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Cerebral venous thrombosis

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Opinion statement

Because of its wide range of presentations, its highly variable mode of onset, its numerous causes, and its unpredictable outcome, cerebral venous thrombosis (CVT) remains a diagnostic and therapeutic challenge. Treatment of CVT consists primarily of symptomatic treatment of seizures and intracranial hypertension, antithrombotics, and etiologic treatment whenever possible. Heparin remains the first line of treatment for CVT; although its systematic use remains debated, recent studies have confirmed its safety even in patients with large hemorrhagic infarctions. The addition of local thrombolysis is indicated for patients with clinical worsening related to extension of the venous thrombosis, despite adequate anticoagulation and optimal symptomatic and etiologic treatment. In contrast to arterial stroke, complete recovery of prolonged or severe neurologic deficit is possible, justifying initiation of anticoagulation and eventually thrombolysis, even when the clinical situation seems desperate. New techniques using mechanical devices disrupting the clot may be used in addition to thrombolysis in rare cases. Ventricular drainage is indicated in cases of cerebellar infarction or deep venous thrombosis associated with hydrocephalus. Decompressive craniotomy may be performed acutely in patients with untractable intracranial hypertension and herniation.

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References and Recommended Reading

  1. Biousse V, Bousser MG: Cerebral venous thrombosis. Neurologist 1999, 5:326–349.

    Article  Google Scholar 

  2. Diaz JM, Schiffman JS, Urban ES, Maccario M: Superior sagittal sinus thrombosis and pulmonary embolism: a syndrome rediscovered. Acta Neurol Scand 1992, 86:390–396.

    PubMed  CAS  Google Scholar 

  3. Cantu C, Barinagarrementaria F: Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke 1993, 24:1880–1884.

    PubMed  CAS  Google Scholar 

  4. Einhaupl KM, Masuhr F: Cerebral venous and sinus thrombosis: an update. Eur J Neurol 1994, 1:109–126.

    Google Scholar 

  5. Daif A, Awada A, Al-Rajeh S, et al.: Cerebral venous thrombosis in adults: a study of 40 cases from Saudi Arabia. Stroke 1995, 26:1193–1195.

    PubMed  CAS  Google Scholar 

  6. Biousse V, Ameri A, Bousser MG: Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 1999, 53:1537–1542.

    PubMed  CAS  Google Scholar 

  7. Crawford SC, Digre KB, Palmer CA, et al.: Thrombosis of the deep venous drainage of the brain in adults. Analysis of seven cases with review of the literature. Arch Neurol 1995, 52:1101–1108.

    PubMed  CAS  Google Scholar 

  8. Jacobs K, Moulin T, Bogousslavsky J, et al.: The stroke syndrome of cortical vein thrombosis. Neurology 1996, 47:376–382.

    PubMed  CAS  Google Scholar 

  9. Perkin GD: Cerebral venous thrombosis: developments in imaging and treatment. J Neurol Neurosurg Psychiatry 1995, 59:1–3.

    PubMed  CAS  Google Scholar 

  10. Einhaupl KM, Villringer A, Habert RL, et al.: Clinical spectrum of sinus venous thrombosis. In Cerebral Sinus Thrombosis: Experimental and Clinical Aspects, vol 1. Edited by Einhaupl, et al. New York: Plenum Press; 1990:149–155.

    Google Scholar 

  11. Tsai FY, Wang AM, Matovitch B, et al.: MR staging of acute dural sinus thrombosis: correlation with venous pressure measurements and implications for treatment and prognosis. Am J Neuroradiol 1995, 16:1021–1029.

    PubMed  CAS  Google Scholar 

  12. Preter M, Tzourio, Ameri A, Bousser MG: Long term prognosis in cerebral venous thrombosis. Follow-up of 77 patients. Stroke 1996, 27:243–246.

    PubMed  CAS  Google Scholar 

  13. Bertina RM, Rosendaal FR: Venous thrombosis. The interaction of genes and environment. N Engl J Med 1998, 338:1840–1841.

    Article  PubMed  CAS  Google Scholar 

  14. Bergui M, Bradac GB, Daniele D: Brain lesions due to cerebral venous thrombosis do not correlate with sinus involvement. Neuroradiology 1999, 41:419–424. A multimodal radiologic study showing that parenchymal lesions in CVT correlate with the involvement of cerebral veins, not the dural sinuses.

