Case report: Cerebral venous thrombosis in association with hormonal supplement therapy

Knox, A.M.; Brophy, Brian P.; Sage, Michael R.

doi:10.1016/s0009-9260(05)81703-9

Cited by 10 publications

(6 citation statements)

References 11 publications

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“…There is a huge amount of evidence linking hormone replacement therapy (HRT) with DVT, but there are no significant data (apart from a few anecdotal reports [26,27]) regarding the relationship between HRT and CVST.…”

Section: Hormone Replacement Therapymentioning

confidence: 99%

Risk Factors of Cerebral Vein and Sinus Thrombosis

Freitas

Bogousslavsky

2007

Handbook on Cerebral Venous Thrombosis

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The risk factors for deep venous thrombosis (and for cerebral vein and sinus thrombosis, CVST) differ from those for arterial disease. The risk factors for venous thrombosis are linked to the Virchow triad of stasis of the blood, changes in the vessel wall, and changes in the composition of the blood, especially the first and third of these. Risk factors are usually divided into acquired (e.g. surgery, trauma, pregnancy, puerperium, lupus anticoagulant, malignant disease, and female hormones) and genetic (congenital thrombophilia). However, the separation of genetic and acquired risk factors is somewhat artificial, since they have additive effects and venous thrombosis is often multifactorial. In this review, we discuss acquired risk factors for CVST. These include hormonal changes (e.g. oral contraceptives use, hormone replacement therapy, pregnancy and puerperium), mechanical precipitants (e.g. head trauma, jugular catheterization, surgery, lumbar puncture), local and generalized infections, cancer, acquired prothrombotic states (e.g. hyperhomocysteinemia, nephrotic syndrome), inflammatory diseases (e.g. vaculitis, intestinal inflammatory disease), hematological disorders, neurological diseases (e.g. dural arteriovenous malformations, spontaneous intracranial hypotension), drugs and other situations. However, only some conditions are consistently present in case series, while many appear only in anecdotal reports. Thus, in most situations, a causal link cannot be established. Determining a cause-and-effect relationship is essential for developing preventive, diagnostic, and therapeutic strategies. Therefore, further multicentered, case-controlled studies are crucial for better understanding the pathogenesis of CVST.

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Section: Hormone Replacement Therapymentioning

confidence: 99%

Risk Factors of Cerebral Vein and Sinus Thrombosis

Freitas

Bogousslavsky

2007

Handbook on Cerebral Venous Thrombosis

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“…3,5,15 In line with recent studies 11,14,15 both subjects were treated with heparin and a thrombolytic drug, despite the observation of acute haemorrhagic lesions in the first case. Bleeding complications did not occur in either case and careful, frequent titration of the heparin infusion, keeping the PTT between 60-80 seconds, is the key for safe treatment.…”

Section: Discussionmentioning

confidence: 54%

“…1 Use of oral contraceptives is a well-known risk factor in young women. [1][2][3][4][5][6][7][8] The mortality of CVT is quite high, ranging from 5.5% in the most favourable series 9 to 30% or even higher. 10,11 Survival may be associated with permanent neurological deficits and poor outcome.…”

Section: Introductionmentioning

confidence: 99%

Aggressive treatment of severe acute cerebral venous thrombosis associated with oral contraceptives in young women

Rosi¹,

Stanca²,

Monfregola³

et al. 1995

Clinical Intensive Care

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The use of oral contraceptives is a known risk factor for cerebral venous thrombosis. This diagnosis may be difficult but should always be considered because of the possible serious consequences if left untreated. Radiological and nuclear magnetic resonance imaging, and cerebral angiography make the diagnosis possible. There is no well-established therapy for this syndrome. Heparin administration is controversial but there is increasing evidence that the presence of intracranial haemorrhage is not a strict contraindication and that anticoagulation achieves the best results.Two cases of severe acute cerebral venous thrombosis in young women taking the contraceptive pill are reported. Following clinical and radiological diagnosis, and worsening of their condition, they were admitted to the ICU and treated aggressively with barbiturate-induced coma, mechanical ventilation, anticoagulants and thrombolytics, and osmotherapy when necessary. Haemorrhagic complications were not observed. On discharge from the hospital and after two years' follow-up, both patients have made a complete clinical recovery.

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“…Different case reports noted the association between tamoxifen (which is an estrogen receptor modulator) and CVT [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review)

Jianu

Dan

et al. 2022

Life

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(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.

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Case report: Cerebral venous thrombosis in association with hormonal supplement therapy

Cited by 10 publications

References 11 publications

Risk Factors of Cerebral Vein and Sinus Thrombosis

Risk Factors of Cerebral Vein and Sinus Thrombosis

Aggressive treatment of severe acute cerebral venous thrombosis associated with oral contraceptives in young women

An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review)

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