深部脳静脈血栓症の3例

Deep Cerebral Venous Thrombosis：A Report of Three Cases and Review of the Literature

　要旨　症例は39歳女性，47歳女性，41歳男性の3例。47歳女性に性腺刺激ホルモン抑制剤の内服歴を認めた以外は特記すべき既往歴，血液生化学的異常所見は認めなかった。軽い頭痛，意識障害で発症した。MRI T2強調画像，FLAIR法では両側大脳基底核，視床に強い高信号域を認め，拡散強調画像ではごく軽度の高信号を示したが，apparent diffusion coefficient値は軽度の上昇を認めた。脳血管撮影，MR静脈撮影で内大脳静脈・ガレン大静脈・直静脈洞の閉塞を確認し，脳深部静脈血栓症と診断した。1例にヘパリン全身投与，1例に血管内手術・ヘパリン全身投与を施行した。全例で症状・画像所見は改善した。稀な疾患であるが，MRIによる診断技術が向上している現在，念頭に置くべき病態である。

　Three cases of cerebral deep venous thrombosis（CDVT） were reported with review of the literature. A 47-year-old female had taken estrogen-derived drug. The other two patients had no specific past history. On MRI, T2-weighted and fluid-attenuated inversion recovery（FLAIR） images showed high signal intensity lesions at basal ganglia and thalamus. Diffusion-weighted image（DWI） detected only slightly high signal spots but apparent diffusion coefficient（ADC） images indicated mild increases of the ADC value. MR venogram and cerebral angiogram revealed obliteration of internal cerebral veins, great vein of Galen, and straight sinus. The two severely impaired patients received systemic heparinization, in which one patient preceded percutaneous transvenous angioplasty of straight sinus. One patient suffered cognitive disturbance and the other two patients fully recovered from their illness. The high signal intensity lesions on both T2-weighted image and FLAIR image disappeared and deep cerebral veins reappeared. The diagnosis of CDVT based on clinical symptoms is not simple but modern technology of MRI is very useful for diagnosis of CDVT.

　Once CDVT is detected, appropriate therapy should be started as soon as possible to avoid devastating outcome.

（Received : March 12, 2004）