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Critical care management of cerebral venous thrombosis

Fam, David; Saposnik, Gustavo; on behalf of the Stroke Outcomes Research Canada Working Group

Current Opinion in Critical Care: April 2016 - Volume 22 - Issue 2 - p 113–119
doi: 10.1097/MCC.0000000000000278
NEUROSCIENCE: Edited by J. Claude Hemphill

Purpose of review: Although recent trials of intervention for acute ischemic stroke have been positive, similar benefit in acute cerebral venous thrombosis (CVT) remains largely unclear. This review aims to summarize the existing evidence regarding the management of CVT, including anticoagulation and endovascular therapy.

Recent findings: The mainstay of treatment in CVT is systemic anticoagulation even in the setting of intracerebral hemorrhage. Nonrandomized studies and case series suggest that endovascular therapy in CVT is relatively safe, and can improve outcomes in the small subset of CVT patients with neurologic deterioration despite anticoagulation.

Summary: Despite a generally favorable prognosis, one in four patients with CVT develop neurological deterioration in the acute phase. Predisposing factors include a neurological deficit or seizures at onset, deep venous thrombosis, venous infarctions, or intracranial hemorrhage with mass effect and an underlying thrombophilia. More randomized trials are needed to compare the benefits of anticoagulation and endovascular therapy.

aDepartment of Neurology, University of Toronto School of Medicine

bStroke Outcomes Research Unit, Li Ka Shing Knowledge Institute

cInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

*Website: http://www.sorcan.ca.

Correspondence to Gustavo Saposnik, MD, MSc, FAHA, FRCPC, Division of Neurology, St. Michael's Hospital, Suite 9-31, 55 Queen St E, Toronto, ON M5C 1R6, Canada. Tel: +1 416 864 5155; fax: +1 416 864 5150; e-mail: saposnikg@smh.ca

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