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脳静脈血栓症の診断と治療のアルゴリズム(SNIS 2018年)

出典
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1: Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee.
J Neurointerv Surg. 2018 Aug;10(8):803-810. doi: 10.1136/neurintsurg-2018-013973. Epub 2018 Jun 5.

脳静脈血栓症の閉塞部位別の症候と頻度

主な脳静脈洞と、その脳静脈洞が閉塞した場合の臨床症候と頻度を示している。
出典
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1: Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association.
著者: Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD; American Heart Association Stroke Council; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension.
雑誌名: Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epub 2024 Jan 29.
Abstract/Text: Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epu...

脳卒中の病型診断と鑑別診断

ASD:心房中隔欠損、AT-III:アンチトロンビンIII、DIC:播種性血管内凝固症候群、FMD:線維筋性形成異常、MRA:悪性関節リウマチ、PLES:後部白質脳症症候群、PN:結節性多発動脈炎、RCVS:可逆性脳血管攣縮症候群、SLE:全身性エリテマトーデス、TGA:一過性全健忘、TTP:血栓性血小板減少性紫斑病、VSD:心室中隔欠損
出典
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1: 著者提供

頭痛のみを呈した左横静脈洞血栓症のCTとMRI(発症翌日)

病歴:51歳女性。鎮痛薬の効果のない左後頭部痛が出現した翌日に来院(緊張型頭痛で以前に診察、頭部CT施行あり、今回はまったく別の頭痛が出現)。臥位で頭痛は増悪し、座位で改善(診察の時点では脳静脈血栓症は考えていなかった)。
診断テストと結果:
CTでは左横静脈洞に一致して高吸収域を認め、脳静脈血栓症と診断した(a、b、d)。
MRIのFLAIRでは右横静脈洞はflow voidを認めるが、左横静脈洞には認めない(c)。
MRVでは左横静脈洞が途絶(閉塞)しており(e)、脳血管造影でも確認した。
治療:ヘパリンとワルファリンによる治療で急速に頭痛は軽減した。
出典
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1: 著者提供

脳静脈血栓症のCTと脳血管造影

病歴:32歳男性。後頭部痛で発症。第4病日夕方、左上肢の鈍重感を自覚。第5病日午後1時頃、30秒ほどの左上肢のけいれんを発症し、午後2時35分、当院へ救急搬入。
診断テストと結果:入院時の単純CTではcord sign(皮質静脈の血栓)を認め(a)、造影CTではempty triangle signを認める(b)。脳血管造影の正面像では上矢状静脈洞、右横静脈洞、両側のS状静脈洞の造影不良を認め(c)、側面像では上矢状静脈洞の造影が不良である(d)。
経過は[ID0606]
出典
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1: 著者提供

脳静脈血栓症のMRI(初日)と脳血管造影(上矢状静脈洞血栓症)

病歴:48歳男性。けいれんで夜間に救急来院(休日の未明)。
診断テストと結果:
けいれん重積と不穏状態のため挿管して治療。夜間にMRI施行直後に当直医は左前頭葉の病変に注目し、脳腫瘍をまず考えていた。夜間救急のルーチンMRIにはMRVはセットされておらず、MRVは施行されなかった。T2*強調画像で皮質静脈内の血栓が低信号域として描出されている(d)。
治療:入院当日(日曜日)の日勤帯にMRI画像で脳静脈血栓症と診断して、ヘパリンとワルファリンで治療開始。
後日の脳血管造影で上矢状静脈洞の閉塞を確認した(e)。
a:DWI(拡散強調画像)
b:FLAIR
c:T1強調画像
d:T2*強調画像
e:後日の脳血管造影
出典
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1: 著者提供

脳静脈血栓症の臨床経過

[ID0605]と同一症例([ID0605]のMRIは発症当日)。
けいれんで夜間に救急来院(休日の未明)。けいれん重積と不穏状態のため挿管して治療。MRIを行い脳静脈血栓症と考えヘパリンとワルファリンによる治療を開始。2病日にMRV施行し、上矢状静脈洞の閉塞を確認。13病日のMRVで上矢状静脈洞や横静脈洞の閉塞性病変はかなり改善している。
出典
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1: 著者提供

出血を伴った脳静脈血栓症

病歴:34歳女性、四肢麻痺、けいれんで入院。
診断テストと結果:CTで左頭頂部に出血を認める(a)。造影CTでempty triangle signを認める(b)。脳血管造影で上矢状静脈洞の閉塞を確認した。
治療:ヘパリン1万単位/日の投与で症候改善(ワルファリン併用)し、後遺症なく社会復帰した。
出典
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1: 著者提供

動脈疾患、静脈血栓症、脳静脈血栓症の危険因子

動脈疾患や深部静脈血栓症は加齢が危険因子となるが、脳静脈血栓症は若年者に多い。深部静脈血栓症や脳静脈血栓症では、高血圧、糖尿病、脂質異常症は危険因子にならず、また、不活動は深部静脈血栓症の危険因子にはなるが、脳静脈血栓症の危険因子にはならない。このように3つの疾患の危険因子には差がみられる。
出典
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1: Caso V, et al: Handbook on Cerebral Venous Thrombosis.KARGER, 2008

