Monitoring of Venous Hemodynamics in Patients With Cerebral Venous Thrombosis by Transcranial Doppler Ultrasound

Valdueza, José M.; Hoffmann, Olaf; Weih, Markus; Mehraein, S.; Einhäupl, Karl M.

doi:10.1001/archneur.56.2.229

Cited by 54 publications

(25 citation statements)

References 22 publications

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“…In this study, drainage pattern correlated with the presence of headaches and disturbed consciousness. Despite controversies with the results of Valdueza and coworkers, 10 our data show that the extent of venous flow disturbance and drainage type are related to the initial clinical picture in acute CVT. …”

Section: Discussioncontrasting

confidence: 70%

“…5,10,11 Sixty-nine percent of patients in this study displayed pathological venous FVs or directions. This has implications for TCCS as a diagnostic tool; the method may positively confirm CVT in more than two thirds of cases but cannot rule out the condition.…”

Section: Discussionmentioning

confidence: 72%

“…Yet, the golden standard of diagnosis remains digital subtraction angiography. Valdueza and coworkers 10 were the first to link venous hemodynamics to clinical parameters in CVT. They reported that the extent of venous FV increase was related to the degree of disturbed consciousness.…”

Section: Discussionmentioning

confidence: 99%

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Intracranial Venous Hemodynamics Is a Factor Related to a Favorable Outcome in Cerebral Venous Thrombosis

Stolz

Gerriets

Bödeker

et al. 2002

Stroke

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Background-In recent studies, coma, cerebral hemorrhage, older age, and infectious origin have been identified as prognostic factors in cerebral venous thrombosis (CVT). However, no studies of the prognosis of CVT have evaluated hemodynamic factors. However, it is conceivable that the presence or absence and the efficiency of venous collaterals, as well as recanalization, may have an impact on brain tissue damage and hence on the prognosis of acute CVT. Methods-Twenty-six patients with acute CVT (mean age, 40Ϯ15 years) were recruited prospectively. All patients were treated with intravenous heparin, followed by oral anticoagulation for 12 months, except for 2 patients who were lost to follow-up after hospital discharge. Neurological deficits were graded on the National Institute of Health Stroke Scale on admission, at hospital discharge, and at 90Ϯ14 days after admission. The functional clinical outcome was graded on the modified Rankin Scale on day 90 after admission. All patients received a venous transcranial duplex sonography (TCCS) on admission and were followed up in case of a pathological result until normalization was recorded (mean follow-up, 316Ϯ395 days; range, 13 to 1180 days). Results-Initial TCCS was pathological in 18 of 26 patients (69%). Four distinct venous drainage types were identified: increased drainage to the cavernous sinus and to the deep cerebral veins, flow reversal in the basal veins, and either compensatory increased or reversed flow in the transverse sinus. Initially normal venous TCCS or normalized TCCS within 90 days was significantly related to favorable outcome. Conclusions-TCCS can be used to evaluate venous drainage patterns in acute CVT. Furthermore, initially normal and normalization of initially pathological venous TCCS within 90 days is related to a favorable outcome in this disease.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 72%

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Intracranial Venous Hemodynamics Is a Factor Related to a Favorable Outcome in Cerebral Venous Thrombosis

Stolz

Gerriets

Bödeker

et al. 2002

Stroke

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“…Doppler studies documented that flow is slower in the transverse sinus 23 and the greater volume of this sinus and longer duration of symptoms before diagnosis of thrombosis may predispose to propagation and to organization of the thrombus. In addition, septic thrombophlebitis may cause a more aggressive endothelial injury.…”

Section: 15mentioning

confidence: 99%

Cerebral sinovenous thrombosis in children: Clinical presentation and extension, localization and recanalization of thrombosis

Vieira

Luís

Monteiro

et al. 2010

European Journal of Paediatric Neurology

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“…In der Time-of-flight-Angiographie (g,h) erscheinen Confluens und linker Sinus transversus mit fehlendem und der Sinus sagittalis superior mit vermindertem Signal Aufgrund der ungenügenden Datenlage und der noch stark limitierten Auflö-sung der TCCS ist eine ausschließlich ultraschallbasierte Diagnose zzt.nicht mög-lich [5, 6, 90,99]. Prinzipiell könnten mit der TCCS hämodynamische Aspekte einer venösen Thrombose wie z.B.das Ausmaß und die Rekrutierung kollateraler Abflusswege erfasst werden,zumal in diesem Fall erhöhte venöse Flüsse gut darstellbar sind [99,105,106].Möglicherweise gelingt es in Zukunft mit dem Ultraschall, den Krankheitsverlauf besser zu überwachen, eine Rekanalisation frühzeitig zu erfassen und eine pathophysiologisch begründete Steuerung der Therapie zu ermöglichen. Mit den bisher verfügbaren Techniken ist dies noch nicht möglich.…”

Section: Vergleich Mr-und Ct-venographieunclassified

Aktuelle Probleme der Diagnose und Therapie zerebraler Venen- und duraler Sinusthrombosen

et al. 2003

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Over the last few years, the results from clinical studies and innovative radiological approaches have significantly altered the management of patients with cerebral venous thrombosis. In contrast to previously held beliefs, cerebral venous thrombosis is considered to be a relatively benign disease with an overall favourable prognosis. Mortality is <10%, and the vast majority of patients recover completely. Although the efficacy of heparin has not been unequivocally proven, it is employed in most centres as the standard therapy. There are not sufficient data supporting long-term anticoagulation. In patients with a proven hypercoagulability syndrome, anticoagulation therapy is generally recommended for a period of 6 months. Whether patients with idiopathic thrombosis should also be treated remains controversial. Non-invasive MR and CT angiography techniques have largely replaced conventional angiography for initial evaluation and follow-up examinations. Both methods have a high sensitivity for cerebral venous thrombosis. Local fibrinolytic therapy or other aggressive recanalizing methods can not be generally recommended.

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Monitoring of Venous Hemodynamics in Patients With Cerebral Venous Thrombosis by Transcranial Doppler Ultrasound

Abstract: Serial TCD studies allow monitoring of venous hemodynamics and collateral pathways in patients with CVT. Normal venous velocities in serial measurements, however, do not exclude a diagnosis of CVT.

Cited by 54 publications

References 22 publications

Intracranial Venous Hemodynamics Is a Factor Related to a Favorable Outcome in Cerebral Venous Thrombosis

Intracranial Venous Hemodynamics Is a Factor Related to a Favorable Outcome in Cerebral Venous Thrombosis

Cerebral sinovenous thrombosis in children: Clinical presentation and extension, localization and recanalization of thrombosis

Aktuelle Probleme der Diagnose und Therapie zerebraler Venen- und duraler Sinusthrombosen

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