Diagnosis and management of cerebral venous thrombosis

Behrouzi, Roya; Punter, Martin

doi:10.7861/clinmedicine.18-1-75

Cited by 76 publications

(114 citation statements)

References 34 publications

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“…Systemic administration of fibrinolytic agents such as urokinase to recanalize thrombosed pathways has been attempted but strong evidence regarding its safety and efficacy is lacking (9). Endovascular thrombolysis may also be considered in patients who are unresponsive and deteriorating, despite aggressive medical treatment (10). Siddiqui et al, in their systematic review assessing mechanical thrombectomy with or without intrasinus thrombolysis suggested that this approach is safe (46).…”

Section: Anticoagulation In Cvstmentioning

confidence: 99%

“…However, this figure rises to 15% of all young strokes in the Asian population (8, 9). The commonest site of origin of thrombosis is believed to be the junction of cerebral veins and larger sinuses (10). Several disorders can cause or predispose patients to CVST such as genetic and acquired prothrombotic disorders, cancer, hematological diseases, vasculitis, systemic inflammatory disorders, pregnancy, puerperium, and infections.…”

Section: Introductionmentioning

confidence: 99%

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Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Avanali¹,

Gopalakrishnan

Devi

et al. 2019

Front. Neurol.

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Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively reduce intracranial pressure just like it works for malignant middle cerebral artery infarcts and traumatic brain injury. But because of the relative rarity of this type of stroke, strong evidence from randomized controlled trials that DC is a life-saving procedure is not available unlike in the latter two conditions. There is a possibility that other forms of interventions like endovascular recanalization, thrombectomy, thrombolysis, and anticoagulation, which cannot be used in established middle cerebral artery infarcts and TBI, can reverse the ongoing pathology of increasing edema in CVST. Such interventions, although presently unproven, could theoretically obviate the need for DC when used in early stages. However, in the absence of such evidence, we recommend that DC be considered early as a life-saving measure whenever there are large hemorrhagic infarcts, expanding edema, radiological, and clinical features of impending herniation. This review gives an overview of the etiology and risk factors of CVST in different patient populations and examines the effectiveness of DC and other forms of interventions.

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Section: Anticoagulation In Cvstmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Avanali¹,

Gopalakrishnan

Devi

et al. 2019

Front. Neurol.

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“…Following the acute-phase treatment, long-term anticoagulants such as Vitamin K antagonist (warfarin) should be continued with a target to achieve an international normalized ratio of 2–3. [79] Currently, direct oral anticoagulants (DOACs) are gaining attention as potential therapy in CVST. In the acute-phase treatment, DOACs have been found to be comparable with warfarin in preventing the recurrence of venous thromboembolism.…”

Section: Management Of Cvstmentioning

confidence: 99%

Clinical aspects, diagnosis and management of cerebral vein and dural sinus thrombosis: A literature review

Alsulaiman

2019

Saudi J Med Med Sci

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Cerebral vein and dural sinus thrombosis (CVST) is an uncommon cause of stroke, but its delayed diagnosis carries significant morbidity and mortality. Several studies have reported higher incidence of CVST than that previously reported. The clinical presentation of CVST varies and can be atypical. Advancement in neuroimaging modalities has made it possible to make an early diagnosis and initiate management with a wide range of therapeutic options, including direct oral anticoagulants and endovascular treatment. This narrative review summarizes the epidemiology, clinical aspects, diagnosis and management of CVST.

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“…The diagnosis is typically based on clinical suspicion and confirmatory neuroimaging. Formerly, the reports of thrombosis were made using angiography; however, today CTV and MRV can be used as reliable alternatives to confirm the diagnosis (11,35,37,38).…”

Section: Resultsmentioning

confidence: 99%

“…The diagnosis is typically based on clinical suspicion and confirmatory neuroimaging findings. Cerebral veins and sinuses can be examined using the following different methods (37).…”

Section: Diagnosismentioning

confidence: 99%

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Paybast

Aghamiri

2020

J Vessel Circ

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Background and Aim: Cerebral venous thrombosis (CVT) is a relatively common disorder of the cerebral venous system accounting for less than 1% of all strokes with a higher prevalence in Iran. Despite the considerable advances in recent years, the diagnosis and treatment of CVT are still challenging predominantly in the emergency setting. Therefore, the present study sought to provide an update on the diagnosis and treatment of CVT. Materials and Methods: PubMed, Web of Science, Google Scholar, Scopus, Elsevier, and Iranian domestic scientific databases were searched within January 1, 2000, to July 1, 2020. In all the electronic databases, the keywords (in the title/abstract) of "cerebral vein thrombosis" OR "CVT" OR "Cerebral venous sinus thrombosis" OR "CVST" AND "risk factor", "diagnosis", "treatment", and "prognosis" were searched. The unrelated articles, studies not concerning humans or pediatric population, and case reports were excluded from the study. In addition, the articles related to CVT in association with coronavirus disease 2019 infection were excluded from the present review. Results: According to the findings of the present study, the diagnosis of CVT might be delayed due to a wide range of clinical manifestations from a subacute headache with or without the signs of intracranial hypertension to the acute focal neurologic deficit and even loss of consciousness. Although the diagnosis is typically based on brain magnetic resonance imaging and magnetic resonance venography, there has been evidence suggesting that the plain computed tomography markers with an attenuation value of > 60.4 Hounsfield unit (HU) and Hounsfield-hematocrit (H: H) ratio of > 1.42 are specific enough for the diagnosis regardless of confirmatory imaging, such as venography. Additionally, the usefulness of D-dimer is still debatable, and an unacceptable false-negative rate of up to 26% has been illustrated. In terms of therapeutic aspects, although warfarin is still the mainstay of treatment, there has been increasing interest in new oral anticoagulants with promising results in both thrombus recanalization and excellent functional recovery. Balloon angioplasty and mechanical thrombectomy might also be considered in severely progressive cases without response to conventional treatments. It is worth mentioning that even for those achieving favorable outcomes, CVT can remain a disabling condition leading to at least neuropsychiatric complaints. Conclusion: The CVT is a rare and important cause of stroke accounting for less than 5% of all strokes mainly affecting young females. With regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.

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Diagnosis and management of cerebral venous thrombosis

Cited by 76 publications

References 34 publications

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Clinical aspects, diagnosis and management of cerebral vein and dural sinus thrombosis: A literature review

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

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