Ji Kangxiang, Zhou Chen, Wu Longfei, Li Weili, Jia Milan, Chu Min, Wu Di, Hou Chengbei, Duan Jiangang, Meng Ran, Ji Xunming
China-America Institute of Neuroscience (K.J., C.Z., L.W., W.L., M.J., M.C., D.W., X.J.), Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology (K.J., C.Z., L.W., W.L., M.J., M.C., D.W., J.D., R.M.), Xuanwu Hospital, Capital Medical University, Beijing, China.
Stroke. 2021 Jan;52(2):531-536. doi: 10.1161/STROKEAHA.120.029820. Epub 2021 Jan 7.
Which factors will influence the presence of severe residual headache after cerebral venous thrombosis (CVT) is unclear. The purpose of this study was to identify risk factors for severe residual headache in a large single-center cohort of patients with CVT.
We consecutively included eligible patients with CVT from a prospective stroke registry. Severe residual headache was defined as a residual headache attack requiring bed rest or hospital admission within 1 month before the last follow-up visit. We identified the risk factors of severe residual headache in all survivors and in those with favorable functional outcome (a modified Rankin Scale score, 0-2).
A total of 325 patients' data were analyzed. At the last follow-up (median 13 months), 43 patients (13.2%) reported severe headache. In the multivariable analysis, isolated intracranial hypertension (odds ratio [OR], 3.309 [95% CI, 1.434-7.634]; =0.005), CVT recurrence (OR, 4.722 [95% CI, 1.639-13.602]; =0.004), and no recanalization (OR, 10.158 [95% CI, 4.194-24.600]; <0.001) were independently associated with severe headache. Severe headache was more frequent in patients with unfavorable outcome (11/25 [44.0%] versus 32/300 [10.7%]; <0.001). In patients with favorable outcome, the risk factors for severe headache were isolated intracranial hypertension (OR, 3.236 [95% CI, 1.268-8.256]; =0.014) and no recanalization (OR, 7.863 [95% CI, 3.120-19.812]; <0.001).
Isolated intracranial hypertension, CVT recurrence, and no recanalization increased the risk for severe residual headache after CVT.
目前尚不清楚哪些因素会影响脑静脉血栓形成（CVT）后严重残留头痛的发生情况。本研究旨在确定一个大型单中心CVT患者队列中严重残留头痛的危险因素。
我们从一个前瞻性卒中登记处连续纳入符合条件的CVT患者。严重残留头痛定义为在最后一次随访前1个月内需要卧床休息或住院治疗的残留头痛发作。我们确定了所有幸存者以及功能预后良好（改良Rankin量表评分，0 - 2分）者中严重残留头痛的危险因素。
共分析了325例患者的数据。在最后一次随访时（中位时间13个月），43例患者（13.2%）报告有严重头痛。在多变量分析中，孤立性颅内高压（比值比[OR]，3.309[95%置信区间，1.434 - 7.634]；P = 0.005）、CVT复发（OR，4.722[95%置信区间，1.639 - 13.602]；P = 0.004）和未再通（OR，10.158[95%置信区间，4.194 - 24.600]；P < 0.001）与严重头痛独立相关。预后不良的患者严重头痛更为常见（11/25[44.0%]对32/300[10.7%]；P < 0.001）。在预后良好的患者中，严重头痛的危险因素是孤立性颅内高压（OR，3.236[95%置信区间，1.268 - 8.256]；P = 0.014）和未再通（OR，7.863[95%置信区间，3.120 - 19.812]；P < 0.001）。
孤立性颅内高压、CVT复发和未再通增加了CVT后严重残留头痛的风险。