    Article  PubMed  CAS  Google Scholar 

  15. Easton JD, Bousser MG, Stam J: Treatment of cerebral venous thrombosis. Cerebrovasc Dis 1993, 3:329–332.

    Google Scholar 

  16. Bousser MG: Cerebral venous thrombosis: nothing, heparin, or local thrombolysis? Stroke 1999, 30:481–483. A critical editorial on the various therapeutic options in CVT.

    PubMed  CAS  Google Scholar 

  17. Brucker AB, Vollert-Rogenhofer H, Wagner M, et al.: Heparin treatment in acute cerebral sinus venous thrombosis: a retrospective clinical and MR analysis of 42 cases. Cerebrovasc Dis 1998, 8:331–337.

    Article  PubMed  CAS  Google Scholar 

  18. Villringer A, Mehraein S, Einhaupl KM: Treatment of cerebral venous thrombosis-beyond the recommendation of anticoagulation. J Neuroradiol 1994, 21:72–80.

    PubMed  CAS  Google Scholar 

  19. Wingerchuk DM, Wijdicks EF, Fulgham JR: Cerebral venous thrombosis complicated by hemorrhagic infarction: factors affecting the initiation and safety of anticoagulation. Cerebrovasc Dis 1998, 8:25–30.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  21. De Bruijn SF, Stam J: Randomized placebo controlled trial of anticoagulant treatment with low molecular weight heparin for cerebral sinus thrombosis. Stroke 1999, 30:484–488. A randomized controlled trial of nadroparin versus placebo in CVT. The study was negative despite fewer deaths in the group receiving nadroparin.

    PubMed  Google Scholar 

  22. Niclot P, Bousser MG: Cerebral venous thrombosis. Curr Treatment Options Neurol 2000, 2:343–352.

    Google Scholar 

  23. Bousser MG: Cerebral venous thrombosis: diagnosis and management. J Neurol 2000, 247:252–258.

    Article  PubMed  CAS  Google Scholar 

  24. DeVeber G, Chan A, Monagle P, et al.: Anticoagulation therapy in pediatric patients with sinovenous thrombosis. A cohort study. Arch Neurol 1998, 55:1533–1537.

    Article  PubMed  CAS  Google Scholar 

  25. Benamer HT, Bone I: Cerebral venous thrombosis: anticoagulants or thrombolytic therapy? J Neurol Neurosurg Psychiatry 2000, 69:427–430.

    Article  PubMed  CAS  Google Scholar 

  26. Di Rocco C, Iannelli A, Leone G, et al.: Heparin-urokinase treatment in aseptic dural sinus thrombosis. Arch Neurol 1981, 38:431–435.

    PubMed  CAS  Google Scholar 

  27. Scott JA, Pascuzzi RM, Hall PV, Becker GJ: Treatment of dural sinus thrombosis with local urokinase infusion. Case report. J Neurosurg 1988, 68:284–287.

    PubMed  CAS  Google Scholar 

  28. Higashida RT, Helmer E, Halbach BB, Heishima GB: Direct thrombolytic therapy for superior sagittal sinus thrombosis. AJNR Am J Neuroradiol 1989, 10:S4-S6.

    PubMed  CAS  Google Scholar 

  29. Barnwell SL, Higashida RT, Halbach VV, et al.: Direct endovascular thrombolytic therapy for dural sinus thrombosis. Neurosurgery 1991, 28:135–142.

    Article  PubMed  CAS  Google Scholar 

  30. Tsai FY, Higashida RT, Matovich V, Alfieri K: Acute thrombosis of the intracranial dural sinus: direct thrombolytic treatment. AJNR Am J Neuroradiol 1992, 13:1137–1141.

    PubMed  CAS  Google Scholar 

  31. Horowitz M, Purdy P, Unwin H, et al.: Treatment of dural sinus thrombosis using selective catheterization and urokinase. Ann Neurol 1995, 38:58–67.

    Article  PubMed  CAS  Google Scholar 

  32. Smith AG, Cornblath WT, Deveikis JP: Local thrombolytic therapy in deep cerebral venous thrombosis. Neurology 1997, 48:1613–1619.

    PubMed  CAS  Google Scholar 

  33. Kim SY, Suh JH: Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of altepase. AJNR Am J Neuroradiol 1997, 18:639–645.

    PubMed  CAS  Google Scholar 

  34. Rael JR, Orrison WW Jr, Baldwin N, Sell J: Direct thrombolysis of superior sagittal sinus thrombosis with coexisting intracranial hemorrhage. AJNR Am J Neuroradiol 1997, 18:1238–1242.

