| Objective:Cerebral venous sinus thrombosis(CVST)is a kind of cerebrovascular illness with complicated risk factors,varying clinical presentations,and disease severity that is highly related to gender.A lack of studies on gender differences in CVST risk factors,clinical presentation,and outcomes exists.Our study is to analyze the correlation between risk factors,clinical features,imaging findings and outcomes of cerebral venous sinus thrombosis and gender differences,to improve clinical and researcher’s understanding of CVST,to help identify new pathophysiology and etiology underlying the disease,and to give a clinical framework for conclusive diagnosis and treatment of the condition.Methods:Patients with continuous CVST who were hospitalized at the Department of Neurology at Jilin University’s First Hospital between January 2017 and September2022 were collected.After screening for inclusion and exclusion criteria,120 participants were recruited in the study.The following information has been obtained:general data,current medical history,concurrent illnesses,personal history,imaging results,laboratory testing,and treatment modalities.The National Institutes of Health Stroke Scale(NIHSS)was used at admission to measure functional impairment,and the modified Rankin Scale(m RS)was utilized at discharge and follow-up to assess clinical outcomes.A statistical analysis was conducted on male and female CVST patients using SPSS 26.0 software to compare risk variables,clinical presentation,imaging findings,and outcomes.We further compared female patients with and without gender-specific risk factors(GSRF),which included oral contraceptives,pregnancy,puerperium,and hormone replacement therapy.Results:The research comprised a total of 120 CVST patients,with a male-to-female proportion of 1:1.6.The age distribution of males and females was mainly between 21 and 50 years.(1)Comparison of baseline characteristics between the two groups of males and females: There was no significant difference between men and women in age,time from onset of illness to admission,length of stay in the hospital,NIHSS score at admission,type of onset,or m RS score at discharge(P>0.05).Among men and females,the onset type of CVST was largely subacute(58.7% and 55.4%,respectively);in terms of clinical presentation,headache was the most prevalent clinical presentation(79.7% and 71.7%,respectively),with no significant difference between the two groups.Visual symptoms were more common in women than in men(24.3% vs.6.5%,P=0.01).(2)Comparison of risk factors between the two groups of men and women: the main CVST risk factors for women were thrombophilic abnormalities(59.5%)gender-specific risk factors(37.8%)and anemia(33.1%).The main CVST risk factors in men were thrombophilic abnormalities(65.2%)and unprovoked cause(15.2%).In terms of risk factors,women had a higher prevalence of anemia(33.1% vs 13%,P=0.025),thrombocythemia(21.6% vs 0%,P=0.001),and antiphospholipid antibody abnormalities(22.4% vs 2.9%,P=0.012),while men had a higher prevalence of hyperhomocysteinemia(60.9% vs 33.8%,P= 0.04).In terms of lifestyle,men had higher rates of smoking(34.8% vs 10.8%,P=0.01)and alcohol consumption(32.6%vs 10.1%,P<0.001)than women.(3)Comparison of imaging findings between the two groups of men and women:There was no gender difference in parenchymal damage,location of thrombosis,or number of affected sinuses(P>0.05).The transverse sinus(73.3%)was the most frequently thrombosed location,followed by the sigmoid sinus(70%)and superior sagittal sinus(64.4%).In this study,29 patients(24.2%)had one sinus affected,42patients(33.0%)had two sinuses involved,and 49 patients(40.8%)had more than two sinuses involved.(4)Comparison between the three groups of men,women with or without gender-specific risk factors(GSRF)showed that women with GSRF were younger at presentation than men,women without GSRF(P=0.019),had a shorter time from presentation to admission(P= 0.008)and better outcome(P=0.022).(5)According to the modified Rankin Scale(m RS),120 patients with cerebral venous sinus thrombosis were classified as having a good outcome(m RS 2 points)or a poor outcome(m RS > 2 points).The results of multi-factor logistic regression analysis revealed that the presence of GSRF was an independent predictor of good outcome(OR=0.109,95%CI 0.013-0.908,P=0.04),while increasing age(OR=1.072,95%CI 0.596-7.571,P=0.001),impaired consciousness(OR=22.927,95%CI 2.793-188.191,P=0.004),and involvement of the straight sinus(OR=10,924,95%CI 2.638-45.238,P=0.001)were found to predict poor outcomes.Conclusion:(1)The ratio of male to female CVST is 1:1.6.(2)In terms of clinical presentation,the incidence of visual symptoms is more common in women than in men.(3)The risk factors for CVST in women are mainly gender-specific risk factors,anemia and thrombotic tendency,while in men the risk factors for CVST are mainly thrombotic tendency and unknown cause.(4)In terms of risk factors,women have a higher incidence of anemia,thrombocythemia and antiphospholipid antibodies;men have a higher incidence of hyperhomocysteinemia and higher rates of smoking and alcohol consumption than women.(5)There was no statistical difference between the male and female groups in terms of parenchymal injury,site of thrombosis,and the number of involved sinuses.(6)Women with sex-specific risk factors were younger at the time of onset,had a shorter time between onset and admission,and had better outcomes than the male group and the group of women with no sex-specific risk factors.(7)The presence of concomitant GSRF was an independent predictor of good outcome,whereas advancing age,impaired consciousness,and involvement of the rectus were independent predictors of poor outcome. |
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