Trombosis Venosa Cerebral - Neurovascular Exchange
40
Stroke: Patología Venosa Trombosis Venosa Cerebral Dra. Rosana Ceratto
Transcript of Trombosis Venosa Cerebral - Neurovascular Exchange
Stroke Patologiacutea Venosa
Trombosis
Venosa
Cerebral
Dra Rosana Ceratto
La trombosis de senos durales o de venas
cerebrales es una infrecuente causa de ACV
que habitualmente afecta a individuos joacutevenes
75 mujeres
Representa del 05 al 1 de todos los ACV
Epidemiologiacutea
Triacuteada de Virchow
Estasis de la sangre
Cambios en la pared del vaso
Cambios en la composicioacuten de
la sangre
Trombosis venosa cerebral
Manifestaciones Cliacutenicas
Formas de Presentacioacuten
bull Aguda
bull Subaguda
bull Croacutenica
Hipertensioacuten
Intracraneana
Sindrome
Focal
Encefalopatiacutea
Cefalea voacutemitos papiledema
Hemiparesia Convulsiones
Signos multifocales Deterioro del sensorio
AJNR Am J Neuroradiol 1992 Jul-Aug13(4)1137-41
Acute thrombosis of the intracranial dural sinus
direct thrombolytic treatment Tsai FY1 Higashida RT Matovich V Alfieri K
Abstract
Acute intracranial dural sinus thrombosis may have severe morbidity or
fatal complications without appropriate treatment Direct dural sinus
venography can be performed safely with a soft Tracker catheter to
document the fresh thrombus as an adjunct to CT or MR We are
reporting our experience with successful direct urokinase thrombolytic
therapy in three cases of superior sagittal sinus and two cases of transverse
and sigmoid sinus thrombosis All five patients have recovered
completely without any residual clinical deficit
Tratamiento
Tratamiento
Guidance Statement
Anticoagulant treatment for a minimum of 3 months should be
considered in patients with transient risk factors Patients without
known risk factors should be considered for 6ndash12 months of
anticoagulation It appears safe to discontinue anticoagulant
treatment in the presence of transient risk factors such as oral
contraceptive use while indefinite treatment duration should be
considered for patients with recurrent CVT and in patients with
permanent major risk factors including severe thrombophilia
(antithrombin protein C or protein S deficiency antiphospholipid
antibodies syndrome homozygous factor V Leiden or
prothrombin gene mutation or combined heterozygous mutation)
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
La trombosis de senos durales o de venas
cerebrales es una infrecuente causa de ACV
que habitualmente afecta a individuos joacutevenes
75 mujeres
Representa del 05 al 1 de todos los ACV
Epidemiologiacutea
Triacuteada de Virchow
Estasis de la sangre
Cambios en la pared del vaso
Cambios en la composicioacuten de
la sangre
Trombosis venosa cerebral
Manifestaciones Cliacutenicas
Formas de Presentacioacuten
bull Aguda
bull Subaguda
bull Croacutenica
Hipertensioacuten
Intracraneana
Sindrome
Focal
Encefalopatiacutea
Cefalea voacutemitos papiledema
Hemiparesia Convulsiones
Signos multifocales Deterioro del sensorio
AJNR Am J Neuroradiol 1992 Jul-Aug13(4)1137-41
Acute thrombosis of the intracranial dural sinus
direct thrombolytic treatment Tsai FY1 Higashida RT Matovich V Alfieri K
Abstract
Acute intracranial dural sinus thrombosis may have severe morbidity or
fatal complications without appropriate treatment Direct dural sinus
venography can be performed safely with a soft Tracker catheter to
document the fresh thrombus as an adjunct to CT or MR We are
reporting our experience with successful direct urokinase thrombolytic
therapy in three cases of superior sagittal sinus and two cases of transverse
and sigmoid sinus thrombosis All five patients have recovered
completely without any residual clinical deficit
Tratamiento
Tratamiento
Guidance Statement
Anticoagulant treatment for a minimum of 3 months should be
considered in patients with transient risk factors Patients without
known risk factors should be considered for 6ndash12 months of
anticoagulation It appears safe to discontinue anticoagulant
treatment in the presence of transient risk factors such as oral
contraceptive use while indefinite treatment duration should be
considered for patients with recurrent CVT and in patients with
permanent major risk factors including severe thrombophilia
(antithrombin protein C or protein S deficiency antiphospholipid
antibodies syndrome homozygous factor V Leiden or
prothrombin gene mutation or combined heterozygous mutation)
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Triacuteada de Virchow
Estasis de la sangre
Cambios en la pared del vaso
Cambios en la composicioacuten de
la sangre
Trombosis venosa cerebral
Manifestaciones Cliacutenicas
Formas de Presentacioacuten
bull Aguda
bull Subaguda
bull Croacutenica
Hipertensioacuten
Intracraneana
Sindrome
Focal
Encefalopatiacutea
Cefalea voacutemitos papiledema
Hemiparesia Convulsiones
Signos multifocales Deterioro del sensorio
AJNR Am J Neuroradiol 1992 Jul-Aug13(4)1137-41
Acute thrombosis of the intracranial dural sinus
direct thrombolytic treatment Tsai FY1 Higashida RT Matovich V Alfieri K
Abstract
Acute intracranial dural sinus thrombosis may have severe morbidity or
fatal complications without appropriate treatment Direct dural sinus
venography can be performed safely with a soft Tracker catheter to
document the fresh thrombus as an adjunct to CT or MR We are
reporting our experience with successful direct urokinase thrombolytic
therapy in three cases of superior sagittal sinus and two cases of transverse
and sigmoid sinus thrombosis All five patients have recovered
completely without any residual clinical deficit
Tratamiento
Tratamiento
Guidance Statement
Anticoagulant treatment for a minimum of 3 months should be
considered in patients with transient risk factors Patients without
