脑静脉窦血栓形成合并癫痫发作的临床分析

Clinical analysis of seizures in cerebral venous sinus thrombosis

目的分析脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)合并癫痫发作的临床表现和危险因素,探讨不同治疗方式对CVST合并癫痫发作预后的影响。方法56例CVST患者,根据是否合并癫痫发作分为合并癫痫组21例和未合并癫痫组35例,比较2组患者临床资料,采用多因素logistic回归分析CVST合并癫痫发作的危险因素,采用改良Rankin量表评价2组预后情况。结果合并癫痫组意识障碍、运动障碍和语言障碍发生率(42.9%、66.7%、33.3%)和入院时重症、颅内出血、血栓形成于上矢状窦、累及单个静脉窦比率(57.1%、90.5%、66.7%、33.3%)均高于未合并癫痫组(17.1%、17.1%、8.6%和11.4%、25.7%、34.3%、11.4%)(P<0.05),年龄[(35.8±12.3)岁]小于未合并癫痫组[(43.8±15.1)岁](P<0.05),头痛、头晕、发热、视力障碍发生率及性别比例、病史、病因与未合并癫痫组比较差异无统计学意义(P>0.05)。颅内出血为CVST合并癫痫发作的独立危险因素(OR=16.469,95%CI:2.192~124.096,P=0.006)。合并癫痫组患者病死率(9.5%)高于未合并癫痫组(5.7%),但差异无统计学意义(P>0.05);合并癫痫组患者行介入治疗预后良好率(90.0%)高于未合并癫痫组(28.6%)(P<0.05);合并癫痫组接受单纯抗凝治疗预后良好率(44.4%)低于未合并癫痫组(80.8%),但差异无统计学意义(P>0.05)。结论对颅内出血患者及时进行干预可降低CVST患者癫痫的发生率,对合并癫痫的CVST患者行介入治疗可明显改善其预后。

Objective To analyze the clinical manifestations and risk factors of seizures in cerebral venous sinus thrombosis and investigate the effect of different treatments on the prognosis of cerebral venous sinus thrombosis with seizures.Methods Fifty-six patients with CVST were divided into CVST+seizures group(n=21)and CVST group(n=35).The clinical data were compared between two groups.The risk factors for CVST complicated with seizures were analyzed by multivariate logistic regression,and the prognosis was evaluated by the modified Rankin scale in two groups.Results CVST+seizures group had higher incidences of consciousness disorders,movement disorders and language disorders(42.9%,66.7%,33.3%),and higher percentages of severe illness,intracranial hemorrhage and thrombosis in the superior sagittal sinus,and involving a single venous sinus at admission(57.1%,90.5%,66.7%,33.3%)than CVST group(17.1%,17.1%,8.6%,11.4%,25.7%,34.3%,11.4%)(P<0.05).The patients were younger in CVST+seizures group((35.8±12.3)years)than in CVST group((43.8±15.1)years)(P<0.05).There were no significant differences in the incidences of headache,dizziness,fever and visual impairment,sex ratio,medical history and etiology between two groups(P>0.05).Intracranial hemorrhage was an independent risk factor for CVST+seizures(OR=16.469,95%CI:2.192-124.096,P=0.006).The case fatality rate was higher in CVST+seizures group(9.5%)than that in CVST group(5.7%),but the difference was not statistically significant(P>0.05).The interventional therapy achieved a better prognosis rate in CVST+seizures group(90.0%)than that in CVST group(28.6%)(P<0.05).The anticoagulant treatment achieved a poorer prognosis rate in CVST+seizures group(44.4%)than in CVST group(80.8%),but the difference was not statistically significant(P>0.05).Conclusion Timely intervention for cerebral hemorrhage can reduce the incidence of seizures in patients with CVST,and interventional therapy can improve the prognosis of the patients with CVST and seizures.