[Cerebral venous thrombosis—diagnosis and treatment]

Hans-Jørgen Johnsen, Anders Vorhaug, Kjell Arne Kvistad
Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række 2007 April 19, 127 (8): 1069-73

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare cause of stroke, and an important differential diagnosis for a number of neurological complaints. This review article concerns the aetiology, pathology, diagnostic work-up and treatment of the condition.

MATERIAL AND METHODS: This article is based on a review of relevant literature and on the authors' personal experience.

RESULTS AND INTERPRETATION: CVT is thought to be responsible for about 0.5-1.0% of all strokes. Headache is the initial symptom in 70-90% of the cases. Apart from this, symptoms vary considerably. CVT was previously assumed to be a rare condition with a high mortality, as the diagnosis could in effect only be made post mortem. Conditions with a benign course can now be diagnosed with modern neuroradiological examinations. All patients should be assessed carefully; particular attention should be given to possible congenital or acquired forms of thrombophilia. Scepsis about the use of anticoagulants in CVT has long prevailed, especially in connection with haemorrhagic infarcts. During the last 10-15 years, several studies indicate that anticoagulation with heparin, or low-molecular heparin, should be the initial treatment of choice. Catheter-based endovascular thrombolytic treatment should be considered in serious cases where anticoagulant treatment is unsuccessful. Mortality is about 10%.

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