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Advances in the Treatment of Cerebral Venous Thrombosis

  • Cerebrovascular Disorders (HP Adams, Jr., Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Patients with recent cerebral venous sinus thrombosis (CVT) should be fully anticoagulated with heparin as soon as the diagnosis is confirmed, even in the presence of cerebral hemorrhagic venous infarcts. Fixed-dose subcutaneous low-molecular-weight heparins (LMWH) in therapeutic dosage have a better safety profile and are probably more effective than dose-adjusted intravenous unfractionated heparin. After the patient is stabilized , oral anticoagulant treatment is started, aimed at an INR value between 2.0 and 3.0 for at least three months after the acute phase. Since about 40 % of patients with CVT have epileptic seizures at onset or during the first days, many require treatment with anti-epileptics. Prophylactic anti-epileptic treatment is an option, but its efficacy has not been investigated. If no new seizures occur after the acute phase, anti-epileptics can be tapered after three to six months. The efficacy of endovascular treatment, with mechanical and/or pharmacologic thrombolysis, has only been published in small case series, and cannot be regarded as proven effective treatment for CVT. Its theoretical advantage of more rapid clearance of thrombi may be offset by severe bleeding complications, and the limited availability and higher cost of the procedure. Patients who deteriorate because of large space-occupying venous infarcts have a high risk of dying from cerebral herniation. In such cases an emergent decompressive hemicraniectomy is often life-saving. Experience from different centers with this procedure shows a good clinical outcome in the majority of these patients. Patients with CVT may develop – and sometimes present with - chronic intracranial hypertension with headache and papilledema. In such patients the priority is prevention of visual function loss; intracranial hypertension should be controlled with acetazolamide, and occasionally with repeated lumbar punctures if vision is threatened. Refractory cases will need a CSF shunting procedure.

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References and Recommended Reading

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

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Compliance with Ethics Guidelines

Conflict of Interest

Dr. Coutinho declares that he has received research grants from The Netherlands Organisation for Scientific Research, Thrombosis Foundation Holland, the Dutch Heart Foundation, and the Netherlands Brain Foundation. He also declares that he has received speaker fees Boehringer Ingelheim, but that all of these fees have been donated to the “Stichting Klinische Neurologie”, a foundation that supports research in the field of neurological disorders.

Dr. Middeldorp declares that she has passed consultancy fees to her institution from Boehringer Ingelheim, Bayer, BMS/Pfizer Alliance, and Daiichi Sankyo. She also declares research grant funding from GSK and BMS/Pfizer Alliance, as well as honoraria payments from Boehringer Ingelheim, Bayer, BMS/Pfizer Alliance, and Daiichi Sankyo. Finally, she declares that she has received reimbursement of travel expenses from BMS/Pfizer Alliance and Daiichi Sankyo.

Dr. Stam declares research grant funding from Thrombosis Foundation Holland, the Dutch Heart Foundation, and the Netherlands Brain Foundation.

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.

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Authors and Affiliations

  1. Department of Neurology of the Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    J. M. Coutinho MD, PhD & J. Stam MD, PhD

  2. Department of Vascular Medicine of the Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    S. Middeldorp MD, PhD

Authors
  1. J. M. Coutinho MD, PhD
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  2. S. Middeldorp MD, PhD
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  3. J. Stam MD, PhD
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Corresponding author

Correspondence to J. M. Coutinho MD, PhD.

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This article is part of the Topical Collection on Cerebrovascular Disorders

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Coutinho, J.M., Middeldorp, S. & Stam, J. Advances in the Treatment of Cerebral Venous Thrombosis. Curr Treat Options Neurol 16, 299 (2014). https://doi.org/10.1007/s11940-014-0299-0

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  • DOI: https://doi.org/10.1007/s11940-014-0299-0

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