| Objective: To explore the clinical features and prognostic factors ofcerebral venous thrombosis (CVT).Methods: The patients with CVT admitted to the People’s hospital ofGuangxi Zhuang Autonomous Region from March2011to January2014wereprospectively explorered. The diagnosis of CVT was confirmed by magneticresonance venography(MRV), computer tomography venography(CTV) ordigital subtraction angiography(DSA). The general information, risk factors,clinical symptoms, signs, results of blood examination, results of cerebrospinalfluid examination, neuroimaging, and3-month outcome were recorded andanalyzed. We used National Institute of Health Stroke Scale(NIHSS) to quantifythe neurological dysfunction, Glasgow Coma Scale(GCS) to assess the level ofconsciousness. Primary outcome was assessed by modified Rankin Scale(mRS)at the end of3-months follow-up. X2Tests or Fisher’s exact test whenappropriate were performed to analyse univariate relations between possibleprognostic factors and outcome. Subsequently, all variables with p<0.05identified in the univariate analysis were presented to a multivariate logisticregression model to assess their independent prognositic value.Results:(1) This study included32patients, of whom19were men, the male to female ratio was1.46. The mean age was47.1years, range14to84years,23were young(<60years).(2) Hyperhomocysteinemia is the mostcommon risk factor for men(47.4%), followed by smoking(36.8%), andgynecologic (pregnancy or puerperium) for women(61.5%).(3) The mode ofonset was subacute in65.6%, acute in28.1%, and chronic in6.3%. The mostusual clinical presenting characteristic was high intracranial pressure (headachein81.3%, nausea/vomiting in31.3%, and retinal abnormalities in31.3%),followed by focal neurological deficit (paralysis in40.6%, unconsciousness in37.5%, aphasia in15.6%, urinary incontinence in15.6%, sensory disturbances in12.5%, mental/behavioral abnormalities in12.5%), and then seizures（focalseizure in15.6%, general seizures in6.3%). The incidence of headache inyoung group was higher than that in the aged group(95.7%vs44.4%, p=0.003).The incidence of headache in patients with superior sagittal sinus thrombosiswas higher than that in patients without superior sagittal sinus thrombosis(95.0%vs58.3%, p=0.018). And also, the incidence of seizures in patients withsuperior sagittal sinus thrombosis was higher than that in patients withoutsuperior sagittal sinus thrombosis(35.0%vs0.0%, p=0.029). At the same time,we noticed that, mental status disorders were more likely to incident in patientswith straight sinus venous or Galen vein thrombosis rather than in non-straightsinus or Galen vein thrombosis (75.0%vs25.0%, p=0.030). The mean NIHSSwas lower in young group than in the older group (3.3±3.7vs10.9±7.9,p=0.020).(4) Multiple brain parenchymal damage were found in71.9%of casesby imaging studies. We found infarcts in46.9%, intracranial hemorrhage in40.6%. Superior sagittal sinus(62.5%), transverse sinus(50.0%), and sigmoidsinus(37.5%) were most commonly involved. Multiple sinuses were involved in59.4%of cases.(5) One patient’s data missed after discharge. At the end of 3-months follow-up,22(71.0%) patients had a good outcome (mRS≤2)，5patients were dependent(mRS3-5)，and mortality was noted in4cases(12.9%).Univariate analysis found6factors associated with poor prognosis， includingage≥60years, GCS <9, NIHSS≥15, intracranial hemorrhage, straight sinusthrombosis, and sinuses involve≥3. Multivariate logistic regression analysisshowed that age≥60years(OR8.62，95%CI:1.04-71.76, p=0.046), GCS<9(OR8.35,95%CI:2.42-59.97, p=0.003) and intracranial hemorrhage(OR5.01,95%CI:1.98-82.63, p=0.016) were independent risk factors for poor outcome.Conclusion:(1) CVT has a specific predilection for young adults.Hyperhomocysteinemia is the most common risk factors for men, followed bysmoking. Femal patiens mainly associate with gynecologic.(2) Subacute is themost common mode of onset. The main clinical presentations of CVT whichcould be simply summarized as intracranial hypertension syndrome, focalneurological deficit and seizures are nonspecific. Headache is the frequentsymptom.(3) Multiple, cross-basin brain parenchymal damage is the feature ofCVT on imaging. Superior sagittal sinus is the most common site involved,followed by transverse sinus, and sigmoid sinus. Multiple sinus are usuallyinvolved.(4) In most patients with CVT, outcome is good. Aged≥60years,GCS <9, NIHSS≥15, intracranial hemorrhage, straight sinus thrombosis, andsinuses involved≥3indicate a poor prognosis. Aged≥60years, GCS <9andintracranial hemorrhage were the independent risk factors for poor outcome. |
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