Treatment of Progressive Cerebral Sinuses Thrombosis with Local Thrombolysis

Cerebral venous thrombosis (CVT) is a potentially serious disease, with nonspecific clinical symptoms and an unpredictable outcome. Despite adequate anticoagulation, a patient's clinical condition can rapidly deteriorate. The aim of this study was to evaluate the efficacy of local thrombolysis in these patients. Consecutive patients with progressive cerebral venous thrombosis between October 2008 and January 2011 were enrolled prospectively. Progressive CVT was defined as the persistence of neurologic findings (headache, blurred vision, and visual field defects) despite at least four days (or 48 hours in patients with involvement of more than one sinus) on full anticoagulation therapy with heparin and development of focal neurologic deficits or cortical hemorrhage. We excluded patients with large hematomas and predisposing malignancies like leukemia. All patients underwent local thrombolysis with 30 mg recombinant tissue plasminogen activator (rtPA). Overall, 26 patients were enrolled with a mean age of 35.5 years (range 18 to 56 years). Six patients (23%) were male and twenty patients (77%) were female. The most common presenting feature was headache and the most common neurologic finding was papilledema, which was present in all patients. Eighty-five percent of women had a history of oral contraceptive pill consumption. Successful recanalization was achieved in all patients except one (96.2%). Neurological examinations and follow-up assessments were based on a modified Rankin scale (mRS). Favorable outcome and recovery was defined as a mRS score of 0–1. Follow-up assessments at the third week showed that 25 out of 26 recovered, with 18 having a mRS score of 0 and 7 with a mRS score of 1. There were no procedure-related neurological complications. Our results show that local thrombolysis is a safe and effective treatment modality for patients suffering from progressive CVT.

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Abstract WP10: Prolonged Microcatheter-based Local Thrombolytic Infusion as a Salvage Treatment for Failed Endovascular Treatment for Cerebral Venous Thrombosis: A Multicenter Registry

Stroke ◽

10.1161/str.48.suppl_1.wp10 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Mikayel Grigoryan ◽

Gaurav K Guliani ◽

Muhammad A Saleem ◽

Emrah Aytac ◽

...

Keyword(s):

Venous Thrombosis ◽

Endovascular Treatment ◽

Cerebral Venous Thrombosis ◽

Recombinant Tissue Plasminogen Activator ◽

Response To Treatment ◽

Tissue Plasminogen ◽

Final Response ◽

Assess Treatment Response ◽

Multicenter Registry

Background: Transvenous endovascular treatment including combination pharmacological and mechanical modalities is reserved for patients with cerebral venous thrombosis (CVT) not responsive to standard anticoagulation. However, transvenous endovascular treatment may not always be successful in achieving recanalization. Objective: To determine the effectiveness of prolonged microcatheter based local thrombolytic infusion in treatment of patients with CVT who achieved no or suboptimal recanalization with endovascular treatment. Methods: Patients who underwent transvenous endovascular treatment for cerebral venous thrombosis at three hospitals were identified through local registries. The final response to treatment was assessed and prolonged microcatheter based local thrombolytic infusion was instituted in selected patients as second line treatment. Serial angiograms were performed to assess treatment response and determine the duration of infusion. Results: Of the 85 patients admitted with CVT, 13 patients underwent 14 transvenous endovascular treatments. Initial treatment was considered suboptimal in 10/14 procedures due to no recanalization in 6, partial recanalization in 3, and re-occlusion in 1 patient. A prolonged microcatheter-based local recombinant tissue plasminogen activator (rt-PA) infusion was used in 9 of the 10 procedures for a median duration of 16 hours (range 15-22 hours). Follow up angiography demonstrated complete recanalization in 4 procedures and improvement of the partial recanalization in 5 additional procedures. One patient died before the follow up imaging could be acquired. None of the patients developed intracranial hemorrhage associated with local thrombolytic infusion. The microcatheter position had shifted during the infusion in one procedure. Conclusion: Prolonged microcatheter based local thrombolytic infusion appears to effective treatment in patients who have suboptimal response to acute transvenous endovascular treatment without any additional adverse events.

