Analysis on risk factors and prognosis of cerebral venous sinus thrombosis with early-onset seizures
Objective To analyze the risk factors and the prognosis in patients with cerebral venous sinus thrombosis(CVST)accompanied by early-onset seizures.Methods A retrospective study was conducted on 163 patients with CVST admitted to the Department of Neurology and Neurosurgery of Shengjing Hospital of China Medical University during August 2011 to November 2022 as the study subjects.Based on whether they had concurrent seizures within 14 days after diagnosis CVST,the patients were divided into the early-onset seizures group(42 cases)and the non-early-onset seizure group(121 cases).Clinical data were collected,including general clinical data,imaging data,laboratory test results,and treatment plans,etc.The general clinical data involves gender,age,suspected etiology(infection[such as mastoiditis,otitis media,sinusitis,etc.],oral contraceptives/estrogen,pregnancy/puerperium,anemia and other factors that can lead to changes in blood composition,hyperhomocysteinemia),clinical manifestations(including headache,dizziness,disturbance of consciousness,nausea and vomiting,limb numbness,hemiplegia,tinnitus,aphasia,diplopia,mental abnormalities,unresponsiveness,isolated intracranial hypertension[papilledema],etc.).Imaging data includes involved venous sinus location,multiple venous sinuses(involving ≥ 2 venous sinuses)and intracranial changes(intracranial hemorrhage,venous cerebral infarction,subarachnoid hemorrhage).All patients were tested for D-dimer on the second day of admission.Patients with intracranial hypertension were examined with spinal puncture and measured cerebrospinal fluid pressure,with elevated cerebrospinal fluid pressure defined as the pressure＞180mmH2O.The patients were followed up by telephone 2 months after discharge,and the modified Rankin scale(mRS)was used to assess the prognosis of the patients(mRS score ≤2 points as good prognosis,mRS score＞2 points as poor prognosis).The mortality rate of patients was measured.The clinical data,imaging data,laboratory test results,treatment and follow-up results of the two groups were compared.The correlation variables with P＜0.05 in the univariate analysis were included in the multivariate Logistic regression model to analyze the independent risk factors of CVST accompanied by early-onset seizures.Results(1)Compared with the non-early-onset seizure group,the proportion of pregnant/puerperal females in the early-onset seizure group was higher(33.3％vs.13.2％,P=0.004),the proportion of patients with hemiplegia was higher(23.8％vs.6.6％,P=0.005),and the proportion of patients with CVST imaging combined with intracranial hemorrhage was higher(40.5％vs.13.2％,P＜0.01),with all the differences were statistically significant.There was no significant difference in other baseline clinical data between the two groups(all P＞0.05).(2)Further multivariate Logistic regression analysis showed that pregnancy/puerperium(OR,4.854,95％CI 1.917-12.290,P=0.001),hemiplegia(OR,3.871,95％CI 1.246-12.028,P=0.019)and intracranial hemorrhage(OR,5.005,95％CI 2.038-12.288,P＜0.01)were independent risk factors for CVST with early-onset seizures.(3)There were 3 patients(7.1％)in the early-onset seizure group and 6 patients(5.0％)in the non-early-onset seizure group dead,and there was no significant difference in the proportion of death between the two groups(P=0.887).The proportion of patients with good prognosis in the early-onset seizure group was lower than that in the non-early-onset epilepsy group(81.0％vs.92.6％),and the difference between the groups was statistically significant(P=0.043).Among the patients treated with anticoagulation alone,the good prognosis rate of non-early-onset seizures group(99/106,93.4％)was higher than that of the early-onset seizure group(32/40,80.0％),and the difference was statistically significant(P=0.029).Conclusions For CVST patients,especially females during pregnancy or postpartum period,clinical manifestations accompanied by hemiplegia,and with intracranial hemorrhage on imaging,the risk of seizures within 14 days of the diagnosis of CVST should be vigilant.The prognosis of CVST patients with early-onset seizures is worse than that of patients without early-onset seizures.
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