Kowoll Christina M, Kaminski Julia, Weiß Verena, Bösel Julian, Dietrich Wenke, Jüttler Eric, Flechsenhar Julia, Guenther Albrecht, Huttner Hagen B, Niesen Wolf-Dirk, Pfefferkorn Thomas, Schirotzek Ingo, Schneider Hauke, Liebig Thomas, Dohmen Christian
Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Department of Radiology and Neuroradiology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Neurocrit Care. 2016 Dec;25(3):392-399. doi: 10.1007/s12028-016-0256-8.
Severe cerebral venous-sinus thrombosis (CVT) is a rare disease, and its clinical course, imaging correlates, as well as long-term prognosis have not yet been investigated systematically.
Multicenter retrospective study. Inclusion criteria were CVT, Glasgow coma scale ≤9, and treatment in the intensive care unit. Primary outcome was death or dependency, assessed by a modified Rankin Score (mRS) >2 at last follow-up.
114 patients were included. At last follow-up (median 2.5 years), 38 patients (33.3 %) showed no or minor residual symptoms (mRS = 0 or 1), 12 (10.5 %) had a mild (mRS = 2), 13 (11.4 %) a moderate (mRS = 3), 12 (10.5 %) a severe disability (mRS = 4 or 5), and 39 (34.2 %) had died. In bivariate analysis, predictors of poor outcome were any signs of mass effect on imaging, clinical deterioration after admission, and age. In contrast, clinical symptoms on admission and parenchymal lesions per se, such as edema, infarction, or hemorrhage were not predictive. Multivariate predictors of poor outcome were an increase in National Institutes of Health Stroke Scale ≥3 after admission [odds ratio (OR) 6.7], bilateral motor signs in the further course (OR 9.2), and midline shift (OR 5.1).
The outcome of severe CVT is almost equally divided between severe impairment or death and survival with no or only mild handicap. Specifically, space-occupying mass effect and associated neurologic deterioration seem to determine a poor outcome. Therefore, early detection and treatment of mass effect should be the focus of critical care.
严重的脑静脉窦血栓形成（CVT）是一种罕见疾病，其临床病程、影像学特征以及长期预后尚未得到系统研究。
多中心回顾性研究。纳入标准为CVT、格拉斯哥昏迷量表评分≤9分以及在重症监护病房接受治疗。主要结局为死亡或依赖，通过末次随访时改良Rankin量表（mRS）评分>2来评估。
共纳入114例患者。在末次随访时（中位时间2.5年），38例患者（33.3%）无或仅有轻微残留症状（mRS = 0或1），12例（10.5%）有轻度残疾（mRS = 2），13例（11.4%）有中度残疾（mRS = 3），12例（10.5%）有重度残疾（mRS = 4或5），39例（34.2%）死亡。在双变量分析中，预后不良的预测因素为影像学上的任何占位效应迹象、入院后临床病情恶化以及年龄。相比之下，入院时的临床症状以及实质病变本身，如水肿、梗死或出血并无预测价值。预后不良的多变量预测因素为入院后美国国立卫生研究院卒中量表评分增加≥3分[比值比（OR）6.7]、病程中出现双侧运动体征（OR 9.2）以及中线移位（OR 5.1）。
严重CVT的结局在严重损伤或死亡与无或仅有轻度残疾的存活之间几乎平分。具体而言，占位性占位效应及相关神经功能恶化似乎决定了不良预后。因此，早期发现和治疗占位效应应成为重症监护的重点。
