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1.
The outcome of cerebral venous thrombosis (CVT) has been studied infrequently. We assessed the frequency of recurrence of cerebral or systemic thromboembolism and factors influencing recurrence. We performed a retrospective study of consecutive patients with CVT in the period 1985-2002 who were admitted to the University Hospital Gasthuisberg. We performed a chart review and a semi-standardized telephone interview that focused on recurrent CVT or systemic thromboembolism. Fifty-four CVT patients with a mean age of 42 years were followed up for a mean of 3.5 years. Eighty percent were women. Coagulation disorders were found in 17 patients (31%). One patient (1.9%) had recurrent CVT and seven patients (12.9%) suffered systemic thromboembolism after a median of 2.5 months. Patients with recurrent thromboembolism more often had coagulopathies (P = 0.04) or a history of deep venous thrombosis (P = 0.007). Patients with early recurrent venous thromboembolism often were not treated with oral anticoagulants (P < 0.001). It was evident from the above study that a substantial number of patients suffer recurrent thromboembolism after CVT. 相似文献
2.
Recanalisation of cerebral venous thrombosis 总被引:17,自引:0,他引:17
Baumgartner RW Studer A Arnold M Georgiadis D 《Journal of neurology, neurosurgery, and psychiatry》2003,74(4):459-461
OBJECTIVE: To investigate recanalisation in the first 12 months after cerebral venous thrombosis. METHODS: 33 consecutive patients presenting with cerebral venous thrombosis were enrolled in the study. Diagnosis was made by magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or catheter angiography. Patients were initially treated with intravenous heparin. Warfarin was given for at least four months. Cerebral MRI and MRV were done at four months and repeated after 12 months if venous thrombosis persisted. Outcome was evaluated by the Rankin scale at 12 months. RESULTS: Outcome at 12 months was good, with a median modified Rankin scale score of 0 (range 0 to 2); 27 patients (82%) had no residual deficits. No patient suffered recurrent cerebral venous thrombosis, deep vein thrombosis, or pulmonary embolism during follow up. After four months, all deep cerebral veins and cavernous sinuses, 94% of superior sagittal sinuses, 80% of straight sinuses, 73% of jugular veins, 58% of transverse sinuses, and 41% of sigmoid sinuses had recanalised. No further recanalisation was observed thereafter. CONCLUSIONS: The results suggest that recanalisation only occurs within the first four months following cerebral venous thrombosis and not thereafter, irrespective of oral anticoagulation. 相似文献
3.
Cerebral venous thrombosis (CVT) is infrequent among cerebrovascular diseases. The simultaneous thrombosis involving both cerebral artery and venous sinus is even extremely rare. We reported a 41-year-old woman who presented with acute headache and left hemiparesis due to concomitant arterial ischemic stroke and recurrent CVT. Extensive investigation disclosed acquired protein C and protein S deficiency, iron deficiency anemia (IDA) and cryoglobulinemia. She was treated with intravenous injection of heparin followed by oral anticoagulant therapy. The headache rapidly subsided; however, left hemiparesis persisted over five months. The rare condition of simultaneous thrombosis of cerebral artery and venous sinus may be caused by the synergistic effect of coagulation disorders, IDA and cryoglobulinemia. 相似文献
4.
Gaurav Nepal Sanjeev Kharel Riwaj Bhagat Yow Ka Shing Megan Ariel Coghlan Prasanta Poudyal Rajeev Ojha Gentle Sunder Shrestha 《Acta neurologica Scandinavica》2022,145(1):10-23
Cerebral venous thrombosis (CVT) is caused by partial or complete occlusion of the major cerebral venous sinuses or the smaller feeding cortical veins which predispose to the risk of venous infarction and hemorrhage. Current guidelines recommend treating CVT with either low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) followed by an oral vitamin K antagonist (VKA) for 3–12 months. Direct oral anticoagulants (DOACs) have already established benefit over warfarin as a long-term treatment of symptomatic venous thromboembolic disorder like deep vein thrombosis (DVT), and pulmonary embolism (PE) given its equal efficacy and better safety profile. The benefit of DOACs over warfarin as a long-term anticoagulation for CVT has likewise been extensively studied, yet it has not been approved as first-line therapy in the current practice. We therefore performed a systematic review and meta-analysis of relevant studies to generate robust evidence regarding the safety and efficacy of DOACs in CVT. This meta-analysis demonstrates that the use of DOACs in CVT has similar efficacy and safety compared to VKAs with better recanalization rate. 相似文献
5.
