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Cerebral Venous Sinus Thrombosis Treatment
Carlos E. Baccin, MD; James D. Rabinov, MD
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KEY FACTS

  • Terminology

    • Pre-Procedure

      • Procedure

        • Post-Procedure

          TERMINOLOGY

          • Definitions

            • Cerebral venous sinus occlusive disease (VSOD): Vaso-occlusive disease in which there is thrombosis of intracranial dural sinuses &/or cerebral veins
              • Also known as dural venous sinus thrombosis
                • 75% of adult cases occur in women
                • Etiology of 1% of acute strokes
                • No cause for VSOD identified in 20-25% of cases
              • Wide spectrum of predisposing causes
                • Trauma
                • Infection/inflammation
                  • Meningitis
                  • Local spread from adjacent sinusitis
                • Cigarette smoking
                • Pregnancy, oral contraceptives
                • Hematological (hypercoagulable state)
                • Inherited predisposing conditions
                  • Activated protein C resistance (usually factor V Leiden); most common cause of sporadic VSOD
                  • Protein S deficiency
                  • Prothrombin factor II gene mutation: G20210A
                  • Antithrombin III deficiency
                • Collagen-vascular disease (e.g., antiphospholipid antibody syndrome)
                • Vasculitis (e.g., Behçet)
                • Drug-related (e.g., androgens, ecstasy)
              • Typical pathophysiology progression
                • Thrombus initially forms in dural sinus
                  • Clot propagates into cortical veins
                • Obstructed venous drainage causes elevated venous pressure
                • Blood-brain barrier breakdown; vasogenic edema
                • Ensuing venous infarct with cytotoxic edema
                • Leads to petechial/parenchymal hemorrhage
              • Potential sites of thrombosis
                • Cortical veins
                • Venous sinuses
                • Deep intracerebral veins
                • Jugular veins

          PRE-PROCEDURE

          • Indications

            • Contraindications

              • Pre-Procedure Imaging

                • Getting Started

                  PROCEDURE

                  • Procedure Steps

                    • Alternative Procedures/Therapies

                      POST-PROCEDURE

                      • Expected Outcome

                        • Things to Do

                          OUTCOMES

                          • Problems

                            • Complications

                              Selected References

                              1. Blackham KA: Extensive dural sinus thrombosis: successful recanalization with thrombolysis and a novel thrombectomy device. J Neurosurg. 114(1):133-5, 2011
                              2. Giraldo EA et al: The "cord sign" in cerebral venous thrombosis associated with high plasma levels of factor VIII. Neurocrit Care. 15(1):186-9, 2011
                              3. Coutinho JM et al: Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke. 41(11):2575-80, 2010
                              4. Nagai M et al: Roles of inflammation and the activated protein C pathway in the brain edema associated with cerebral venous sinus thrombosis. Stroke. 41(1):147-52, 2010
                              5. Ferro JM et al: Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 28(1):39-44, 2009
                              6. Khan SH et al: Intracranial dural sinus thrombosis: novel use of a mechanical thrombectomy catheter and review of management strategies. Clin Med Res. 7(4):157-65, 2009
                              7. Lv X et al: Intraarterial and intravenous treatment of transverse/sigmoid sinus dural arteriovenous fistulas. Interv Neuroradiol. 15(3):291-300, 2009
                              8. Saadatnia M et al: Cerebral venous sinus thrombosis risk factors. Int J Stroke. 4(2):111-23, 2009
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Pre-Procedure

                                  • Procedure

                                    • Post-Procedure

                                      TERMINOLOGY

                                      • Definitions

                                        • Cerebral venous sinus occlusive disease (VSOD): Vaso-occlusive disease in which there is thrombosis of intracranial dural sinuses &/or cerebral veins
                                          • Also known as dural venous sinus thrombosis
                                            • 75% of adult cases occur in women
                                            • Etiology of 1% of acute strokes
                                            • No cause for VSOD identified in 20-25% of cases
                                          • Wide spectrum of predisposing causes
                                            • Trauma
                                            • Infection/inflammation
                                              • Meningitis
                                              • Local spread from adjacent sinusitis
                                            • Cigarette smoking
                                            • Pregnancy, oral contraceptives
                                            • Hematological (hypercoagulable state)
                                            • Inherited predisposing conditions
                                              • Activated protein C resistance (usually factor V Leiden); most common cause of sporadic VSOD
                                              • Protein S deficiency
                                              • Prothrombin factor II gene mutation: G20210A
                                              • Antithrombin III deficiency
                                            • Collagen-vascular disease (e.g., antiphospholipid antibody syndrome)
                                            • Vasculitis (e.g., Behçet)
                                            • Drug-related (e.g., androgens, ecstasy)
                                          • Typical pathophysiology progression
                                            • Thrombus initially forms in dural sinus
                                              • Clot propagates into cortical veins
                                            • Obstructed venous drainage causes elevated venous pressure
                                            • Blood-brain barrier breakdown; vasogenic edema
                                            • Ensuing venous infarct with cytotoxic edema
                                            • Leads to petechial/parenchymal hemorrhage
                                          • Potential sites of thrombosis
                                            • Cortical veins
                                            • Venous sinuses
                                            • Deep intracerebral veins
                                            • Jugular veins

                                      PRE-PROCEDURE

                                      • Indications

                                        • Contraindications

                                          • Pre-Procedure Imaging

                                            • Getting Started

                                              PROCEDURE

                                              • Procedure Steps

                                                • Alternative Procedures/Therapies

                                                  POST-PROCEDURE

                                                  • Expected Outcome

                                                    • Things to Do

                                                      OUTCOMES

                                                      • Problems

                                                        • Complications

                                                          Selected References

                                                          1. Blackham KA: Extensive dural sinus thrombosis: successful recanalization with thrombolysis and a novel thrombectomy device. J Neurosurg. 114(1):133-5, 2011
                                                          2. Giraldo EA et al: The "cord sign" in cerebral venous thrombosis associated with high plasma levels of factor VIII. Neurocrit Care. 15(1):186-9, 2011
                                                          3. Coutinho JM et al: Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke. 41(11):2575-80, 2010
                                                          4. Nagai M et al: Roles of inflammation and the activated protein C pathway in the brain edema associated with cerebral venous sinus thrombosis. Stroke. 41(1):147-52, 2010
                                                          5. Ferro JM et al: Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 28(1):39-44, 2009
                                                          6. Khan SH et al: Intracranial dural sinus thrombosis: novel use of a mechanical thrombectomy catheter and review of management strategies. Clin Med Res. 7(4):157-65, 2009
                                                          7. Lv X et al: Intraarterial and intravenous treatment of transverse/sigmoid sinus dural arteriovenous fistulas. Interv Neuroradiol. 15(3):291-300, 2009
                                                          8. Saadatnia M et al: Cerebral venous sinus thrombosis risk factors. Int J Stroke. 4(2):111-23, 2009