Demonstration of significant resolution of cerebral sino-venous thrombosis associated with intravenous recombinant tissue plasminogen activator.
BACKGROUND
Cerebral sino-venous thrombosis (CVT) is commonly treated with anticoagulant therapy. There are reports of response to endovascular thrombolysis with or without mechanical aspiration in patients with clinical deterioration.


METHODS
We present a 29-year-old man with acute onset of severe headache, found to have extensive CVT by magnetic resonance venography (MRV). His atypical presentation led to cerebral angiography that was complicated by global aphasia and right hemiparesis from left middle cerebral artery distribution ischemia. He received intravenous rt-PA (recombinant tissue plasminogen activator) within an hour of the procedure followed, 24 hours later, by intravenous heparin infusion with significant clinical improvement. The headache severity and CVT, on follow-up MRV, resolved significantly within 2 days.


CONCLUSIONS
We demonstrate clinical and neuroimaging response to systemic rt-PA in CVT. Thrombolysis may have a role in CVT management with an extended therapeutic window.
Misra
Vivek
V
Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA.
Elliott
Debra G
DG
Gonzalez-Toledo
Eduardo
E
Kelley
Roger E
RE
D000328:Adult; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000188:drug therapy*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D010959:Tissue Plasminogen Activator