| PartⅠ Analysis of Relative Factors of Cerebral Venous Thrombosis onEarly DiagnosisObjective: The rapid identification of CVT in the early stage of disease has become a challenge due to the variety of symptoms and signs.There are many factors affecting CVT diagnosis,including age,risk factors,clinical symptoms,blood D-D level and imaging findings.And the results of the study are different because of the different level of diagnosis and treatment and the severity of disease.We are going to investigate the factors related to early diagnosis of cerebral venous thrombosis(CVT)by univariate and multivariate analysis in this study.Methods:Among 104 patients in Changhai Hospital from September 2008 to August 2016 we identified thepatients with CVT.Demographic data,history of present illness,past history,clinical features,laboratory and imaging results,therapeutic methods,detailed mRS score of one day before discharge and follow up were collected.The patients were divided into early CVT diagnosis group(≤7 days)and delayed CVT diagnosis group(>7 days)according to their time from having symptoms to have a definite diagnosis.The clinical data of 104 CVT patients were analyzedby univariate analysis and multivariate logistic regression analysis.Results:53patients(51.0%)with early CVT diagnosis,there were 30 women(56.6%),and 23(43.4%)were men;The age was 18-64 years,with an average age of 34.13 ±13.78 years.And 51(49.0%)with delayed CVT diagnosis,there were 21 women(41.2%),and 30(58.8%)were men;The age was 18-75 years with an average age of 42.57±15.07 years.Univariate analysis showed that there were statistical significance of difference in age(P=0.043),the illness of pregnancy or puerperal(P=0.029),the level of plasma D-dimer(P=0.003),brain parenchyma injury(P=0.000)and venous recanalization after treatment(P=0.037).Multivariate Logistic regression analysis showed that age(OR=4.197,95%CI=1.378~12.785;P=0.012),the level of plasma D-dimer(OR=0.896,95%CI=0.809~0.992;P=0.034),brain parenchyma injury(OR=0.167,95%CI=0.052~0.540;P=0.003)were the independent risk factors of early diagnosis.Conclusion: Age,serum D-D level and brain parenchyma injury are important factors affecting the early diagnosis of CVT.Early diagnosis is helpful for the recanalization of cerebral veins after treating.PartⅡ TheClinical characteristics of lateral sinus thrombosisObjective:Lateral sinus thrombosis is 10% of the total cerebral venous thrombosis,it had became an important cause of misdiagnosis because the atypicalclinical symptoms under the compensation of the patency of the contralateral sinus.With compared the differences of intracranial pressure and brain parenchymabetween LST and other sites of CVT,we are going to compare the clinical symptoms,imaging findings and treatment of LST,and to explore the clinical features and imaging patterns of LST in order to provide guidance for clinical diagnosis and treatment.Methods: Among all patients in Changhai Hospital from September 2008 to August 2016 we identified thepatients with CVT.According to the results of MRV,CTV or DSA,the cases were divided into LST and other parts of CVT,the clinical data of the two groups were compared.Results:A total of 104 patients were included for the research.Of the included patients,51(49.0%)were women,and 53(51.0%)were men,all with a range age of 18-75 years(mean 38.20±14.44 years).The imageology showed that 51(49.0%)had SSS thrombosis and 91(87.5%)had Lateral sinus involvement,some of which are SSST only 7(6.7%),LST33(31.7%).LST33(31.7%),aged 18-75 years,with an average of 41.85 ±16.00 years old;thrombosis in other sites 71(68.3%),aged 18-68 years,with an average of 36.56 ± 13.34 yearsThere were no statistically significant differences between the two groups in the parameters such as age,sex and cases(P>0.05).By contrast,66.7% of the patients with LST presented with headache only,far more than patients with other sites of CVT(66.7%vs23.9%,P=0.001).A focal syndrome with focal deficits and epilepsy were less frequent in patients with LST(P1=0.003、P2=0.000),it is mainly patients with limb paralysis were significantly lower than those in other parts of the CVT patients(3.0%vs22.5%,P=0.011).And the proportion of intracranial hypertension and mean value of CSF in LST were significantly lower than that of patients with other parts of CVT(P1=0.000、P2=0.000),while there was no significant difference was found in the blood D-D and brain parenchyma between the two groups(P>0.05).LST patients accounted for less than other parts of CVT in the diagnosis within 7 days(36.4%vs57.8%,P=0.042).There was no difference between the two groups in the choice of treatment and the recent neurological outcome,too(P>0.05).LST patients compared with patients with bilateral sinus involvement,the proportion of intracranial hypertension,mean value of CSF were significantly lower(P1=0.013 、 P2=0.001).And patients withLST had less neuroimaging lesions(P=0.033).Conclusion: Thepatients withLST who have headache only are two-thirds,show epilepsy and focal neurological symptoms are relatively rare.Because of the patency of the unaffected venous sinus,the ICP is relatively low in LST.The early diagnosis of LST is not easy. |
PDF Full Text Request