D W Schultz S M Davis B M Tress C J Kilpatrick J O King 《Journal of clinical neuroscience》1996,3(2):133-138
Little is known of the natural history and rate of sinus recanalisation after cerebral venous thrombosis (CVT). Although acute anticoagulation is effective, the duration of therapy remains speculative. We aimed to determine the relationship between sinus recanalisation and clinical outcome. We studied 12 consecutive patients with aseptic CVT with evidence of sinus thrombosis on initial magnetic resonance imaging, followed up 5-68 months after onset, using 15 repeat magnetic resonance scans in 9 of the patients to assess recanalisation. All patients initially had one or more thrombosed sinuses and were treated with anticoagulants for at least 6 months, including 3 with haemorrhagic infarction. Residual neurological deficits were present in only one patient. No patient had a recurrent thrombosis. Recanalisations was incomplete in 6 of the 9 cases. Sinus recanalisation after cerebral venous thrombosis does not correlate with clinical outcome. Although empirical, the general recommendation of 6 months anticoagulant therapy is appropriate. 相似文献
6.
M. Roriz I. Crassard S. Lechtman D. Saadoun K. Champion B. Wechsler H. Chabriat D. Sène 《Revue neurologique》2018,174(3):162-166
There is as yet no consensus on the treatment of cerebral venous thrombosis (CVT) in Behçet's disease, and the place of anticoagulation is also still being debated. This report is of a series of seven patients with Behçet's disease (BD)-associated CVT, for which anticoagulation was stopped, and discusses the possibility of stopping anticoagulation during follow-up while receiving optimal treatment for BD. The diagnosis of BD was established during follow-up, which lasted a median of 120 [range: 60–1490] days after CVT diagnosis. The median duration of anticoagulation therapy was 29.5 months. On stopping anticoagulation, concomitant treatment then included colchicine, steroids and azathioprine, all introduced after BD was diagnosed. With a median follow-up of 25 months after anticoagulation interruption, only one relapse of CVT was observed. No relapse of CVT or other venous thrombosis was observed in the six patients treated by steroids associated with an immunosuppressant or colchicine. Our results emphasize that corticosteroids are essential for the treatment of BD-associated CVT, and that anticoagulant therapy may be safely stopped during follow-up in the presence of optimal BD treatment (steroids alone or with immunosuppressive drugs). 相似文献
7.
Ribeiro DD Lijfering WM Barreto SM Silva IB Chalup MM Rosendaal FR Rezende SM 《Thrombosis research》2011,128(3):227-232
Objective
Strategies that can classify the risk for recurrent venous thrombosis are needed. Some patients may have experienced many risk situations during their life time without developing venous thrombosis (VT), while others may have experienced few of such risk factors and then develop VT idiopathically or after a single provoked risk factor. We hypothesized that those who had 'survived' many risk situations without developing VT would, after a first VT, have a low recurrence risk.Methods
Brazilian tertiary hospital cohort was followed for an average of 30 months after anticoagulation withdrawal for a first VT. Patients with indication for indefinite anticoagulation were not included. The primary end point was objective recurrent VT.Results
Recurrent VT was recorded in 7% of 378 eligible patients. Patients with a provoked first event and positive past risk situations for VT had an incidence rate of recurrence of 1.16 (95% confidence interval [CI], 0.47-2.39) per 100 patient-years. The incidence rate ratio (IRR) of this subgroup compared to patients with a provoked event without other past risk situations for VT was 1.1 (95% CI, 0.3-4.4). This IRR was 3.3 (95% CI, 1.3-8.7) in patients with an unprovoked event and positive past risk situations and 5.1 (95% CI, 1.6-16.1) in patients with an unprovoked event and no past risk situations.Conclusions
Asking a patient about past exposure of venous thrombosis risk factors long before the occurrence of a first venous thrombosis occurred, does not provide information to classify patients at lower risk for recurrence of venous thrombosis. 相似文献8.
