Skip to main content
SpringerLink
Log in

Sinusthrombose und idiopathische intrazerebrale Hypertonie

Thrombophilie und Hormoneinfluss als potenziell kausal relevante Gemeinsamkeiten

Sinus thrombosis and idiopathic intracerebral hypertension

Thrombophilia and hormonal influence as potentially relevant causal connections

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Sinusthrombose und die idiopathische intrazerebrale Hypertension (IIH) können zu Sehstörungen führen, weswegen die Verdachtsdiagnose bei Vorliegen von Sehstörungen initial häufig durch den Augenarzt gestellt wird.

Ziel/Fragestellung

Die vorliegende Arbeit setzt sich zum Ziel, Gemeinsamkeiten der beiden Grunderkrankungen aufzudecken und auf dieser Basis dem Augenarzt konkrete Maßnahmen zur differenzialdiagnostischen Untersuchung und zum Management betroffener Patienten an die Hand zu geben.

Material und Methode

Die beiden Profile der Grunderkrankungen werden zunächst ausführlich einzeln vorgestellt, um im Folgenden einen Vergleich zu ermöglichen, bei dem die Gemeinsamkeiten bezüglich der Risikofaktoren hervorgehoben werden.

Ergebnisse

Aus den Einzelbetrachtungen der Grunderkrankungen ergibt sich eine gemeinsame Schnittmenge an Risikofaktoren: 1) Frauen vor der Menopause, 2) Einnahme weiblicher Hormone, 3) Thrombophilie.

Diskussion

Auf der Grundlage dieser Ähnlichkeiten liegt die Vermutung zumindest partiell gemeinsamer pathophysiologischer Mechanismen nahe. Insbesondere könnten unerkannte zerebrale Thrombosen bzw. Mikrothrombosen eine Ursache der IIH darstellen. Ein solcher Mechanismus könnte die typische thrombophile Risikokonstellation der IIH in Analogie zur Sinusthrombose erklären (einschließlich der bekannten Interaktion von Östrogenen und thrombophilen Risikofaktoren).

Abstract

Background

Cerebral venous sinus thrombosis and idiopathic intracerebral hypertension (IIH) can lead to impaired vision, which is why the suspected diagnosis is often initially made by an ophthalmologist.

Problem and aims

This study aimed at discovering common features between the two underlying conditions and provide ophthalmologists with concrete measures for differential diagnosis and for the management of affected patients based on these similarities.

Material and methods

This article presents detailed profiles of the underlying conditions and compares the two, focusing on similarities with respect to risk factors.

Results

The following common risk factor profiles of the two underlying conditions could be determined: (1) women before menopause, (2) administration of female hormones and (3) thrombophilia.

Discussion

Based on these findings at least a partial overlap of both pathophysiologies is suspected. In particular, undiagnosed cerebral thrombosis or microthrombosis can cause IIH. This mechanism could explain the typical thrombophilic risk profile of IIH, which is analogous to that of cerebral venous sinus thrombosis, including the well-established interaction of estrogens and thrombophilic risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Ahmed RM, Wilkinson M, Parker GD et al (2011) Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol 32:1408–1414

    Article  CAS  PubMed  Google Scholar 

  2. Biousse V, Bruce BB, Newman NJ (2012) Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry 83:488–494

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bousser MG, Ferro JM (2007) Cerebral venous thrombosis: an update. Lancet Neurology 6:162–170

    Article  CAS  PubMed  Google Scholar 

  4. Canhao P, Falcao F, Ferro JM (2003) Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovasc Dis 15:159–166

    Article  CAS  PubMed  Google Scholar 

  5. Coutinho JM, Zuurbier SM, Aramideh M et al (2012) The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke 43:3375–3377

    Article  PubMed  Google Scholar 

  6. de Bruijn SF, Stam J (1999) Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 30:484–488

    Article  PubMed  Google Scholar 

  7. De Simone R, Ranieri A, Montella S et al (2014) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 82:1011–1012

    Article  PubMed  Google Scholar 

  8. Dentali F, Gianni M, Crowther MA et al (2006) Natural history of cerebral vein thrombosis: a systematic review. Blood 108:1129–1134

