Jain Rajendra Singh, Sripadma P V, Tejwani Shankar
Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India.
Ann Indian Acad Neurol. 2022 Mar-Apr;25(2):229-234. doi: 10.4103/aian.aian_718_21. Epub 2022 Feb 8.
Recanalization rates in cerebral venous thrombosis (CVT) and its effect on neurological outcome have been debated worldwide and are inadequately addressed in studies from India. Our objective was to study the clinical profile of CVT and determine recanalization rates with its predictors and its effect on outcome.
A prospective single centre cohort study on 101 patients with radiologically confirmed acute CVT between October 2018 and June 2021 was conducted. Anticoagulation was given for 3-12 months or lifelong for thrombophilias. Recanalization status of vessels was assessed between 3-6 months and at 12 months after ictus. Outcome was defined as favorable (mRS 0-1) or unfavorable. Patients with atleast one CT/MR venogram on follow up were included.
Of the 101 enrolled patients, 83 completed study protocol. Mean age of patients was 34.2 ± 11.7 years. Clinical characteristics included headache (75.9%),seizure (66.2%), altered mentation(20.4%) with clustering of cases during summers. Transverse- sigmoid sinuses were predominantly involved (66.2 %) followed by superior sagittal sinus (SSS,65.0%).Commonest etiologies were thrombophilia (27.7%) and postpartum state (15.6%). Complete recanalization was achieved in 67.4%, partial in 26.5% and no recanalization in 6.02% at end of 12 months. Recanalization rates improved from 83.09% between 3-6 months to 93.9 % at 12 months. Median time to last follow-up was 12months and at last follow up 95.1% had favorable mRS with recurrence in two patients with raised factor VIII levels.
Recanalization occurred in more than 90% of CVT patients. Isolated superior sagittal sinus thrombosis and age <50 years were predictors of complete recanalization. Most patients, except few achieved a favorable mRS.
脑静脉血栓形成（CVT）的再通率及其对神经功能预后的影响在全球范围内一直存在争议，而印度的相关研究对此关注不足。我们的目的是研究CVT的临床特征，确定其再通率、预测因素及其对预后的影响。
对2018年10月至2021年6月期间101例经影像学确诊的急性CVT患者进行了一项前瞻性单中心队列研究。对于血栓形成倾向患者，抗凝治疗3至12个月或终身抗凝。在发病后3至6个月和12个月时评估血管的再通状态。预后定义为良好（改良Rankin量表评分0 - 1分）或不良。纳入至少有一次随访CT/MR静脉造影的患者。
101例入组患者中，83例完成了研究方案。患者的平均年龄为34.2±11.7岁。临床特征包括头痛（75.9%）、癫痫发作（66.2%）、意识改变（20.4%），夏季病例聚集。横窦 - 乙状窦主要受累（66.2%），其次是上矢状窦（SSS，65.0%）。最常见的病因是血栓形成倾向（27.7%）和产后状态（15.6%）。12个月末，完全再通率为67.4%，部分再通率为26.5%，未再通率为6.02%。再通率从3至6个月时的83.09%提高到12个月时的93.9%。最后一次随访的中位时间为12个月，最后一次随访时，95.1%的患者改良Rankin量表评分良好，两名因子VIII水平升高的患者复发。
超过90%的CVT患者发生了再通。孤立的上矢状窦血栓形成和年龄<50岁是完全再通的预测因素。除少数患者外，大多数患者改良Rankin量表评分良好。
