Role of local thrombolysis in cerebral hemorrhagic venous infarct.
BACKGROUND
Chemical thrombolysis in cerebral venous thrombosis (CVT) is one of the treatment options and the data is limited.


METHODS
Prospective observational nonrandomized study.


METHODS
This is a prospective study of 10 patients (six females and four males) admitted between May 2007 and June 2013. Grading system proposed by Department of Interventional Neuroradiology (INR), King Edward Memorial Hospital (KEM), Mumbai was used to grade the clinical status at admission. There were six patients with clinical Grade 3, two with Grade 4, and two with Grade 5. Patients with either Grade less than 3 or more than Grade 5 were excluded. Those patients, who were diagnosed with Cerebral venoussinous thrombosis (CSVT) but without hemorrhagic venous infarct and treated  according to INR KEM criteria, were excluded from the study. Average duration of thrombolysis was 13 hours (range 10-18 hours). Average dose of urokinase was 12.2 lakh units (range 9.2-16.8 lakh units).


RESULTS
Six patients presented with clinical Grade 3 had modified Rankin Scale (mRS) sore of 1 at 30-day follow-up. Of the two patients with Grade 4, one had mRS 1 and the other had mRS 2 at 30-day follow-up. Of the two patients with Grade 5, one had mRS 2 at 30-day follow-up and the other did not respond to local thrombolysis and succumb to intracranial hemorrhagic infarct within 48 hours.


CONCLUSIONS
This small prospective single-center study showed local dural venous thrombolysis significantly improves clinical and radiological outcome in patients with CVT. A randomized control trial with large sample size is needed to substantiate our findings.
Department of Neurointervention Radiology and Neurology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Shaileshkumar S
SS
Garge
Virti D
VD
Shah
Nirmal
N
Surya
Satish S
SS
Khadilkar
Pranav D
PD
Modi
Sharad B
SB
Ghatge
D000328:Adult; D020520:Brain Infarction / Q000150:complications / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents