脑静脉窦血栓形成后的慢性颅内高压——发生率及危险因素

Chronic intracranial hypertension after cerebral venous and sinus thrombosis - frequency and risk factors.

作者信息

Geisbüsch Christina, Herweh Christian, Gumbinger Christoph, Ringleb Peter A, Möhlenbruch Markus A, Nagel Simon

机构信息

Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.

Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.

出版信息

Neurol Res Pract. 2021 May 17;3(1):28. doi: 10.1186/s42466-021-00127-y.

DOI:10.1186/s42466-021-00127-y

PMID:33993881

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8127194/

Abstract

BACKGROUND

Cerebral venous sinus thrombosis (CVST) can infrequently lead to chronical intracranial hypertension (IH) due to the altered venous drainage. The aim of this study was to ascertain the risk of IH after CVST and to stratify underlying risk factors.

METHODS

We performed a retrospective cohort analysis of all cases treated for acute CVST at our department between 2013 and 2019. IH was diagnosed at follow-up according to the modified Dandy criteria. CVST-patients with and without IH were descriptively compared conforming to available clinical and radiological data as well as outcomes.

RESULTS

Our study included 102 patients with acute CVST. In 70 cases complete follow-up data was available (68.6%). Seven of these patients developed symptomatic intracranial hypertension (10%; N = 7, n = 70) within a median follow-up of 6 months. Four of these patients (57.1% (N = 4, n = 7) vs. 3.2% (N = 2, n = 63); p < 0.001) presented recurrent sinus thrombosis in the further course. There were no significant differences between patients with or without IH concerning gender, age, risk factors, occluded vessels and treatment for their CVST. However the presence of visual deterioration at initial admission was higher in patients who developed IH afterwards (57.1% (N = 4, n = 7) vs. 20.6% (N = 13, n = 63); p = 0.03). Patients with chronic IH after CVST showed significantly less likely recanalization of the occluded vessel on follow-up MRI (no recanalization in 28.6% (N = 2, n = 7) vs. 4.8% (N = 3, n = 63); p = 0.02). All patients with IH had a good outcome (mRS 0-2) at discharge and follow-up.

CONCLUSION

IH occurred in around 10% after CVST. Insufficient recanalization status may facilitate IH. Patients with visual disturbances seem to develop more likely IH afterwards. Patients who present IH after CVST may develop recurrent cerebral venous thrombosis.

摘要

背景

由于静脉引流改变，脑静脉窦血栓形成（CVST）偶尔可导致慢性颅内高压（IH）。本研究的目的是确定CVST后发生IH的风险，并对潜在风险因素进行分层。

方法

我们对2013年至2019年在我科接受急性CVST治疗的所有病例进行了回顾性队列分析。根据改良的丹迪标准在随访时诊断IH。根据可用的临床、放射学数据以及结果，对有和没有IH的CVST患者进行描述性比较。

结果

我们的研究纳入了102例急性CVST患者。其中70例有完整的随访数据（68.6%）。这些患者中有7例在中位随访6个月内出现症状性颅内高压（10%；N = 7，n = 70）。其中4例患者（57.1%（N = 4，n = 7）对3.2%（N = 2，n = 63）；p < 0.001）在后续病程中出现复发性窦血栓形成。有或没有IH的患者在性别、年龄、风险因素、闭塞血管和CVST治疗方面无显著差异。然而，初始入院时出现视力下降的患者在之后发生IH的比例更高（57.1%（N = 4，n = 7）对20.6%（N = 13，n = 63）；p = 0.03）。CVST后发生慢性IH的患者在随访MRI上闭塞血管再通的可能性明显较低（28.6%（N = 2，n = 7）无再通对4.8%（N = 3，n = 63）；p = 0.02）。所有有IH的患者在出院和随访时预后良好（mRS 0 - 2）。