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Cerebral Venous Thrombosis: an Update

  • José M. FerroEmail author
  • Diana Aguiar de Sousa
Stroke (H.C. Diener, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke

Abstract

Purpose of Review

The purpose of this update is to summarize the recent advances on the management of cerebral venous thrombosis (CVT).

Recent Findings

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.

Summary

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.

Keywords

Cerebral venous thrombosis Dural sinus thrombosis Cerebral vein CT venography MR venography MRI Prognosis Anticoagulants Dabigatran Seizures Intracranial hypertension Decompressive surgery Hemicraniectomy Thrombolysis Thrombectomy Pregnancy 

Notes

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Ageno W, Beyer-Westendorf J, Garcia D, Lazo-Langner A, McBane R, Paciaroni M. Guidance for the management of venous thrombosis in unusual sites. J Thromb Thrombolysis. 2016;41(2016):129–43.CrossRefGoogle Scholar
  2. 2.
    Ferro JM, Canhão P, Aguiar de Sousa D. Cerebral venous thrombosis. Presse Med. 2016;45(12 Pt 2):e429–50.  https://doi.org/10.1016/j.lpm.2016.10.007.CrossRefPubMedGoogle Scholar
  3. 3.
    Silvis SM, de Sousa DA, Ferro JM, Coutinho JM. Cerebral venous thrombosis. Nat Rev Neurol. 2017;13(9):555–65.  https://doi.org/10.1038/nrneurol.2017.104.CrossRefPubMedGoogle Scholar
  4. 4.
    Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012;43(12):3375–7.  https://doi.org/10.1161/STROKEAHA.112.671453.CrossRefGoogle Scholar
  5. 5.
    Devasagayam S, Wyatt B, Leyden J, Kleinig T. Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke. 2016;47(9):2180–2.  https://doi.org/10.1161/STROKEAHA.116.013617.CrossRefGoogle Scholar
  6. 6.
    Coutinho JM, Zuurbier SM, Stam J. Declining mortality in cerebral venous thrombosis: a systematic review. Stroke. 2014;45(2014):1338–41.CrossRefGoogle Scholar
  7. 7.
    Zuurbier SM, Middeldorp S, Stam J, Coutinho JM. Sex differences in cerebral venous thrombosis: a systematic analysis of a shift over time. Int J Stroke. 2016;11(2):164–70.  https://doi.org/10.1177/1747493015620708.CrossRefPubMedGoogle Scholar
  8. 8.
    Zuurbier SM, Hiltunen S, Lindgren E, Silvis SM, Jood K, Devasagayam S, et al. Cerebral venous thrombosis in older patients. Stroke. 2018;49(1):197–200.  https://doi.org/10.1161/STROKEAHA.117.019483.CrossRefPubMedGoogle Scholar
  9. 9.
    •• Green M, Styles T, Russell T, Sada C, Jallow E, Stewart J, et al. Non-genetic and genetic risk factors for adult cerebral venous thrombosis. Thromb Res. 2018;169:15–22.  https://doi.org/10.1016/j.thromres.2018.07.005 A systematic review and odds ratio for some non-genetic and genetic risk factors for adult CVT. CrossRefPubMedGoogle Scholar
  10. 10.
    • Silvis SM, Lindgren E, Hiltunen S, Devasagayam S, Scheres LJ, Jood K, et al. Postpartum period is a risk factor for cerebral venous thrombosis. Stroke. 2019;50(2):501–3.  https://doi.org/10.1161/STROKEAHA.118.023017 A case-control study concluding that the risk of CVT is higher during the first 6 weeks postpartum. CrossRefPubMedGoogle Scholar
  11. 11.
    Zuurbier SM, Arnold M, Middeldorp S, Broeg-Morvay A, Silvis SM, Heldner MR, et al. Risk of cerebral venous thrombosis in obese women. JAMA Neurol. 2016;73(2016):579–84.CrossRefGoogle Scholar
  12. 12.
    • Silvis SM, Hiltunen S, Lindgren E, Jood K, Zuurbier SM, Middeldorp S, et al. Cancer and risk of cerebral venous thrombosis: a case-control study. J Thromb Haemost. 2018;16(1):90–5.  https://doi.org/10.1111/jth.13903 A case-control study confirming that cancer is a risk factor for CVT. CrossRefPubMedGoogle Scholar
  13. 13.
    Ranta S, Tuckuviene R, Mäkipernaa A, Albertsen BK, Frisk T, Tedgård U, et al. Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology. Br J Haematol. 2015 Feb;168(4):547–52.  https://doi.org/10.1111/bjh.13162.CrossRefPubMedGoogle Scholar
  14. 14.
