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Neurocritical Care
Published in: Neurocritical Care 1/2010

01-02-2010 | Practical Pearl

Sequential Escalation of Therapy in “Malignant” Cerebral Venous and Sinus Thrombosis

Authors: Christian Dohmen, Norbert Galldiks, Walter Moeller-Hartmann, Gereon R. Fink, Lars Timmermann

Published in: Neurocritical Care | Issue 1/2010

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Abstract

Background

The best treatment of fulminant or progressive cerebral venous and sinus thrombosis (CVST) despite dose-adjusted heparin remains controversial. Local thrombolysis has been successfully performed in several cases. In cases of impending herniation hemicraniectomy has been suggested as ultima ratio. We describe sequential escalation of therapy in “malignant” CVST.

Methods

Case report.

Results

We report a case of fulminant CVST in whom sequential escalation of therapy with intravenous heparin, local thrombolysis, and hemicraniectomy was necessitated by the progressive clinical course. The patient survived with a relatively good outcome.

Conclusions

This first description on the combined treatment with local thrombolysis and hemicraniectomy illustrates that even in severely affected individuals, therapeutic nihilism is unwarranted and that all available therapeutic options including local thrombolysis and hemicraniectomy should be taken into consideration.
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Metadata
Title
Sequential Escalation of Therapy in “Malignant” Cerebral Venous and Sinus Thrombosis
Authors
Christian Dohmen
Norbert Galldiks
Walter Moeller-Hartmann
Gereon R. Fink
Lars Timmermann
Publication date
01-02-2010
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 1/2010
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-009-9301-1

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