Cerebral venous and sinus thrombosis.
Cerebral venous and sinus thrombosis (CVST) can present with a variety of clinical symptoms ranging from isolated headache to deep coma. Prognosis is better than previously thought and prospective studies have reported an independent survival of more than 80% of patients. Although it may be difficult to predict recovery in an individual patient, clinical presentation on hospital admission and the results of neuroimaging investigations are--apart from the underlying condition--the most important prognostic factors. Comatose patients with intracranial haemorrhage (ICH) on admission brain scan carry the highest risk of a fatal outcome. Available treatment data from controlled trials favour the use of anticoagulation (AC) as the first-line therapy of CVST because it may reduce the risk of a fatal outcome and severe disability and does not promote ICH. A few patients deteriorate despise adequate AC which may warrant the use of more aggressive treatment modalities such as local thrombolysis. The risk of recurrence is low (< 10%) and most relapses occur within the first 12 months. Analogous to patients with extracerebral venous thrombosis, oral AC is usually continued for 3 months after idiopathic CVST and for 6-12 months in patients with inherited or acquired thrombophilia but controlled data proving the benefit of long-term AC in patients with CVST are not available.
Dept. of Neurology, Charité Medical School, Humboldt-Universität, Schumannstrasse 20/21, 10117 Berlin, Germany.
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Masuhr
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Mehraein
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Einhäupl
D002550:Cerebral Veins / Q000473:pathology / Q000503:physiopathology*; D003376:Counseling; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D012851:Sinus Thrombosis, Intracranial / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy