Incidence and epidemiology of cerebral venous thrombosis

Cerebral venous sinus thrombosis is a disorder whose epidemiology has changed over the past few decades. It is no longer regarded as a uniformly fatal disease. CVST is not a rare disorder. It may have a differential geographic distribution with a higher incidence in the Asian world. It is a disease of neonates, younger women and men, often a hypercoagulable state, either acquired [eg cancer] or a genetic prothrombotic condition may be present. Outcome is not uniformly dismal and prognostic criteria that detect patients with a poor outcome have become available from prospective studies. There is a paucity of well designed large scale epidemiologic studies focused on venous thrombosis from regions where it is relatively frequent [South Asia, Middle East]. The newer epidemiologic data derived from a Caucasian database; suggest a better overall prognosis, younger age at distribution than arterial stroke

Pathophysiology of cerebral venous thrombosis - an overview

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described.A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g. hemiparesis and global signs due to raised ICP from an obstructed venous system - papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations

Thrombolytic therapy in cerebral venous sinus thrombosis

The use of thrombolytic agents to rapidly lyse the clot has emerged as a therapeutic modality, in concert with interventional neuroradiologic approaches to deliver the agent locally at the site of thrombosis.There are no randomized, double blind, placebo, controlled trials to support thrombolysis as a first line therapy in patients with cerebral venous sinus thrombosis compared to standard therapy using anticoagulation with weight based dose adjusted unfractionated Heparin. Numerous case reports and a single non randomized trial have shown that it is comparatively safe and may rescue patients who are deteriorating despite anticoagulation with unfractionated Heparin. Consideration must be given to the use of thrombolysis in this group. This is an approach that must be restricted to centers with considerable experience in neurointerventional therapy

Heparin in the treatment of cerebral venous thrombosis

Cerebral venous thrombosis [CVT] is a potentially life-threatening condition requiring rapid diagnosis and urgent treatment. Heparin anticoagulation is the time-honoured treatment, and is advocated in all cases of CVT, irrespective of etiology or presence of haemorrhage. The supportive evidence is largely observational; data from randomized placebo-controlled trials shows a nonsignificant trend favouring heparin. Current practice is to begin heparin [unfractionated or low-molecular weight] immediately on confirmation of the diagnosis. Newer anti-thrombotic agents such as ximelagatran may offer advantages over heparin and need to be investigated in the treatment of CVT

Complications associated with cerebral venous thrombosis

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided. The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary embolism. In the chronic stages of CVT, one may encounter dural AV - fistula, progressive psychiatric disease, residual epilepsy and recurrence. Cerebral venous sinus thrombosis is associated with unique acute and chronic complications, some of them may be avoidable e.g. pulmonary embolism. The chronic complications are rare but are potentially treatable e.g. dural AVFistula nidus obliteration with intervention

Isolated deep venous thrombosis - case series, literature review and long term follow up

Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are reported. Even when one patient required intubation and mechanical ventilation for stupor, both had excellent neurologic recovery. Over 6 years of follow up there has been no recurrence. In spite of stupor at presentation, complete recovery is possible without long term recurrence