Document Detail


A review of therapeutic strategies for the management of cerebral venous sinus thrombosis.
MedLine Citation:
PMID:  19883208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Although initially described in the 19th century, cerebral venous sinus thrombosis (CVST) remains a diagnostic and therapeutic dilemma. It has an unpredictable course, and the propensity for hemorrhagic infarction produces significant consternation among clinicians when considering anticoagulation. It is the purpose of this review to analyze the evidence available on the management of CVST and to provide appropriate recommendations. METHODS: A thorough literature search was conducted through MEDLINE and PubMed, with additional sources identified through cross-referencing. A classification and level of evidence assignment is provided for recommendations based on the American Heart Association methodologies for guideline composition. RESULTS: Of the publications identified, the majority were isolated case reports or small case series. Few prospective trials have been conducted. Existing data support the use of systemic anticoagulation as an initial therapy in all patients even in the presence of intracranial hemorrhage. Chemical and/or mechanical thrombectomy, in conjunction with systemic anticoagulation, is an alternative strategy in patients with progressive deterioration on heparin therapy or in those who are moribund on presentation. Mechanical thrombectomy is probably preferred in patients with preexisting intracranial hemorrhage. CONCLUSIONS: Effective treatments exist for the management of CVST, and overall outcomes are more favorable than those for arterial stroke. Further research is necessary to determine the role of individual therapies; however, the rarity of the condition poses a significant limitation.
Authors:
Ricky Medel; Stephen J Monteith; R Webster Crowley; Aaron S Dumont
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Neurosurgical focus     Volume:  27     ISSN:  1092-0684     ISO Abbreviation:  Neurosurg Focus     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-03     Completed Date:  2009-12-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896471     Medline TA:  Neurosurg Focus     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E6     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use*
Fibrinolytic Agents
Humans
Intracranial Hemorrhages / drug therapy,  surgery,  therapy
Sinus Thrombosis, Intracranial / drug therapy,  surgery,  therapy*
Thrombectomy / methods*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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