Materiały źródłowe

• #1

  https://www.nhs.uk/conditions/cavernous-sinus-thrombosis/

  Cavernous sinus thrombosis needs treatment in hospital. […] In most cases, you’ll be treated in an intensive care unit, so you can be closely monitored. […] Antibiotics are the main treatment for cavernous sinus thrombosis. Treatment will be started as soon as possible, even before tests have confirmed if a bacterial infection is responsible. […] Most people will require antibiotics for a few weeks to ensure the infection has been fully cleared from their body. The antibiotics will be given through an intravenous drip directly connected to one of your veins. […] You may also be given a medicine called heparin to help dissolve the clot and prevent further clots. Heparin is an anticoagulant medicine, which means it makes the blood less sticky. […] Some people are also given steroid medicine (corticosteroids). Corticosteroids can reduce inflammation and swelling in your body.

• #2

  https://111.wales.nhs.uk/cavernoussinusthrombosis/

  Cavernous sinus thrombosis needs treatment in hospital. […] In most cases, you’ll be treated in an intensive care unit, so you can be closely monitored. […] Antibiotics are the main treatment for cavernous sinus thrombosis. Treatment will be started as soon as possible, even before tests have confirmed if a bacterial infection is responsible. […] Most people will require antibiotics for a few weeks to ensure the infection has been fully cleared from their body. The antibiotics will be given through an intravenous drip directly connected to one of your veins. […] You may also be given a medication called heparin to help dissolve the clot and prevent further clots. Heparin is an anticoagulant medicine, which means it makes the blood less sticky. […] Some people are also given steroid medicine (corticosteroids). Corticosteroids can reduce inflammation and swelling in your body.

• #3 Cavernous Sinus Thrombosis Treatment & Management: Emergency Department Care, Consultations, Prevention

  https://emedicine.medscape.com/article/791704-treatment

  The mainstay of therapy for cavernous sinus thrombosis (CST) is early and aggressive antibiotic administration. Although S aureus is the usual cause, broad-spectrum coverage for gram-positive, gram-negative, and anaerobic organisms should be instituted pending the outcome of cultures. […] Empiric antibiotic therapy should include a penicillinase-resistant penicillin plus a third- or fourth-generation cephalosporin. If dental infection or other anaerobic infection is suspected, an anaerobic coverage should also be added. […] IV antibiotics are recommended for a minimum of 3-4 weeks. […] Controversy exists on the use of anticoagulation for cavernous sinus thrombosis. Because of the rarity of this syndrome, no prospective trials have been performed on the use of anticoagulation for CST. Some retrospective studies have shown a decrease in mortality and clot propagation by anticoagulation.

• #4 Cavernous sinus thrombosis medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Cavernous_sinus_thrombosis_medical_therapy

  Cavernous sinus thrombosis is a medical emergency. Pharmacologic medical therapies for cavernous sinus thrombosis include antithombotic agents, antibiotics, and drugs such as mannitol, steroids and acetazolamide to decrease the intracranial pressure. Empiric antimicrobial therapy for septic thrombosis of cavernous or dural venous sinus includes metronidazole plus either nafcillin or oxacillin with either ceftriaxone or cefotaxime. Generally, the preferred empiric regimen for the treatment of cavernous sinus thrombosis is (Vancomycin 3045 mg/kg IV q812h for 3-4 weeks OR Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks) AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 812 g/day IV q46h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h for 3-4 weeks. If the risk of MRSA is high, vancomycin should be used instead of either nafcillin or oxacillin. Other pharmacologic therapies include antithrombotic agents (usually LMWH) to prevent clot formation, steroid therapy (e.g. Dexamethasone 10 mg q6h) for symptomatic relief, and mannitol and acetazolamide to reduce the elevated intracranial pressure. Antiepileptic therapy should be administered only if patients develop seizures.

• #5 Cavernous Sinus Thrombosis Medication: Antibiotic, Miscellaneous, Anticoagulants, Corticosteroids

  https://emedicine.medscape.com/article/791704-medication

  Antibiotic therapy ideally is started after appropriate cultures but should not be delayed if difficulties exist in obtaining specimens. Antibiotics selected should be broad-spectrum, particularly active against S aureus, and capable of achieving high levels in the cerebrospinal fluid. With the recent increased prevalence of community-acquired MRSA, the emergency physician should consider additional coverage with intravenous antibiotics, such as vancomycin, if MRSA infection is suspected. […] However, a case report and literature review by Naesens et al of community-acquired MRSA infections of the central nervous system, including cavernous sinus thrombosis, showed that patients treated with linezolid had a better outcome than those treated with vancomycin. […] Empiric broad-spectrum coverage for gram-positive, gram-negative, and anaerobic organisms is necessary. Therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

• #6 Cavernous Sinus Thrombosis Medication: Antibiotic, Miscellaneous, Anticoagulants, Corticosteroids

  https://emedicine.medscape.com/article/791704-medication

  In cases of suspected MRSA infection, vancomycin should be added for additional coverage. […] Unfractionated IV heparin and fractionated low-molecular-weight SC heparins are the 2 options in anticoagulation therapy. […] These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli. When the course of CST leads to pituitary insufficiency, corticosteroids definitely are indicated to prevent adrenal crisis.

• #7 Cavernous Sinus Thrombosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448177/

  Cavernous sinus thrombosis (CST) is a rare, life-threatening disorder that can complicate facial infection, sinusitis, orbital cellulitis, pharyngitis, or otitis or following traumatic injury or surgery, especially in the setting of a thrombophilic disorder. […] Despite modern treatment with antibiotics and anticoagulation, the risk of long-term sequelae, such as vision, diplopia, and stroke, remains significant. […] This activity examines when cavernous sinus thrombosis should be considered, how to properly evaluate this condition and the role of the interprofessional team in caring for patients with this condition. […] Outline the treatment options for cavernous sinus thrombosis. […] Antimicrobial therapy includes an anti-staphylococcal agent (vancomycin if methicillin resistance is high, or nafcillin), a third-generation cephalosporin, and metronidazole (for anaerobic coverage) as well as antifungal therapy with amphotericin B. A prolonged duration of parenteral therapy, typically three to four weeks or at least two weeks beyond clinical resolution is suggested.

• #8 Cavernous Sinus Thrombosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19035

  Because of the rarity of diagnosis, no randomized controlled trials are available, and expert opinion guides treatment. In general, antimicrobial and antithrombotic therapies are primary considerations. […] Antimicrobial therapy includes an anti-staphylococcal agent (vancomycin if methicillin resistance is high, or nafcillin), a third-generation cephalosporin, and metronidazole (for anaerobic coverage) as well as antifungal therapy with amphotericin B. A prolonged duration of parenteral therapy, typically three to four weeks or at least two weeks beyond clinical resolution is suggested. […] Most experts recommend anticoagulation, in the absence of strong contraindications, with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) for several weeks to several months. Though not supported by prospective clinical trials in cavernous sinus thrombosis, retrospective reviews suggest a possible decrease in mortality from 40% to 14% with UFH and reduction in neurologic morbidity, from 61% to 31% when anticoagulation is combined with antibiotics for septic cavernous sinus thrombosis.

• #9 Cavernous sinus thrombosis medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Cavernous_sinus_thrombosis_medical_therapy

  Antithrombotics to prevent clot formation. […] Anticoagulation (usually heparin / LMWH). […] Thrombolysis may be performed with agents like urokinase, TPA generally given via microcatheters inserted for local infusion. […] Antibiotics if infectious precipitant. […] Reduction of intracranial pressure. […] Medical: mannitol, steroids, acetazolamide, repeat LPs. […] Duration of therapy is usually a total of 3-4 weeks. More prolonged administration of antimicrobial therapy (total of 6-8 weeks) may be indicated among patients who are suspected to have developed complications (e.g. suppurative intracranial disease). […] Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.

• #10 Cavernous sinus thrombosis – Wikipedia

  https://en.wikipedia.org/wiki/Cavernous_sinus_thrombosis

  Recognizing the primary source of infection (i.e., facial cellulitis, middle ear, and sinus infections) and treating the primary source expeditiously is the best way to prevent cavernous sinus thrombosis. […] Broad-spectrum intravenous antibiotics are used until a definite pathogen is found. […] People with CST are usually treated with prolonged courses (34 weeks) of IV antibiotics. If there is evidence of complications such as intracranial suppuration, 68 weeks of total therapy may be warranted. […] Anticoagulation with heparin is controversial. […] Surgical drainage with sphenoidotomy is indicated if the primary site of infection is thought to be the sphenoidal sinuses.

• #11 Cavernous Sinus Thrombosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448177/

  Most experts recommend anticoagulation, in the absence of strong contraindications, with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) for several weeks to several months. […] Though not supported by prospective clinical trials in cavernous sinus thrombosis, retrospective reviews suggest a possible decrease in mortality from 40% to 14% with UFH and reduction in neurologic morbidity, from 61% to 31% when anticoagulation is combined with antibiotics for septic cavernous sinus thrombosis. […] The advantage would be to halt the progression of thrombosis, prevent clot propagation, and possibly allow penetration of antibiotics, whereas the risk would be systemic or intracranial bleeding or even dissemination of septic emboli. […] The International Study on Cerebral Veins and Dural Sinus Thrombosis (ISCVT) reported steroid use in 24% of cerebral thrombosis with no evidence of improvement.

• #12 Cavernous Sinus Thrombosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19035

  There does remain controversy with anticoagulation. The advantage would be to halt the progression of thrombosis, prevent clot propagation, and possibly allow penetration of antibiotics, whereas the risk would be systemic or intracranial bleeding or even dissemination of septic emboli. […] Although cavernous sinus thrombosis differs from cerebral venous and sinus thrombosis, the Cochrane Collaboration (Coutinho) suggests that anticoagulation for cerebral venous and sinus thrombosis appears safe, even in the presence of intracranial hemorrhage, and demonstrates a potentially important mortality reduction (though not statistically significant). […] The European Federation of Neurological Societies (EFNS) recommends three months of anticoagulation in secondary cerebral venous and sinus thrombosis with a transient risk factor, six to 12 months for idiopathic cerebral venous and sinus thrombosis and those with mild thrombophilia and indefinitely if subsequent cerebral venous and sinus thrombosis or severe thrombophilia.

• #13 Cavernous Sinus Thrombosis – emDocs

  https://www.emdocs.net/cavernous-sinus-thrombosis/

  Antibiotics are primary in the treatment of CST. Empiric therapy should consist of a third generation cephalosporin, nafcillin, and metronidazole. Vancomycin can be substituted for nafcillin if methicillin-resistant Staphylococcus aureus (MRSA) is a concern. […] Along with antibiotics, surgery may be necessary; it is rarely needed for drainage of the primary infection. […] The use of anticoagulation and corticosteroids remains controversial. Some studies have found improved cranial nerve function with steroid use, but there is currently no data to support its routine use. […] Regarding anticoagulation, data is also limited given the rarity of CST and the lack of prospective trials. It is theorized that anticoagulation may prevent the spread of the thrombus to other sinuses as well as help dissolve the clot, allowing the antibiotic to reach the infected thrombus more readily. […] Most authors recommend considering anticoagulation only if there is no evidence of severe bleeding risk or current hemorrhage by history, exam, and imaging. It is always best to consult with specialists regarding treatment regimens.