    Ghanem KM, Dhayni RM, Al-Aridi C, Tarek N, Tamim H, Chan AKC, et al. Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: risk factors and management. Pediatr Blood Cancer. 2017;64(12).  https://doi.org/10.1002/pbc.26694.CrossRefGoogle Scholar
  15. 15.
    Zuurbier SM, Lauw MN, Coutinho JM, Majoie CB, van der Holt B, Cornelissen JJ, et al. Clinical course of cerebral venous thrombosis in adult acute lymphoblastic leukemia. J Stroke Cerebrovasc Dis. 2015;24(7):1679–84.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.041.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee KR, Subrayan V, Win MM, Fadhilah Mohamad N, Patel D. ATRA-induced cerebral sinus thrombosis. J Thromb Thrombolysis. 2014 Jul;38(1):87–9.  https://doi.org/10.1007/s11239-013-0988-7.CrossRefPubMedGoogle Scholar
  17. 17.
    Coutinho JM, Zuurbier SM, Gaartman AE, Dikstaal AA, Stam J, Middeldorp S, et al. Association between anemia and cerebral venous thrombosis: case-control study. Stroke. 2015;46(10):2735–40.  https://doi.org/10.1161/STROKEAHA.115.009843.CrossRefPubMedGoogle Scholar
  18. 18.
    Vecht L, Zuurbier SM, Meijers JCM, Coutinho JM. Elevated factor VIII increases the risk of cerebral venous thrombosis: a case-control study. J Neurol. 2018;265(7):1612–7.  https://doi.org/10.1007/s00415-018-8887-7.CrossRefPubMedGoogle Scholar
  19. 19.
    Uluduz D, Midi I, Duman T, Colakoglu S, Tüfekci A, Bakar M, et al. Behçet’s disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study. Rheumatology (Oxford). 2019;58(4):600–8.  https://doi.org/10.1093/rheumatology/key153.CrossRefGoogle Scholar
  20. 20.
    Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664–70.CrossRefGoogle Scholar
  21. 21.
    • Duman T, Uluduz D, Midi I, Bektas H, Kablan Y, Goksel BK, et al. A multicenter study of 1144 patients with cerebral venous thrombosis: the VENOST study. J Stroke Cerebrovasc Dis. 2017;26(8):1848–57.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.04.020 The largest published CVT series. The study is however retrospective. CrossRefPubMedGoogle Scholar
  22. 22.
    Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F, ISCVT Investigators. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke. 2005;36(9):1927–32.CrossRefGoogle Scholar
  23. 23.
    Coutinho JM, Gerritsma JJ, Zuurbier SM, Stam J. Isolated cortical vein thrombosis: systematic review of case reports and case series. Stroke. 2014;45(6):1836–8.  https://doi.org/10.1161/STROKEAHA.113.004414.CrossRefPubMedGoogle Scholar
  24. 24.
    Panda S, Prashantha DK, Shankar SR, Nagaraja D. Localized convexity subarachnoid haemorrhage--a sign of early cerebral venous sinus thrombosis. Eur J Neurol. 2010;17:1249–58.CrossRefGoogle Scholar
  25. 25.
    Geraldes R, Sousa PR, Fonseca AC, Falcao F, Canhao P, Pinho e Melo T. Nontraumatic convexity subarachnoid hemorrhage: different etiologies and outcomes. J Stroke Cerebrovasc Dis. 2014;23(1):e23–30.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.08.005.CrossRefPubMedGoogle Scholar
  26. 26.
    Fu FW, Rao J, Zheng YY, Song L, Chen W, Zhou QH, et al. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis: a case report and review of literature. Medicine (Baltimore). 2017;96(33):e7374.  https://doi.org/10.1097/MD.0000000000007374.CrossRefGoogle Scholar
  27. 27.
    Azeemuddin M, Awais M, Mubarak F, Rehman A, Baloch NU. Prevalence of subarachnoid haemorrhage among patients with cranial venous sinus thrombosis in the presence and absence of venous infarcts. Neuroradiol J. 2018;31(5):496–503.  https://doi.org/10.1177/1971400918783060.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Leavell Y, Khalid M, Tuhrim S, Dhamoon MS. Baseline characteristics and readmissions after cerebral venous sinus thrombosis in a nationally representative database. Cerebrovasc Dis. 2018;46(5–6):249–56.  https://doi.org/10.1159/000495420.CrossRefPubMedGoogle Scholar
  29. 29.
    Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F, ISCVT Investigators. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke. 2008;39(4):1152–8.  https://doi.org/10.1161/STROKEAHA.107.487363.CrossRefPubMedGoogle Scholar
