[Place of local thrombolytic therapy in the treatment for cerebral venous thrombosis].
BACKGROUND
Cerebral venous thrombosis (CVT) is uncommon with a variable clinical presentation and an unpredictable outcome. Heparin is used for first-line treatment in association with symptomatic and etiologic management. Despite adequate anticoagulation, the condition may deteriorate in some patients warranting the use of local thrombolysis (LT) known for good efficacy and safety. But there are few cases and trials upon which to base guidelines for the use of LT.


METHODS
A retrospective review of the medical and radiological records of patients with CVT was managed in the Caen hospital over a six-year period. We compared clinical factors of poor prognosis and radiological findings according to treatment delivered.


RESULTS
Thirty-six patients are treated for CVT. LT was performed in eight of them; dose-adjusted intravenous heparin was the only treatment in the 28 others. Good outcome was achieved in two thirds of the patients with functional sinus patency in all cases. Based on an analysis of the radiological data of the 36 patients, we propose a summary of radiological risk factors associated with a worsening condition despite adequate anticoagulation.


CONCLUSIONS
Based on our experience and a review of the literature which includes 98 previous cases, LT appears to be a relative effective end safe procedure even in the presence of a hemorrhagic infarct. The treatment by LT should be considered in patients who present clinical criteria of gravity and radiological risk factors associated with failure of heparin treatment. The usefulness of LT remains to be determined in a randomized trial comparing heparin alone and heparin associated with LT.
Jaillon-Riviere
V
V
Service de neurologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 5, France.
Courthéoux
P
P
Defer
G-L
GL
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012449:Safety; D015912:Thrombolytic Therapy / Q000379:methods*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D006493:Heparin