• #14 Cavernous Sinus Thrombosis Treatment & Management: Emergency Department Care, Consultations, Prevention

  https://emedicine.medscape.com/article/791704-treatment

  A Cochrane review found two small trials involving 79 patients who were treated with anticoagulants. Limited evidence suggests anticoagulant drugs are probably safe and may be beneficial for people with sinus thrombosis. […] Therefore, anticoagulation with heparin should be considered since the goal is to prevent further thrombosis and to reduce the incidence of septic emboli. […] One review suggests that low-molecular weight heparin (LMWH) is superior to unfractionated heparin (UFH). […] Heparin is contraindicated in the presence of intracerebral hemorrhage or other bleeding diathesis. […] Locally administered thrombolytics have also been used in the treatment of CST. However, use of thrombolytics should be considered experimental and only for severe refractory cases. […] Corticosteroids may help to reduce inflammation and edema and should be considered as an adjunctive therapy. They should be instituted after antibiotic coverage.

• #15 Cavernous Sinus Thrombosis Treatment & Management: Emergency Department Care, Consultations, Prevention

  https://emedicine.medscape.com/article/791704-treatment

  When the course of CST leads to pituitary insufficiency, however, corticosteroids definitely are indicated to prevent adrenal crisis. Dexamethasone or hydrocortisone should be considered. […] Surgery on the cavernous sinus is technically difficult and has never been shown to be helpful. The primary source of infection should be drained, if feasible (eg, sphenoid sinusitis, facial abscess). It is important to recognize the infected sphenoid sinus early and to prevent spread of the infection to the cavernous sinus.

• #16 Cavernous Sinus Thrombosis – Eye Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/cavernous-sinus-thrombosis

  IV high-dose antibiotics. […] Sometimes corticosteroids. […] Sometimes anticoagulation. […] Initial antibiotics for patients with cavernous sinus thrombosis include, eg, nafcillin or oxacillin 1 to 2 g every 4 hours combined with a third-generation cephalosporin (eg, ceftriaxone 1 g every 12 hours). […] In cases with underlying sphenoid sinusitis, surgical sinus drainage is indicated, especially if there is no clinical response to antibiotics within 24 hours. […] Secondary treatment for cavernous sinus thrombosis may include corticosteroids (eg, dexamethasone 10 mg IV or orally every 6 hours) for cranial nerve dysfunction. […] Anticoagulation is controversial; unfractionated and low-molecular-weight heparin have been used in patients without contraindications. […] These drugs may reduce morbidity, but evidence establishing their efficacy in reducing mortality will require further study.

• #17 Symptoms and treatment of cavernous sinus thrombosis | Nasodren

  https://nasodren.com/symptoms-and-treatment-of-cavernous/

  Treatment During initial stage, aggressive treatment is required to prevent the infection from spreading further. Patients shall be monitored during treatment to observe any further complications and / or improvements. However, even after treatment, cranial nerve paralysis (palsies) does not disappear. Half of the patients who recover from CST suffer from complete or partial palsies of the cranial nerve. An assortment of antibiotics is administered to treat these side effects of sinus infection. However, the type of antibiotics depends on the result of the sinus exudate and blood cultures. Besides systemic antibiotic therapy, emergency surgery may be required to drain the infection. If CST patients do not respond to antibiotics, corticosteroids may be administered to reduce chances of adrenal insufficiency and orbital congestion. However, use of systemic corticosteroids is controversial. Intravenously given anticoagulants may check growth of the thrombosis. Anticoagulants may facilitate recanalization of thrombous (clot), enabling easy and quick penetration of antibiotics. However, anticoagulation therapy may cause septic emboli, thereby causing risk of intracranial bleeding. In addition, very few studies have been conducted on effectiveness of anticoagulation. The use of anticoagulation, thus, is controversial. Some times steroid therapy is used for the treatment, but it is also controversial. So, consult your physician.