  30. 30.
    Masuhr F, Busch M, Amberger N, Ortwein H, Weih M, Neumann K, et al. Risk and predictors of early epileptic seizures in acute cerebral venous and sinus thrombosis. Eur J Neurol. 2006;13(2006):852–6.CrossRefGoogle Scholar
  31. 31.
    Mahale R, Mehta A, John AA, Buddaraju K, Shankar AK, Javali M, et al. Acute seizures in cerebral venous sinus thrombosis: what predicts it? Epilepsy Res. 2016;123(2016):1–5.CrossRefGoogle Scholar
  32. 32.
    Ding H, Xie Y, Li L, Chu H, Tang Y, Dong Q, et al. Clinical features of seizures after cerebral venous sinus thrombosis and its effect on outcome among Chinese Han population. Stroke Vasc Neurol. 2017;2(4):184–8.  https://doi.org/10.1136/svn-2017-000095 eCollection.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    • Kalita J, Misra UK, Singh VK, Dubey D. Predictors and outcome of status epilepticus in cerebral venous thrombosis. J Neurol. 2019;266(2):417–25.  https://doi.org/10.1007/s00415-018-9145-8 A large case series comparing CVT patients without and with seizures, including 18% with status epilepticus. CrossRefPubMedGoogle Scholar
  34. 34.
    Kowoll CM, Kaminski J, Weiss V, Bosel J, Dietrich W, Juttler E, et al. Severe cerebral venous and sinus thrombosis: clinical course, imaging correlates, and prognosis. Neurocrit Care. 2016;25(3):392–9.CrossRefGoogle Scholar
  35. 35.
    Soyer B, Rusca M, Lukaszewicz AC, Crassard I, Guichard JP, Bresson D, et al. Outcome of a cohort of severe cerebral venous thrombosis in intensive care. Ann Intensive Care. 2016;6(1):29.  https://doi.org/10.1186/s13613-016-0135-7 Erratum in: Ann Intensive Care.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ferro JM, Bacelar-Nicolau H, Rodrigues T, Bacelar-Nicolau L, Canhão P, Crassard I, et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2009;28(1):39–44.  https://doi.org/10.1159/000215942.CrossRefPubMedGoogle Scholar
  37. 37.
    Barboza MA, Chiquete E, Arauz A, Merlos-Benitez M, Quiroz-Compeán A, Barinagarrementería F, et al. A practical score for prediction of outcome after cerebral venous thrombosis. Front Neurol. 2018;9:882.  https://doi.org/10.3389/fneur.2018.00882 eCollection 2018.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    • Liberman AL, Gialdini G, Bakradze E, Chatterjee A, Kamel H, Merkler AE. Misdiagnosis of cerebral vein thrombosis in the emergency department. Stroke. 2018;49(6):1504–6.  https://doi.org/10.1161/STROKEAHA.118.021058 A study using administrative data showing that misdiagnosis of CVT occurred in 1 out of 30 patients. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    •• Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - Endorsed by the European Academy of Neurology. Eur Stroke J. 2017;2(3):195–221.  https://doi.org/10.1177/2396987317719364 A comprehensive, evidence-based guideline addressing both diagnostic and therapeutic recommendations.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Dentali F, Squizzato A, Marchesi C, Bonzini M, Ferro JM, Ageno W. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost. 2012;10(4):582–9.CrossRefGoogle Scholar
  41. 41.
    Buyck PJ, de Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel D. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am J Neuroradiol. 2013;34:1568–72.CrossRefGoogle Scholar
  42. 42.
    Rodallec MH, Krainik A, Feydy A, Hélias A, Colombani JM, Jullès MC, et al. Cerebral venous thrombosis and multidetector CT angiography: tips and tricks. Radiographics. 2006;26(Suppl 1):S5–18.CrossRefGoogle Scholar
  43. 43.
    Idbaih A, Boukobza M, Crassard I, Porcher R, Bousser MG, Chabriat H. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images. Stroke. 2006;37(4):991–5.CrossRefGoogle Scholar
  44. 44.
    Niu PP, Yu Y, Guo ZN, Jin H, Liu Y, Zhou HW, et al. Diagnosis of non-acute cerebral venous thrombosis with 3D T1-weighted black blood sequence at 3T. J Neurol Sci. 2016;367:46–50.CrossRefGoogle Scholar
  45. 45.
