Derin serebral ven trombozu

Özet

Derin serebral venöz tromboz, talamus ve bazal gangliyonları drene eden derin venöz sistemde; iç serebral venler, Galen veni veya düz sinüs düzeyinde görülebilir. Kontrastsız BT'de bilateral talamik ödem görülebilir, ancak BT normal olabilir; BT venografide venöz trombüs dolum kusuru olarak gösterilebilir. Talamik bulgular arteriyel talamoperforan infarkta benzeyebileceğinden lezyonun simetrisi ve derin venlerin açıklığı birlikte değerlendirilmelidir. Derin serebral venöz tromboz bilinç değişikliği ve koma ile seyredebilir; ödem ilerlediğinde beyin herniasyonu gelişebilir.

Faz ve pencere

Kontrastsız tanısal

Derin venöz trombozda talamusları, bazal gangliyonları veya internal kapsülü tutan parankimal değişiklikler görülebilir; venöz infarktlar arteriyel sınırları aşabilir ve kanama eşlik edebilir. Akut venöz trombüs kontrastsız BT'de dural sinüs veya kortikal vende spontan hiperdens görülebilir; BT'nin normal olması trombozu dışlamaz.

Venöz tanısal

Derin serebral venöz tromboz şüphesinde venografide derin venöz sistem ve düz sinüs değerlendirilir; venöz trombüs dolum kusuru olarak görülebilir.

BT bulguları

• İki taraflı talamik ödem — BT'de iki talamusta ödem görülebilir; bu, serebral venöz trombozun dolaylı bulgularındandır.
• Derin serebral venöz trombozda talamik ödem görülebilir; yaygın ödemde ventrikül boşluklarının boyutu azalabilir.
• Derin ven hiperdensliği — kontrastsız BT’de akut trombüs dural sinüs içinde spontan hiperdens görülebilir.
• Derin parankimal hemoraji — talamus veya bazal gangliyonlarda ödemle karışık kanama; venöz infarkt arter alanı sınırlarını izlemeyebilir.
• Derin beyaz cevher tutulumu — venöz infarktlarda subkortikal ve periventriküler beyaz cevher ödemi görülebilir.
• Düz sinüs ve Galen veni dolum kusuru — venografide derin drenaj yolundaki trombüsün doğrudan görünümü.
• Talamus bölgesindeki ödemin neden olduğu difüz beyin şişmesi ventrikül boyutlarında küçülme ve sulcus görünümünün azalmasına yol açabilir.
• Derin serebral venöz trombozda iskemi ve kanama arteriyel sınırları aşabilir, bilateral ve asimetrik olabilir; kontrastsız BT normal olsa da kuşku varsa BT veya MR venografi yapılmalıdır.

Normalde

Talamuslar ve üçüncü ventrikül derin serebral venöz sistem tarafından drene edilir. Derin serebral venler iç serebral venlere, Galen venine ve düz sinüse doğru uzanarak sinüs konfluensine boşalır; bu venöz yapıların açıklığı venografide değerlendirilir.

Ayırıcı tanı

Arteria Percheron infarktı

bilateral paramedian talamik infarkt yapabilir; pıhtı derin venlerde değil küçük arteriyel perforatör dağılımındadır ve kanama daha az tipiktir.

Talamik gliom

talamik yerleşimli gliomlar, talamik lezyonların neoplastik ayırıcı tanısında yer alabilir.

Wernicke ensefalopatisi

medial talamusla birlikte periaquaduktal gri cevher ve mamiller cisimler tutulabilir; venografi tromboz göstermez.

Osmotik demiyelinizasyon sendromunda pons, talamus ve bazal gangliyonları içerebilen simetrik lezyonlar görülebilir.

Bilateral talamik lezyonlarda düz sinüs trombozu ile bilateral talamik alanı besleyen tek arter varyantı arteria Percheron ayırıcı tanıda düşünülmelidir; venografide düz sinüs ve derin venöz sistemde trombüs veya dolum kusuru araştırılır.

Tuzaklar

• Bilateral talamik hipodensiteyi doğrudan arter infarktı saymayın; venöz damarları ve düz sinüsü venografiyle değerlendirin.
• Kontrastsız BT normal olsa bile serebral venöz tromboz dışlanamaz; şüphe sürüyorsa BT veya MR venografiyle inceleme yapılmalıdır.
• Tek taraflı derin ven trombozu asimetrik talamik ödem yapabilir; bulgunun iki taraflı olmamasını dışlama ölçütü olarak kullanmayın.
• Hemorajik talamik lezyon primer hipertansif kanama gibi görünebilir; çevresel iki taraflı ödemi ve venografideki derin drenaj yolunu birlikte inceleyin.

Kendini dene

1. BT'de bilateral talamik ödem ve BT venografide düz sinüste dolum kusuru saptanan hastada en olası tanı nedir?

   • Derin serebral ven trombozu
   • Arteria Percheron infarktı
   • Talamik gliom
   • Wernicke ensefalopatisi
   Cevabı göster

   Derin serebral ven trombozu. Düz sinüsteki dolum kusuru trombüsü destekler; talamik bulgular derin venöz trombozla uyumludur.

2. Bilateral talamik alanı besleyen tek arter varyantı hangisidir?

   • Arteria Percheron
   • Baziler arter
   • Anterior koroidal arter
   • Orta serebral arter
   Cevabı göster

   Arteria Percheron. Arteria Percheron, tek bir arterin iki talamik alanı beslediği anatomik varyanttır.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 24 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.