Neurocritical Care

, Volume 12, Issue 1, pp 98–102

Sequential Escalation of Therapy in “Malignant” Cerebral Venous and Sinus Thrombosis

  • Christian Dohmen
  • Norbert Galldiks
  • Walter Moeller-Hartmann
  • Gereon R. Fink
  • Lars Timmermann
Practical Pearl

Abstract

Background

The best treatment of fulminant or progressive cerebral venous and sinus thrombosis (CVST) despite dose-adjusted heparin remains controversial. Local thrombolysis has been successfully performed in several cases. In cases of impending herniation hemicraniectomy has been suggested as ultima ratio. We describe sequential escalation of therapy in “malignant” CVST.

Methods

Case report.

Results

We report a case of fulminant CVST in whom sequential escalation of therapy with intravenous heparin, local thrombolysis, and hemicraniectomy was necessitated by the progressive clinical course. The patient survived with a relatively good outcome.

Conclusions

This first description on the combined treatment with local thrombolysis and hemicraniectomy illustrates that even in severely affected individuals, therapeutic nihilism is unwarranted and that all available therapeutic options including local thrombolysis and hemicraniectomy should be taken into consideration.

Keywords

Cerebral venous thrombosis Cerebral sinus thrombosis Cerebral venous and sinus thrombosis Therapy Stroke Brain edema Intracerebral hemorrhage Thrombolysis Hemicraniectomy 

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Christian Dohmen
    • 1
    • 2
  • Norbert Galldiks
    • 1
  • Walter Moeller-Hartmann
    • 3
  • Gereon R. Fink
    • 1
    • 4
  • Lars Timmermann
    • 1
  1. 1.Department of NeurologyUniversity Hospital of CologneCologneGermany
  2. 2.Max-Planck-Institut for neurological ResearchCologneGermany
  3. 3.Department of RadiologyUniversity of CologneCologneGermany
  4. 4.Cognitive Neurology Section, Institute of Neuroscience and Medicine (INM-3), Research Centre JülichJülichGermany

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