    Yang Q, Duan J, Fan Z, Qu X, Xie Y, Nguyen C, et al. Early detection and quantification of cerebral venous thrombosis by magnetic resonance black-blood thrombus imaging. Stroke. 2016;47(2):404–9.CrossRefGoogle Scholar
  46. 46.
    Rollins N, Ison C, Reyes T, Chia J. Cerebral MR venography in children: comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques. Radiology. 2005;235(3):1011–7.CrossRefGoogle Scholar
  47. 47.
    Conforto AB, Nader SN, Puglia Junior P, Yamamoto FI, Gonçalves MR, Vasconcelos FR, et al. Dural arteriovenous fistula and cerebral venous thrombosis. Arq Neuropsiquiatr. 2015;73:548.CrossRefGoogle Scholar
  48. 48.
    Aguiar de Sousa D, Lucas Neto L, Jung S, Penas S, Panos L, Heldner MR, et al. Brush sign is associated with increased severity in cerebral venous thrombosis. Stroke. 2019;50(6):1574–7.CrossRefGoogle Scholar
  49. 49.
    Qureshi A, Perera A. Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: a systematic review and meta-analysis. Ann Med Surg (Lond). 2017;17:22–6.CrossRefGoogle Scholar
  50. 50.
    Hersh DS, Shimony N, Groves ML, Tuite GF, Jallo GI, Liu A, et al. Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma. J Neurosurg Pediatr. 2018;21(3):258–69.  https://doi.org/10.3171/2017.9.PEDS17311.CrossRefPubMedGoogle Scholar
  51. 51.
    Zuurbier SM, Coutinho JM, Stam J, Canhão P, Barinagarrementeria F, Bousser MG, et al. Clinical outcome of anticoagulant treatment in head or neck infection-associated cerebral venous thrombosis. Stroke. 2016;47(5):1271–7.  https://doi.org/10.1161/STROKEAHA.115.011875.CrossRefPubMedGoogle Scholar
  52. 52.
    Aguiar de Sousa D, Ferro J, Canhao P, Barinagarrementeria F, Bousser M, Stam J, et al. Cerebral venous thrombosis causing posterior fossa lesions: description of a case series and assessment of safety of anticoagulation. Cerebrovasc Dis. 2014;38(2014):384–8.CrossRefGoogle Scholar
  53. 53.
    • Goedemans T, Verbaan D, Coert BA, Kerklaan BJ, van den Berg R, Coutinho JM, et al. Neurologic outcome after decompressive craniectomy: predictors of outcome in different pathologic conditions. World Neurosurg. 2017;105:765–74 A comparison of the outcome after decompressive craniectomy in several neurological diseases, showing that those with CVT had the better outcomes. CrossRefGoogle Scholar
  54. 54.
    Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(2011):1158–92.CrossRefGoogle Scholar
  55. 55.
    Lee SK, Mokin M, Hetts SW, Fifi JT, Bousser MG, Fraser JF, et al. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg. 2018;10(8):803–10.CrossRefGoogle Scholar
  56. 56.
    Siddiqui FM, Dandapat S, Banerjee C, Zuurbier SM, Johnson M, Stam J, et al. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke. 2015;46:1263–8.CrossRefGoogle Scholar
  57. 57.
    Coutinho JM, Ferro JM, Zuurbier SM, Mink MS, Canhão P, Crassard I, et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int J Stroke. 2013 Feb;8(2):135–40.  https://doi.org/10.1111/j.1747-4949.2011.00753.x.CrossRefPubMedGoogle Scholar
  58. 58.
    • Siddiqui FM, Weber MW, Dandapat S, Scaife S, Buhnerkempe M, Ortega-Gutierrez S, et al. Endovascular thrombolysis or thrombectomy for cerebral venous thrombosis: study of Nationwide Inpatient Sample 2004–2014. J Stroke Cerebrovasc Dis. 2019;28(6):1440–7 This study based on an administrative database showed that endovascular treatment was associated with worse outcomes. CrossRefGoogle Scholar
  59. 59.
    Ferro JM, Dentali F, Coutinho JM, Kobayashi A, Caria J, Desch M, et al. Rationale, design, and protocol of a randomized controlled trial of the safety and efficacy of dabigatran etexilate versus dose-adjusted warfarin in patients with cerebral venous thrombosis. Int J Stroke. 2018;13(7):766–70.  https://doi.org/10.1177/1747493018778125.CrossRefPubMedGoogle Scholar
  60. 60.
    Nasr DM, Brinjikji W, Cloft HJ, Saposnik G, Rabinstein AA. Mortality in cerebral venous thrombosis: results from the national inpatient sample database. Cerebrovasc Dis. 2013;35(1):40–4.  https://doi.org/10.1159/000343653.CrossRefPubMedGoogle Scholar
