[Therapeutic options in malignant cerebral venous and sinus thrombosis]

S Schönenberger1, C Geisbüsch, S Nagel

  • 1Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland, silvia.schoenenberger@med.uni-heidelberg.de.

Der Nervenarzt
|February 5, 2014
PubMed

Insights

Aggressive treatment for severe cerebral venous and sinus thrombosis (CVST) involving thrombectomy and hemicraniectomy can lead to excellent outcomes. Early intervention in high-risk CVST patients improves prognosis, reducing disability.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Intensive Care Medicine

Background:

  • Cerebral venous and sinus thrombosis (CVST) is a rare condition, predominantly affecting young women, with a significant mortality risk due to cerebral herniation.
  • Standard care for severe CVST often involves intensive treatment strategies similar to those for severe ischemic stroke.
  • This case series explores aggressive interdisciplinary management options for severe CVST.

Observation:

  • Five patients with severe CVST presented with impending or incipient cerebral herniation and profound neurological deficits.
  • These patients required immediate interventions including thrombectomy, thrombolysis, or hemicraniectomy.
  • Despite critical illness and intensive care complications, all patients survived the acute phase.

Findings:

  • Aggressive interdisciplinary management, including endovascular thrombectomy and hemicraniectomy, resulted in unexpectedly good clinical outcomes for all five patients.
  • Patients were transferred to rehabilitation without significant disability or severe dependency.
  • The study highlights the effectiveness of early and escalating treatment in preventing poor outcomes.

Implications:

  • Aggressive, early, and escalatory interdisciplinary management is crucial for patients with severe CVST at high risk of unfavorable outcomes.
  • Endovascular thrombectomy and hemicraniectomy can significantly improve clinical outcomes in life-threatening CVST cases.
  • This approach offers hope for patients facing severe neurological deficits due to CVST.
Abstract

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
482
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
469
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
415
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
19
Venous Thrombosis I: Introduction01:30

Venous Thrombosis I: Introduction

Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
822
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
749