コホート研究における脳静脈血栓症の予後不良因子[AHA/ASA学術的声明(2011年)]

表に示された因子を持つ脳静脈血栓症では、致死的になったり、重度の後遺症を残すことがある。
出典
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1: Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
著者: Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY; American Heart Association Stroke Council and the Council on Epidemiology and Prevention.
雑誌名: Stroke. 2011 Apr;42(4):1158-92. doi: 10.1161/STR.0b013e31820a8364. Epub 2011 Feb 3.
Abstract/Text: BACKGROUND: The purpose of this statement is to provide an overview of cerebral venous sinus thrombosis and to provide recommendations for its diagnosis, management, and treatment. The intended audience is physicians and other healthcare providers who are responsible for the diagnosis and management of patients with cerebral venous sinus thrombosis.
METHODS AND RESULTS: Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represent different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 1966 and used the American Heart Association levels-of-evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee.
CONCLUSIONS: Evidence-based recommendations are provided for the diagnosis, management, and prevention of recurrence of cerebral venous thrombosis. Recommendations on the evaluation and management of cerebral venous thrombosis during pregnancy and in the pediatric population are provided. Considerations for the management of clinical complications (seizures, hydrocephalus, intracranial hypertension, and neurological deterioration) are also summarized. An algorithm for diagnosis and management of patients with cerebral venous sinus thrombosis is described.
Stroke. 2011 Apr;42(4):1158-92. doi: 10.1161/STR.0b013e31820a8364. Epu...

脳静脈血栓症の発症部位の報告

括弧内の数字は静脈系が単独で障害された症例を示している。
出典
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1: Bousser MG, Russell RR (eds): Cerebral venous thrombosis. Major problems in Neurology, Saunders, New York, vol 33, 1997, p31

脳静脈血栓症の素因と医学的状態[AHA 科学的声明(2024年)]

CVT:脳静脈血栓症
出典
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1: Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association.
著者: Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD; American Heart Association Stroke Council; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension.
雑誌名: Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epub 2024 Jan 29.
Abstract/Text: Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epu...

脳静脈血栓症診断におけるCTとMRIの利点・欠点[AHA/ASA学術的声明(2011年)]

脳静脈血栓症のスクリーニングや確定診断は、通常、CT/CTVあるいはMRI/MRVで行うようになっており、その利点、欠点、感度/特異度、実際の適用を熟知して行う。
出典
imgimg
1: Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
著者: Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY; American Heart Association Stroke Council and the Council on Epidemiology and Prevention.
雑誌名: Stroke. 2011 Apr;42(4):1158-92. doi: 10.1161/STR.0b013e31820a8364. Epub 2011 Feb 3.
Abstract/Text: BACKGROUND: The purpose of this statement is to provide an overview of cerebral venous sinus thrombosis and to provide recommendations for its diagnosis, management, and treatment. The intended audience is physicians and other healthcare providers who are responsible for the diagnosis and management of patients with cerebral venous sinus thrombosis.
METHODS AND RESULTS: Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represent different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 1966 and used the American Heart Association levels-of-evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee.
CONCLUSIONS: Evidence-based recommendations are provided for the diagnosis, management, and prevention of recurrence of cerebral venous thrombosis. Recommendations on the evaluation and management of cerebral venous thrombosis during pregnancy and in the pediatric population are provided. Considerations for the management of clinical complications (seizures, hydrocephalus, intracranial hypertension, and neurological deterioration) are also summarized. An algorithm for diagnosis and management of patients with cerebral venous sinus thrombosis is described.
Stroke. 2011 Apr;42(4):1158-92. doi: 10.1161/STR.0b013e31820a8364. Epu...

脳静脈血栓症管理のアルゴリズム

2024年のAHAの脳静脈血栓症の診断と管理の科学的声明で提案されている脳静脈血栓症管理のアルゴリズムを示す。
CTV:CT静脈造影
MRV:MR静脈撮影
出典
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1: Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association.
著者: Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD; American Heart Association Stroke Council; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension.
雑誌名: Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epub 2024 Jan 29.
Abstract/Text: Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epu...

脳静脈血栓症の診断と治療のアルゴリズム(SNIS 2018年)

出典
imgimg
1: Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee.
J Neurointerv Surg. 2018 Aug;10(8):803-810. doi: 10.1136/neurintsurg-2018-013973. Epub 2018 Jun 5.

脳静脈血栓症の閉塞部位別の症候と頻度

主な脳静脈洞と、その脳静脈洞が閉塞した場合の臨床症候と頻度を示している。
出典
imgimg
1: Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association.
著者: Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD; American Heart Association Stroke Council; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension.
雑誌名: Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epub 2024 Jan 29.
Abstract/Text: Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
Stroke. 2024 Mar;55(3):e77-e90. doi: 10.1161/STR.0000000000000456. Epu...