• #18

  https://www.nhs.uk/conditions/cavernous-sinus-thrombosis/

  If the symptoms of cavernous sinus thrombosis were caused by an infection spreading from a boil or sinusitis, it may be necessary to drain away pus from that site. This can be done either using a needle or during surgery. […] Several weeks of antibiotic treatment are usually necessary to ensure the infection has cleared. However, it can take a long time to recover fully, and it may be several months before you’re well enough to leave hospital.

• #19

  https://111.wales.nhs.uk/cavernoussinusthrombosis/

  If the symptoms of cavernous sinus thrombosis were caused by an infection spreading from a boil or sinusitis, it may be necessary to drain away pus from that site. This can be done either using a needle or during surgery. […] Several weeks of antibiotic treatment are usually necessary to ensure the infection has cleared. However, it can take a long time to recover fully, and it may be several months before you’re well enough to leave hospital.

• #20 Cavernous Sinus Thrombosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448177/

  No surgical interventions are recommended for the cavernous sinuses themselves. However, some patients might require sphenoidectomy, ethmoidectomy, maxillary antrostomy, mastoidectomy, abscess drainage, craniotomy (subdural empyema), orbital decompression, or ventricular shunt placement. […] Patients should be followed closely even after the discontinuation of the antibiotics.

• #21 Cavernous Sinus Thrombosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19035

  As in cerebral venous and sinus thrombosis, there is inadequate evidence to support thrombolysis in cavernous sinus thrombosis. […] Corticosteroids are often given but without demonstrated efficacy. The potential benefit would be decreased inflammation and vasogenic edema surrounding cranial nerves and orbital structures. […] No surgical interventions are recommended for the cavernous sinuses themselves. However, some patients might require sphenoidectomy, ethmoidectomy, maxillary antrostomy, mastoidectomy, abscess drainage, craniotomy (subdural empyema), orbital decompression, or ventricular shunt placement. […] Patients should be followed closely even after the discontinuation of the antibiotics.

• #22 Cavernous sinus thrombosis: Treatment, causes, and more

  https://www.medicalnewstoday.com/articles/cavernous-sinus-thrombosis

  Supportive measures: Doctors may prescribe pain relievers, such as nonsteroidal anti-inflammatory drugs, to alleviate severe headaches and eye pain. Corticosteroids, such as dexamethasone, may also help reduce inflammation. Doctors may also administer intravenous fluids to maintain hydration, particularly if the individual experiences fever. […] The treatment plan for CST is highly individualized and depends on various factors, including the severity of the infection, the presence of complications, and the patients overall health. […] A person must receive treatment promptly to prevent further complications and improve outcomes.

• #23 New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-024-00320-9

  Following the acute phase, oral anticoagulation with direct oral anticoagulants instead of vitamin K antagonists should be given for 3 to 12 months to enhance recanalization and prevent recurrent CVT as well as extracerebral venous thrombosis. […] Women with previous CVT in connection with the use of combined hormonal contraceptives or pregnancy shall refrain from continuing or restarting contraception with oestrogenprogestagen combinations due to an increased risk of recurrence if anticoagulation is no longer used. […] Women with previous CVT and without contraindications should receive LMWH prophylaxis during pregnancy and for at least 6 weeks post partum. […] Anticoagulation in the acute phase of CVT is essential to prevent propagation of the thrombus or renewed thrombotic occlusion of vessel sections that have already been reopened by the body’s own fibrinolysis.

• #24 Challenges in Cerebral Venous Thrombosis Management—Case Reports and Short Literature Review

  https://www.mdpi.com/2075-1729/13/2/334

  The issue of using new oral anticoagulants for chronic post-CVT anticoagulation is still being studied. […] The European Stroke Association Guideline recommends the use of enoxaparin instead of UFH, excluding situations in which the patient has renal failure or is likely to require neurosurgical intervention in the near future, or if the patient is pregnant or in the postpartum period. […] The presence of bleeding at the onset makes it difficult to establish a quick diagnosis and the therapeutic decision balances risk–benefit, requiring close monitoring. […] An anticoagulant treatment, even in the therapeutic dose, may not offer safe protection for the development or occurrence of other thrombotic complications. […] The first episode of CVT with transient risk factors requires ACO treatment for three to six months (six to twelve months if cryptogenic).

