Comparison of Outcomes between Stent Retriever Combined with Contact Aspiration and Contact Aspiration Alone in Patients without Hyperdense Artery Sign/Susceptibility Vessel Sign.

PURPOSE: To examine the relationship between hyperdense artery sign (HAS)/susceptibility vessel sign (SVS) and thrombus composition and evaluate the effect of HAS/SVS status on the association between first-line thrombectomy techniques and outcomes in patients with acute anterior circulation large vessel occlusion (LVO). MATERIALS AND METHODS: From January 2018 to June 2021, 103 consecutive patients with acute anterior circulation LVO (75 [63.1%] men; median age, 66 years) who underwent thrombectomy and for whom the removed clot was available for histological analyses were retrospectively reviewed. The presence of HAS and SVS was assessed on unenhanced computed tomography (CT) and susceptibility-weighted imaging, respectively. Association of first-line thrombectomy techniques (stent retriever [SR] combined with contact aspiration [CA] vs CA alone) with outcomes was assessed according to HAS/SVS status. RESULTS: Among the included patients, 55 (53.4%) were HAS/SVS-negative, and 69 (67.0%) underwent first-line SR + CA. Higher relative densities of fibrin/platelets (0.56 vs 0.51; P < .001) and lower relative densities of erythrocytes (0.32 vs 0.42; P < .001) were observed in HAS/SVS-negative patients compared with HAS/SVS-positive patients. First-line SR + CA was associated with reduced odds of distal embolization (adjusted odds ratio, 0.18; 95% CI, 0.04-0.83; P = .027) and a more favorable 90-day functional outcome (adjusted odds ratio, 5.29; 95% CI, 1.06-26.34; P = .042) in HAS/SVS-negative patients and a longer recanalization time (53 vs 25 minutes; P = .025) and higher risk of subarachnoid hemorrhage (24.2% vs 0%; P = .044) in HAS/SVS-positive patients. CONCLUSIONS: Absence of HAS/SVS may indicate a higher density of fibrin/platelets in the thrombus, and first-line SR + CA yielded superior functional outcomes than CA alone in patients with acute LVO without HAS/SVS.

Challenges in diagnosis and management of cerebral venous thrombosis as underlying cause of lobar intracerebral hemorrhage.

OBJECTIVES: Cerebral venous thrombosis is an uncommon, yet life-threatening condition, affecting mainly young and middle-aged individuals. Moreover, it represents an underrecognised etiology of lobar intracerebral hemorrhage (ICH). The clinical course of CVT is variable in the first days after diagnosis and medical complications including pulmonary embolism (PE) may result in early neurological deterioration and death if left untreated. MATERIALS AND METHODS: Case report. RESULTS: We describe a 46-year-old man with acute left hemiparesis and dysarthria in the context of lobar ICH due to underlying CVT of Trolard vein. Diagnosis was delayed because of misinterpretation of the initial neuroimaging study. Subsequently, the patient rapidly deteriorated and developed submassive PE and left iliofemoral venous thrombosis in the setting of previously undiagnosed hereditary thrombophilia (heterozygous prothrombin gene mutation G2021A). Emergent aspiration thrombectomy was performed resulting in the successful management of PE. A follow-up MRI study confirmed the thrombosed Trolard vein, thus establishing the CVT diagnosis. Anticoagulation treatment was immediately escalated to enoxaparine therapeutic dose resulting in clinical improvement of neurological deficits. CONCLUSIONS: Delayed diagnosis of cerebral venous thrombosis with underlying causes of lobar ICH may result in dire complications. Swift initiation of anticoagulants is paramount even in patients with lobar intracerebral hemorrhage as the initial manifestation of cerebral venous thrombosis.

Multicenter registry study of cerebral venous thrombosis in china (RETAIN-CH): Rationale and design.

