East Coast Railway Central Hospital, Bhubaneswar, India.
Department Of Emergency medicine & Trauma, Jawaharlal Institute Of Postgraduate Medical Education & Research, Puducherry, India.
Am J Emerg Med. 2024 Nov;85:65-70. doi: 10.1016/j.ajem.2024.08.034. Epub 2024 Sep 2.
To better understand the clinical and radiological characteristics of Cerebral Venous Thrombosis (CVT), we conducted a study focusing on the assessment of neurological outcomes and factors associated with poor prognosis in patients with CVT.
This prospective, observational study took place over two years (July 2020 to June 2022) in a tertiary care teaching hospital in South India, encompassing adults aged 18 years and over. Key data points included demographic information, symptomatology, physical and neurological examinations, neuroimaging findings, hospital interventions, and neurological outcomes at discharge and at a six-week telephonic follow-up.
A total of 140 patients with CVT, median age 34 years, were studied. 61.4 % were males. The most common symptoms and signs were headaches (70.7 %) and papilledema (60.7 %). Hemorrhagic infarct was the most prevalent finding on the non-contrast computed tomography (NCCT) of the brain, involving 39.4 % of patients. The most commonly affected sinus was the superior sagittal sinus. Risk factors most often observed were alcoholism (45 %), smoking (21.4 %), anemia (27.1 %), oral contraceptive pill usage (12.1 %), and hypertension (12.1 %). Deep vein thrombosis or pulmonary embolism was present in 5 % of the patients. The mean hospital stay was 13.9 days, with 6.4 % of patients requiring endotracheal intubation at presentation and 22.9 % during their stay. The observed in-hospital mortality rate was 17.9 %, increasing to 22.4 % at the six-week follow-up. Morbidity (mRS 3-5) was 24.3 % at discharge, decreasing to 8.2 % at six-week follow-up. Favorable outcomes were reported in 57.9 % of cases at discharge, rising to 69.4 % at six weeks.
Our study underscores the importance of recognizing cardinal symptoms and diverse risk factors of CVT, including alcoholism and anemia. Majority of CVT occurrences were observed in males aged 18-29. Critical determinants of heightened morbidity and mortality were identified, including lower GCS scores and the necessity for advanced interventions. Notably, majority of patients presented favorable neurological outcomes at six-week follow-up.
为了更好地了解脑静脉血栓形成（CVT）的临床和影像学特征，我们进行了一项研究，重点评估 CVT 患者的神经功能预后和与不良预后相关的因素。
这是一项前瞻性、观察性研究，在印度南部的一家三级教学医院进行，时间跨度为两年（2020 年 7 月至 2022 年 6 月），纳入年龄在 18 岁及以上的成年人。关键数据点包括人口统计学信息、症状、体格检查和神经系统检查、神经影像学发现、医院干预措施以及出院时和 6 周电话随访时的神经功能预后。
共纳入 140 例 CVT 患者，中位年龄为 34 岁，其中 61.4%为男性。最常见的症状和体征是头痛（70.7%）和视乳头水肿（60.7%）。非增强 CT 扫描（NCCT）显示最常见的脑梗死为出血性梗死，占 39.4%的患者。最常受累的窦是上矢状窦。最常见的危险因素是酒精中毒（45%）、吸烟（21.4%）、贫血（27.1%）、口服避孕药（12.1%）和高血压（12.1%）。5%的患者存在深静脉血栓形成或肺栓塞。平均住院时间为 13.9 天，有 6.4%的患者在就诊时需要气管插管，22.9%的患者在住院期间需要气管插管。住院期间死亡率为 17.9%，6 周随访时增至 22.4%。出院时的发病率（mRS 3-5）为 24.3%，6 周随访时降至 8.2%。出院时报告的良好预后为 57.9%，6 周随访时上升至 69.4%。
本研究强调了认识 CVT 的主要症状和多种危险因素（包括酒精中毒和贫血）的重要性。CVT 多发生在 18-29 岁的男性中。确定了导致高发病率和死亡率的关键决定因素，包括较低的格拉斯哥昏迷评分和需要高级干预。值得注意的是，大多数患者在 6 周随访时的神经功能预后良好。