  61. 61.
    Liberman AL, Merkler AE, Gialdini G, Messé SR, Lerario MP, Murthy SB, et al. Risk of pulmonary embolism after cerebral venous thrombosis. Stroke. 2017;48(3):563–7.CrossRefGoogle Scholar
  62. 62.
    Lindgren E, Jood K, Tatlisumak T. Vocational outcome in cerebral venous thrombosis: long-term follow-up study. Acta Neurol Scand. 2018;137(3):299–307.CrossRefGoogle Scholar
  63. 63.
    Koban Y, Ozlece H, Karayol S, Huseyinoglu N. Decreased retinal nerve fiber layer thickness in patients with cerebral venous thrombosis. BMC Ophthalmol. 2019;19(1):57.CrossRefGoogle Scholar
  64. 64.
    Lim HY, Ng C, Donnan G, Nandurkar H, Ho P. Ten years of cerebral venous thrombosis: male gender and myeloproliferative neoplasm is associated with thrombotic recurrence in unprovoked events. Thromb Thrombolysis. 2016;42(3):423–31.CrossRefGoogle Scholar
  65. 65.
    Martinelli I, De Stefano V, Carobbio A, Randi ML, Santarossa C, Rambaldi A, et al. Cerebral vein thrombosis in patients with Philadelphia-negative myeloproliferative neoplasms. An European Leukemia Net study. Am J Hematol. 2014;89(11):E200–5.CrossRefGoogle Scholar
  66. 66.
    • Pires GS, Ribeiro DD, JAQ O, Freitas LC, Vaez R, Annichino-Bizzacchi JM, et al. Risk factors associated with recurrent venous thromboembolism after a first cerebral venous thrombosis event: a cohort study. Thromb Res. 2019;178:85–90 A cohort study for Brazil reporting a lower risk of recurrent venous thromboembolism than previous investigations. CrossRefGoogle Scholar
  67. 67.
    •• Aguiar de Sousa D, Lucas Neto L, Canhão P, Ferro JM. Recanalization in cerebral venous thrombosis. Stroke. 2018;49(8):1828–35 A systematic review of recanalization after CVT, showing that recanalization occurs in up to 85% of the patients and is associated with better outcome. CrossRefGoogle Scholar
  68. 68.
    Kenet G, Kirkham F, Niederstadt T, Heinecke A, Saunders D, Stoll M, ; European Thromboses Study Group et al. Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study. Lancet Neurol 2007;6:595–603. doi:  https://doi.org/10.1016/S1474-4422(07)70131-X.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    • Kashkoush AI, Ma H, Agarwal N, Panczykowski D, Tonetti D, Weiner GM, et al. Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review. J Clin Neurosci. 2017;39:9–15 This systematic review confirms that CVT during pregnancy has usually a very good prognosis. CrossRefGoogle Scholar
  70. 70.
    •• Aguiar de Sousa D, Canhão P, Crassard I, Coutinho J, Arauz A, Conforto A, et al. Safety of pregnancy after cerebral venous thrombosis: results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 PREGNANCY Study. Stroke. 2017;48(11):3130–3.  https://doi.org/10.1161/STROKEAHA.117.018829 A 14-year follow-up study of women in fertile age from the ISCVT cohort, showing that recurrent venous thrombotic events were infrequent in subsequent pregnancies. CrossRefPubMedGoogle Scholar
  71. 71.
    Martinelli I, Passamonti SM, Maino A, Abbattista M, Bucciarelli P, Somigliana E, et al. Pregnancy outcome after a first episode of cerebral vein thrombosis. J Thromb Haemost. 2016;14(12):2386–93.CrossRefGoogle Scholar
  72. 72.
    Aguiar de Sousa D, Canhão P, Ferro JM. Safety of pregnancy after cerebral venous hrombosis: a systematic review. Stroke. 2016;47(3):713–8.CrossRefGoogle Scholar
  73. 73.
    • Aguiar de Sousa D, Canhão P, Ferro JM. Safety of pregnancy after cerebral venous thrombosis: systematic review update. J Neurol. 2018;265(1):211–2.  https://doi.org/10.1007/s00415-017-8666-x This systematic review confirmed that the risk of recurrent cerebral venous thrombosis and other venous thromboembolism is low during subsequent pregnancies. CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Serviço de Neurologia, Department of Neurosciences and Mental Health, Centro Hospitalar Lisboa Norte, Instituto de Medicina MolecularLisbonPortugal
  2. 2.Faculdade de MedicinaUniversidade de LisboaLisbonPortugal

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