BACKGROUND AND RATIONALE: Cerebral venous thrombosis (CVT) is a rare cerebrovascular disorder that mainly affects young and middle-aged adults. Epidemiological data on the incidence, risk factors, diagnosis, treatment, and prognosis of CVT are lacking in China. In addition, there is a lack of evidence from large, multicenter, real-world studies on the efficacy and safety of endovascular. AIM: To understand the incidence, diagnosis and treatment status of CVT in China and to estimate the effectiveness and safety of endovascular treatment in the real-world. METHODS: A multicenter, retrospective observational cohort study will be conducted on CVT patient records from 104 hospitals, between January 1, 2018 and June 30, 2022, identified using a 2-stage cluster sampling design based on per capita gross domestic product. Each enrolled participant is required to complete a further follow-up, which includes the current situation and the assessment at 3 and 12 months after discharge. STUDY OUTCOMES: The outcomes of this study will include the current status of the incidence, pathogenesis, etiology, clinical symptoms, diagnosis, and treatment of CVT in China, as well as the effectiveness and safety of endovascular treatment in the real-world. DISCUSSION: Results from this study will provide evidence on the incidence, specific risk factors, symptomatic and imaging features, and clinical outcomes of CVT in China as well as indicate whether endovascular treatment is superior to medical management alone for patients with acute CVT in the real-world. TRIAL REGISTRATION: http://www. CLINICALTRIALS: gov. IDENTIFIER: NCT05448248.

External validation of the SI2NCAL2C score for outcomes following cerebral venous thrombosis.

OBJECTIVES: Prognostication for cerebral venous thrombosis (CVT) remains difficult. We sought to validate the SI2NCAL2C score in an international cohort. MATERIALS AND METHODS: The SI2NCAL2C score was originally developed to predict poor outcome (modified Rankin Scale (mRS) 3-6) at 6 months, and mortality at 30 days and 1 year using data from the International CVT Consortium. The SI2NCAL2C score uses 9 variables: the absence of any female-sex-specific risk factors, intracerebral hemorrhage, central nervous system infection, focal neurological deficits, coma, age, lower level of hemoglobin, higher level of glucose, and cancer. The ACTION-CVT study was an international retrospective study that enrolled consecutive patients across 27 centers. The poor outcome score was validated using 90-day mRS due to lack of follow-up at the 6-month time-point in the ACTION-CVT cohort. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations. RESULTS: Mortality data were available for 950 patients and poor outcome data were available for 587 of 1,025 patients enrolled in ACTION-CVT. Compared to the International CVT Consortium, the ACTION-CVT cohort was older, less often female, and with milder clinical presentation. Mortality was 2.5% by 30 days and 6.0% by one year. At 90-days, 16.7% had a poor outcome. The SI2NCAL2C score had an AUC of 0.74 [95% CI 0.69-0.79] for 90-day poor outcome, 0.72 [0.60-0.82] for mortality by 30 days, and 0.82 [0.76-0.88] for mortality by one year. CONCLUSIONS: The SI2NCAL2C score had acceptable to good performance in an international external validation cohort. The SI2NCAL2C score warrants additional validation studies in diverse populations and clinical implementation studies.

Cerebral venous thrombosis.

Cerebral venous thrombosis is part of the so-called thrombosis in unusual sites. It is defined as an occlusion in the cerebral venous territory. Its incidence is progressively increasing, especially in developing countries. It is more frequently observed in young women, with hormonal factors such as pregnancy or hormonal contraception being significant risk factors in the development of this condition. The clinical presentation will depend fundamentally on the topography of the thrombosis, with a confirmatory diagnosis based mainly on imaging tests. The treatment generally consists of anticoagulation, and other options may be considered depending on the severity of the case. Overall, the prognosis is better than that of other intracranial vascular disorders. This review describes the current evidence available regarding cerebral venous thrombosis.

Reducing the global burden of cerebral venous thrombosis: An international research agenda.

