title: Intrasinus thrombolysis in cerebral venous sinus thrombosis: Experience from a university hospital, India.
abstract: BACKGROUND
  Intrasinus thrombolysis (IST) is believed to improve outcome in patients of cerebral venous sinus thrombosis (CVST) unresponsive to heparin.
  
  
  OBJECTIVE
  The purpose of this article is to describe our experience with IST in patients of CVST unresponsive to heparin.
  
  
  METHODS
  Hospital databases were searched, and patients with CVST who underwent IST from May 2011 to March 2014 were identified. Data on clinical presentation, duration of symptoms, and indications and dosage of IST were retrieved and outcomes analyzed.
  
  
  RESULTS
  Twenty-four patients received IST. The presenting symptoms included headache (n = 19), seizures (n = 16), and altered sensorium (n = 14); signs included papilledema (n = 20) and hemiparesis (n = 15). Nineteen patients received unfractionated heparin (UFH), four received low-molecular-weight heparin (LMWH), and one received both. In one patient, microcatheter could not be passed, two patients bled intracranially, and three had nonintracranial bleeds. Among four deaths, none was due to iatrogenic bleeding. On discharge, 10 patients (43.5%) had good improvement with the modified Rankin Scale (score; mRS) ≤2 and eight (34.8%) had partial improvement with mRS = 3, 4. Seventeen patients (73.9%) had mRS ≤2 at 6 months follow-up. Bleeding complications of urokinase were less than those of alteplase. Recanalization of the involved sinuses was achieved in all. Early intervention led to successful recanalization. Functional recanalization decreased intracranial bleeding.
  
  
  CONCLUSIONS
  Till date, our study is the largest series of IST in CVST reported from India. IST may be more effective than systemic heparin anticoagulation in moribund and unresponsive patients despite the potential for bleeding manifestations. Functional recanalization is adequate for good results. However, a randomized prospective study comparing heparin anticoagulation with IST is warranted.
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Neeharika L
authors: NL
authors: Mathukumalli
authors: Department of Radiology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Ram Murti
authors: RM
authors: Susarla
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Mridula R
authors: MR
authors: Kandadai
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Suryaprabha
authors: S
authors: Turaga
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Jabeen A
authors: JA
authors: Shaik
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Suvarna
authors: S
authors: Alladi
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Meena A
authors: MA
authors: Kanikannan
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Rupam
authors: R
authors: Borgohain
authors: Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India.
authors: Subhash
authors: S
authors: Kaul
keywords: Cerebral venous sinus thrombosis (CVST); intrasinus thrombolysis (IST); outcome