神马文学网叩诊锤论坛--脑室出血，病因？(有明确结论！)4
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脑室出血，病因？(有明确结论！) 
2008-3-1 21:41:00 
Re:脑室出血，病因？(有明确结论！) Quote: 以下是引用 drzhenghb 于 2008-2-29 21:52:22 的发言 一点不同意见
战友们画的怎么看都不太像是静脉畸形的水母征或者叫海蛇头征，其DSA诊断要点：放射状扩张的髓静脉和粗的的引流静脉在晚期出现，显影时间延长。
耶，郑版也来了。学习了。
刚刚查了一篇文献似乎和郑版说的不同。
血管造影是CVM的最佳诊断方法,其典型表现是在静脉期中出现许多细小扩张的髓静脉呈放射状汇入一条或多条粗
大的引流静脉。后者通常经表浅的皮层静脉进入静脉窦,或向深部进入深静脉系统,表现为“水母头”征,或称为“伞状”,“车辐状”,“星簇状”改变。在静脉早期出现,持续到静脉晚期,髓静脉在静脉中期显示最清。Yasargi总结了CVM的诊断标准:1、缺乏供血动脉;2、病灶出现在静脉期;3、许多细小扩张的髓静脉;4、经扩张的脑贯穿静脉(表浅型)或室管膜下静脉(深部型)引流。根据髓静脉的部位CVM分为:1、皮层表浅型,引流入浅静脉系统或浅深静脉同时引流;2、皮层下型,引流入深静脉系统或深浅静脉同时引流;3、脑室旁型,引流入室管膜下深静脉系统。根据引流静脉的类型分为表浅型和深部型。幕上浅型经皮层静脉进入静脉窦,幕上深型注入侧脑室上外侧角的
室管膜下静脉。幕下浅型向小脑蚓静脉或小脑表面静脉引流。幕下深型向第四脑室侧隐窝静脉,前中央静脉或桥横静脉引流[3]。
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2008-3-3 19:50:00 Re:脑室出血，病因？(有明确结论！) 又来了。
Clinical Examination. This 32-year-old previously healthy
right-handed man was admitted to our hospital because of
a headache that had occurred suddenly. He had no stroke
risk factor. Initially, he presented with increasing intensity
of headache and vomiting. His initial Glasgow Coma Scale
score was 14. Results of the remainder of a general physical
examination were unremarkable. Several hours after admission,
the patient’s headaches worsened and he suffered
several more bouts of emesis. His level of consciousness
deteriorated rapidly and he was intubated (Glasgow Coma
Scale score 7 of 15).
Radiological Findings. The initial unenhanced CT scan
exhibited a spontaneous curvilinear and tubular hyperdensity
located on the left middle cerebellar peduncle in the vicinity
of the fourth ventricle, which later proved to be the
thrombus in the venous angioma collector (Fig. 1 left and
center). There was no mass effect. After the patient’s condition
worsened, another CT scan revealed acute obstructive
hydrocephalus (Fig. 1 right). An MR image of the brain
demonstrated an extensive ischemic lesion located on the
pons, the mesencephalus, the cerebellum culmen, and the
middle and superior left cerebellar peduncles (Fig. 2). There
was no coexisting cavernous angioma. In addition, MR imaging
studies clearly revealed the typical “caput medusae”
appearance of the left cerebellum venous angioma (Fig. 3).
Results of cerebral angiography on Day 2 postadmission
were normal.
Laboratory Studies. Antithrombin III, protein C, and protein
S levels were normal. There was no activated protein
C resistance or factor V Leiden mutation. Antiphospholipid
antibodies were not detected. Results of the other routine
laboratory tests were also normal.
FIG. 1. Left and Center: Unenhanced CT scans obtained at the level of the pons, demonstrating a tubular, high-density
structure corresponding to the clot in the draining vein of the venous angioma. This malformation was located deep in
the left middle cerebellar peduncle in the vicinity of the fourth ventricle. Right: Unenhanced CT scan obtained after the
patient’s condition had worsened, revealing a secondary obstructive hydrocephalus.