BACKGROUND: Due to the rarity of cerebral venous thrombosis (CVT), performing high-quality scientific research in this field is challenging. Providing answers to unresolved research questions will improve prevention, diagnosis, and treatment, and ultimately translate to a better outcome of patients with CVT. We present an international research agenda, in which the most important research questions in the field of CVT are prioritized. AIMS: This research agenda has three distinct goals: (1) to provide inspiration and focus to research on CVT for the coming years, (2) to reinforce international collaboration, and (3) to facilitate the acquisition of research funding. SUMMARY OF REVIEW: This international research agenda is the result of a research summit organized by the International Cerebral Venous Thrombosis Consortium in Amsterdam, the Netherlands, in June 2023. The summit brought together 45 participants from 15 countries including clinical researchers from various disciplines, patients who previously suffered from CVT, and delegates from industry and non-profit funding organizations. The research agenda is categorized into six pre-specified themes: (1) epidemiology and clinical features, (2) life after CVT, (3) neuroimaging and diagnosis, (4) pathophysiology, (5) medical treatment, and (6) endovascular treatment. For each theme, we present two to four research questions, followed by a brief substantiation per question. The research questions were prioritized by the participants of the summit through consensus discussion. CONCLUSIONS: This international research agenda provides an overview of the most burning research questions on CVT. Answering these questions will advance our understanding and management of CVT, which will ultimately lead to improved outcomes for CVT patients worldwide.

Exploring thrombus composition in cerebral venous thrombosis: the first case report with initial insights and implications for treatment advancements.

BACKGROUND: Endovascular thrombectomy (EVT) is a treatment option in patients with a cerebral venous thrombosis (CVT) who deteriorate despite anticoagulant treatment. Assessment of thrombus composition in CVT may provide insights into the pathophysiology of the disease and suggest new therapeutic strategies. CASE REPORT: A 47-year-old woman (smoking habit and estradiol/progesterone-releasing intra-uterine device) diagnosed with massive CVT underwent EVT (complete recanalization via aspiration catheter and stentriever) due to acute-onset left-sided weakness and dysarthria despite 72 h of full-dose subcutaneous low-molecular heparin. Two main reddish clots (maximum diameter 15 mm) were retrieved. Microscopic assessment showed an erythrocyte-rich thrombus (83.9% of entire thrombus surface) with layers of platelets/fibrin (lines of Zahn: 13.9% fibrin and 38.5% platelet [CD61+]). The immunological profile was dominated by neutrophils (30% MPO+), with neutrophil extracellular traps (NETs) in 1.9% of thrombus surface. T- (CD3+), B-lymphocytes (CD20+), and monocytes/macrophages (CD68+) were rather rare (2.2%, 0.7%, and 2.0% respectively). We found no evidence (0.0%) of hemosiderin and endothelial cells (CD34+). Full clinical recovery occurred prior to discharge. CONCLUSION: This is the first case report of a CVT with histologic assessment of the thrombus retrieved via EVT. Evaluating thrombi in CVT can provide key insights into disease pathophysiology and guide treatment advancements.

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association.

Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.

Trombosis venosa cerebral secundaria al tratamiento con inmunoglobulina intravenosa / Cerebral venous thrombosis following treatment with intravenous immunoglobulin

No disponible

Arteritis de Takayasu y trombosis venosa cerebral: a propósito de un caso / Takayasu arteritis and cerebral venous thrombosis: report of a case

Las palpitaciones, parestesias y ansiedad son motivos de consulta muy frecuentes en atención primaria. Presentamos el caso de una mujer de 40 años de raza caucásica que acudió a la consulta con esta sintomatología y que fue diagnosticada de una arteritis de Takayasu. Posteriormente presentó un cuadro de cefalea, como síntoma inicial de una trombosis venosa cerebral. La arteritis de Takayasu consiste en una vasculitis sistémica que afecta a las arterias de mediano y gran calibre, produciendo estenosis principalmente de la aorta y sus ramas. Afecta más frecuentemente a mujeres asiáticas, siendo mucho más rara en Europa. El médico de atención primaria tiene un papel fundamental en el diagnóstico de sospecha y seguimiento de los pacientes con enfermedades raras, como la enfermedad de Takayasu, y debe ser un apoyo básico para el paciente y la familia, informando, asesorando y contribuyendo con su trabajo a disminuir la vulnerabilidad de este colectivo (AU)

