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Stroke Research and Treatment
Volume 2010, Article ID 956302, 7 pages
http://dx.doi.org/10.4061/2010/956302
Review Article

Controversies of Treatment Modalities for Cerebral Venous Thrombosis

Department of Medicine (Neurology), Aga Khan University, Stadium Road, Karachi 74800, Pakistan

Received 13 August 2010; Revised 15 October 2010; Accepted 8 November 2010

Academic Editor: Chelsea S. Kidwell

Copyright © 2010 Maria Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cerebral vein thrombosis has been well recognized for nearly two centuries. However, therapeutic options for the condition are limited due to lack of large randomized trials. The various modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, and mechanical thrombectomy. Of these, antiplatelets are the least studied, and there are only anecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modality with favorable outcomes documented in two randomized controlled trials. Various fibrinolytic agents have also been tried. Local infusions have shown more promise compared to systemic agents. Similarly, mechanical thrombectomy has been used to augment the effects of chemical thrombolysis. However, in the absence of randomized controlled trials; there is no concrete evidence of the safety and efficacy of either of these modalities. Limited study series disclosed that decompression surgery in malignant CVT can be life saving and provides good neurological outcome in some cases. Conclusion. Overall therapeutics for CVT need larger randomized controlled trials. Anticoagulaion with heparin is the only modality with a reasonable evidence to support its use in CVT. Endovascular thrombolysis and mechanical thrombectomy are reserved for selected cases who fail anticoagulation and decompression surgery for malignant CVT with impending herniation.