cerebral venous thrombosis; dural sinus thrombosis
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Etiology
risk factors
- hypercoagulable state
- oral contraceptives
- pregnancy & the post-partum period
- malignancy
- sepsis
- head trauma
- intracranial surgery
- smoking? 9 Covid-19 vaccine[8]
Pathology
- superior sagittal sinus is the most common location
- increased intracranial pressure
- hemorrhagic infarction can occur
Clinical manifestations
- signs of increased intracranial pressure
Laboratory
- complete blood count (CBC)[4]
- chemistry panel[4]
- PT (INR) & aPTT[4]
- workup for hypercoagulable state
Diagnostic procedures
- lumbar puncture with CSF analysis if diagnosis in question
Radiology
- magnetic resonance venography (test of choice)
- CT venography
- CT or MRI of the brain without contrast is generally normal
- cerebral angiography (expensive, invasive)
Complications
- in patients with cerebral venous sinus thrombosis after SARS-CoV2 vaccination 67% had thrombosis with thrombocytopenia
- 24% ot these comatose at presentation
- 68% with intracerebral hemorrhage
- 36% with concomitant thromboembolism
- 47% mortality during hospitalization[9]
Differential diagnosis
Management
- smoking cessation[1]
- discontinuation of oral contraceptives
- anticoagulation
- duration 3-6 months if transient risk factor, 6-12 months if unexplained but without risk for thrombophilia, lifelong if recurrent or risk of thrombophilia[2]
- bleeding, progressive cerebral venous thrombosis, & recurrent venous thromboembolism similar with dabigatran or warfarin[7]
- for Covid-19 associated cerebral sinus venous thrombosis suggested treatment with argatroban, danaparoid, fondaparinux, or direct oral anticoagulants +/- intravenous immune globulin +/- high-dose glucocorticoids[8]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005 Apr 28;352(17):1791-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15858188
- ↑ 4.0 4.1 4.2 4.3 Bushnell C et al Guidelines for the Pevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. Feb 6, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24503673 <Internet> http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48.full.pdf+html
- ↑ Pikija S, Mutzenbach JS Septic Cerebral Venous Thrombosis. N Engl J Med 2015; 373:1553. October 15, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26465988 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1415937
- ↑ Sparaco M, Feleppa M, Bigal ME. Cerebral Venous Thrombosis and Headache--A Case-Series. Headache. 2015 Jun;55(6):806-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26084237
- ↑ 7.0 7.1 Ferro JM, Coutinho JM, Dentali F et al. Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: A randomized clinical trial. JAMA Neurol 2019 Sep 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31479105 Free PMC Article https://jamanetwork.com/journals/jamaneurology/fullarticle/2749167
- ↑ 8.0 8.1 8.2 Cines DB, Bussel JB SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021. April 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33861524 https://www.nejm.org/doi/full/10.1056/NEJMe2106315
Rizk JG, Gupta A, Sardar P et al Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine- Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis. A Review. JAMA Cardiol. Published online August 10, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34374713 https://jamanetwork.com/journals/jamacardiology/fullarticle/2783051 - ↑ 9.0 9.1 Sanchez van Kammen M, Aguiar de Sousa D, Poli S et al Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. JAMA Neurol. 2021;78(11):1314-1323 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34581763 PMCID: PMC8479648 (available on 2022-09-28) https://jamanetwork.com/journals/jamaneurology/fullarticle/2784622