known risk factors should be considered for 6ndash12 months of
anticoagulation It appears safe to discontinue anticoagulant
treatment in the presence of transient risk factors such as oral
contraceptive use while indefinite treatment duration should be
considered for patients with recurrent CVT and in patients with
permanent major risk factors including severe thrombophilia
(antithrombin protein C or protein S deficiency antiphospholipid
antibodies syndrome homozygous factor V Leiden or
prothrombin gene mutation or combined heterozygous mutation)
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Trombosis venosa cerebral
Manifestaciones Cliacutenicas
Formas de Presentacioacuten
bull Aguda
bull Subaguda
bull Croacutenica
Hipertensioacuten
Intracraneana
Sindrome
Focal
Encefalopatiacutea
Cefalea voacutemitos papiledema
Hemiparesia Convulsiones
Signos multifocales Deterioro del sensorio
AJNR Am J Neuroradiol 1992 Jul-Aug13(4)1137-41
Acute thrombosis of the intracranial dural sinus
direct thrombolytic treatment Tsai FY1 Higashida RT Matovich V Alfieri K
Abstract
Acute intracranial dural sinus thrombosis may have severe morbidity or
fatal complications without appropriate treatment Direct dural sinus
venography can be performed safely with a soft Tracker catheter to
document the fresh thrombus as an adjunct to CT or MR We are
reporting our experience with successful direct urokinase thrombolytic
therapy in three cases of superior sagittal sinus and two cases of transverse
and sigmoid sinus thrombosis All five patients have recovered
completely without any residual clinical deficit
Tratamiento
Tratamiento
Guidance Statement
Anticoagulant treatment for a minimum of 3 months should be
considered in patients with transient risk factors Patients without
known risk factors should be considered for 6ndash12 months of
anticoagulation It appears safe to discontinue anticoagulant
treatment in the presence of transient risk factors such as oral
contraceptive use while indefinite treatment duration should be
considered for patients with recurrent CVT and in patients with
permanent major risk factors including severe thrombophilia
(antithrombin protein C or protein S deficiency antiphospholipid
antibodies syndrome homozygous factor V Leiden or
prothrombin gene mutation or combined heterozygous mutation)
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
AJNR Am J Neuroradiol 1992 Jul-Aug13(4)1137-41
Acute thrombosis of the intracranial dural sinus
direct thrombolytic treatment Tsai FY1 Higashida RT Matovich V Alfieri K
Abstract
Acute intracranial dural sinus thrombosis may have severe morbidity or
fatal complications without appropriate treatment Direct dural sinus
venography can be performed safely with a soft Tracker catheter to
document the fresh thrombus as an adjunct to CT or MR We are
reporting our experience with successful direct urokinase thrombolytic
therapy in three cases of superior sagittal sinus and two cases of transverse
and sigmoid sinus thrombosis All five patients have recovered
completely without any residual clinical deficit
Tratamiento
Tratamiento
Guidance Statement
Anticoagulant treatment for a minimum of 3 months should be
considered in patients with transient risk factors Patients without
known risk factors should be considered for 6ndash12 months of
anticoagulation It appears safe to discontinue anticoagulant
treatment in the presence of transient risk factors such as oral
contraceptive use while indefinite treatment duration should be
considered for patients with recurrent CVT and in patients with
permanent major risk factors including severe thrombophilia
(antithrombin protein C or protein S deficiency antiphospholipid
antibodies syndrome homozygous factor V Leiden or
prothrombin gene mutation or combined heterozygous mutation)
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Tratamiento
Guidance Statement
Anticoagulant treatment for a minimum of 3 months should be
considered in patients with transient risk factors Patients without
known risk factors should be considered for 6ndash12 months of
anticoagulation It appears safe to discontinue anticoagulant
treatment in the presence of transient risk factors such as oral
contraceptive use while indefinite treatment duration should be
considered for patients with recurrent CVT and in patients with
permanent major risk factors including severe thrombophilia
(antithrombin protein C or protein S deficiency antiphospholipid
antibodies syndrome homozygous factor V Leiden or
prothrombin gene mutation or combined heterozygous mutation)
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Femenino
42 antildeos
Anticonceptivos
Hemiparesia braquial derecha suacutebita cefalea
crisis convulsiva TCG
Caso Cliacutenico
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Flair T1 T2
24216
41214
Pre Tto
Control 14m
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Flair T1 T2
41214
24216 Control 14m
Pre Tto
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Flair T1 T2
41214
24216
Control 14m
Pre Tto
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
24216
41214 Angio TOF Venosa
Control 14m
Pre Tto
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
24216
41214 Angio TOF Venoso
Control 14m
Pre Tto
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
AJNR Am J Neuroradiol 161021ndash1029 May 1995
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Treated Group (n = 12) Nontreated Group (n = 21)
Full recovery 625 29
Mild disability 125 13
Severe disability 125 96
Fatal outcome 125 48
W Alvin McElveen MD Director Stroke Unit Lakewood Ranch Medical Center Neurologist Manatee Memorial Hospital
Muchas Gracias
Muchas Gracias
