颅内静脉窦血栓形成伴早发性癫痫发作的危险因素及预后分析  

Analysis on risk factors and prognosis of cerebral venous sinus thrombosis with early-onset seizures

作　　者：姚思彤 徐薇淇 丛树艳[1] Yao Sitong;Xu Weiqi;Cong Shuyan(Department of Neurology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院神经内科,沈阳110004

出　　处：《中国脑血管病杂志》2024年第6期369-377,共9页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析颅内静脉窦血栓形成(CVST)伴早发性癫痫发作的危险因素及其预后。方法回顾性连续纳入2011年8月至2022年11月中国医科大学附属盛京医院神经内科及神经外科收治的163例CVST患者,根据其确诊CVST后14 d内是否并发癫痫发作,将患者分为早发性癫痫发作组(42例)和非早发性癫痫发作组(121例)。收集两组患者的一般临床资料、影像学资料及实验室检查结果、治疗方案等,其中一般临床资料包括性别、年龄、可疑病因[感染(如乳突炎、中耳炎、鼻窦炎等)、口服避孕药/雌激素、妊娠/产褥期、贫血及其他可导致血液成分改变的因素、高同型半胱氨酸血症]、临床表现[包括头痛、头晕、意识障碍、恶心呕吐、肢体麻木、偏瘫、耳鸣、失语、复视、精神异常、反应迟钝、孤立性颅内高压(视乳头水肿)等];影像学资料包括CVST累及静脉窦部位、累及多个静脉窦(累及≥2个静脉窦)以及颅内实质病变情况(合并颅内出血、静脉性脑梗死、蛛网膜下腔出血)。所有患者入院第2天进行D-二聚体水平检测;对出现颅内压增高征患者行腰椎穿刺术检查,并测定脑脊液压力,将脑脊液压力>180 mmH 2O定义为脑脊液压力升高。所有患者行单纯抗凝治疗或抗凝联合血管内治疗。出院后2个月开始对患者进行电话随访,并采用改良Rankin量表(mRS)评估患者预后情况(将mRS评分≤2分为定义为预后良好,mRS评分>2分定义为预后不良),统计患者病死率。对比两组的临床资料、影像学资料、实验室检查结果、治疗情况及随访结果等;将单因素分析中P<0.05的相关变量纳入多因素Logistic回归模型中,分析CVST并发早发性癫痫发作的独立危险因素。结果(1)与非早发性癫痫发作组比较,早发性癫痫发作组妊娠/产褥期女性占比更高(33.3%比13.2%,P=0.004),偏瘫比例更高(23.8%比6.6%,P=0.005),CVST影像学颅内出血者占比更高(40.5%�Objective To analyze the risk factors and the prognosis in patients with cerebral venous sinus thrombosis(CVST)accompanied by early-onset seizures.Methods A retrospective study was conducted on 163 patients with CVST admitted to the Department of Neurology and Neurosurgery of Shengjing Hospital of China Medical University during August 2011 to November 2022 as the study subjects.Based on whether they had concurrent seizures within 14 days after diagnosis CVST,the patients were divided into the early-onset seizures group(42 cases)and the non-early-onset seizure group(121 cases).Clinical data were collected,including general clinical data,imaging data,laboratory test results,and treatment plans,etc.The general clinical data involves gender,age,suspected etiology(infection[such as mastoiditis,otitis media,sinusitis,etc.],oral contraceptives/estrogen,pregnancy/puerperium,anemia and other factors that can lead to changes in blood composition,hyperhomocysteinemia),clinical manifestations(including headache,dizziness,disturbance of consciousness,nausea and vomiting,limb numbness,hemiplegia,tinnitus,aphasia,diplopia,mental abnormalities,unresponsiveness,isolated intracranial hypertension[papilledema],etc.).Imaging data includes involved venous sinus location,multiple venous sinuses(involving≥2 venous sinuses)and intracranial changes(intracranial hemorrhage,venous cerebral infarction,subarachnoid hemorrhage).All patients were tested for D-dimer on the second day of admission.Patients with intracranial hypertension were examined with spinal puncture and measured cerebrospinal fluid pressure,with elevated cerebrospinal fluid pressure defined as the pressure>180 mmH 2O.The patients were followed up by telephone 2 months after discharge,and the modified Rankin scale(mRS)was used to assess the prognosis of the patients(mRS score≤2 points as good prognosis,mRS score>2 points as poor prognosis).The mortality rate of patients was measured.The clinical data,imaging data,laboratory test results,treatment and follow-up results o

关 键 词：窦血栓形成 颅内 癫痫 危险因素 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]