Stephan Moll, MD writes…
2011 Consensus Statement
A superb, comprehensive and thoughtful expert summary was published for health care professionals in February 2011 [ref 1]. It gives a wealth of solid recommendations on diagnosis and treatment.
A few comments on cerebral venous thrombosis:
- Diagnosis: Not new, but worthwhile to highlight: The diagnosis of cerebral venous thrombosis (aka sinus and cerebral vein thrombosis and other terms) can be missed if one only obtains a plain CT or MRI of the brain, with or without contrast. MRV (MRI venogram) or CTV (CR venogram) need to be obtained to reliably rule out cerebral vein thrombosis. The health care professional who evaluates the patient with severe headache or neurological symptoms needs to have cerebral venous thrombosis in his/her differential diagnosis and know which test to obtain, otherwise he/she may miss the diagnosis The pretest probability for a cerebral venous thrombosis to be present is increase if the patient has (a) the worst headache ever, (b) risk factors for venous thromboembolism (hormonal contraceptives – estrogens or progestins, pregnancy), (c) a personal or family history of thrombosis or thrombophilia.
- Acute Treatment: In the acute setting, heparin is typically given, even if there is venous hemorrhagic infarction.
- Length of Warfarin Therapy: Warfarin is given for varying lengths of time, depending on the trigger of the thrombosis: for 3-6 months if there was a clear temporary trigger (infection, estrogens); 6-12 months if the thrombosis was unexplained and no strong thrombophilia has been found; long-term, if a strong thrombophilia is present.
- Risk for recurrence and other clots: The risk for recurrent cerebral venous thrombosis, once warfarin has been stopped, is relatively low – only approximately 1.5 % of patients will develop another cerebral venous thrombosis per year [ref 2]. However, patients are also at increased risk – ca. 4 % per year – to develop venous thromboembolism in other territories (mostly leg DVT and PE). Thus, patients who stop warfarin need to be educated about the symptoms of DVT and PE and need good VTE prophylaxis in future risk situations.
- Long-term outcome: Almost 80% of patients fully recover, but it may take several weeks or months to get back to normal. Headaches, and seizures may persist for some time. Minor disability (concentration or memory problems) occurs in 6 % of patients; 14 % percent will have a poor outcome, with major neurological deficits.
Patient information handout
A detailed discussion of cerebral venous thrombosis, written for patients, and taken into consideration the above mentioned new Consensus Statement, is available on the Clot Connect Patient blog- connect here. We hope that the health care professional will find this write-up suitable to be printed out as an educational handout for patients who have suffered a sinus or cerebral vein thrombosis.
- Saposnik G 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: pre-published on the web in February 2011.
- Bruno M et al. Venous Thromboembolic Events After Cerebral Vein Thrombosis. Stroke. 2010;41:1901-1906
Disclosure: I have no financial disclosure relevant to the content of this blog post.
Last updated Jan 2nd, 2013