ABSTRACT
The only randomized data on heparin treatment in acute cerebral sinus venous thrombosis (CSVT) are derived from a small number of patients. The rate of intracranial hemorrhages as a complication of high-dose heparin treatment is still unknown. This retrospective study evaluates the clinical features, neuroimaging monitoring and outcome of 42 patients with proven CSVT. Diagnosis was established by DSA, CT, MR tomography and MR angiography. All patients received heparin intravenously guided by doubling the aPTT value for 3 weeks, followed by oral anticoagulation. Partial or complete recanalization was found in 36 cases. 40 patients improved clinically, in 26 of them complete recovery was observed. One patient deteriorated and developed an apallic syndrome, one further patient died of septic multiorgan failure. Only in one patient was hemorrhagic transformation of infarcted brain tissue observed but without clinical deterioration.
Subject(s)
Fibrinolytic Agents/administration & dosage , Heparin/administration & dosage , Intracranial Embolism and Thrombosis/drug therapy , Venous Thrombosis/drug therapy , Acute Disease , Adolescent , Adult , Aged , Cerebral Angiography , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/drug therapy , Cerebral Veins/physiopathology , Female , Humans , Intracranial Embolism and Thrombosis/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Occipital Lobe/blood supply , Retrospective Studies , Temporal Lobe/blood supply , Venous Thrombosis/diagnosisABSTRACT
A 47 year old male patient with Miller-Fisher-syndrome did not respond to treatment with plasmapheresis and intravenous high dose 7 S immune globulins. Only cerebrospinal fluid pheresis, administered as final alternative, lead to definite improvement and cure.
Subject(s)
Immunoglobulin G/cerebrospinal fluid , Miller Fisher Syndrome/therapy , Ultrafiltration , Female , Humans , Male , Middle Aged , Miller Fisher Syndrome/cerebrospinal fluid , Miller Fisher Syndrome/immunology , Neurologic Examination , Plasmapheresis , Treatment FailureABSTRACT
The case of a 67 year old patient with ileus caused by multiple carcinoids of ileum without endocrine symptoms is reported. Frequency, localisation and ways of metastasation , so as diagnostic and therapeutic possibilities are discussed.