Risk of cerebral venous thrombosis
and novel gene polymorphisms of the
coagulation and fibrinolytic systems 总被引:3,自引:0,他引:3
Lichy C Dong-Si T Reuner K Genius J Rickmann H Hampe T Dolan T Stoll F Grau A 《Journal of neurology》2006,253(3):316-320
BACKGROUND AND PURPOSE: Genetic thrombophilic conditions such as those associated with Factor V Leiden (FVL) and the prothrombin mutant (PT G20210A) have been identified as risk factors for cerebral venous thrombosis (CVT). Recently, a single nucleotide polymorphism (SNP) of the thrombin activatable fibrinolysis inhibitor (TAFI G-438A) has been shown to be associated with lower TAFI levels and to decrease the risk for peripheral venous thrombosis. Furthermore, a protective role in juvenile stroke was shown for a SNP of the vitamin K dependent protein Z (PZ Intron F G79A) which is linked with low PZ levels. PATIENTS AND METHODS: In 77 consecutive patients with CVT and in 203 randomly selected population controls from the same region of Southern Germany, we investigated the following functional SNPs using PCR and restriction fragment analysis techniques: TAFI G-438A, PZ Intron F G79A, FVL and PT G20210A. RESULTS: The prevalence of FVL tended to be higher (OR 2.08, 95 % CI 0.91-4.75, p = 0.06) and that of PT G20210A (OR 4.57, 95 % CI 1.45-14.44, p = 0.007) was significantly higher in patients with CVT than in controls. The A-allele frequency of the TAFI G-438A polymorphism did not significantly differ between patients (21.3 %) and controls (26.9%; OR 0.71, 95 % CI 0.45-1.12; p = 0.17). For the PZ G79A SNP, the frequency of the A-allele was 19.5% in CVT and 24.6% in controls (OR 0.77, 95 % CI 0.49-1.21; p = 0.31). CONCLUSIONS: In this large series of CVT patients, a positive association with established thrombophilic risk factors FVL and especially the PT G20210A mutation was confirmed. In contrast, our study found no significant association of CVT with SNPs of the TAFI and the PZ genes. Other than testing for FVL and the PT G20210A mutation, exploration of these potential thrombophilic variants seems to be of limited value in the investigation of CVT. 相似文献
9.
Cerebral venous thrombosis: diagnosis and management 总被引:58,自引:0,他引:58
Bousser MG 《Journal of neurology》2000,247(4):252-258
In contrast to arterial stroke, cerebral venous thrombosis (CVT) is an infrequent condition which presents with a wide spectrum
of signs and with a highly variable mode of onset. The clinician must therefore consider it systematically in all brain syndromes
and perform the appropriate neuroimaging investigations: computed tomography (CT) with computed tomography angiography and/or
magnetic resonance imaging with magnetic resonance angiography and, if necessary intra-arterial angiography. Once the diagnosis
is established, a wide investigation for should be carried out in search of the cause, and treatment started as soon as possible.
Treatment is based on the combination of intravenous heparin (followed by oral anticoagulants for 3–6 months), symptomatic
treatment (anticonvulsants, analgesics, treatment of increased intracranial pressure) and treatment of the cause. Local thrombolysis
is indicated if there is deterioration due to thrombosis extension despite adequate anticoagulation. Diagnosis and treatment
of CVT should be considered as an emergency because of the considerable potential for full recovery in this condition.
Received: 26 August 1999/Accepted: 1 October 1999 相似文献
10.
S Eichinger E Minar M Hirschl C Bialonczyk M Stain C Mannhalter A Stümpflen B Schneider K Lechner P A Kyrle 《Thrombosis and haemostasis》1999,81(1):14-17
A G20210A transition in the prothrombin gene is a common risk factor of venous thrombosis. The risk of recurrent venous thromboembolism in carriers of the 20210A allele is unknown and guidelines for secondary thromboprophylaxis in these patients are not available. In a prospective multicenter trial, 492 patients with a history of objectively documented venous thromboembolism were followed for a mean observation time of 24+/-16 months after discontinuation of oral anticoagulants. Forty-two patients (8.5%) were carriers of the 20210A allele. Three of the 42 patients with the G20210A mutation (7%) and 54 of 450 patients without the mutation (12%) experienced recurrent venous thrombosis. At 24 months, the probability of recurrence was 8% (95% CI 0-16.7) in patients with the mutation and was 12.2% (95% CI 8.8-15.6) in patients without the mutation. In conclusion, the risk of early recurrent venous thromboembolism is not higher in patients with the G20210A mutation than in those without the mutation. Therefore, long-term secondary thromboprophylaxis with oral anticoagulants in heterozygous carriers of the 20210A allele is not justified. 相似文献
11.
