摘要：

研究背景 大脑浅静脉血栓形成为临床少见脑血管病，病因多样、发病形式和临床表现复杂且不具有特异性，易误诊或漏诊。本文通过对1 例大脑浅静脉血栓形成伴出血性脑梗死患者大脑浅静脉解剖学、浅静脉血栓形成病理生理学知识的复习及诊断与治疗要点的回顾，以提高对其诊断与鉴别诊断能力。方法与结果 男性患者，18 岁。进行性头痛4 年伴左侧肢体无力2 d。头部MRI显示右侧额顶叶类圆形占位性病变，MRV 显示上矢状窦前2/3 显影不清。手术切除右侧额顶叶部分病变组织并去骨瓣减压，术中可见脑组织苍白，部分呈黄色或暗红色，浅静脉怒张；组织学形态观察，软脑膜浅静脉血栓和软脑膜下软化灶形成，大脑皮质多灶性和局部脑实质出血，周围组织大量“格子细胞”，并可见“血管套袖”现象，脑实质血管明显增生。术后左手活动明显受限。结论 大脑浅静脉血栓形成伴出血性脑梗死临床诊断困难，影像学和血清学检查可提供一定帮助，应重视多学科联合诊断与治疗，以减少误诊和漏诊并积累临床经验。

关键词: 脑, 静脉血栓形成, 颅内出血, 脑梗死, 免疫组织化学, 病理学

Abstract:

Background Cerebral superficial vein thrombosis was rare and often misdiagnosed or missed for its various etiological factors, and complicated and nonspecific clinical manifestations. This paper reported one case of superficial vein thrombosis in right fronto-parietal lobe with hemorrhagic infarction. The anatomy of superficial vein, pathophysiological points, diagnosis and treatment of superficial vein thrombosis were reviewed to help to reduce missed diagnosis or misdiagnosis. Methods and Results  A 18-year-old male patient had suffered from progressive headache for 4 years and weakness of left limbs for 2 d. Head MRI showed circular space-occupying lesion in right fronto-parietal lobe. Magnetic resonance venography (MRV) examination showed the front two-thirds of the superior sagittal sinus was not clear. The lesions were removed and decompressive craniectomy was conducted, showing the brain tissue was pale, partly yellow or dark red, and superficial venous engorgement. Histological observation showed pial superficial vein thrombosis and subpial encephalomalacia, and multifocal hemorrhage of cerebral cortex and local parenchymal hemorrhage. A large number of "grid cells" and vascular "cuff" phenomenan were visible in surrounding tissue, and the parenchymal blood vessel proliferation was obvious. Left hand activity of the patient was obviously limited after the operation. Conclusions Clinical diagnosis of superficial vein thrombosis with hemorrhagic infarction is difficult, and brain imaging and serological examination can provide certain help. Much attention should be paid to the multidisciplinary diagnosis and treatment to reduce misdiagnosis or missed diagnosis, and gather clinical experience.

Key words: Brain, Venous thrombosis, Intracranial hemorrhages, Brain infarction, Immunohistochemistry, Pathology