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Risk factors and clinical manifestations of cerebral venous thrombosis in patients admitted to Zahedan city hospitals during 2011-2017

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i3.19184 ◽

2018 ◽

Vol 9 (3) ◽

pp. 6-9 ◽

Cited By ~ 1

Author(s):

Hamed Amirifard ◽

Alireza Khosravi ◽

Hoseinali Akbarian

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Symptoms ◽

Post Partum ◽

Oral Contraceptive Pill ◽

Clinical Manifestations ◽

City Hospital ◽

Blood Clots ◽

Prevalent Symptom

Background: In Cerebral venous thrombosis (CVT), blood clots are create in the veins and, blood clots may form in the veins or sinuses. In 78% of cases this problem occurred in people lower than 50 years and in women more than men. The annual prevalence of CVT in Iran was 12.3 per one million which was 2.5 times more than world prevalence.Aims and Objective: The aim of this study was to investigate the Risk factors and clinical manifestations of cerebral venous thrombosis in patients admitted to Zahedan city hospitals. Methods and Materials: This retrospective descriptive study was done on 50 patients with CVT which hospitalized in the Zahedan city hospital. Necessary information such as clinical symptoms, risk factors and demographic data extracted from patients file and analyzed by statistical methods in SPSS.16.Results: In this study, 68% of patients were female and 32% were male. The most prevalent season was summer age group 34-43 years constituting about 28 % of the cases. The prevalent season was summer with 38 % cases and headache was the most prevalent symptom (66%). The most prevalent risk factor was infection comprising 30 % of the total patients.Conclusion: Results showed higher prevalence of CVT in women than in men which could be due to the positive relation between prevalence of this disease and risk factors such as oral contraceptive pill (OCP), pregnancy and post-partum period. Also, in this study the most prevalent symptom was headache and the most prevalent season was summer, which could be due to dehydration of patients. The validity of the current study could be further substantiated with study in the similar pattern with more sample size.Asian Journal of Medical Sciences Vol.9(2) 2018 6-9

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Cerebral venous thrombosis as a rare thromboembolic complication of celiac disease: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa200 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-5

Author(s):

Maha Bouziane ◽

Salim Arous ◽

Rachida Habbal

Keyword(s):

Celiac Disease ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Anticoagulation Therapy ◽

Thromboembolic Complication ◽

Favourable Outcome ◽

Complete Regression ◽

Thromboembolic Events ◽

Cerebral Magnetic Resonance Imaging

Abstract Background Celiac disease is a digestive inflammatory syndrome with several complications. It is associated with coagulation and platelets abnormalities leading to thromboembolic events. Cerebral venous thrombosis is an exceptional localization of thrombosis in celiac disease and could be life-threatening. Case summary A 17-year-old female patient with history of celiac disease and not following a gluten-free diet, checked in to the emergency department for a sudden, 2-week-old, and deteriorating, onset of intense headache and muscle weakness. The cerebral computed tomography-scan showed bilateral fronto-parietal hypodensity with micro-bleeds. We investigated using a cerebral magnetic resonance imaging that revealed superior longitudinal sinus thrombosis and right transverse and sigmoid sinuses thrombosis, along with right haematoma and ischaemic areas. The patient was prescribed anticoagulation therapy. Follow-ups over a 2-year period confirmed a favourable outcome and a complete regression of symptoms. Discussion Evolution of celiac disease could be associated with several complications. Eighty-five percent of patients is potentially exposed to thromboembolic events due to the hypercoagulability state of the disease and different coagulation and fibrinolysis abnormalities (e.g. hyperhomocysteinaemia, protein C and S deficiencies, vitamin K and B deficiencies). Cerebral venous thrombosis is a rare thromboembolic localization. Anticoagulation is efficient in most cases though endovascular treatment might be required.

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Re: “Report of Dramatic Improvement after a Lumboperitoneal Shunt Procedure in a Case of Anticoagulation Therapy-Resistant Cerebral Venous Thrombosis”

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2016.02.033 ◽

2016 ◽

Vol 25 (6) ◽

pp. 1557-1558

Author(s):

Halil Onder ◽

Yasemin Gursoy Ozdemir

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Anticoagulation Therapy ◽

Dramatic Improvement ◽

Lumboperitoneal Shunt ◽

Shunt Procedure

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Thalamic Hemorrhagic Stroke in the Term Newborn: A Specific Neonatal Syndrome With Non-uniform Outcome

Journal of Child Neurology ◽

10.1177/0883073817703503 ◽

2017 ◽

Vol 32 (8) ◽

pp. 746-753 ◽

Cited By ~ 6

Author(s):