• #25 Cerebral venous thrombosis – WikEM

  https://wikem.org/wiki/Cerebral_venous_thrombosis

  Anticoagulation: Heparin or low molecular weight heparin (Grade 1C) […] Following the acute phase, patients should transition to oral anticoagulation for a 3-6 month duration […] Warfarin is recommended as oral anticoagulation of choice […] There is a controversy regarding the use of direct oral anticoagulants. However, findings from the RE-SPECT CVT trial which was published recently and compared warfarin to dabigatran, suggest that both agents have similar effectiveness and safety for preventing recurrent CVT. […] Seizure prophylaxis: Recommended for patients with seizure at presentation PLUS focal cerebral lesion (edema, infarction or hemorrhage on CT/MRI) (Grade 1B) […] Only required if the patient has a seizure […] Prophylaxis with antiepileptic is NOT required if the patient has a single seizure with no signs of supratentorial cerebral lesion.

• #26 Cerebral Venous Sinus Thrombosis (CVST): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22560-cerebral-venous-sinus-thrombosis

  Alternatively, if your healthcare provider chooses a direct oral anticoagulant, it can thin your blood at the desired level within a few hours. […] After you’ve had a cerebral venous sinus thrombosis, your healthcare provider will want to keep you from having another blood clot. […] This means you’ll need to take an anticoagulant or blood thinner like warfarin. […] A cerebral venous sinus thrombosis, or CVST, can happen again, so it’s important to go to all of your follow-up appointments with your healthcare provider.

• #27 Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis | Scientific Reports

  https://www.nature.com/articles/s41598-020-78434-8

  In patients, who continue to deteriorate despite systemic anticoagulation therapy, endovascular therapy should be considered according to several guidelines and consensus statements. […] Currently, IST is performed by introducing a catheter via the femoral or internal jugular vein and rtPA is delivered directly to the site of the thrombus, while developing an effort to disrupt the clot to increase the surface area exposed to rtPA. […] The fact that this therapy increases the chance of the achievement of a good outcome has been confirmed by the meta-analysis of 235 patients treated with MT for an unfavorable development of CVST. […] The optimal treatment approach remains uncertain in the rare subgroup of CVST affecting the deep venous system, leading to more frequent venous infarctions and parenchymal bleeding.

• #28 Cerebral Venous Sinus Thrombosis – Interventional Neuroradiology | UCLA Health

  https://www.uclahealth.org/medical-services/radiology/interventional-neuroradiology/diseases-treated/cerebral-venous-sinus-thrombosis

  Anticoagulation, the administration of a blood thinning drug is the first line of treatment and has been shown to be very effective. […] However, when the clot burden is too large and/or the patient condition deteriorates despite anticoagulation treatment, catheter based clot-busting treatment becomes a consideration. […] Using the state-of-the-art interventional suite equipped with the latest biplane X-ray machine, we can safely navigate a catheter into the cerebral venous sinus that is blocked with the clot. Via the catheter, we can deploy a clot-capturing device or aspirate the clot from the catheter itself.

• #29 Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis | Scientific Reports

  https://www.nature.com/articles/s41598-020-78434-8

  The recent European guidelines did not formulate a clear opinion on endovascular therapy of CVST; these guidelines only suggest avoiding this therapy in patients with a low probability of poor outcomes. […] In our patient set, we also opted for endovascular therapy in patients in a severe condition. […] The presence of GSRF was identified as significant independent positive predictor and, female sex and the presence of focal neurologic deficit as significant independent negative predictors of excellent clinical outcome.

