Cerebral venous thrombosis in spontaneous intracranial hypotension: A report of 8 cases and review of the literature
| Autor: | Francesco Allegrini, Giuseppe Petrecca, Michele Trimboli, Enrico Ferrante |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Intracranial Hypotension Subdural haematoma Asymptomatic 03 medical and health sciences 0302 clinical medicine medicine Spontaneous Intracranial Hypotension Humans In patient 030212 general & internal medicine Epidural blood patch Venous Thrombosis business.industry medicine.disease Surgery Venous thrombosis Hematoma Subdural Neurology Cohort Neurology (clinical) medicine.symptom Intracranial Thrombosis business 030217 neurology & neurosurgery Orthostatic headache Blood Patch Epidural |
| Zdroj: | Journal of the neurological sciences. 425 |
| ISSN: | 1878-5883 |
| Popis: | Background The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described. Methods We reviewed our cases of SIH complicated by CVT among a cohort of 445 SIH patients observed and treated during the last years. All published case reports and case series reporting patients with SIH and CVT were also ascertained and reviewed. Results Eight (2%) out of 445 patients suffering with SIH, were also diagnosed with CVT. All patients observed had orthostatic headache, three of them experienced a change in their headache pattern over the SIH course. Six out of eight patients received both AC and EBP treatments. Two patients were treated using only AC or EBP. A bilateral subdural haematoma enlargement after 1 month of AC was observed in one case. Complete CVT recanalization after treatment was obtained in three patients, including two with multiple CVT at baseline; partial CVT recanalization was achieved in two patients. Three patients experienced no CVT recanalization. After 6–48 months' follow-up all patients were still asymptomatic. Conclusions The use of AC therapy should be weighed against the intracranial haemorrage risk and should be monitored carefully if initiated. Effective and prompt EBP, even without AC therapy, might lead to a good prognosis in selected cases. |
| Databáze: | OpenAIRE |
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