Laura Merlini ◽

Sylviane Hanquinet ◽

Joel Fluss

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Hemorrhagic Stroke ◽

Late Onset ◽

Predicting Factors ◽

Anterior Thalamus ◽

Cerebral Sinus Venous Thrombosis ◽

Cerebral Sinus ◽

Deep Cerebral Venous Thrombosis

Background: Neonatal thalamic hemorrhagic stroke is related to cerebral sinus venous thrombosis and associated with neurological sequelae. Predicting factors are however lacking. Methods: Clinical and radiological findings at onset and on follow-up of 5 neonates with thalamic hemorrhage stroke are described. Results: All neonates presented with abrupt lethargy, ophistotonos, irritability and/or seizures. The thalamic hemorrhagic stroke was most often unilateral (4/5), involving the posterior/entire thalamus in 3 cases and the anterior thalamus in 2. Cerebral venous thrombosis was identified in a single patient. At follow-up, children with unilateral anterior thalamic hemorrhagic stroke demonstrated thalamic atrophy without neurological symptoms, whereas children whose thalamus lesion was extensive exhibit a porencephalic cavity and presented with late-onset epilepsy. Discussion: Although deep cerebral venous thrombosis is probably the cause of neonatal thalamic hemorrhagic stroke, its radiological evidence is challenging. Outcome seems dependent of the size and location of thalamic hemorrhagic stroke. Epilepsy is a frequent morbidity after thalamic hemorrhagic stroke.

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Cerebral venous thrombosis after caesarean section

Česká gynekologie ◽

10.48095/cccg2021339 ◽

2021 ◽

Vol 86 (5) ◽

pp. 339-342

Author(s):

Lucie Drábková ◽

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Caesarean Section ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Interdisciplinary Collaboration ◽

Contextual Knowledge ◽

Follow Up Care

Objective: Case report of a patient with cerebral venous thrombosis after caesarean section. Case report: We present a case of a 22-year-old patient after an acute caesarean section, which was complicated by cerebral venous thrombosis. The etiology of the thrombosis was multifactorial. Diagnosis was determined using imaging methods once the neurological symptoms were expressed. Follow-up care for the patient included comprehensive care in the intensive care unit, including a temporary decompresive craniectomy. Conclusion: Cerebral venous thrombosis is a rare disease with a varied clinical manifestation whose development is aff ected by a number of acquired and congenital factors. The incidence is increased in women in the puerperium, but we can also see it in gynecological practice in young contraception users. Contextual knowledge is essential in early dia gnosis as well as using a correct treatment strategy with a multidisciplinary approach and interdisciplinary collaboration. Key words: cerebral venous thrombosis – caesarean section – laparotomy dehiscence – headache

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Cerebral Venous Thrombosis

10.4018/978-1-7998-7433-1.ch007 ◽

2022 ◽

pp. 113-119

Author(s):

Ozcan Demetgul

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Symptoms ◽

Rare Condition ◽

Epileptic Seizures ◽

Lateral Sinus ◽

Younger Adults ◽

Sagittal Sinus ◽

Vital Functions ◽

Visual Problems

Cerebral venous thrombosis (CVT) is a rare condition involving various symptoms that is mainly seen in younger adults. The most commonly involved are the superior sagittal sinus, lateral sinus, and simoid sinus. About 1% of all ischemic strokes are considered CVT. It is seen 3-fold more in young women. The incidence was estimated to be approx. 1/1000000. Cerebral venous sinuses are superficial and deep spaces, and they have vital functions. There are many symptoms. The most common complaint is headache (89%). Studies reported many different clinical symptoms. Neurological signs including motor and sensorial losses, impaired consciousness, speech disorder, epileptic seizures, visual problems (hemianopia, nystagmus, diplopia, and papilledema), and cranial nerve signs may be seen. The diagnosis is made primarily by suspecting the clinical condition and radiological presentation of thrombosis. The most basic diagnostic method is cranial imaging. Anticoagulants are the main method of treatment. The prognosis has improved over the last years thanks to early diagnosis.

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Endovascular treatment of cerebral venous thrombosis.

Russian neurological Journal ◽

10.30629/2658-7947-2021-26-5-24-29 ◽

2021 ◽

Vol 26 (5) ◽

pp. 24-29

Author(s):

A. A. Kulesh ◽

A. O. Karakulov

Keyword(s):

Blood Flow ◽

Venous Thrombosis ◽

Endovascular Treatment ◽

Cerebral Venous Thrombosis ◽

Clinical Case ◽

Lymphoblastic Leukemia ◽

Prolonged Administration ◽

Local Thrombolysis ◽

Cerebral Sinus ◽

Transverse Sinuses

The article describes a clinical case of cerebral venous thrombosis involving the deep venous system in a 42-year-old patient suﬀering from acute lymphoblastic leukemia. As the patient’s condition progressively deteriorated despite anticoagulant therapy, endovascular treatment was attempted. Transvenous thrombectomy and local thrombolysis were performed, which made it possible to achieve only partial recanalization. Further prolonged administration of alteplase into the cerebral sinus through a microcatheter facilitated complete recanalization of the direct and transverse sinuses. The restoration of blood flow was accompanied by regression of neurological deficit. This case is discussed in the context of modern approaches to endovascular treatment of cerebral venous thrombosis.

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