• #30 Cerebral venous thrombosis (CVT) – EMCrit Project

  https://emcrit.org/ibcc/cvt/

  Infection may be an indication for obtaining cultures, starting antibiotics, and possibly obtaining additional imaging studies to evaluate for an underlying focus of infection. […] This may include local administration of thrombolytics into the cerebral veins, and/or mechanical clot disruption. […] Available RCT-level evidence has not shown benefit from interventional therapy. […] Typically reserved as a rescue therapy, when all other therapies have failed.

• #30 Cerebral venous thrombosis (CVT) – EMCrit Project

  https://emcrit.org/ibcc/cvt/

  If unfractionated heparin is used, particular care should be taken to avoid either supratherapeutic or subtherapeutic drug levels. […] Seizures occur in 10-40% of all patients with CVT. […] If seizures do occur, these should be treated aggressively. Even a single seizure is an indication for antiepileptic therapy. […] Impaired drainage of CSF into the venous sinuses may lead to communicating hydrocephalus and thereby cause elevated intracranial pressure. […] Drainage of CSF may be necessary: External ventricular drain (EVD) placement may rarely be necessary. […] Acetazolamide could be considered to reduce CSF production, in the absence of high-quality evidence. […] Focal tissue infarction with subsequent edema may compress adjacent tissue. […] Decompressive craniectomy may occasionally be necessary to prevent herniation.

• #31 New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-024-00320-9

  Over the last years, new evidence has accumulated on multiple aspects of diagnosis and management of cerebral venous and dural sinus thrombosis (CVT) including identification of new risk factors, studies on interventional treatment as well as treatment with direct oral anticoagulants. […] Patients with CVT should preferably be treated with low molecular weight heparine (LMWH) instead of unfractionated heparine in the acute phase. […] On an individual basis, endovascular recanalization in a neurointerventional center may be considered for patients who deteriorate under adequate anticoagulation. […] Despite the overall low level of evidence, surgical decompression should be performed in patients with CVT, parenchymal lesions (congestive edema and/or hemorrhage) and impending incarceration to prevent death.

• #32 New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-024-00320-9

  In CVT patients, the duration of anticoagulation shall not be less than 3 months. […] In CVT patients with an increased risk of recurrent CVT or extracerebral venous thrombosis, anticoagulation should be continued in the long term as secondary prophylaxis to prevent VTE recurrences. […] CVT occurring during pregnancy or the postpartum period should be treated with subcutaneously administered LMWH in therapeutic doses. […] Women with previous CVT in connection with the use of combined hormonal contraceptives or pregnancy shall refrain from continuing or restarting contraception with oestrogenprogestagen combinations due to an increased risk of recurrence if anticoagulation is no longer used.

• #33 Cerebral Venous Sinus Thrombosis (CVST) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/cerebra-venous-sinus-thrombosis-cvst

  If patients do not improve upon administration of heparin or another blood thinner, the doctor may administer thrombolytic enzymes, which can dissolve existing blood clots. Because they may cause hemorrhage, these medications are typically used only in severe cases. Alternatively, a surgeon may perform a procedure known as a thrombectomy to remove the blood clot(s). The goal of thrombolytic enzymes and thrombectomy is the same: to remove the blood clot and restore blood flow. […] Treatment for people who experience CVST following Johnson Johnson vaccination differs from the usual treatment protocols. These patients should not take heparin, as it may be unsafe for the particular type of clot associated with this vaccine. Anyone who experiences headache, stomach pain, leg pain, or shortness of breath within three weeks of receiving the Johnson Johnson vaccine should get in touch with their health care provider.