Millán M García S Capellades J Ferrer X Escudero D Vila N 《Neurología (Barcelona, Spain)》2002,17(8):443-446
Changes in the apparent diffusion coefficient (ADC) are well established in acute ischemic stroke of arterial origin. However, ADC behaviour and its prognostic significance in cerebral venous thrombosis (CVT) are not fully understood. Diffusion-weighted imaging (DWI) findings in a 34-year old woman with deep cerebral venous thrombosis are described. Recent literature concerning DWI and cerebral venous thrombosis is also reviewed. A MRI performed within 7 hours from onset revealed hyperintensities in deep grey matter bilaterally (FLAIR/T2), without changes in ADC maps, suggesting vasogenic edema. After anticoagulation a new MRA disclosed complete recanalization of venous thrombosis. Despite her good clinical outcome the MRI showed hemorrhagic lesions suggesting venous infarct. Lesions detected in acute CVT with DWI may have normal ADC values. There is no good correlation between the acute ADC values and clinical and radiological evolution. The prognostic value of ADC in the acute phase of CVT remains unsettled. 相似文献
12.
目的 探讨和研究脑静脉窦血栓形成(CVT)的早期诊断和治疗方法。方法 回顾性分析,15例CVT病人的临床资料,就其临床表现、影像学特征、脑脊液检查、治疗与预后,结合文献进行分析。结果 (1)年龄在19~52岁;(2)急性或亚急性起病;(3)早期表现为头痛(87%)、呕吐(60%)、视力障碍(33%),伴或不伴局灶性神经功能缺损;(4)影像学表现为静脉窦闭塞及局限性脑梗死(67%),其中20%伴有出血;(5)颅压明显升高,脑脊液白细胞及蛋白定量正常或升高;(6)病因治疗及脱水、抗凝、溶栓等治疗效果好。结论 对临床以颅内压增高为主要表现、伴或不伴有脑局灶性症状、体征的年轻病人,应考虑到CVT,及时行MRI或MRA检查,早期明确诊断,尽早治疗,抗凝治疗为其首选方法。 相似文献
13.
Dindagur Nagaraja T P Kruthika-Vinod Rita Christopher 《Journal of clinical neuroscience》2007,14(7):635-638
Pregnancy and puerperium raise the risk of thrombotic events, and these risks are likely to be increased in women who are carriers of thrombophilic gene polymorphisms. Prothrombin G20210A variant is reported to be the second most frequent prothrombotic polymorphism in Caucasians. Our aim was to determine the prevalence of this variant in south Indian women and examine its association with cerebral venous and sinus thrombosis occurring during puerperium. We investigated 96 women with puerperal cerebral veno-sinus thrombosis (CVT) and 103 age-matched women with no post-partum complications. We used restriction fragment length polymorphism analysis to identify their genotypes. The prothrombin G20210A variant was not detected in either the CVT patients or the healthy control subjects. Our study on a large series of patients with puerperal CVT shows that the prothrombin G20210A variant is not present in south Indian women and is not associated with puerperal CVT. This study also highlights the fact that there are racial differences in the risk factors for thrombosis, which should be considered when investigating these patients. 相似文献
14.
目的对比静脉肝素抗凝与脑介入治疗脑静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析我院14例脑静脉窦血栓患者,按治疗方法分为介入组(脑静脉窦血管内治疗)和抗凝组(静脉肝素抗凝),每组7例,比较2组平均住院时间、血管完全再通率、mRS及并发症发生率。结果脑静脉窦介入组住院时间较抗凝组短,血管完全再通率高于抗凝组,mRS平均评分低于抗凝组,差异均有统计学意义(P0.05)。2组并发症发生率无显著差异(P0.05)。结论脑静脉窦血管内治疗可改善CVST患者的转归,疗效优于静脉肝素溶栓保守治疗。 相似文献
15.
16.