Palpitations, paresthesias and anxiety are very common reasons of consultation in primary care. We report the case of a 40 year-old Caucasian woman who came to the clinic due to these symptoms, and was finally diagnosed with Takayasu arteritis. Later, she had an episode of headache, as the initial manifestation of cerebral venous thrombosis. Takayasu arteritis is a systemic vasculitis affecting medium and large arteries, mainly leacausing stenosis of the aorta and its branches. It most frequently affects Asian women, being much rarer in Europe. The primary care doctor plays a key role in the initial diagnosis and monitoring of patients with rare diseases, such as Takayasu arteritis, and must be a basic support for the patient and family, providing information and advice, and contributing with his work to reduce the vulnerability of this group (AU)

Trombolisis mecánica de tronco basilar con Solitaire FR®: caso clínico / Mechanical thrombolysis of the basilar artery: Report of one case

We report a 40year-old male presenting in the emergeney room with headache, vértigo and left hemiparesis. A magnetic resonante imaging reporten a left cerebellar infarction with occlusion of the basilar artery ana dissection ofthe right vertebral artery. Thepatient experienced a clinical deterioration with the appearance ofa right hemiparesis. Therefore a brain angiography wasperformed alongwith a mechanical thrombolysis using a Solitaire FR® revascularization device. A thrombus located in the distal third ofthe artery was eliminated obtaining a complete perfusión ofthe artery. Thepatient had a satisfactory evolution.

Trombosis venosa cerebral / Cerebral venous thrombosis

La trombosis venosa cerebral (TvC) es una rara enfermedad que se incluye dentro del grupo de trombosis en sitios infrecuentes. El correcto estudio y manejo terapéutico de la misma es de capital importancia por la alta morbimortalidad que conlleva de no diagnosticarse y tratarse correctamente. El desarrollo en el conocimiento de los factores de riesgo como las trombofilias entre otros, ha sido de gran importancia diagnóstica. Aún faltan estudios randomizados y controlados de gran número de pacientes para definir la duración óptima del tratamiento según cada caso particular. Por el momento las recomendaciones terapéuticas en este tipo de trombosis se basan en estudios observacionales y opinión de expertos, los cuales recomiendan anticoagulación a largo plazo para pacientes con trombosis inexplicadas, trombosis recurrentes, o asociadas a trombofilias de alto riesgo o combinadas. El objetivo de esta publicación es presentar una serie de casos clínicos, revisar el tema de TvC dado la importancia por las posibles complicaciones evolutivas; conocer los factores de riesgo y discutir las posibilidades terapéuticas.

Trombosis venosa cerebral: aspectos actuales del diagnóstico y tratamiento / Cerebral venous thrombosis: a diagnostic and treatment update

Introducción: La trombosis venosa cerebral (TVC) representa hasta la fecha tanto un reto diagnóstico como terapéutico, debido principalmente a la alta variabilidad de presentación y a la falta de un consenso terapéutico claro. Fuentes: Se realizó la búsqueda de literatura médica en PubMed con el término TVC y epidemiología (428 resultados), fisiopatología (504 resultados), etiología (2714 resultados), diagnóstico (2.802 resultados), tratamiento (2.173 resultados) y pronóstico (648 resultados). Se seleccionaron las publicaciones originales y de revisión consideradas como más útiles para la revisión. Se incluyeron también textos clásicos o históricos. Desarrollo: En la presente revisión se destacan los aspectos epidemiológicos, fisiopatológicos y etiológicos fundamentales de la TVC. Se comparan las manifestaciones clínicas iniciales más frecuentes de acuerdo a diferentes series y se exponen las pruebas neurorradiológicas de elección actual para su diagnóstico. Asimismo, se analiza la evidencia disponible hasta el momento en lo que corresponde al tratamiento y pronóstico, con el propósito de brindar una herramienta sólida para la práctica clínica y la investigación. Conclusiones: La TVC representa alrededor del 0,5% de todos los casos de enfermedad vascular cerebral a nivel mundial. La cefalea, los déficits focales y las crisis convulsivas constituyen las manifestaciones iniciales más comunes con el 89, 50 y 35% de frecuencia respectivamente. El diagnóstico neurorradiológico más sensible y específico es la imagen por resonancia magnética (IRM) combinada con venorresonancia. La venografía por tomografía computarizada constituye una buena alternativa debido a resultados equiparables a los de la IRM. El tratamiento con heparina es en la actualidad el más aceptado. Tiene una mortalidad del 10% y la recurrencia se sitúa en 2,8 por cada 100 casos a pesar de terapia anticoagulante (AU)