• #34 Cerebral Venous and Dural Sinus Thrombosis – EyeWiki

  https://eyewiki.org/Cerebral_Venous_and_Dural_Sinus_Thrombosis

  If there are no contraindications, anticoagulation in the acute phase with either body-weight adjusted subcutaneous LMWH or dose-adjusted intravenous heparin is the medical therapy of choice. Concomitant intracranial hemorrhage related to the CVST is not an absolute contraindication for heparin therapy. In uncomplicated cases, LMWH is preferred over IV heparin due to less major bleeding problems. There is no evidence available for duration of anticoagulation after the acute phase. […] In cases of intracranial hypertension with secondary papilledema, progressive headache, or third or sixth nerve palsies, management consists of a collection of strategies to reduce the pressure and preserve vision. The first measure is listed above; anticoagulation to reduce thrombotic occlusion of venous outflow. Other measures resemble the treatment of IIH. Serial lumbar punctures to reduce CSF volume can be considered with the caveat of needing to hold anticoagulation while it is performed. Other alternatives include treatment with acetazolamide to decrease CSF production.

• #35 Cerebral Venous and Dural Sinus Thrombosis – EyeWiki

  https://eyewiki.org/Cerebral_Venous_and_Dural_Sinus_Thrombosis

  Optic Nerve Sheath Fenestration (ONSF) can be considered in patients with CVST with elevated ICP when medical management has failed and visual function is failing. In patients where intracranial hypertension remains persistent despite adequate medical management and a lumbar drain, a CSF diversion procedure (ventriculoperitoneal or lumboperitoneal shunt) may be considered. […] Endovascular thrombolysis and mechanical thrombectomy have not played a prominent role in the treatment of CVST but may be considered in cases of severe neurological deterioration despite use of anticoagulation, venous infarcts causing mass effect, or intracerebral hemorrhage causing treatment resistant intracranial hypertension.

• #36 2. Acute Treatment of Symptomatic Cerebral Venous Thrombosis | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/cerebral-venous-thrombosis/2-acute-treatment-of-symptomatic-cerebral-venous-thrombosis

  Systemic intravenous thrombolysis is not recommended in the acute treatment of CVT [Strong recommendation; Low quality of evidence]. […] Endovascular therapy should not be routinely used as first-line therapy for the acute treatment of cerebral venous thrombosis [Conditional recommendation; Moderate quality of evidence]. […] Decompressive hemicraniectomy should be considered in cases of life-threatening malignant mass effect due to venous infarction and/or hemorrhage [Strong recommendation; Moderate quality of evidence].

• #37 Cavernous sinus thrombosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cavernous-sinus-thrombosis?lang=us

  Cavernous sinus thrombosis (CST), the presence of thrombus in the cavernous sinus, is a rare condition, most commonly infectious in nature, and the diagnosis on imaging is not always straightforward. It has high mortality and morbidity rates. […] Primary consideration for the management of cavernous sinus thrombosis is the use of antimicrobials and antithrombotic agents. The mortality rate is up to 30%. Significant morbidity (e.g. blindness, cranial nerve palsy) in survivors not uncommon.

• #38 Cavernous Sinus Thrombosis: Successful Treatment Using Functional Endonasal Sinus Surgery – University of Miami

  https://scholarship.miami.edu/esploro/outputs/journalArticle/Cavernous-Sinus-Thrombosis-Successful-Treatment-Using/991031598935502976?institution=01UOML_INST&skipUsageReporting=true&recordUsage=false

  OBJECTIVE: Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50% of the patients recover completely, and the mortality rate is approximately 30%. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. […] INTERVENTION: The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. […] CONCLUSIONS: The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.

• #39 Cavernous Sinus Thrombosis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23520-cavernous-sinus-thrombosis

  Cavernous sinus thrombosis requires immediate treatment. […] Treatments include: […] Antibiotics. Your provider will begin antibiotic treatment through an IV to clear the infection thats causing the clot. […] Anticoagulants. You may need medicines that thin your blood, like heparin, to dismantle the clot and prevent new clots from forming. […] Corticosteroids. Your provider may prescribe steroids to reduce the inflammation causing pressure in your sinuses. […] Sinus surgery. You may need surgery to drain any fluid build-up related to your infection and blood clot.

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