FIG. 2. Axial T2-weighted MR images at the level of the pons
exhibiting a high signal intensity corresponding to the nonhemorrhagic
subcortical infarction of the vermis and left cerebellum. The
tubular hypointensity and round shape correspond to the clot in the
draining vein (arrows).
FIG. 3. Axial three-dimensional spoiled gradient–recalled acquisition
MR sequence revealing the venous angioma with its typical
caput medusae appearance resulting from the convergence of small
veins (arrowheads) on a large, thrombosed draining vein.
FIG. 4. Axial T2-weighted MR images obtained at 1 month postadmission,
demonstrating partial resolution of the cerebellar infarct
and an area of high signal intensity related to an old clot in the draining
vein (arrows).
FIG. 5. Drawing of parasagittal section showing the location of
the patient’s venous angioma with its drainage vein (dv) and collector
trunk (ct). Other main veins of the posterior fossa that could
drain possible venous angiomas are also marked. Amv = anterior
medullary vein; apmv = anterior pontomesencephalic vein; irtv =
inferior retrotonsillar vein; ivv = inferior vermian vein; lbv = lateral
brachial vein; pcev = precentral vein; pcuv = preculminate vein;
psv = posterior spinal vein; pv = petrosal vein; srtv = superior retrotonsillar
vein; svv = superior vermian vein; tpv = transverse pontine
vein; vlr = vein of lateral recess of fourth ventricle.
本贴已被 作者 于 2008-3-3 19:53:40 编辑过 查看此帖需要积分 0 分 2008-3-5 15:42:00 Re:脑室出血，病因？(有明确结论！) 再来一个！
本贴已被 作者 于 2008-3-5 15:44:19 编辑过 查看此帖需要积分 0 分 2008-3-12 14:17:00 Re:脑室出血，病因？(有明确结论！) 好帖，精彩。
来一个更加精彩的，CT诊断静脉畸形。
Fig. 1. a., b. Brain CT without IV contrast administration showing hyperdense hematoma (large arrow) in the left high frontal lobe, interspersed with multiple small punctate-like calcifications (small arrows). Moderate-degree perifocal edema can also be noted (arrowheads). c., d. Post-contrast CT at the same anatomic levels showing abnormal contrast-opacified vasculature (large arrowheads).
Fig. 2. Left common carotid digital subtraction cerebral angiograms: A-C (frontal projection, in early arterial, late arterial, and venous phases, respectively), D-F (lateral projection, in early arterial, late arterial, and venous phases, respectively) showing the paradoxical dilated left ACA and MCA (small black arrows), the nidus of AVM (large black arrows), the draining vein of AVM (large white arrows, the descending limb; long thin white arrows, the ascending limb), the umbrella-like venous malformation and its stem vein (large white arrowheads), the engorged cortical draining vein (small white arrows), and the deep draining vein of the venous malformation (small white arrowheads) which drains to the internal cerebral vein (black arrowheads). It is worth noting that in the frontal projection, the ascending limb of the draining vein of the AVM was superimposed over the stem vein of the venous malformation (hollow arrow).
本贴已被 作者 于 2008-3-12 14:18:1 编辑过 查看此帖需要积分 0 分 2008-3-19 14:12:00 Re:脑室出血，病因？(有明确结论！) 
Picture 1. Brain, venous vascular malformation. Coronal T1-weighted contrast-enhanced image obtained in a patient who had undergone surgery in the past for an arteriovenous malformation (AVM) shows bilateral developmental venous anomalies (DVAs) and the classic caput medusa appearance. Note the signal intensity abnormality in the inferior right cerebellar hemisphere due to the prior surgery.
Picture 2. Brain, venous vascular malformation. Coronal T1-weighted contrast-enhanced image clearly shows the draining vein and associated venous network of a developmental venous anomaly (DVA).
Picture 3. Brain, venous vascular malformation. Axial proton density–weighted image in the same patient as image 2 demonstrates the high signal intensity of the draining vein, which is typical on images obtained with this sequence. Note the yin-yang appearance of the vessel with an area of decreased signal intensity adjacent to the area with increased signal intensity
本贴已被 作者 于 2008-3-19 14:17:1 编辑过 查看此帖需要积分 0 分 2008-3-19 14:17:00 Re:脑室出血，病因？(有明确结论！) 
Picture 4. Brain, venous vascular malformation. Axial proton density–weighted image in the same patient as Image 2 and Image 3 shows an area of marked signal intensity loss in the right cerebellum adjacent to the developmental venous anomaly (DVA). This finding is consistent with a coexistent cavernous angioma.