Introduction: Cerebral venous thrombosis (CVT) is still a significant diagnostic and therapeutic challenge, due to its high variability of clinical manifestations and its lack of a clear therapeutic consensus. Sources: A search of the medical literature was made through PubMed using the conjoined terms of CVT and epidemiology (428 results), pathophysiology (504 results), aetiology (2714 results), diagnosis (2802 results), treatment (2173 results) and outcome (648 results). Original and review publications deemed to be useful for this review were selected. Classical and historical works on CVT were also included. Development: The present paper reviews the fundamental aspects of the epidemiology, pathophysiology and aetiology of CVT. There is a comparison of the most common initial clinical manifestations along with a description of the most important neuroradiological studies needed to establish a diagnosis, all based on multiple published series. Moreover, in order to serve as an important tool in both clinical practice and continuing research, there is also an analysis of recent evidence on treatment and prognosis. Conclusions: CVT represents approximately 0.5% of all stroke cases worldwide. Headache, focal deficits and seizures are the most frequent initial clinical manifestations, representing 89%, 50%, and 35% of appearances, respectively. Magnetic resonance imaging (MRI) in combination with magnetic resonance venography has proved to have the highest sensitivity and specificity in establishing a diagnosis. An equal alternative to MRI is computed tomography venography due to similar diagnostic results. Pharmacological treatment with heparin is widely accepted today. Recurrence and mortality rates of CVT are 2.8 per 100 cases and 10%, respectively, despite of anticoagulation treatment (AU)

Trombosis aguda de la arteria basilar / Acute basilar artery thrombosis

La trombosis aguda de la arteria basilar (TAB) ha sido considerada una catástrofe neurológica. Únicamente alrededor de un 20% de los pacientes alcanza un buen pronóstico con tratamiento convencional. Es importante establecer una sospecha diagnóstica precoz para evitar un retraso en el inicio del tratamiento. La evaluación diagnóstica incluye confirmación de la oclusión basilar y estimación de la viabilidad del tejido isquémico, y puede realizarse con resonancia magnética multiparamétrica o con angiotomografía computarizada combinada con sus imágenes fuente. La recanalización arterial precoz determina la posibilidad de alcanzar un buen pronóstico; sin embargo, se desconoce cuál es el mejor tratamiento de la TAB. No se ha demostrado que la trombólisis intraarterial sea superior a la intravenosa, de modo que en ausencia de contraindicaciones debe iniciarse cuanto antes la trombólisis intravenosa, que puede ser el tratamiento principal si no se cuenta con acceso al neurointervencionismo. Recientemente se han notificado tasas excelentes de buen pronóstico (50% de independencia funcional) empleando estrategias escalonadas de combinación de varias modalidades terapéuticas (trombólisis intravenosa ultraprecoz seguida de trombectomía mecánica endovascular de rescate). Estos resultados representan una esperanza para pacientes y neurólogos y suponen un reclamo para continuar innovando e investigando en este campo (AU)

