title: Sequential escalation of therapy in "malignant" cerebral venous and sinus thrombosis.
abstract: BACKGROUND
  The best treatment of fulminant or progressive cerebral venous and sinus thrombosis (CVST) despite dose-adjusted heparin remains controversial. Local thrombolysis has been successfully performed in several cases. In cases of impending herniation hemicraniectomy has been suggested as ultima ratio. We describe sequential escalation of therapy in "malignant" CVST.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  We report a case of fulminant CVST in whom sequential escalation of therapy with intravenous heparin, local thrombolysis, and hemicraniectomy was necessitated by the progressive clinical course. The patient survived with a relatively good outcome.
  
  
  CONCLUSIONS
  This first description on the combined treatment with local thrombolysis and hemicraniectomy illustrates that even in severely affected individuals, therapeutic nihilism is unwarranted and that all available therapeutic options including local thrombolysis and hemicraniectomy should be taken into consideration.
authors.affiliation: Department of Neurology, University Hospital of Cologne, Kerpenerstr. 62, 50924, Cologne, Germany. christian.dohmen@uk-koeln.de
authors.forename: Christian
authors.initials: C
authors.lastname: Dohmen
authors.forename: Norbert
authors.initials: N
authors.lastname: Galldiks
authors.forename: Walter
authors.initials: W
authors.lastname: Moeller-Hartmann
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
mesh_terms: D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000008:administration & dosage*; D001929:Brain Edema / Q000175:diagnosis; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D003131:Combined Modality Therapy; D003422:Critical Care; D056424:Decompressive Craniectomy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009460:Neurologic Examination; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator