重症脑深静脉血栓形成并溃疡性结肠炎一例

doi:10.3969/j.issn.1672-6731.2024.03.014

摘要/Abstract

Key words: Venous thrombosis, Cerebral veins, Colitis, ulcerative, Case reports

王金宝, 谷亚钦, 段建钢. 重症脑深静脉血栓形成并溃疡性结肠炎一例[J]. 中国现代神经疾病杂志, 2024, 24(3): 193-198.

Jin-bao WANG, Ya-qin GU, Jian-gang DUAN. Severe deep cerebral venous thrombosis associated with ulcerative colitis: one case report[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(3): 193-198.

https://journal11.magtechjournal.com/cjcnn/CN/Y2024/V24/I3/193

图/表 9

图 1 入院当日头部CT检查显示，双侧丘脑、基底节区斑片状低密度影（粗箭头所示），大脑大静脉、双侧大脑内静脉区密度升高（细箭头所示） 1a 基底节层面 1b 侧脑室体部层面

Figure 1 Head CT at admission showed low-density in bilateral thalamus and basal ganglia area (thick arrows indicate), and high-density in great cerebral vein and bilateral internal cerebral venous area (thin arrows indicate). Basal ganglia level (Panel 1a). Lateral ventricle body level (Panel 1b).

图 2 入院当日头部MRI检查所见 2a 横断面T₁WI显示，双侧大脑脚、双侧丘脑、左侧基底节区、左侧侧脑室周围、胼胝体压部低信号影（箭头所示） 2b 横断面T₂WI显示，双侧大脑脚、双侧丘脑、左侧基底节区、左侧侧脑室周围、胼胝体压部高信号影（箭头所示）

Figure 2 Head MRI findings at admission Axial T₁WI showed hypointensity involving bilateral cerebral peduncle, bilateral thalamus, left basal ganglia, around left lateral ventricle and corpus callosum (arrows indicate, Panel 2a). Axial T₂WI showed hyperintensity involving bilateral cerebral peduncle, bilateral thalamus, left basal ganglia, around left lateral ventricle and corpus callosum (arrows indicate, Panel 2b).

图 3 入院当日头部静脉MRBTI显示，大脑大静脉、双侧大脑内静脉、下矢状窦、直窦近窦汇处高信号影（箭头所示） 3a 横断面MRBTI 3b 矢状位MRBTI

Figure 3 Head vein MRBTI at admission showed hyperintensity involving great cerebral vein, bilateral internal cerebral veins, inferior sagittal sinus, straight sinus (arrows indicate) Axial MRBTI (Panel 3a). Sagittal MRBTI (panel 3b).

图 4 入院当日头颈部增强MRV所见 4a 头部侧位增强MRV显示大脑大静脉、双侧大脑内静脉、直窦血栓形成（箭头所示） 4b 颈部正位增强MRV显示右颈内静脉上段闭塞（箭头所示）

Figure 4 Head and neck enhanced MRV findings at admission Lateral head enhanced MRV showed no visualization of great cerebral vein, bilateral internal cerebral veins, straight sinus (arrow indicates, Panel 4a). Frontal neck enhanced MRV showed no visualization of the upper part of the right jugular vein (arrow indicates, Panel 4b).

表 1 患者住院期间血常规、炎性指标和脑脊液压力检查结果

Table 1. Results of blood routine examination, inflammatory index and CSF pressure during hospitalization

检测时间	Hb(g/L)	WBC(× 10⁹/L)	PLT(× 10⁹/L)	hs-CRP(mg/L)	IL-6(pg/ml)	PCT(ng/L)	脑脊液压力(mm H₂O)
2022-07-07	77	10.83	169	27.29	24.17	80	220
2022-07-13	90	9.28	303	0.15	＜1.50	20	150(2022-07-14)
2022-07-22	102	6.54	315	37.27	38.65	40	140
2022-07-25	—	—	—	18.39	21.69	60	160(2022-07-28)
2022-08-01	102	10.98	331	1.01	2.82	—	—
2022-08-10	—	—	—	0.21	＜1.50	20	—
正常参考值	110 ~ 150	4~10	100 ~ 300	0 ~ 3	＜7	＜50	80 ~ 180

图 5 入院第16天复查头部MRI显示，双侧丘脑、左侧基底节区、左侧侧脑室周围、胼胝体压部异常信号范围较前缩小 5a 横断面T₁WI 5b 横断面T₂WI

Figure 5 Head MRI at 16th day of admission showed the range of abnormal signals of bilateral thalamus, left basal ganglia, around left lateral ventricle and corpus callosum were reduced. Axial T₁WI(Panel 5a). Axial T₂WI(Panel 5b).

图 6 住院期间头部CT动态变化 6a 入院第16天可见左侧枕叶高密度影 6b 入院第23天可见左侧枕叶斑片状高密度影及其周围低密度水肿带较前扩大 6c 入院第31天可见左侧枕叶高密度影程度较前降低 6d 入院第37天可见左侧枕叶高密度影较前缩小

Figure 6 Dynamic changes of head CT during hospitalization Axial CT showed high-density shadow in the left occipital cortex at the 16th day of admission (Panel 6a). Axial CT showed high-density shadow of the left occipital cortex and the surrounding low-density edema band at the 23th day of admission was larger than before (Panel 6b). Axial CT showed high-density shadow of the left occipital cortex at the 31th day of admission was lower than before (Panel 6c). Axial CT showed high-density shadow of the left occipital cortex was reduced at the 37th day of admission (Panel 6d).

图 7 出院后6个月复查头部静脉MRBTI显示，双侧丘脑、下矢状窦、大脑大静脉、双侧大脑内静脉异常信号较前缩小 7a 横断面MRBTI 7b 矢状位MRBTI

Figure 7 Head vein MRBTI at 6-month after discharge showed the range of abnormal signals of bilateral thalamus, inferior sagittal sinus, great cerebral vein, bilateral internal cerebral veins were reduced. Axial MRBTI (Panel 7a). Sagittal MRBTI (Panel 7b).

图 8 出院后6个月复查头颈部增强MRV显示，直窦、大脑大静脉、双侧大脑内静脉显影较前清晰 8a 头部侧位增强MRV 8b 颈部正位增强MRV

Figure 8 Head and neck enhanced MRV at 6-month after discharge showed the straight sinus, great cerebral vein and bilateral internal cerebral veins were clearer than before. Lateral head enhanced MRV (Panel 8a). Frontal neck enhanced MRV (Panel 8b).

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