Cerebral Venous Thrombosis: Diagnosis and Treatment

Cerebral Venous Thrombosis (CVT) has been recognized since the beginning of the 19th century. It was long thought to be a rare and severe disease responsible for bilateral or alternating focal deficits, seizures and coma often leading to death and diagnosed only at autopsy

Thromboses veineuses cérébrales au cours de l hémoglobinurie paroxystique nocturne (à propos de 15 cas)

Les thromboses veineuses sont une complication grave et fréquente de l hémoglobinurie paroxystique nocturne (HPN). L atteinte du système nerveux central est classique mais reste peu connue. Nous proposons ici de décrire une série de patients avec thrombose veineuse cérébrale (TVC) et HPN.Les patients ont été inclus de manière rétrospective d une série de patients TVC/HPN inclus à partir du registre HPN de la Société Française d Hématologie (SFH) et des services d hématologie français ; description puis comparaison aux cas publiés, aux patients du registre SFH et aux patients d une cohorte prospective de TVC de l hôpital Lariboisière.Quinze patients ont été inclus entre 1990 et 2012; 80% étaient des femmes. La TVC révélait l HPN dans 3 cas. L âge médian au diagnostic de TVC était de 29 ans. En dehors de ce jeune âge, il n y avait pas de différence majeure avec les patients de la cohorte Lariboisière en termes de caractéristiques cliniques, radiologiques et pronostiques des TVC. Le taux de récidive de thrombose était de 50% six ans après la TVC. La survie des patients à long terme est significativement moindre comparée à celle des patients HPN indemnes de TVC. Dans le registre SFH, les veines cérébrales étaient le 3ème site de thrombose avec une incidence de 6 cas/1000 patients-années. Dans la cohorte Lariboisière, l HPN était retrouvée chez 0,8% des patients. Malgré sa rareté, l HPN est une cause qu il faut savoir évoquer devant une TVC. Si aucun caractère de gravité neurologique particulier n a été mis en évidence dans cette étude, la survenue d une TVC impose néanmoins une prise en charge adaptée et une réévaluation thérapeutique rapide de l HPN.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Thromboses veineuses cérébrales (A propos de 185 cas)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Thromboses veineuses cérébrales associées aux maladies inflammatoires chroniques intestinales (A propos de huit cas et revue de la littérature)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Reversible cerebral vasoconstriction syndrome in the context of recent cerebral venous thrombosis: Report of a case

International audienceINTRODUCTION:Reversible cerebral constriction syndrome and cerebral venous thrombosis are two rare conditions. Reversible cerebral constriction syndrome affects the cerebral arteries and the pathology is still largely unknown. To date, no physiological link with cerebral venous thrombosis has been reported.CASE RESULTS:We report here the case of a 24-year-old woman who presented a reversible cerebral constriction syndrome in the setting of a cerebral venous thrombosis. Cerebral venous thrombosis had developed in her left lateral venous sinus, within the stent placed one year before, in order to treat an idiopathic intracranial hypertension.DISCUSSION:The co-occurrence of cerebral venous thrombosis and reversible cerebral constriction syndrome in the same patient raises the issue of a potential link between them. We discuss the potential common trigger factors in this case: recent hormonal therapy; intracranial hypotension iatrogenically induced by lumbar puncture

Temporary application of Lower Body Positive Pressure improves intracranial velocities in symptomatic acute carotid occlusion or tight stenosis: a pilot study

International audienceBackground: Patients with isolated cervical carotid artery occlusion not eligible to recanalization therapies but with compromised intracranial hemodynamics may be at risk of further clinical events. Apart from lying flat until spontaneous recanalization or adjustment of the collateral circulation hopefully occurs, no specific treatment is currently implemented. Improving collateral flow is an attractive option in this setting. Lower body positive pressure (LBPP) is known to result in rapid venous blood shift from the lower to the upper body part, in turn improving cardiac preload and output, and is routinely used in acute hemorrhagic shock. We report here cerebral blood flow velocities measured during LBPP in this patient population.Methods: This is a retrospective analysis of the clinical, physiological, and transcranial Doppler monitoring data collected during and 15 min after LBPP in 21 consecutive patients (10 females, median age: 54 years) with recently symptomatic isolated carotid occlusion/tight stenosis (unilateral in 18) mostly due to atherosclerosis or dissection. LBPP was applied for 90 min at a median 5 days after symptom onset.Results: At baseline, middle-cerebral artery velocities were markedly lower on the symptomatic, as compared to asymptomatic, side. LBPP significantly improved blood flow velocities in both the symptomatic and asymptomatic middle-cerebral artery as well as the basilar artery, which persisted 15 min after discontinuing the procedure. LBPP also resulted in mild but significant increases in mean arterial blood pressure.Conclusions: LBPP improved intracranial hemodynamics downstream recently symptomatic carotid occlusion/tight stenosis as well as in the contralateral and posterior circulations, which persisted after LBPP deflation. Randomized trials should determine if this easy-to-use, noninvasive, nonpharmacologic approach has long-lasting benefits on the intracranial circulation and improves functional outcome