中国西南地区颅内静脉窦血栓形成患者的临床特点及预后分析

目的前瞻性研究分析中国西南地区颅内静脉窦形成 (CVST）患者的临床表现、危险因素、影像学特点、治疗、预后及相关因素，为颅内静脉窦血栓的早期诊治提供依据及探讨预后预测因素。方法对2009年1月至2012年1月在四川大学华西医院神经内科确诊为CVST并接受治疗的所有患者的临床资料进行前瞻性分析研究，并进行连续性的电话随访。结果共纳入73例颅内静脉窦血栓患者。急性起病占13.7%，亚急性起病占50.7%，慢性起病占35.6%。早期最常见的症状为头痛 (66例，90.4%），2.7%CVST患者最初的症状为视力下降或视物模糊, 2.7%以突发一侧肢体无力起病，1.4%以复视为首发症状,1.4%以突发痫性发作起病。46例行了头部CT扫描，结果发现8例 (17.4%)有出血性梗死，影像学检查特点中，头部平扫CT中34.8%有delta征，30.4%有细绳征，而头部MRI检查，27.5%表现为脑水肿,55.0%delta征，45.0%细绳征。最常累及的静脉窦为右侧横窦68.5%，其次分别为左侧横窦57.5%，上矢状窦53.4%，左侧乙状窦50.7%，右侧乙状窦47.9%，窦汇32.9%，下矢状窦21.9%，直窦20.5%，颈静脉12.3%，大脑大静脉9.6%。所有CVST患者均随访12个月，其中死亡5例（6.8%），53例〔72.6%，改良Rankin评分（mRS)<2〕为预后良好；20例（27.4%，MRS评分≥2）为预后差，回归分析显示癫痫 (P=0.030, OR=5.184,95%CI 1.170~22.966,）和视乳头水肿 (P=0.008,OR=10.811,95%CI 1.858~62.893）为预后不良（mRS≥2)的独立危险因素。结论 CVST患者临床表现多样，早期识别困难，合理的影像学检查可为诊断提供帮助。癫痫和视乳头水肿为CVST患者预后不良独立危险因素。

英文摘要:

Objective Cerebral venous sinus thrombosis (CVST) is a rare cerebral vascular disease. Early diagnosis and treatments are crucial for a better prognosis. This study investigated the clinical characteristics and risk factors associated with the prognosis of patients with CVST. Methods From Jan 2009 to Jan 2013, patients who were admitted to the Department of Neurology of West China Hospital with confirmed CVST (according to the 2006 guideline of European neurology with neuroimaging when necessary) were consecutively recruited. Their medical records including demographic information and detailed clinical data were analyzed. The functional outcome of CVST was assessed 12 months after discharge using the modified Rankin Scale (mRS). Results A total of 73 patients were enrolled in this study. Acute and chronic onset of illness accounted for 13.7% and 35.6% of all patients, respectively. The earliest common symptom was headache (90.4%). Other initial symptoms included decreased visual acuity or blurred vision (2.7%), unilateral limb weakness (2.7%), diplopia (1.4%) and seizure (1.4%). CT scan was conducted in 46 patients (63.3%), which revealed 8 (17.4%) cases of cerebial hemorrhagic infarction. Delta sign and cord sign was shown in 34.8% and 30.4% CT imaging, respectively. The MRI scan confirmed that 27.5% of those patients had encephaledema, 55% had delta sign and 45% had cord sign. The commonly involved location of CVST was right lateral sinus (68.5%), left lateral sinus (57.5%), ongitudinal sinus (53.4%), left sigmoid sinus (50.7%), right sigmoid sinus (47.8%), confluence sinuum (32.9%), nferior sagittal sinus (21.9%), sinus rectus (20.5%), jugular vein (12.3%) and cerebral vein (9.6%). During the 12-month follow-up, 6.8% patients died, 72.6% had good mRS outcome (<2) and 27.4% had poor mRS outcome (≥2). [CM(155.3mm]The regression analysis identified epilepsy and papilledma as independent predictors of poor prognosis of CVST. Conclusion It is difficult to recognize CVST at an early stage due to its diverse clinical presentations. Neuroimaging may be helpful for the diagnosis. Epilepsy and papilledema are potentially independent predictors for the 12-month functional outcome of patients with CVST.

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