ABSTRACT
OBJECTIVES: Newer oral anticoagulants like rivaroxaban are increasingly becoming the mainstay of treatment in systemic thrombosis. However cerebral venous thrombosis (CVT) is conventionally treated with heparin followed by oral vitamin K antagonists. Currently very little information is available about the use of rivaroxaban in CVT. Rivaroxaban has been used only after the initial treatment with heparin in the available studies. PATIENTS & METHODS: All patients with CVT between January 2017 and June 2017 were initiated directly on oral rivaroxaban. Critically ill patients including those requiring surgical intervention were excluded. The modified Rankin scale was used to assess clinical severity and a scale of 0-1 was defined as excellent outcome. Recanalization was assessed at 3 months follow-up with MR angiography. Complications of the drug including bleeding episodes during treatment and at follow-up were noted. RESULTS: Twenty patients were initiated on rivaroxaban and followed up for a mean duration of 6 months. Eighty percent (16/20) were males and the mean age was 34.1 years. Associated cerebral hemorrhagic infarcts were seen in 11(55%).Outcome was excellent in 19(95%). Complete recanalization was noted in 12(60%) and partial recanalization in 8(40%). No complications emerged out of the drug use. CONCLUSIONS: In clinically stable CVT rivaroxaban is safe and effective and may be used without previous heparin therapy. This can shorten the duration of hospitalization thereby decreasing the costs of treatment.
Subject(s)
Factor Xa Inhibitors/administration & dosage , Heparin , Intracranial Thrombosis/drug therapy , Rivaroxaban/administration & dosage , Venous Thrombosis/drug therapy , Administration, Oral , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Intracranial Thrombosis/diagnostic imaging , Male , Middle Aged , Prospective Studies , Treatment Outcome , Venous Thrombosis/diagnostic imaging , Young AdultSubject(s)
Posterior Leukoencephalopathy Syndrome/diagnosis , Subarachnoid Hemorrhage/diagnosis , Adult , Diagnosis, Differential , Headache/etiology , Humans , Hypertension , Magnetic Resonance Imaging , Male , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Hemispherotomy is the currently preferred surgical treatment option for refractory unihemispheric epilepsies. The incidence of hydrocephalus is greatly reduced in this disconnective procedure when compared with the resective procedure of anatomical hemispherectomy. We describe the occurrence of ipsilateral trapped lateral ventricle months after hemispherotomy for Rasmussen's encephalitis. There is enough evidence to suggest that this rare and interesting complication is due to the local inflammatory changes associated with the surgical trauma.
