老年患者的脑静脉血栓形成。
Cerebral venous thrombosis in elderly patients.
机构信息
Stroke Units and Department of Neurology of Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Paris, France.
Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University of Paris City, INSERM 1144, Paris, France.
出版信息
Eur J Neurol. 2024 Dec;31(12):e16504. doi: 10.1111/ene.16504. Epub 2024 Oct 4.
BACKGROUND AND PURPOSE
We aimed to report the characteristics of cerebral venous thrombosis (CVT) in elderly people (aged ≥65 years).
METHODS
This multicenter retrospective cohort included elderly patients hospitalized for a first CVT in nine Paris-Ile-de-France hospitals between 2011 and 2021. The estimated incidence was compared to CVT recorded by the French health insurance data system. Lariboisière Hospital's CVT registry allowed comparisons of our elderly cohort with individuals younger than 65 years.
RESULTS
One hundred fourteen patients were included in this study (mean age = 74.2 years, range = 65-93, 61% female). The CVT annual incidence in Ile-de-France was 5.9-7.1 per million elderly individuals versus 8.5 per million nationwide. Headaches and focal deficits were the most common initial clinical features (50% and 51%, respectively), followed by seizures and confusion (40% and 27%). Treatment included anticoagulation (93%) and, rarely, endovascular procedure (2%) or craniectomy (1%). Compared with adult patients aged <65 years (younger adults), elderly patients presented fewer headaches (50% vs. 96%, p < 0.01) and intracranial hypertension (7% vs. 22%, p < 0.01) but more seizures and focal deficits (40% vs. 27% and 51% vs. 38%, respectively, p < 0.01). Underlying cancer, hemopathy, and locoregional infections were more frequent in elderly patients than among younger adults (p < 0.01). The prognosis of patients from our elderly cohort was poorer than that of younger adults; 8% died in the acute phase, and 73% had a favorable outcome at 1 year (vs. 1.7% and 87%, respectively, p < 0.01).
CONCLUSIONS
CVT in elderly patients has a specific clinical presentation, epidemiology, and risk factors such as cancer or hemopathy, justifying specialized management.
背景与目的
本研究旨在报告老年人（年龄≥65 岁）脑静脉血栓形成（CVT）的特征。
方法
本多中心回顾性队列研究纳入了 2011 年至 2021 年期间在巴黎法兰西岛的 9 家医院因首次 CVT 住院的老年患者。通过与法国健康保险数据系统记录的 CVT 进行比较，估算了发病率。Lariboisière 医院的 CVT 登记册使我们能够对老年队列与年龄小于 65 岁的个体进行比较。
结果
本研究共纳入 114 例患者（平均年龄 74.2 岁，范围 65-93 岁，61%为女性）。法兰西岛的 CVT 年发病率为每 100 万老年人 5.9-7.1 例，而全国为每 100 万 8.5 例。头痛和局灶性缺损是最常见的初始临床特征（分别为 50%和 51%），其次是癫痫发作和意识障碍（分别为 40%和 27%）。治疗包括抗凝（93%），很少采用血管内治疗（2%）或开颅手术（1%）。与年龄小于 65 岁的成年患者（年轻成年人）相比，老年患者头痛（50% vs. 96%，p<0.01）和颅内压升高（7% vs. 22%，p<0.01）的发生率较低，但癫痫发作和局灶性缺损的发生率较高（40% vs. 27%和 51% vs. 38%，均 p<0.01）。与年轻成年人相比，老年患者的基础癌症、血液病和局部感染更为常见（p<0.01）。本研究中老年患者的预后比年轻成年人差；急性期死亡 8%，1 年时预后良好者 73%（分别为 1.7%和 87%，p<0.01）。
结论
老年患者的 CVT 具有特定的临床表现、流行病学和危险因素，如癌症或血液病，需要进行专门的管理。
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