High-dose heparin plus warfarin administration in non-traumatic dural sinuses thrombosis. A clinical and neuroradiological study.
BACKGROUND
The management of intracranial dural sinuses thrombosis is still controversial and uncertain. The authors report the cases of 7 patients with non-traumatic thrombosis of the dural sinuses and describe the most important radiographic findings, the indication, effectiveness of antithrombotic therapy, and outcome.


METHODS
A retrospective review was conducted of 7 cases of dural sinus thrombosis admitted, between 1994 and 1996, to our division. All patients underwent full anticoagulation therapy. Heparin was administered, using a dose of 25,000 units/day for two weeks; warfarin was given using a dose of 5 mg twice daily. Treatment course was followed by maintenance treatment with a single administration of 5 mg/day of warfarin. All patients were submitted to close titration and coagulation profile monitoring.


RESULTS
In 4 cases Magnetic Resonance Imaging-Angiography (Angio-MRI) was performed for following up the recanalization of the sinuses, resulting a persistent no patency of the dural sinuses. Three patients underwent contrast-enhanced CT scan, demonstrated an "empty delta sign" in the sagittal sinus, confirming no recanalization. Nevertheless, six patients had have a good quality recovery, and one patient a moderate disability.


CONCLUSIONS
Cerebral venous sinus thrombosis is an uncommon cause of cerebral infarction, and may be mistaken, unless specifically sought. The natural history of the disease is highly variable, with a mortality rates range from 10% to 20%. At present, in our opinion, the venous phase of Angio-MRI is the definitive examination, and a gold standard for diagnosis of dural sinus thrombosis. In our cases, antithrombotic therapy has been found to be a safe and effective treatment, despite contrast-CT scans and Angio-MRI showed no recanalization of the sinuses, in all patients.
Cipri
S
S
Division of Neurosurgery, Bianchi-Morelli-Melacrino Hospital, Reggio Calabria, Italy.
Gangemi
A
A
Campolo
C
C
Cafarelli
F
F
Gambardella
G
G
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D006493:Heparin