    Article  CAS  PubMed  Google Scholar 

  9. Dentali F, Squizzato A, Gianni M et al (2010) Safety of thrombolysis in cerebral venous thrombosis. A systematic review of the literature. Thromb Haemost 104:1055–1062

    Article  CAS  PubMed  Google Scholar 

  10. Einhaupl KM, Villringer A, Meister W et al (1991) Heparin treatment in sinus venous thrombosis. Lancet 338:597–600

    Article  CAS  PubMed  Google Scholar 

  11. Ferro JM, Crassard I, Coutinho JM et al (2011) Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 42:2825–2831

    Article  PubMed  Google Scholar 

  12. Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81:1159–1165

    Article  PubMed  Google Scholar 

  13. Kesler A, Kliper E, Assayag EB et al (2010) Thrombophilic factors in idiopathic intracranial hypertension: a report of 51 patients and a meta-analysis. Blood Coagul Fibrinolysis 21:328–333

    Article  CAS  PubMed  Google Scholar 

  14. Khandelwal N, Agarwal A, Kochhar R et al (2006) Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol 187:1637–1643

    Article  CAS  PubMed  Google Scholar 

  15. Lauw MN, Barco S, Coutinho JM et al (2013) Cerebral venous thrombosis and thrombophilia: a systematic review and meta-analysis. Semin Thromb Hemost 39:913–927

    Article  CAS  PubMed  Google Scholar 

  16. Linn J, Ertl-Wagner B, Seelos KC et al (2007) Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses. AJNR Am J Neuroradiol 28:946–952

    CAS  PubMed  Google Scholar 

  17. Martinelli I, Bucciarelli P, Passamonti SM et al (2010) Long-term evaluation of the risk of recurrence after cerebral sinus-venous thrombosis. Circulation 121:2740–2746

    Article  PubMed  Google Scholar 

  18. Martinelli I, De S, V (2012) Extra-abdominal venous thromboses at unusual sites. Best Pract Res Clin Haematol 25:265–274

    Article  PubMed  Google Scholar 

  19. Martinelli I, Franchini M, Mannucci PM (2008) How I treat rare venous thromboses. Blood 112:4818–4823

    Article  CAS  PubMed  Google Scholar 

  20. Miranda B, Ferro JM, Canhao P et al (2010) Venous thromboembolic events after cerebral vein thrombosis. Stroke 41:1901–1906

    Article  PubMed  Google Scholar 

  21. Mollan SP, Markey KA, Benzimra JD et al (2014) A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension. Pract Neurol 14:380–390

    Article  PubMed Central  PubMed  Google Scholar 

  22. Piazza G (2012) Cerebral venous thrombosis. Circulation 125:1704–1709

    Article  PubMed  Google Scholar 

  23. Puffer RC, Mustafa W, Lanzino G (2013) Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature. J Neurointerv Surg 5:483–486

    Article  PubMed  Google Scholar 

  24. Saposnik G, Barinagarrementeria F, Brown RD Jr et al (2011) Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American heart association/American stroke association. Stroke 42:1158–1192

    Article  PubMed  Google Scholar 

  25. Stam J, de Bruijn SF, deVeber G (2002) Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev CD002005

  26. Wüllner U (2012) S1-Leitlinie: Idiopathische intrakranielle Hypertension. In: Diener H-C, Weimar C (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie, Herausgegeben von der Kommission „Leitlinien“ der Deutschen Gesellschaft für Neurologie. Thieme Verlag, Stuttgart

Download references

Author information

Authors and Affiliations

  1. Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Immermannstr. 65a, 40210, Düsseldorf, Deutschland

    Rainer B. Zotz

Authors
  1. Rainer B. Zotz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rainer B. Zotz.

Ethics declarations

Interessenkonflikt

R.B. Zotz gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zotz, R. Sinusthrombose und idiopathische intrazerebrale Hypertonie. Ophthalmologe 112, 828–833 (2015). https://doi.org/10.1007/s00347-015-0061-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-015-0061-3

Schlüsselwörter

Keywords

Search

Navigation