Picture 5. Brain, venous vascular malformation. Coronal T1 postcontrast demonstrates a typical location for a DVA, here within the periventricular white matter. This malformation drained into a cortical vein along the parietal convexity.
Picture 6. Brain, venous vascular malformation. Axial postcontrast image from the same patient as in Image 5 demonstrates the fine network of feeder veins that converge into the single draining vein. 查看此帖需要积分 0 分 2008-3-19 14:17:00 Re:脑室出血，病因？(有明确结论！) 
Picture 7. Brain, venous vascular malformation. Axial T2 image from same patient as Images 5 and 6 shows that the DVA can be subtle. In this patient, the draining vein is large enough to have a flow void on the image. The parenchymal abnormality is typically not visible.
Picture 8. Brain, venous vascular malformation. Axial fluid-attenuated inversion recovery shows some artifactual increased signal within the vessel, which can aid in detection of DVAs on noncontrasted studies.
Picture 9. Brain, venous vascular malformation. On fast low-angle shot images, both the venous cluster and the draining vein may have mild susceptibility artifact (although not as much as hemosiderin) secondary to the deoxyhemoglobin within the slow-flowing veins (arrows). 查看此帖需要积分 0 分 2008-3-19 14:17:00 Re:脑室出血，病因？(有明确结论！) 
Picture 10. Brain, venous vascular malformation. Axial T1 postcontrast demonstrates a large DVA originating from the frontal lobe white matter. Note the cluster of small vessels that form the large draining vein.
Picture 11. Brain, venous vascular malformation. Slightly higher image in the same patient as Image 10. The large draining vein is noted to drain into the superior sagittal sinus 查看此帖需要积分 0 分 2008-3-19 22:34:00 Re:脑室出血，病因？(有明确结论！) 高乐高！ 黎明在哪里 查看此帖需要积分 0 分 2008-8-10 10:34:00 Re:脑室出血，病因？(有明确结论！) 想看看在TCD方面有没有什么依据？ 查看此帖需要积分 0 分
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2008-3-1 21:41:00 Re:脑室出血，病因？(有明确结论！) Quote: 以下是引用 drzhenghb 于 2008-2-29 21:52:22 的发言 一点不同意见战友们画的怎么看都不太像是静脉畸形的水母征或者叫海蛇头征，其DSA诊断要点：放射状扩张的髓静脉和粗的的引流静脉在晚期出现，显影时间延长。
耶，郑版也来了。学习了。
刚刚查了一篇文献似乎和郑版说的不同。
血管造影是CVM的最佳诊断方法,其典型表现是在静脉期中出现许多细小扩张的髓静脉呈放射状汇入一条或多条粗
大的引流静脉。后者通常经表浅的皮层静脉进入静脉窦,或向深部进入深静脉系统,表现为“水母头”征,或称为“伞状”,“车辐状”,“星簇状”改变。在静脉早期出现,持续到静脉晚期,髓静脉在静脉中期显示最清。Yasargi总结了CVM的诊断标准:1、缺乏供血动脉;2、病灶出现在静脉期;3、许多细小扩张的髓静脉;4、经扩张的脑贯穿静脉(表浅型)或室管膜下静脉(深部型)引流。根据髓静脉的部位CVM分为:1、皮层表浅型,引流入浅静脉系统或浅深静脉同时引流;2、皮层下型,引流入深静脉系统或深浅静脉同时引流;3、脑室旁型,引流入室管膜下深静脉系统。根据引流静脉的类型分为表浅型和深部型。幕上浅型经皮层静脉进入静脉窦,幕上深型注入侧脑室上外侧角的
室管膜下静脉。幕下浅型向小脑蚓静脉或小脑表面静脉引流。幕下深型向第四脑室侧隐窝静脉,前中央静脉或桥横静脉引流[3]。
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2008-3-3 19:50:00 Re:脑室出血，病因？(有明确结论！) 又来了。Clinical Examination. This 32-year-old previously healthy
right-handed man was admitted to our hospital because of
a headache that had occurred suddenly. He had no stroke
risk factor. Initially, he presented with increasing intensity
of headache and vomiting. His initial Glasgow Coma Scale
score was 14. Results of the remainder of a general physical
examination were unremarkable. Several hours after admission,
the patient’s headaches worsened and he suffered
several more bouts of emesis. His level of consciousness
deteriorated rapidly and he was intubated (Glasgow Coma
Scale score 7 of 15).