    PubMed  CAS  Google Scholar 

  35. Niwa J, Ohyama H, Matumura S, et al.: Treatment of acute superior sagittal sinus thrombosis by t-PA infusion via venography-direct thrombolytic therapy in the acute phase. Surg Neurol 1998, 49:425–429.

    Article  PubMed  CAS  Google Scholar 

  36. Philips MF, Bagley LJ, Sinson GP, et al.: Endovascular thrombolysis for symptomatic cerebral venous thrombosis. J Neurosurg 1999, 90:65–71.

    Article  PubMed  CAS  Google Scholar 

  37. Frey JL, Muro GJ, McDougall CG, et al.: Cerebral venous thrombosis: combined intrathrombus rtPA and intravenous heparin. Stroke 1999, 30:489–494. This is one of the largest series of intravascular delivery of thrombolytic agents to treat CVT.

    PubMed  CAS  Google Scholar 

  38. Yamini B, Loch Macdonald R, Rosenblum J: Treatment of deep cerebral venous thrombosis by local infusion of tissue plasminogen activator. Surg Neurol 2001, 55:340–346.

    Article  PubMed  CAS  Google Scholar 

  39. Hsu FP, Kuether T, Nesbit G, Barnwell SL: Dural sinus thrombosis endovascular therapy. Crit Care Clin 1999, 15:743–753.

    Article  PubMed  CAS  Google Scholar 

  40. Wasay M, Bakshi R, Kojan S, et al.: Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis. Stroke 2001, 32:2310–2317.

    PubMed  CAS  Google Scholar 

  41. Stefini R, Latronico N, Cornali C, et al.: Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery 1999, 45:626–629.

    Article  PubMed  CAS  Google Scholar 

  42. Ekseth K, Bostrom S, Vegfors M: Reversibility of severe sagittal sinus thrombosis with open surgical thrombectomy combined with local infusion of tissue plasminogen activator: technical case report. Neurosurgery 1998, 43:960–965.

    Article  PubMed  CAS  Google Scholar 

  43. Sindou M, Mercier P, Bokor J, Brunon J: Bilateral thrombosis of the transverse sinus: microsurgical revascularization with venous bypass. Surg Neurol 1980, 13:215–220.

    PubMed  CAS  Google Scholar 

  44. Bagley LJ, Hurst RW, Galetta S, et al.: Use of a microsnare to aid direct thrombolytic therapy of dural sinus thrombosis. AJR Am J Roentgenol 1998, 170:784–786.

    PubMed  CAS  Google Scholar 

  45. Gomez CR, Misra VK, Terry JB, et al.: Emergency endovascular treatment of cerebral sinus thrombosis with a rheolytic catheter device. J Neuroimaging 2000, 10:177–180.

    PubMed  CAS  Google Scholar 

  46. Chow K, Gobin YP, Saver J, et al.: Endovascular treatment of dural sinus thrombosis with rheolytic thrombectomy and intra-arterial thrombolysis. Stroke 2000, 31:1420–1425.

    PubMed  CAS  Google Scholar 

  47. Chaloupka JC, Mangla S, Huddle DC: Use of mechanical thrombolysis via microballoon percutaneous transluminal angioplasty for the treatment of acute dural sinus thrombosis: case presentation and technical report. Neurosurgery 1999, 45:650–656.

    Article  PubMed  CAS  Google Scholar 

  48. Malek AM, Higashida RT, Balousek PA, et al.: Endovascular recanalization with balloon angioplasty and stenting of an occluded occipital sinus for treatment of intracranial venous hypertension: technical case report. Neurosurgery 1999, 44:896–901.

    Article  PubMed  CAS  Google Scholar 

  49. Higgins JN, Owler BK, Cousins C, Pickard JD: Venous sinus stenting for refractory benign intracranial hypertension. Lancet 2002, 359:228–230.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neuro-ophthalmology Unit, Emory Eye Center, 1365-B Clifton Road, 30322, Atlanta, GA, USA

    Valérie Biousse MD

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  1. Valérie Biousse MD
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  2. Frank Tong MD
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  3. Nancy J. Newman MD
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Biousse, V., Tong, F. & Newman, N.J. Cerebral venous thrombosis. Curr Treat Options Neurol 5, 409–420 (2003). https://doi.org/10.1007/s11940-003-0031-y

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