Ding Jiayue, Zhou Da, Geng Tingting, Pan Liqun, Ya Jingyuan, Wang Zhongao, Hu Yanyu, Ding Yuchuan, Zhang Xuxiang, Meng Ran
Departments of Neurology and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
Eur Neurol. 2018;80(1-2):28-33. doi: 10.1159/000492184. Epub 2018 Aug 22.
Visual damage is one of the most common complications of cerebral venous sinus thrombosis (CVST)-associated intracranial hypertension (IH). This study is aimed at stratifying the risk of IH-induced visual damage in an attempt to predict its deterioration and prevent high-risk patients from irreversible eyesight impairment promptly.
A total of 94 patients with confirmed diagnosis of CVST were eligible for enrollment in this study. According to cerebrospinal fluid pressure at admission, the involved patients were classified into mild IH (< 250 mmH2O), moderate IH (250-330 mmH2O), and severe IH (≥330 mmH2O) groups.
The ratio of visual deterioration in the severe IH group was 75%, which was significantly higher than in either the moderate (44.4%) or the mild groups (14.3%). As regards subjects without visual symptoms at admission, visual deterioration occurred in 9.4 ± 4.5 days after admission in the severe group while it occurred in 30.5 ± 16.8 days in the moderate group (p = 0.024). The conditional inference tree and random forest revealed that severe IH might be considered as an index of visual deterioration. Visual field defect, fading eyesight, and papilledema were significantly worse in patients with severe IH as compared to patients with mild or moderate IH, all p < 0.01.
IH ≥330 mmH2O may be a cut-off value to predict the deterioration of visual damage in CVST, revealing that ophthalmologic interventions should be considered in a timely manner in this condition, particularly when recanalization of cerebral venous sinus cannot be achieved within a short time.
视觉损害是脑静脉窦血栓形成（CVST）相关颅内高压（IH）最常见的并发症之一。本研究旨在对IH引起视觉损害的风险进行分层，以预测其病情恶化，并及时防止高危患者出现不可逆的视力损害。
共有94例确诊为CVST的患者符合本研究的入组条件。根据入院时的脑脊液压力，将纳入患者分为轻度IH（<250 mmH2O）、中度IH（250 - 330 mmH2O）和重度IH（≥330 mmH2O）组。
重度IH组视觉恶化的比例为75%，显著高于中度组（44.4%）和轻度组（14.3%）。对于入院时无视觉症状的患者，重度组在入院后9.4±4.5天出现视觉恶化，而中度组在30.5±16.8天出现（p = 0.024）。条件推断树和随机森林显示，重度IH可被视为视觉恶化的一个指标。与轻度或中度IH患者相比，重度IH患者的视野缺损、视力减退和视乳头水肿明显更严重，所有p<0.01。
IH≥330 mmH2O可能是预测CVST患者视觉损害恶化的一个临界值，表明在这种情况下应及时考虑眼科干预，特别是在短时间内无法实现脑静脉窦再通时。
