Deep Cerebral Venous Thrombosis

Abstract

A 43-year-old woman was su¤ering from an upper respiratory infection during the previous 7 days, followed by 3 days of severe headache. She was deeply drowsy 8 hours prior to admission. She had paranasal sinusitis (PNS) and had been for several years. Neurological examination revealed hyperreflexia. Analysis of the cerebrospinal fluid showed increased pressure, slightly turbid, 250 WBCs/cm 3 , 350 RBCs with a normal sugar level and protein of 540 mg/dl, oligoclonal band positive, and myelin sheath protein positive. The brain computed tomogram (CT) upon admission revealed a high-density thrombus in the vein of Galen and the straight sinus, and a marked bilateral hypodensity of the thalamus and the basal ganglia Fig. 1A). T2-weighted MRI revealed a high signal in the thalami, the basal ganglia, and the periventricular white matter Fig. 1B). The venous phase of carotid angiography demonstrated a lack of opacification of the deep cerebral veins, the inferior sagittal sinus, the vein of Galen, and the straight sinus Fig. 1C). Intravenous 1,500,000 IU of a bolus urokinase (UK) dosage was infused through the vein, and over the next 2 hours, 1,500,000 IU of UK was infused continuously. After UK infusion was finished, heparin was infused at 750 U per hour for the next two days. She was then given aspirin and coumadin. The patient awoke 2 days after treatment. A Follow-up CT, obtained 4 days later, demonstrated the resolution of the thalamic infarctions and straight sinus thrombus with a high density Fig. 1D). Cerebral angiography, obtained 3 weeks after the onset of the illness, disclosed recanalization of the deep cerebral vein Fig. 1E). The patient recovered dramatically.

Systemic Thrombolysis for Cerebral Venous and Dural Sinus Thrombosis: A Systematic Review

“…The following were excluded: 66 because only anticoagulation and/or other treatment modalities, but no thrombolytic treatment, were used to treat the patients; 23 because local and/or mechanical thrombolysis was used, with or without systemic thrombolysis; 1 because CVT was diagnosed by CT only; and 3 because they were written in languages (Japanese, Chinese and Finnish) for which translation could not be obtained. Two cases from the ISCVT [8] and 7 additional studies [14,15,16,17,18,19,20], which were identified by manual review of references, were included. Therefore, 16 studies [8,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27], totaling 26 patients, were included in the review (fig.…”

“…All studies were case reports or case series. Two studies [19,22] reported on 5 patients and 10 studies [13,14,15,16,17,18,21,23,26,27] were single-case reports. Hence, the quality of the evidence was poor.…”