Saudi Journal of Medicine and Medical Sciences

EDITORIAL
Year
: 2019  |  Volume : 7  |  Issue : 3  |  Page : 135--136

Cerebral venous sinus thrombosis


Hosam M Al-Jehani 
 Department of Neurosurgery, Interventional Radiology and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Correspondence Address:
Hosam M Al-Jehani
Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam
Saudi Arabia




How to cite this article:
Al-Jehani HM. Cerebral venous sinus thrombosis.Saudi J Med Med Sci 2019;7:135-136


How to cite this URL:
Al-Jehani HM. Cerebral venous sinus thrombosis. Saudi J Med Med Sci [serial online] 2019 [cited 2019 Nov 12 ];7:135-136
Available from: http://www.sjmms.net/text.asp?2019/7/3/135/265654


Full Text



The diagnosis and management of cerebral venous sinus thrombosis (CVST) is challenging. It involves a multidisciplinary, integrated approach including emergency physicians, neurologists, hematologists and neurosurgeons. Each discipline has a role in the management of CVTS patients. Astute observation is necessary to suspect sinus thrombosis owing to multifactorial, gender-related specific causes. The “malingering” filter is often incorrectly imposed for these patients, most of who are young females with repeated episode of headache. Despite the clarity of CVST guidelines and treatment protocols, there is a diagnostic delay in the earliest phases in many CVST patients. By the time a correct diagnosis is made, the condition would have deteriorated, which likely affects the prognosis. In addition, the acute phase of this disorder is unpredictable and has a high mortality rate. Favorable prognosis is possible through a rapid diagnosis and prompt initiation of the treatment.[1]

Repeated visits to the emergency room should lower the threshold of suspected CVST in patients with its risk factors. This could be improved by refinement of our triaging systems to alert the physicians and increase their clinical awareness about such predisposing factors and conditions. The initial imaging assessments of these patients are important. It should be noted that there is a paucity in the literature addressing stratification of the venous thrombosis and its effect on the clinical course and management strategies.[2] Involvement of cortical veins as well as superficial and deep venous systems results in diverse and nonspecific clinical presentations.[3] This imposes the need for different treatment modalities that should be considered in the upcoming standard guidelines and treatment protocols. Another aspect of imaging that has clinical implications is perfusion imaging, which can be used as an inference gauge to the degree of tissue edema and gradation of tissue vulnerability.[4]

The mainstay of management for CVST is anticoagulants. Choosing the right anticoagulant for optimal duration is important for better prognosis. Patients with CVST are candidates for interventional therapy and surgical hemispheric decompression.[5],[6] The key to the success of these escalation therapies is that they should be implemented before major deterioration in a patient's level of consciousness, which usually reflects serious brainstem compromise. If the brainstem is indeed compromised, the escalation of therapy might border on futility. This cannot be overemphasized in CVST complicating traumatic brain trauma injury. For traumatic brain injury patients labeled with refractory intracranial hypertension, decompressive craniectomy can be offered. However, if the cause of the refractoriness is CVST, decompressive surgery and interventional therapy would result in significant improvements in the course of these patients.[7]

References

1Saposnik G, Barinagarrementeria F, Brown RD Jr., 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;42:1158-92.
2Coutinho JM, Gerritsma JJ, Zuurbier SM, Stam J. Isolated cortical vein thrombosis: Systematic review of case reports and case series. Stroke 2014;45:1836-8.
3Luo Y, Tian X, Wang X. Diagnosis and treatment of cerebral venous thrombosis: A review. Front Aging Neurosci 2018;10:2.
4Mokin M, Ciambella CC, Masud MW, Levy EI, Snyder KV, Siddiqui AH, et al. Whole-brain computed tomographic perfusion imaging in acute cerebral venous sinus thrombosis. Interv Neurol 2016;4:104-12.
5Yang X, Wu F, Liu Y, Duan J, Meng R, Chen J, et al. Predictors of successful endovascular treatment in severe cerebral venous sinus thrombosis. Ann Clin Transl Neurol 2019;6:755-61.
6Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology. Eur Stroke J 2017;2:195-221.
7Chen KW, Lin YH, Lee CW. Acute posttraumatic cerebral venous sinus thrombosis-induced malignant increased intracranial pressure treated with endovascular dural sinus thrombectomy and stenting: A case report. World Neurosurg 2019. pii: S1878-8750(19)31379-8.