eMedicine Specialties > Neurology > Neuro-vascular Diseases

Cerebral Venous Thrombosis: Follow-up

Author: W Alvin McElveen, MD, Director, Stroke Unit, Lakewood Ranch Medical Center; Neurologist, Manatee Memorial Hospital
Coauthor(s): Ralph F Gonzalez, MD, Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Blake Hospital, Lakewood Ranch Medical Center, Manatee Memorial Hospital; Andrew P Keegan, MD, Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Manatee Memorial Hospital, Lakewood Ranch Medical Center, Blake Medical Center
Contributor Information and Disclosures

Updated: Nov 5, 2008

Follow-up

Prognosis

Smith compared outcomes of patients treated with heparin and local infusion of urokinase with those of patients who received no treatment.18 Twelve patients received treatment and 21 patients received no treatment. Results are tabulated below.

Patients With Cerebral Venous Thrombosis Treated With Heparin and Local Infusion of Urokinase vs Nontreated Group

Open table in new window

[ CLOSE WINDOW ]
Table


Treated Group, % (n = 12)
Nontreated Group, % (n = 21)
Full recovery62.529
Mild disability12.513
Severe disability12.59.6
Fatal outcome12.548
Treated Group, % (n = 12)
Nontreated Group, % (n = 21)
Full recovery62.529
Mild disability12.513
Severe disability12.59.6
Fatal outcome12.548


Miscellaneous

Medicolegal Pitfalls

Potential medical/legal pitfalls involve failure to properly diagnose associated conditions. Following are some examples:

  • Failure to aggressively treat frontal sinusitis leading to subdural empyema or cerebral venous thrombosis (CVT)
  • Failure to consider MRI or MRV in patients with pseudotumor cerebri to look for lateral sinus thrombosis (unless other etiology is found)
  • Failure to consider CVT in patients with thunderclap headache; since such headache is not limited to SAH and may be seen with CVT, lack of evidence of SAH should prompt MRV
  • Failure to check patients with CVT for associated medical conditions such as hypercoagulable states, nephrotic syndrome, pregnancy, liver disease, and inflammatory bowel disease
  • Failure to consider medications that might lead to CVT, such as steroids and oral contraceptives
  • Failure to distinguish normal anatomic gaps in the dural sinuses from thrombosis on MRV

 


More on Cerebral Venous Thrombosis

Overview: Cerebral Venous Thrombosis
Differential Diagnoses & Workup: Cerebral Venous Thrombosis
Treatment & Medication: Cerebral Venous Thrombosis
Follow-up: Cerebral Venous Thrombosis
Multimedia: Cerebral Venous Thrombosis
References
[ CLOSE WINDOW ]

References

  1. Towbin A. The syndrome of latent cerebral venous thrombosis: its frequency and relation to age and congestive heart failure. Stroke. May-Jun 1973;4(3):419-30. [Medline].

  2. Daif A, Awada A, al-Rajeh S, et al. Cerebral venous thrombosis in adults. A study of 40 cases from Saudi Arabia. Stroke. Jul 1995;26(7):1193-5. [Medline].

  3. Ferro JM, Lopes MG, Rosas MJ, et al. Long-Term Prognosis of Cerebral Vein and Dural Sinus Thrombosis. results of the venoport study. Cerebrovasc Dis. 2002;13(4):272-8. [Medline].

  4. Buccino G, Scoditti U, Patteri I, et al. Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis. Acta Neurol Scand. May 2003;107(5):330-5. [Medline].

  5. Ameri A, Bousser MG. Cerebral venous thrombosis. Neurol Clin. Feb 1992;10(1):87-111. [Medline].

  6. Oppenheim C, Domigo V, Gauvrit JY, et al. Subarachnoid hemorrhage as the initial presentation of dural sinus thrombosis. AJNR Am J Neuroradiol. Mar 2005;26(3):614-7. [Medline].

  7. Farb RI, Vanek I, Scott JN, et al. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. May 13 2003;60(9):1418-24. [Medline].

  8. Tardy B, Tardy-Poncet B, Viallon A, et al. D-dimer levels in patients with suspected acute cerebral venous thrombosis. Am J Med. Aug 15 2002;113(3):238-41. [Medline].

  9. Lalive PH, de Moerloose P, Lovblad K, et al. Is measurement of D-dimer useful in the diagnosis of cerebral venous thrombosis?. Neurology. Oct 28 2003;61(8):1057-60. [Medline].

  10. Kosinski CM, Mull M, Schwarz M, et al. Do normal D-dimer levels reliably exclude cerebral sinus thrombosis?. Stroke. Dec 2004;35(12):2820-5. [Medline].

  11. Adams WM, Laitt RD, Beards SC, et al. Use of single-slice thick slab phase-contrast angiography for the diagnosis of dural venous sinus thrombosis. Eur Radiol. 1999;9(8):1614-9. [Medline].

