Cerebral Venous Sinus Thrombosis in Children with Acute Lymphoblastic Leukemia carrying the MTHFR TT677 Genotype and Further Prothrombotic Risk Factors

Wermes, C.; Fleischhack, G.; Junker, Ralf; Schobeß, R.; Schwabe, Dirk; Sykora, K W; Nowak-Göttl, U.

doi:10.1055/s-2008-1043790

Cited by 29 publications

(16 citation statements)

References 8 publications

(12 reference statements)

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“…Several cases of CVST linked to asparaginase are found in the literature [196][197][198][199][200][201][202]. CVST is a unique feature of asparaginase-related thrombosis and is reported to occur in 1-3% of patients [202].…”

Section: Drugsmentioning

confidence: 99%

“…Thus, in most situations, a causal relationship cannot be established. Most reported cases are related to medications for cancer (asparaginase [196][197][198][199][200][201][202], tamoxifen [203][204][205], and thalidomide [206][207][208]), to hormone stimulation (androgen [209][210][211][212], danazol [213], isoflavone [215], and drugs for ovary stimulation [216][217][218]), stimulation of progenitor cells (erythropoietin [219,220]), or drugs related to homeostasis (heparin [221], heparinoid [222,223], and epsilon aminocaproic acid [224,225]). …”

Section: Drugsmentioning

confidence: 99%

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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: Drugsmentioning

confidence: 99%

Section: Drugsmentioning

confidence: 99%

Risk Factors of Cerebral Vein and Sinus Thrombosis

Freitas

Bogousslavsky

2007

Handbook on Cerebral Venous Thrombosis

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“…Sinus thrombosis is a well known complication of ALL. 15,16 The combination of ALL and sinus thrombosis has a worse prognosis than each condition separately. 16 Factors that contribute to poor outcome are effects of chemotherapy (L-aspariginase) and thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 The combination of ALL and sinus thrombosis has a worse prognosis than each condition separately. 16 Factors that contribute to poor outcome are effects of chemotherapy (L-aspariginase) and thrombocytopenia. Two patients with ALL (5 and 7) had some increased intraventricular blood on their CT scan after thrombolysis and low thrombocyte counts of 131 and 43ϫ10 9 /L, respectively.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy and Thrombolysis for Severe Cerebral Sinus Thrombosis

Stam

Majoie

Delden

et al. 2008

Stroke

167

119

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Background and Purpose— Most patients with cerebral sinus thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods— Prospective case series. Patients with sinus thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight sinus thrombosis, or large space-occupying lesions. Urokinase was infused into the sinuses (bolus 120 to 600×10 3 U; then 100×10 3 U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results— We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P =0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P =0.04). Seizures were less frequent in the fatal cases ( P =0.05). Patients who died had a larger mean lesion surface than survivors (30.5 versus 13.6 cm 2 ; P =0.03), larger midline shift (5.2 versus 1.7 mm; P =0.02), and a more rapid course (2.7 versus 8.2 days; P =0.01). Five patients who died had large hemispheric infarcts and edema before thrombolysis, causing herniation. Five patients had increased cerebral hemorrhage (3 minor, 2 major) after thrombolysis. Conclusions— Thrombolysis can be effective for severe sinus thrombosis, but patients may deteriorate because of increased cerebral hemorrhage. Patients with large infarcts and impending herniation did not benefit.

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“…Genetic prothrombotic conditions [antithrombin deficiency (5), protein C and protein S deficiency (6,7), factor V Leiden mutation (8), prothrombin mutation (9), homocysteinemia caused by gene mutations in methylenetetrahydrofolate reducatase (10)]; acquired prothrombotic states [nephritic syndrome, antiphospholipid antibodies (11), homocysteinemia (10), pregnancy (12), puerperium (12)]; infections (otitis, mastoiditis and sinusitis, meningitis and systemic infectious disease) (6); inflammatory disease [Systemic lupus erythematosus (13), Wegener's granulomatosis (7), sarcoidosis, inflammatory bowel disease (14), behcet syndrome (15)]; hematologic conditions [polycitemia primary and secondary (2), thrombocitemia (2), leukemia (16) and anemia including paroxysmal nocturnal hemoglobinuria (17)], drugs [asparaginase (6,16) and oral contrapceptives (18)]; traumas or mechanical causes [head injury (19), injury to sinuses or jugular vein, jugular catheterization, neurosurgical procedures and lumbar puncture (20)], miscellaneous (dehydration, especially in children and cancer) (6) and high altitudes (21).…”

Section: Introductionmentioning

confidence: 99%