Thrombosis cerebral venous

This category includes patients with rare causes of strokes such as nonatherosclero-tic vasculopathies, cerebral venous thrombosis, hypercoagulable states, or hematologic disorders. Two such disorders are discussed below. 

Kalbag RM, Woolf AL. Cerebral venous thrombosis. London University Press 1967. 

Ameri A, Bousser M. Cerebral venous thrombosis. Neurol Clin 1992 10 87-111. 

Bousser MG. Cerebral venous thrombosis nothing, heparin, or local thrombolysis Stroke 1999 30 481 83. 

Frey JL, Muro GJ, McDougall CG, Dean BE, Jahnke HK. Cerebral venous thrombosis combined intrathrombus rtPA and intravenous heparin. Stroke 1999 30 489 94. 

Smith AG, Cornblath WT, Deveikis JP. Local thrombolytic therapy in deep cerebral venous thrombosis. Neurology 1997 48 1613-1619. 

Holder CA, Bell DA, Lundell AL, Ulmer JL, Glazier SS. Isolated straight sinus and deep cerebral venous thrombosis successful treatment with local infusion of urokinase. J Neurosurgery 1997 86 704-707. 

Cerebral venous thrombosis associated with glucocorticoid treatment has rarely been reported. A relation between glucocorticoids and venous thrombosis has already been suggested but has never been clearly understood. Three young patients, two women (aged 28 and 45)... 

A 40-year-old Korean woman who had taken oxy-metholone for aplastic anemia (doses not stated) developed cerebral venous thrombosis accompanied by a tentorial subdural hematoma (30). 

Chu K, Kang DW, Kim DE, Roh JK. Cerebral venous thrombosis associated with tentorial subdural hematoma during oxymetholone therapy. J Neurol Sci 2001 185(l) 27-30. 

Although the authors pointed to the absence of risk factors other than the drug, it must be remembered that cerebral venous thrombosis is a recognized complication... 

Twenty-five percent ofthrombophilic patients develop thrombosis at unusual sites resulting in cerebral venous thrombosis, mesenteric vein thrombosis, hepatic venous thrombosis, retinal vein thrombosis, purpura fulminans, splenic vein thrombosis, portal vein thrombosis, renal vein thrombosis, or axillary vein thrombosis. The thrombotic disorders may involve inflammatory factors that contribute to the vascular deficit. In addition, embolic events also play a role in the development of these thrombotic complications. 

Thrombosis of superficial and deep cerebral veins as well as the venous sinuses is referred to as cerebral venous thrombosis, Advances in imaging techniques are making it possible to diagnose these conditions more frequently. The clinical features of cerebral vein thrombosis include headache,... 

In children the majority of cases of cerebral venous thrombosis occur under the age of I year, The optimal diagnostic test is MRI with MRV CT is less sensitive than MRI, The treatment of cerebral venous thrombosis in children is controversial. While some clinicians use anticoagulants, others prefer to treat conservatively,... 

Fig. 1.4. Patient with cerebral venous thrombosis. Venous MRA demonstrates occlusion of the sagittal sinus. MRI shows an intracranial hemorrhage, the typical complication of cerebral venous thrombosis. (Courtesy of Prof, von Kummer)...

Bornstein NM, Norris JW (1986) Subclavian steal a harmless haemodynamic phenomenon Lancet 2 303-305 Bousser MG, Chiras J, Bories J et al (1985) Cerebral venous thrombosis-a review of 38 cases. Stroke 16 199-213 Brandt T, Dieterich M (1993) Skew deviation with ocular torsion a vestibular brainstem sign of topographic diagnostic value. Ann Neurol 33 528-534... 

Chu K, Kang DW, Yoon BW, Roh JK (2001) Diffusion-weighted magnetic resonance in cerebral venous thrombosis. Arch Neurol 58 1569-1576... 

Cantu C, Barinagarrementeria F (1993) Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke 24 1880-1884... 

Deschiens MA, Conard J, Horellou MH, Ameri A, Preter M, Chedru F, Samana MM, Bousser MG (1996) Coagulation studies, factor V Leiden,and anticardiolipin antibodies in 40 cases of cerebral venous thrombosis. Stroke 27 1724-1730... 

Akins PT, Glen S, Nemeth PM et al. (i996). Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis. Stroke 27 i002-i005 Al-Hakim M, Katirji MB, Osorio I et al. (i993). Cerebral venous thrombosis in paroxysmal... 

Thrombosis in the dural sinuses or cerebral veins is much less common than cerebral arterial thromboembolism. It causes a variety of clinical syndromes, which often do not resemble stroke (Bousser and Ross Russell 1997). While ischemic arterial stroke and cerebral venous thrombosis share some causes (Southwick et al. 1986), others are specific to cerebral venous thrombosis (Table 29.1). A particularly high index of suspicion is required in women on the oral contraceptive pill (Saadatnia and Tajmirriahi 2007) and in the puerperium. In the past, cerebral venous thrombosis was strongly associated with otitis media and mastoiditis, lateral sinus thrombosis or otitic hydrocephalus, but the most common causes are now pregnancy and the puerperium, which cause 5-20% of the cerebral venous thrombosis in the developed world, the oral contraceptive pill, malignancy, dehydration, inflammatory disorders and hereditary coagulation disorders. No cause is found in around 20% of cases. 

Headache, papilloedema and a normal CT scan should raise the possibility of cerebral venous thrombosis. Often cerebral venous thrombosis is not considered until other diagnoses have been excluded, particularly when the presentation is atypical. However, it is not a diagnosis of exclusion - it must be confirmed on imaging. 

Magnetic resonance imaging has greater sensitivity than CT for the changes of cerebral venous thrombosis (Bousser and Ross Russell 1997 Ferro et at 2007). In the acute phase, at less than three to five days, the thrombus is isointense on both Ti- and T2-weighted sequences. Subsequently, the thrombus becomes hyperintense (Fig. 29.3). After two to three weeks, findings depend on whether or not the sinus remains occluded or whether it is partly or completely recanalized. 

Cerebral angiography with late venous views is the gold standard for the diagnosis of cerebral venous thrombosis. Nowadays, this should only be performed in those cases where the diagnosis remains in doubt after MRI. There should be total or partial occlusion of... 

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