Radiological Findings. The initial unenhanced CT scan
exhibited a spontaneous curvilinear and tubular hyperdensity
located on the left middle cerebellar peduncle in the vicinity
of the fourth ventricle, which later proved to be the
thrombus in the venous angioma collector (Fig. 1 left and
center). There was no mass effect. After the patient’s condition
worsened, another CT scan revealed acute obstructive
hydrocephalus (Fig. 1 right). An MR image of the brain
demonstrated an extensive ischemic lesion located on the
pons, the mesencephalus, the cerebellum culmen, and the
middle and superior left cerebellar peduncles (Fig. 2). There
was no coexisting cavernous angioma. In addition, MR imaging
studies clearly revealed the typical “caput medusae”
appearance of the left cerebellum venous angioma (Fig. 3).
Results of cerebral angiography on Day 2 postadmission
were normal.
Laboratory Studies. Antithrombin III, protein C, and protein
S levels were normal. There was no activated protein
C resistance or factor V Leiden mutation. Antiphospholipid
antibodies were not detected. Results of the other routine
laboratory tests were also normal.
FIG. 1. Left and Center: Unenhanced CT scans obtained at the level of the pons, demonstrating a tubular, high-density
structure corresponding to the clot in the draining vein of the venous angioma. This malformation was located deep in
the left middle cerebellar peduncle in the vicinity of the fourth ventricle. Right: Unenhanced CT scan obtained after the
patient’s condition had worsened, revealing a secondary obstructive hydrocephalus.
FIG. 2. Axial T2-weighted MR images at the level of the pons
exhibiting a high signal intensity corresponding to the nonhemorrhagic
subcortical infarction of the vermis and left cerebellum. The
tubular hypointensity and round shape correspond to the clot in the
draining vein (arrows).
FIG. 3. Axial three-dimensional spoiled gradient–recalled acquisition
MR sequence revealing the venous angioma with its typical
caput medusae appearance resulting from the convergence of small
veins (arrowheads) on a large, thrombosed draining vein.
FIG. 4. Axial T2-weighted MR images obtained at 1 month postadmission,
demonstrating partial resolution of the cerebellar infarct
and an area of high signal intensity related to an old clot in the draining
vein (arrows).
FIG. 5. Drawing of parasagittal section showing the location of
the patient’s venous angioma with its drainage vein (dv) and collector
trunk (ct). Other main veins of the posterior fossa that could
drain possible venous angiomas are also marked. Amv = anterior
medullary vein; apmv = anterior pontomesencephalic vein; irtv =
inferior retrotonsillar vein; ivv = inferior vermian vein; lbv = lateral
brachial vein; pcev = precentral vein; pcuv = preculminate vein;
psv = posterior spinal vein; pv = petrosal vein; srtv = superior retrotonsillar
vein; svv = superior vermian vein; tpv = transverse pontine
vein; vlr = vein of lateral recess of fourth ventricle.
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2008-3-5 15:42:00 Re:脑室出血，病因？(有明确结论！) 再来一个！本贴已被 作者 于 2008-3-5 15:44:19 编辑过 查看此帖需要积分 0 分
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2008-3-12 14:17:00 Re:脑室出血，病因？(有明确结论！) 好帖，精彩。来一个更加精彩的，CT诊断静脉畸形。
Fig. 1. a., b. Brain CT without IV contrast administration showing hyperdense hematoma (large arrow) in the left high frontal lobe, interspersed with multiple small punctate-like calcifications (small arrows). Moderate-degree perifocal edema can also be noted (arrowheads). c., d. Post-contrast CT at the same anatomic levels showing abnormal contrast-opacified vasculature (large arrowheads).
