Wasay Mohammad, Bakshi Rohit, Bobustuc George, Kojan Suleman, Sheikh Zubair, Dai Alper, Cheema Zahid
Aga Khan University, Karachi, Pakistan.
J Stroke Cerebrovasc Dis. 2008 Mar-Apr;17(2):49-54. doi: 10.1016/j.jstrokecerebrovasdis.2007.10.001.
The data regarding diagnosis, prognosis, management, and outcome of patients with cerebral venous thrombosis are limited from the United States.
Patients with diagnosis of cerebral venous thrombosis were identified by International Classification of Diseases, Ninth Revision coding system at 10 centers in the United States during a 10-year period by retrospective chart review (1991-1997) or prospective enrollment (1997-2001). In all, 232 patients were screened for study inclusion and 182 of these patients were included in the study.
The age range was 13 to 82 years (mean 38 years). Hypercoagulable state was the most common predisposing factor followed by pregnancy, malignancy, and homocystinemia. Neurologic examination revealed normal findings in 69 patients (38%); 37 (20%) were comatose, 59 (32%) had papilledema, and 71 (39%) had hemiparesis. In all, 61 patients (33%) had evidence of hemorrhage by computed tomography/magnetic resonance imaging. A total of 27 patients (15%) were treated with thrombolysis and 124 (68%) with anticoagulation. Overall mortality was 13% (n = 24). One-year follow up was available for 96 patients (53%). Of these, 26 (27%) were healthy, 43 (45%) were ambulatory with assistance, and 27 (28%) were still bedridden. On multivariate analysis, the best predictors of a poor outcome were coma at presentation (odds ratio 15.2 [95% confidence interval; 1.5-66]) and intracerebral hemorrhage (odds ratio 8.7 [95% confidence interval; 1.3-34.5]).
Clinical and radiologic presentation of cerebral venous thrombosis in the United States is not much different from other parts of world but spectrum and frequency of predisposing factors are different. Number of patients treated with thrombolysis is higher as compared with other reported series of such patients. Coma at presentation and intracerebral hemorrhage were the strongest predictors of poor outcome, which is comparable with other series.
来自美国的关于脑静脉血栓形成患者的诊断、预后、治疗及转归的数据有限。
通过国际疾病分类第九版编码系统，在美国10个中心，采用回顾性病历审查（1991 - 1997年）或前瞻性入组（1997 - 2001年）的方式，确定脑静脉血栓形成的患者。总共筛查了232例患者以纳入研究，其中182例患者被纳入研究。
年龄范围为13至82岁（平均38岁）。高凝状态是最常见的诱发因素，其次是妊娠、恶性肿瘤和高同型半胱氨酸血症。神经系统检查显示69例患者（38%）结果正常；37例（20%）昏迷，59例（32%）有视乳头水肿，71例（39%）有偏瘫。总共61例患者（33%）通过计算机断层扫描/磁共振成像有出血证据。27例患者（15%）接受了溶栓治疗，124例（68%）接受了抗凝治疗。总体死亡率为13%（n = 24）。96例患者（53%）有1年的随访数据。其中，26例（27%）健康，43例（45%）在辅助下可活动，27例（28%）仍卧床。多因素分析显示，预后不良的最佳预测因素是就诊时昏迷（比值比15.2 [95%置信区间；1.5 - 66]）和脑出血（比值比8.7 [95%置信区间；1.3 - 34.5]）。
在美国，脑静脉血栓形成的临床和影像学表现与世界其他地区没有太大差异，但诱发因素的范围和频率不同。与其他报道的此类患者系列相比，接受溶栓治疗的患者数量更多。就诊时昏迷和脑出血是预后不良的最强预测因素，这与其他系列相当。
