| Objectives:1.to investigate the incidence and clinical characteristics of seizures in patients who suffered cerebral venous sinus thrombosis.2.to study the predictive factors of seizures in patients who suffered cerebral venous sinus thrombosis and its impact on patients'clinical outcome.Methods:The study was a registry of 102 CYST patients who admitted to Qilu Hospital of Shandong University from January 2013 to June 2018.Cerebral venous sinus thrombosis was confirmed by Magnetic Resonance Venography(MRV)or Digital Subtraction Angiography(DSA)in all patients of this study.Collecting the relevant clinical data of the patients,according to whether the patient experienced seizures,the patients were divided into two groups:seizure group and non-seizure group.The clinical characteristics of'the two groups were st.atistically analyzed by SPSS21.0 statistical software,including sex,age,risk factors,imaging examination and laboratory examination.The prognosis of the two groups was compared.The study is aim at investigating the incidence?risk factors?clinical characteristics of seizures in CVST and the influence of seizures on the prognosis of patients with CVST.Admission standard:the patients were diagnosed as CVST by clinical and imaging examination(MRV or DSA).Exclusion criteria:?the patients who lack of imaging examination to confirm CVST;?patients with incomplete clinical data;?Patients with a history of seizures or currently treated with antiepileptic drugs.Result:1.Baseline characteristics:102 patients were included in the study,with a average age of 35.3 years old,and their age range from 15 to 79 years old.Patients were divided into two groups:(1)patients with seizures(n=35,34.3%)(2)patients without seizures(n=67,65.7%).There were 14 males and 21 females in the seizure group and 25 males and 42 females in the non-seizure group.After statistical analysis,there was no significant difference in sex and age between the two groups.2.The clinical characteristics of seizures in CVST patients:among the 35 patients who had seizures,the median time from CVST onset to seizure presentation was 3 days(IQR:1-6).eight(7.8%)patients presented with seizures as the first symptom,thirty-two(31.4%)patients had early seizures within 2 weeks from CVST onset,three(2.9%)patients had late seizures.As for seizure type,6(5.9%)patients had only focal seizures,and 29(28.4%)suffered generalised seizures.3.Through univariate analysis,the results showed that patients with CVST complicated with epileptic seizures were more common in the symptoms of focal nerve defect(65.7 vs.41.8%;p=0.022)and dyskinesia(54.3 vs.22.4%;P=0.001),D-dimer level increased(91.4 vs.68.7%;P=0.01),fibrinogen increased(51.4 vs.22.4%):P=0.003),neutrophil lymphocyte ratio(NLR))2.1(88.6 vs.68.6%;P=0.026),frontal lobe lesions(54.3 vs.19.4%;P=0.000),supratentorial lesions(97.1 vs.46.3%;P=0.000),bilateral hemispheric lesions(51.4 vs.11.9%;P=0.000),involved cerebral lobes)2(65.7 vs.31.3%;P=0.001),hemorrhagic infarction/cerebral hemorrhage(57.1 vs.34.3%;P=0.027).Through multivariate analysis,the result showed that fibrinogen increased(OR 4.234,.950%CI 1.190-15.068,p=0.026),supratentorial lesions(OR 47.896.95%CI 4.233-541.926,P=0.002)and bilateral hemispheric lesions(OR 7.572,95%CI I.302-44.034,p=0.024)were independent risk factors for seizures in patients with CVST.4.In this study,a total of 30 patients underwent lumbar puncture,of which 25(83.30%)had intracranial pressure higher than 200 mmH20,suggesting that intracranial pressure increased in most CVST patients.t test analysis showed that there was no significant difference in Intracranial Pressure between the two groups(P?0.184),which meant that the increase of intracranial pressure in the two groups was consistent,and there was no significant difference between the two groups.In addition,through statistical analysis,it was found that there was no significant correlation between the involvement of venous sinus in different parts and the occurrence of seizures in patients with CVST.ROC curves were constructed for NLR and PLR,and it was found that they were of low diagnostic value in CVST patients with epileptic seizures5.At discharge,28(80.0%)patients in the seizure group had a good prognosis(mRS=0-2)and 7(20.O0%)patients had a poor prognosis(mRS=3-6).In the non-seizure group,62(92.50%)patients had a good prognosis(MRS:0-2)and 5(7.5%)patients had a poor prognosis(mRS=3-6).The mRS scores at discharge of the two groups were compared and analyzed,and we found that there was no significant difference in the prognosis between the two groups.Conclusion:1.Seizures are one of the common and important clinical manifestations in patients with CVST.2.CVST patients with seizures,It is more often accompanied by symptoms of focal neurological deficit,dyskinesia,elevated levels of D-dimer,elevated fibrinogen,NLR(neutrophil lymphocyte ratio)?2.1,frontal lobe lesions,supratentorial lesions,bilateral hemispheric lesions,involved lobes?2,hemorrhagic infarction or cerebral hemorrhage.3.Elevated fibrinogen,supratentorial lesions and bilateral hemispheric lesions are independent risk factors for seizures in patients with CVST.4.The incidence of early seizures in CVST patients is higher,and the generalized seizures is the main type of seizures.5.Seizures had no significant effect on the short-term prognosis of CVST patients.Significance:Seizures are a common and important clinical manifestation of CVST patients,about 1/3 of CVST patients have seizures after onset,and the main type of seizures is generalized seizures.Seizures can lead to the deterioration of CVST patients,which is one of the important risk factors for short-term death of CVST patients.Therefore,by understanding and mastering the incidence,predictive factors,clinical characteristics of epileptic seizures in patients with CVST,and the influence of epileptic seizures on their clinical outcome.It is helpful for clinicians to identify the CVST patients who have a higher risk of epilepsy at early stage,and to evaluate the condition timely and determine whether relevant measures are needed to prevent acute seizures,which is helpful to improve the prognosis of patients. |
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