留现象,左侧大脑深静脉回流速度延迟,左侧颈内静脉显示欠佳,侧支开放。干预：及时给予动、静脉溶栓及抗凝,同时辅以降颅压、止痛、恢复脑功能改善循环、减轻血管痉挛等对症支持治疗。预后：因早期及时的溶栓、抗凝治疗,患者高颅压症状较前减轻,在出院1月后随访,患者颅内压症状再次加重,在“北京301医院”,确诊为乳腺癌转移性脑膜癌,经当地医院姑息保守治疗后死亡。结论：对于存在顽固性头痛、持续性高颅压症状,同时出现局部神经功能缺损、部分性或全面性癫痫发作,证实为颅内静脉窦血栓形成的患者,经给予抗凝、溶栓及对症治疗后症状仍短期减轻仍有反复加重趋势,应在病因诊断上多加斟酌,特别是既往患有恶性肿瘤病史,病因诊断不排外脑膜癌。在临床应反复多次送检脑脊液,增加脑脊液细胞学肿瘤细胞检出的阳性率。当患者病情趋于稳定时,基于其病因或原有的基础病史,预后仍存在很大程度的不可预测性。
[Abstract]:Objective: to investigate the clinical manifestation and diagnosis of meningeal carcinoma with intracranial venous sinus thrombosis. Methods: a case of meningeal carcinoma with intracranial venous sinus thrombosis was retrospectively analyzed and reviewed with literature review. Design: case report Cases: middle-aged women, Intermittent headache developed 2 months before admission, with the temporal lobes on both sides as beating pain, which lasted for about 5 minutes. In the first week of admission, the headache gradually aggravated with dizziness, nausea and vomiting, and on the first 2 days of admission, the above symptoms aggravated. Combined with the CT findings of the external hospital, there were no obvious intracranial abnormalities, MRI MRV and enhanced cranial MRI suggested that the proximal end of the left transverse sinus was small. Lumbar puncture indicated that the pressure was 350mm H20.The cerebral angiography showed that the internal carotid artery, vertebral artery and intracranial artery branches were normal, the blood flow was slow, the cerebral circulation time was obviously delayed, the shape of the superior sagittal sinus was good, the sinus confluence and the left transverse sinus were not well developed. We can see the phenomenon of contrast agent retention, the left deep cerebral vein is delayed, the left internal jugular vein is not well displayed, and the lateral branch is open. Intervention: timely administration of thrombolysis and anticoagulant therapy of artery and vein, as well as reduction of intracranial pressure to relieve pain, Recovery of cerebral function, improvement of circulation, relief of vasospasm and other symptomatic support treatment. Prognosis: early and timely thrombolytic and anticoagulant therapy, the symptoms of high intracranial pressure were alleviated, and the intracranial pressure symptoms were aggravated again after 1 month of discharge. In Beijing 301 Hospital, metastatic meningeal carcinoma of breast cancer was diagnosed and died after palliative and conservative treatment in the local hospital. In patients with partial or comprehensive seizures and confirmed to be intracranial venous sinus thrombosis, after anticoagulation, thrombolytic therapy and symptomatic treatment, there is still a tendency of repeated exacerbation of symptoms, which should be taken into account in the etiological diagnosis. In particular, the history of previous malignant tumors, etiological diagnosis of non-exclusive meningeal carcinoma. Cerebrospinal fluid (CSF) should be examined repeatedly in clinic to increase the positive rate of CSF cytological tumor cells. When the patient's condition tends to be stable, the prognosis is still largely unpredictable based on the etiology or the original history of the disease.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.45

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