Fig. 2. Left common carotid digital subtraction cerebral angiograms: A-C (frontal projection, in early arterial, late arterial, and venous phases, respectively), D-F (lateral projection, in early arterial, late arterial, and venous phases, respectively) showing the paradoxical dilated left ACA and MCA (small black arrows), the nidus of AVM (large black arrows), the draining vein of AVM (large white arrows, the descending limb; long thin white arrows, the ascending limb), the umbrella-like venous malformation and its stem vein (large white arrowheads), the engorged cortical draining vein (small white arrows), and the deep draining vein of the venous malformation (small white arrowheads) which drains to the internal cerebral vein (black arrowheads). It is worth noting that in the frontal projection, the ascending limb of the draining vein of the AVM was superimposed over the stem vein of the venous malformation (hollow arrow).
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2008-3-19 14:12:00 Re:脑室出血，病因？(有明确结论！) Picture 1. Brain, venous vascular malformation. Coronal T1-weighted contrast-enhanced image obtained in a patient who had undergone surgery in the past for an arteriovenous malformation (AVM) shows bilateral developmental venous anomalies (DVAs) and the classic caput medusa appearance. Note the signal intensity abnormality in the inferior right cerebellar hemisphere due to the prior surgery.
Picture 2. Brain, venous vascular malformation. Coronal T1-weighted contrast-enhanced image clearly shows the draining vein and associated venous network of a developmental venous anomaly (DVA).
Picture 3. Brain, venous vascular malformation. Axial proton density–weighted image in the same patient as image 2 demonstrates the high signal intensity of the draining vein, which is typical on images obtained with this sequence. Note the yin-yang appearance of the vessel with an area of decreased signal intensity adjacent to the area with increased signal intensity
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2008-3-19 14:17:00 Re:脑室出血，病因？(有明确结论！) Picture 4. Brain, venous vascular malformation. Axial proton density–weighted image in the same patient as Image 2 and Image 3 shows an area of marked signal intensity loss in the right cerebellum adjacent to the developmental venous anomaly (DVA). This finding is consistent with a coexistent cavernous angioma.
Picture 5. Brain, venous vascular malformation. Coronal T1 postcontrast demonstrates a typical location for a DVA, here within the periventricular white matter. This malformation drained into a cortical vein along the parietal convexity.
Picture 6. Brain, venous vascular malformation. Axial postcontrast image from the same patient as in Image 5 demonstrates the fine network of feeder veins that converge into the single draining vein. 查看此帖需要积分 0 分
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2008-3-19 14:17:00 Re:脑室出血，病因？(有明确结论！) Picture 7. Brain, venous vascular malformation. Axial T2 image from same patient as Images 5 and 6 shows that the DVA can be subtle. In this patient, the draining vein is large enough to have a flow void on the image. The parenchymal abnormality is typically not visible.
Picture 8. Brain, venous vascular malformation. Axial fluid-attenuated inversion recovery shows some artifactual increased signal within the vessel, which can aid in detection of DVAs on noncontrasted studies.
Picture 9. Brain, venous vascular malformation. On fast low-angle shot images, both the venous cluster and the draining vein may have mild susceptibility artifact (although not as much as hemosiderin) secondary to the deoxyhemoglobin within the slow-flowing veins (arrows). 查看此帖需要积分 0 分
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2008-3-19 14:17:00 Re:脑室出血，病因？(有明确结论！) Picture 10. Brain, venous vascular malformation. Axial T1 postcontrast demonstrates a large DVA originating from the frontal lobe white matter. Note the cluster of small vessels that form the large draining vein.
Picture 11. Brain, venous vascular malformation. Slightly higher image in the same patient as Image 10. The large draining vein is noted to drain into the superior sagittal sinus 查看此帖需要积分 0 分
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2008-3-19 22:34:00 Re:脑室出血，病因？(有明确结论！) 高乐高！ 黎明在哪里 查看此帖需要积分 0 分 - bents
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