  12. Ayanzen RH, Bird CR, Keller PJ, et al. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol. Jan 2000;21(1):74-8. [Medline].

  13. Mas JL, Meder JF, Meary E, Bousser MG. Magnetic resonance imaging in lateral sinus hypoplasia and thrombosis. Stroke. Sep 1990;21(9):1350-6. [Medline].

  14. Ozsvath RR, Casey SO, Lustrin ES, et al. Cerebral venography: comparison of CT and MR projection venography. AJR Am J Roentgenol. Dec 1997;169(6):1699-707. [Medline].

  15. de Bruijn SF, Stam J, Vandenbroucke JP. Increased risk of cerebral venous sinus thrombosis with third- generation oral contraceptives. Cerebral Venous Sinus Thrombosis Study Group. Lancet. May 9 1998;351(9113):1404. [Medline].

  16. Einhaupl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet. Sep 7 1991;338(8767):597-600. [Medline].

  17. Ekseth K, Bostrom S, Vegfors M. Reversibility of severe sagittal sinus thrombosis with open surgical thrombectomy combined with local infusion of tissue plasminogen activator: technical case report. Neurosurgery. Oct 1998;43(4):960-5. [Medline].

  18. Smith AG, Cornblath WT, Deveikis JP. Local thrombolytic therapy in deep cerebral venous thrombosis. Neurology. Jun 1997;48(6):1613-9. [Medline].

  19. Benamer HT, Bone I. Cerebral venous thrombosis: anticoagulants or thrombolyic therapy?. J Neurol Neurosurg Psychiatry. Oct 2000;69(4):427-30. [Medline].

  20. Cipri S, Gangemi A, Campolo C, et al. High-dose heparin plus warfarin administration in non-traumatic dural sinuses thrombosis. A clinical and neuroradiological study. J Neurosurg Sci. Mar 1998;42(1):23-32. [Medline].

  21. D'Alise MD, Fichtel F, Horowitz M. Sagittal sinus thrombosis following minor head injury treated with continuous urokinase infusion. Surg Neurol. Apr 1998;49(4):430-5. [Medline].

  22. Davis KR, Kistler JP, Buonanno FS. Clinical neuroimaging approaches to cerebrovascular diseases. Neurol Clin. Nov 1984;2(4):655-65. [Medline].

  23. Gold Standard Multimedia. Urokinase, Altevase, Streptokinase, Heparin, Warfarin. Clinical Pharmacology. 2000;Available at:http://cp.gsm.com/. [Full Text].

  24. Gomez CR, Misra VK, Terry JB, et al. Emergency endovascular treatment of cerebral sinus thrombosis with a rheolytic catheter device. J Neuroimaging. Jul 2000;10(3):177-80. [Medline].

  25. Gustafsson D, Elg M. The pharmacodynamics and pharmacokinetics of the oral direct thrombin inhibitor ximelagatran and its active metabolite melagatran: a mini-review. Thromb Res. Jul 15 2003;109 Suppl 1:S9-15. [Medline].

  26. Jacobs K, Moulin T, Bogousslavsky J, et al. The stroke syndrome of cortical vein thrombosis. Neurology. Aug 1996;47(2):376-82. [Medline].

  27. Leys D, Cordonnier C. Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management. Ann Indian Acad Neurol. 2008;11:79-87. [Full Text].

  28. Meyer-Lindenberg A, Quenzel EM, Bierhoff E, et al. Fatal cerebral venous sinus thrombosis in heparin-induced thrombotic thrombocytopenia. Eur Neurol. 1997;37(3):191-2. [Medline].

  29. Zweifler RM. Management of acute stroke. South Med J. Apr 2003;96(4):380-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

cerebral venous thrombosis, CVT, sagittal sinus thrombosis, lateral sinus thrombosis, jugular foramen syndrome, cavernous sinus thrombosis, thrombus, clotting, blood clot, cerebral hemorrhage, venous thrombosis, cranial nerve palsies, cerebral infarction

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

W Alvin McElveen, MD, Director, Stroke Unit, Lakewood Ranch Medical Center; Neurologist, Manatee Memorial Hospital
W Alvin McElveen, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Neuroimaging, American Stroke Association, and Southern Clinical Neurological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Ralph F Gonzalez, MD, Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Blake Hospital, Lakewood Ranch Medical Center, Manatee Memorial Hospital
Ralph F Gonzalez, MD is a member of the following medical societies: American Academy of Neurology and Florida Medical Association
Disclosure: Nothing to disclose.

Andrew P Keegan, MD, Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Manatee Memorial Hospital, Lakewood Ranch Medical Center, Blake Medical Center
Andrew P Keegan, MD is a member of the following medical societies: American Academy of Neurology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Norman C Reynolds Jr, MD, Neurologist, Veterans Affairs Medical Center of Milwaukee; Professor Medical College of Wisconsin (retired)
Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.