| Part Ⅰ.Clinical features and prognosis analysis of acute and chronic Cerebral venous sinus thrombosisObjective: A retrospective analysis of patients with different modes of cerebral venous sinus thrombosis was conducted,focusing on the clinical characteristics and prognosis of patients with acute and chronic origins to improve clinicians’ understanding of the disease and reduce the rate of misdiagnosis and underdiagnosis.Methods: The clinical data of CVST patients hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University from January 2017 to September 2020 were retrospectively analyzed,and the patients were followed up by telephone from 3m-46m(median follow-up time was 23m),and 115 CVST patients were finally included.The patients were divided into acute(≤48 h,17 cases),subacute(48 h~30 d,74 cases),and chronic(>30 d,24 cases)according to the mode of onset,and spss23.0 statistical software was applied for statistical analysis to compare the clinical differences of patients with different modes of onset and to investigate the clinical characteristics and prognosis of patients with acute and chronic onset.Results:1.Comparison of Age and sex The mean age of the 115 patients with CVST was 36.38±12.64 years,and male:female was 1:1.6.The mean age of CVST patients in the chronic onset group was higher than in the acute onset and subacute onset groups,and after age stratification,there were more patients older than 50 years in the chronic onset group than in the subacute onset and acute onset groups.The differences were statistically significant(P < 0.05).More patients in the acute onset group were21~30 years old than in the subacute onset group and the chronic onset group,with a statistically significant difference of P < 0.05.In the acute onset group,there were more female patients than in the subacute and chronic onset groups,but the difference was not statistically significant,P=0.616.2.Comparison of risk factors The top three risk factors among 115 patients were hyperhomocysteinemia,hematologic abnormalities,and pregnancy and puerperium-related.The most common risk factors in the acute onset group were pregnancy and puerperium-related than in the subacute and chronic onset groups,and more patients with combined immune-related diseases in the chronic onset group than in the subacute onset group,with statistically significant differences(P < 0.05).3.Comparison of clinical manifestations Among the 115 patients,the most common symptoms were headache,followed by nausea and vomiting,blurred vision,and seizures.More patients had seizures in the acute onset group than in the chronic onset group and more patients in the chronic onset group had blurred vision than in the subacute and acute onset groups,with statistically significant differences(P < 0.05).4.Comparison of thrombosed sinuses and imaging features Among 115 patients with CVST,the most frequently involved site was the transverse sinus,which was more involved in the chronic onset group than in the acute onset group,and more patients with hemorrhagic venous infarction in the acute onset group than in the subacute onset and chronic onset groups,with statistically significant differences(P < 0.05).5.Comparison of Prognosis Only 58.3% of the chronic onset group could achieve complete recovery(mRS=0),which was lower than the subacute onset patients (85.1%),P<0.05,and the difference was statistically significant.Conclusions:1.patients with acute onset CVST are more likely to be 21~30years old,mostly associated with pregnancy and puerperium,prone to venous infarction with hemorrhage,and have clinical presentation with seizures more often than patients with chronic onset.2.Patients with chronic onset CVST are on average older,with more patients >50 years of age,more prone to blurred vision,more often involve the transverse sinus than patients with acute onset,more often have combined immune-related diseases than subacute patients,and have a poor clinical prognosis and are more likely to have residual neurological deficits.Part Ⅱ Analysis of the efficacy and benefit of endovascular treatme nt of cerebral venous sinus thrombosisObjective: The purpose of this study was to evaluate the clinical effectiveness of endovascular therapy versus conventional anticoagulation and and the benefit of patients,to provide a reference basis for clinical work and to achieve the purpose of standardized treatment.Methods: Retrospective analysis of CVST patients hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University from January 2017 to September 2020,and patients were followed up by telephone from 3 m to 46 m after discharge(median follow-up time was 23 m,),and 115 CVST patients were finally included,75 of whom received endovascular treatment on the basis of conventional anticoagulation therapy Of these patients,The other 40 cases received only anticoagulation alone.The data were analyzed by applying spss23.0 software,and the indicators with statistically significant general data and factors that may affect prognosis were adjusted as covariates to analyze the clinical outcomes and patient benefits of receiving different treatments.Results:The difference in mRs score at admission was not statistically significant between the two groups,(P=0.326),and the difference before and after treatment within the group was statistically significant,P<0.001.Both treatment groups significantly improved the prognosis of patients,with more patients receiving endovascular treatment with a good prognosis(mRS0-2)(96.0%)than those receiving anticoagulation alone(87.5%),(P=0.104.OR=3.429,95% CI0.775-15.171),with 78.7%receiving endovascular treatment with complete recovery(mRS=0)and77.5% with anticoagulation,(P=0.885,OR1.071,95% CI0.424-2.700),with no statistically significant difference,and adjusting the indicators with statistically significant differences in general clinical data for factors that have been shown to affect prognosis as covariates still did not reveal that different treatments were associated with a good prognos is(mRS0-2)and complete recovery(mRS=0).(P=0.327,OR=3.233,95%CI0.310-33.712),(P=0.784,OR=0.885,95% CI0.187-3.537).The median cost of endovascular therapy was 44,616.83 and the median cost of anticoagulation alone was 19,328.02,(P<0.001),a statistically significant difference.The median length of stay in hospital was 16 days for endovascular combination therapy and 15 days for anticoagulation therapy,P=0.358,with no statistically significant difference.Conclusions:1.Endovascular treatment and anticoagulation both significantly improved the prognosis of patients,but there was no statistical difference between them.2.The cost of hospitalization was significantly higher with endovascular therapy than with anticoagulation alone.3.Endovascular therapy did not reduce hospitalization time compared with anticoagulation alone. |
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