初诊颅内静脉窦血栓形成的硬脑膜动静脉瘘一例

Diagnosis and Treatment of Dural Arteriovenous Fistula with Intracranial Venous Sinus Thrombosis: A Case Report

摘要: 目的：探讨硬脑膜动静脉瘘患者临床初始误诊为颅内静脉窦血栓形成一例的诊疗经过。方法：分析1例初步诊断为颅内静脉窦血栓形成的硬脑膜动静脉瘘患者的临床资料。结果：本例患者为中年男性，临床表现为意识障碍、肢体活动不灵等症状，早期颅脑影像学检查提示深静脉梗死、符合静脉栓塞表现，经积极抗凝及对症治疗后临床病情进行性加重，为寻找病因行全脑血管造影术提示为硬脑膜动静脉瘘。结论：获得性硬脑膜动静脉瘘的早期诊断虽较为困难，但及时行脑血管造影检查是确诊硬脑膜动静脉瘘的金标准，结合影像学检查做出正确诊断，可减少疾病的漏诊误诊。当遇到早期影像学结果支持颅内静脉窦血栓形成诊断且治疗后效果不佳的患者时，应考虑硬脑膜动静脉瘘的可能性并积极行脑血管造影检查明确诊断，避免错误治疗。

Abstract: Objective: To investigate the diagnosis and treatment of a patient with dural arteriovenous fistula initially misdiagnosed as intracranial venous sinus thrombosis. Method: The clinical data of 1 case with dural arteriovenous fistula (DAVF) initially diagnosed as intracranial venous sinus thrombosis were analyzed. Results: The patient was a middle-aged male with symptoms of disturbance of consciousness and poor limb movement. Early brain imaging examination showed deep vein infarction, which was consistent with the manifestation of venous embolism. After active anticoagulation and symptomatic treatment, the clinical condition was gradually aggravated. In order to find the cause, whole brain angiography showed dural arteriovenous fistula. Conclusion: Early diagnosis of acquired dural arteriovenous fistula is difficult, but timely cerebral angiography is the gold standard for the diagnosis of dural arteriovenous fistula. Combined with imaging examination, correct diagnosis can reduce missed diagnosis and misdiagnosis of the disease. When the early imaging results support the diagnosis of intracranial venous sinus thrombosis with poor treatment results, the possibility of dural arteriovenous fistula should be considered and cerebral angiography should be performed actively to confirm the diagnosis to make a definite diagnosis and avoid wrong treatment.