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Thrombose veineuse cérébrale

Cerebral venous thrombosis

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Réanimation

Résumé

La thrombose veineuse cérébrale est une pathologie rare. Le diagnostic doit être porté d’urgence malgré une symptomatologie neurologique très polymorphe, dominée initialement par les céphalées. Il repose sur la mise en évidence d’une occlusion veineuse et doit être affirmé avec certitude, ce qui nécessite parfois de répéter l’imagerie (imagerie par résonance magnétique, couplée à l’angiorésonance magnétique, angiotomodensitométrie voire artériographie cérébrale). Compte tenu de la diversité des causes et facteurs favorisants, un large bilan est souvent nécessaire. Le traitement repose sur l’anticoagulation efficace même en présence de lésions hémorragiques. L’évolution est imprévisible avec, à la phase aiguë, un risque non négligeable d’aggravation. Le pronostic vital et fonctionnel est nettement meilleur qu’au cours de l’ischémie artérielle. La prise en charge en réanimation est nécessaire en cas de troubles de la vigilance ou en présence de volumineuses lésions avec risque d’engagement cérébral. Des mesures de traitement agressives de l’oedème cérébral doivent rapidement être instaurées dans ces formes graves. Ainsi la craniectomie de décompression a montré une efficacité sur la survie des patients et l’amélioration fonctionnelle.

Abstract

Cerebral venous thrombosis (CVT) is a rare disease, requiring urgent diagnosis and treatment. Clinical presentation is highly variable but headache result in the most frequent presentation (90%). Diagnosis is based on magnetic resonance imaging which shows the thrombus and parenchymal lesions, completed by angiography, magnetic resonance angiography and/or CT angiography. A large spectrum of general and local causes or predisposing factors should be investigated. Treatment is based on full anticoagulation even in the hemorrhagic varieties. Prognosis is better in comparison to arterial stroke (death rate: around 5%). Some severe or even malignant cases need to be identified in order to prevent further complications like cerebral herniation leading to death. In these cases, management in the intensive care unit is indicated and decompressive craniectomy may be lifesaving, allowing a good final functional recovery.

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Authors and Affiliations

  1. Service de neurologie, hôpital Lariboisière, 2 rue Ambroise Paré, F-75475, Paris cedex 10, France

    P. Reiner & I. Crassard

  2. Département d’anesthésie réanimation, hôpital Lariboisière, 2 rue Ambroise Paré, F-75475, Paris cedex 10, France

    A. -C. Lukaszewicz

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  1. P. Reiner
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  2. I. Crassard
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  3. A. -C. Lukaszewicz
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Correspondence to P. Reiner.

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Reiner, P., Crassard, I. & Lukaszewicz, A.C. Thrombose veineuse cérébrale. Réanimation 22, 624–633 (2013). https://doi.org/10.1007/s13546-013-0726-3

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