Cerebral Venous Thrombosis: an Update
Purpose of Review
The purpose of this update is to summarize the recent advances on the management of cerebral venous thrombosis (CVT).
There is a trend in declining frequency of CVT patients presenting with focal deficits or coma and a decrease in mortality over time. Anemia and obesity were identified as risk factors for CVT. During pregnancy and puerperium, the higher risk of CVT occurs in the first months post-delivery. With appropriate management, 1/3 of comatose CVT patients can have a full recovery.
The management of CVT patients includes treatment of associated conditions, anticoagulation with parenteral heparin, prevention of recurrent seizures, and decompressive neurosurgery in patients with large venous infarcts/hemorrhages with impending herniation. After the acute phase, patients should be anticoagulated for 3–12 months. Results of recently completed randomized controlled trials on endovascular treatment and comparing dabigatran with warfarin will improve the treatment of CVT.
KeywordsCerebral venous thrombosis Dural sinus thrombosis Cerebral vein CT venography MR venography MRI Prognosis Anticoagulants Dabigatran Seizures Intracranial hypertension Decompressive surgery Hemicraniectomy Thrombolysis Thrombectomy Pregnancy
Compliance with Ethical Standards
Conflict of Interest
José M. Ferro reports personal fees from Boehringer Ingelheim (principal investigator RE-SPECT CVT trial) during the conduct of the study. Dr. Ferro also reports grants from Boehringer Ingelheim, outside the submitted work, and grants and personal fees from Bayer, outside the submitted work. Diana Aguiar de Sousa declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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