Myungah Lee Youngjae Heo Taewon Kim 《Journal of stroke and cerebrovascular diseases》2019,28(2):344-346
Our objective is to present a case of Vernet's syndrome (cranial nerve (CN) IX, X, and XI palsy) associated with cerebral venous thrombosis (CVT) in an internal jugular vein. The patient presented with acutely developed dysphagia. The weakness of the left sternocleidomastoid and trapezius muscles was observed. The initial magnetic resonance imaging and computed tomography (CT) with contrast enhancement showed contrast-filling defect in the left internal jugular vein inside the jugular foramen. The magnetic resonance venography with contrast enhancement revealed a partial filling defect in the left sigmoid sinus and total occlusion of the left internal jugular vein. Under the diagnosis of CVT associated with CN IX, X palsy, anticoagulation therapy with low-molecular-weighted heparin was initiated. Despite the continued anticoagulation therapy for 3 months, neither the burden of thrombosis in the left sigmoid sinus and internal jugular vein on neck CT nor dysphagia symptoms improved. Clinicians need to be aware of internal jugular venous thrombosis as one of the differential diagnoses in Vernet's syndrome in patients in a hypercoagulable state. Further reporting of similar cases is needed to confirm the association between CVT and Vernet's syndrome. 相似文献
17.
Cerebral venous thrombosis. 总被引:32,自引:0,他引:32
Neuroimagining facilities allow early recognition of cerebral venous thrombosis (CVT), which now appears far more common than previously assumed. The diagnosis remains difficult because of a wide spectrum of clinical presentation and a highly variable mode of onset. Numerous conditions (presently mostly noninfectious) can cause or predispose to CVT, which therefore requires an extensive etiologic work-up. The functional and vital prognosis is much better than classically thought with, in noninfectious CVT, a fatality rate of less than 10% and a complete recovery in over 70%. Although spontaneous recovery is possible, the efficacy of heparin is now well established. 相似文献
18.
Zuurbier SM Coutinho JM Majoie CB Coert BA van den Munckhof P Stam J 《Journal of neurology》2012,259(6):1099-1105
Small retrospective case series suggest that decompressive hemicraniectomy can be life saving in patients with cerebral venous thrombosis (CVT) and impending brain herniation. Prospective studies of consecutive cases are lacking. Thus, a single centre, prospective study was performed. In 2006 we adapted our protocol for CVT treatment to perform acute decompressive hemicraniectomy in patients with impending herniation, in whom the prognosis with conservative treatment was considered infaust. We included all consecutive patients with CVT between 2006 and 2010 who underwent hemicraniectomy. Outcome was assessed at 12 months with the modified Rankin Scale (mRS). Ten patients (8 women) with a median age of 41 years (range 26-52 years) were included. Before surgery 5 patients had GCS < 9, 9 patients had normal pupils, 1 patient had a unilaterally fixed and dilated pupil. All patients except one had space-occupying intracranial hemorrhagic infarcts. The median preoperative midline shift was 9 mm (range 3-14 mm). Unilateral hemicraniectomy was performed in 9 patients and bilateral hemicraniectomy in one. Two patients died from progressive cerebral edema and expansion of the hemorrhagic infarcts. Five patients recovered without disability at 12 months (mRS 0-1). Two patients had some residual handicap (one minor, mRS 2; one moderate, mRS 3). One patient was severely handicapped (mRS 5). Our prospective data show that decompressive hemicraniectomy in the most severe cases of cerebral venous thrombosis was probably life saving in 8/10 patients, with a good clinical outcome in six. In 2 patients death was caused by enlarging hemorrhagic infarcts. 相似文献
19.
Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome. 相似文献
20.
颅内静脉血栓形成的临床特点分析 总被引:1,自引:0,他引:1
目的探讨颅内静脉血栓形成(CVT)的病因、临床特点、诊断、治疗。方法回顾性分析12例CVT患者的临床资料,并结合文献分析。结果12例CVT患者中8例病因明确,临床表现以头痛伴恶心呕吐、视乳头水肿为主,脑脊液(CSF)检查以压力升高为主要特点,D-二聚体(DD)检查有62.5%的患者高于正常,CT主要表现局限性脑梗死及脑水肿,MRI联合MRV表现静脉窦闭塞者占91.7%,病因及脱水、溶栓、抗凝治疗疗效较好。结论CVT临床表现复杂多样,产褥期、感染、白塞病可继发CVT,MRI和MRV相结合诊断率高,肝素抗凝为首选治疗。 相似文献