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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Cerebral Venous Thrombosis
Susanna M Zuurbier1, Jonathan M Coutinho2
1Department of Neurology, Academic Medical Center - University of Amsterdam, Room H2-218, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
Insights
Cerebral venous thrombosis (CVT) is a significant cause of stroke in young adults, predominantly affecting women. Treatment involves anticoagulation, with surgery reserved for severe cases, leading to generally favorable outcomes.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Cerebral venous thrombosis (CVT) is a critical cause of stroke, particularly in younger populations.
- CVT disproportionately affects women, with a 3:1 ratio compared to men.
- Common symptoms include headache, seizures, and focal neurological deficits.
Purpose of the Study:
- To review the epidemiology, diagnosis, risk factors, and management of cerebral venous thrombosis.
- To highlight the diagnostic modalities and therapeutic strategies for CVT.
- To discuss the prognosis and potential long-term sequelae of CVT.
Main Methods:
- Review of existing literature on cerebral venous thrombosis.
- Analysis of diagnostic techniques such as MRI, CT-venography, and catheter angiography.
- Evaluation of treatment options including anticoagulation, endovascular therapy, and decompressive surgery.
Main Results:
- Intracerebral hemorrhage occurs in approximately 40% of CVT patients.
- Anticoagulation with heparin is the primary treatment, with low-molecular weight heparin often preferred.
- Decompressive surgery may be life-saving in cases of impending herniation.
Conclusions:
- Cerebral venous thrombosis requires prompt diagnosis and management.
- While prognosis is generally favorable compared to arterial stroke, chronic symptoms can persist.
- Further randomized trials are needed to confirm the efficacy of endovascular treatments.
Abstract:
Cerebral venous thrombosis is an important cause of stroke in the young. Unlike venous thromboembolism (VTE), women are affected three times more often than men by CVT. The most common symptoms are headache, seizures and focal neurological deficits. The diagnosis can be confirmed with MRI, CT-venography, or catheter angiography. An intracerebral hemorrhage is found on cerebral imaging in approximately 40 % of patients, and can range from small juxtacortical hemorrhages to large space-occupying lesions. Many risk factors for CVT have been reported, most of which overlap with those of VTE. The primary therapy for CVT is anticoagulation with heparin, based on limited evidence from randomized trials. Both unfractionated or low-molecular weight heparin can be used to treat CVT, although the latter is generally preferable. Small studies have shown promising results of endovascular treatment in severe patients, but these data require confirmation in a randomized trial. In patients who develop clinical and radiological signs of impending herniation decompressive surgery can be both life-saving and result in a good functional outcome. The prognosis is nowadays favorable in most cases, especially compared to arterial stroke, although a significant proportion of patients do suffer from chronic symptoms.
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