#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Local Thrombolysis in Severe Cerebral Venous and Sinus Thrombosis – Two Case Reports


Authors: L. Pospíšilová 1;  D. Krajíčková 1;  A. Krajina 2;  J. Náhlovský 3;  M. Vališ 1
Authors place of work: LF UK a FN Hradec Králové Neurologická klinika 1;  LF UK a FN Hradec Králové Radiologická klinika 2;  LF UK a FN Hradec Králové Neurochirugická klinika 3
Published in the journal: Cesk Slov Neurol N 2014; 77/110(1): 117-120
Category: Case Report

Summary

Unlike arterial thrombosis, cerebral venous and sinus thrombosis is a relatively rare disease, accounting for 0.5–1% of all strokes. It may be associated with serious sequelae and often affects young individuals. Currently, standard treatment involves anticoagulant therapy with intravenous heparin or subcutaneous low molecular weight heparin. Over the recent years, local thrombolysis has also been performed using recombinant tissue plasminogen activator administered directly to the clot, usually combined with simultaneous mechanical thrombectomy. Due to the continuing insufficiency of reliable evidence, this treatment is used in selected patients only. We report two cases of patients successfully treated with local thrombolysis. In the first case, thrombolysis was performed on the third day following admission to a hospital as the clinical picture did not improved despite treatment with therapeutic doses of anticoagulants. The second case is a woman who was urgently treated with local thrombolysis, to respond to her poor condition and rapidly decreasing level of consciousness on admission.

Key words:
cerebral venous and sinus thrombosis – heparin – thrombolysis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Zdroje

1. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6(2): 162–170.

2. Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis. A cross-sectional study. Stroke 2012; 43(12): 3375–3377.

3. de Bruijn SF, de Haan RJ, Stam J for the Cerebral Venous Sinus Thrombosis Study Group. Clinical features and prognostic factors of cerebral venous and sinus thrombosis in a prospective series of 59 pa­tients. J Neurol Neurosurg Psychiatry 2001; 70(1): 105–108.

4. Procházka M, Procházka V, Ľubušký M, Procházková J, Hrbáč T. Mozková žilní trombóza u uživatelek hormonální antikoncepce. Cesk Slov Neurol N 2007; 70/103(5): 521–527.

5. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35(3): 664–670.

6. Canhão P, Falcão F, Ferro JM. Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovasc Dis 2003; 15(3): 159–166.

7. Ferro JM, Lopes MG, Rosas MJ, Ferro MA, Fontes J, Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT). Long-term prognosis of cerebral vein and dural sinus thrombosis: results of the VENOPORT Study. Cerebrovasc Dis 2002; 13(4): 272–278.

8. Breteau G, Mounier-Vehier F, Godefroy O, Gauvrit JL, Mackowiak-Cordoliani MA, Girot M et al. Cerebral venous thrombosis: 3-year clinical outcome in 55 consecutive patients. J Neurol 2003; 250(1): 29–35.

9. Einhäupl K, Stam J, Bousser MG, de Bruijn SFTM, Ferro JM, Martinelli I et al. EFNS guideline on the treatment of the cerebral venous and sinus thrombosis in adult patients. Eur J Neurol 2010; 17(10): 1229–1235.

10. Saposnik G, Barinagarrementeria F, Brown RD, Bushnell CD, Cucchiara B, Cushman M et al. Diagnosis and management of cerebral venous thrombosis. A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42(4): 1158–1192.

11. Bousser MG. Cerebral venous thrombosis: nothing, heparin, or local thrombolysis? Stroke 1999; 30(3): 481–483.

12. Frey JL, Muro GJ, McDougall CG, Dean BL, Jahnke HK. Cerebral venous thrombosis: combined intrathrombus rtPA and intravenous heparin. Stroke 1999; 30(3): 489–494.

13. Kim SY, Suh JH. Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase. AJNR Am J Neuroradiol 1997; 18(4): 639–645.

14. Stam J, Majoie CBLM, van Delden OM, van Lienden KP, Reekers JA. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke 2008; 39(5): 1487–1490.

15. Zeleňák K, Zeleňáková J, Nosáľ V, Kantorová E, Kurča E, Poláček H. Kombinácia mechanickej trombektómie a lokálnej trombolýzy pri liečbe trombózy venóznych splavov. Neurológia 2012; 7(1): 29–32.

Štítky
Paediatric neurology Neurosurgery Neurology

Článok vyšiel v časopise

Czech and Slovak Neurology and Neurosurgery

Číslo 1

2014 Číslo 1
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#