Acute basilar artery thrombosis (ABT) has been largely considered a neurological catastrophe. With conventional treatment, only around 20% of patients achieve functional independence. An early presumptive diagnosis is essential to avoid treatment delay. Either multiparametric magnetic resonance imaging or computed tomography angiography source images may represent valid non-invasive tools to confirm ABT and evaluate ischemic tissue viability. The main determinant of ABT outcome is early recanalization but the most effective therapeutic option remains to be clarified. The BASICS prospective registry showed no superiority of intra-arterial over intravenous thrombolysis. Therefore, in the absence of contraindications, intravenous thrombolysis should be started as soon as possible and can be used as the main therapy when interventional procedures are not available. However, recent case series have reported high rates of functional independence (50%) after staged escalation therapy (ultra-early intravenous thrombolysis followed by on-demand endovascular mechanical thrombectomy). These results represent a hope for patients and neurologists and reinforce the need for innovation and research in this field (AU)

Actualización en el diagnóstico neurorradiológico de la trombosis venosa cerebral / Review of the neuroradiological diagnosis of cerebral venous thrombosis

La trombosis venosa cerebral (TVC) es una entidad multifactorial, poco frecuente y cuyo diagnóstico debe ser rápido con la finalidad de instaurar un tratamiento precoz, evitar complicaciones graves y mejorar el pronóstico del paciente. La técnica de elección para confirmar el diagnóstico es la resonancia magnética (RM) combinada con venografía-RM. Sin embargo, el cuadro clínico suele presentarse en el ámbito de urgencias y la tomografía computarizada (TC) craneal combinada con un estudio de venografía-TC puede establecer el diagnóstico, ya que es una técnica con gran sensibilidad en la identificación de las venas cerebrales y senos durales, y probablemente equivalente a la venografía-RM para establecer el diagnóstico de TVC. El dúplex transcraneal codificado en color, si bien no tienen un papel en el diagnóstico inicial si que es útil en su seguimiento. Los objetivos de este trabajo son describir la distribución de los territorios de drenaje venoso, analizar el valor de las distintas modalidades neurradiológicas, analizar los signos directos e indirectos, y discutir los falsos diagnósticos (y la solución de éstos) que un radiólogo debe dominar ante un paciente con sospecha clínica de trombosis venosa (AU)

We describe the distribution of the territories of venous drainage, analyze the usefulness of the different neuroradiological modalities, analyze the direct and indirect signs of central venous thrombosis, and discuss strategies to avoid the diagnostic pitfalls in patients with clinical suspicion of venous thrombosis (AU)

Utilidad de la trombólisis in situ en pacientes con trombosis venosa cerebral / No disponible

No disponible

Trombosis venosa cerebral. Una realidad en Urgencias / Cerebral venous thrombosis: a reality in the Emergency setting

La trombosis de los senos venosos cerebrales es una entidad de diagnóstico poco frecuente e inicialmente se pensaba que de pronóstico fatal. La implantación de modernas técnicas de neuroimagen, en especial, Resonancia Nuclear Magnética (RNM) y la angiografía por TAC o por RNM ha permitido comprobar que es más frecuente de lo que se pensaba y su pronóstico es favorable en la mayoría de los pacientes con un manejo adecuado. Se describe el caso de una paciente, en tratamiento con anticonceptivos orales, que consultó en el servicio de urgencias por cefalea y se diagnosticó de trombosis de seno venoso cerebral longitudinal superior y seno recto mediante TC y Angio - TC urgente. Ante estos hallazgos, se inició tratamiento anticoagulante con heparina sódica intravenosa y su evolución fue favorable. A propósito de este caso, se hace una revisión de la trombosis venosa cerebral, de su diagnóstico y de las controversias terapéuticas (AU)

Cerebral venous sinus thrombosis is a seldom-diagnosed entity, which was initially considered to bear a fatal prognosis. The introduction of modern neuroimaging techniques, mainly magnetic nuclear resonance (MNR) imaging and/or CT scan and/or MNR imaging angiography, have demonstrated that this condition is quite more frequent than previously thought and also that it bears a favourable prognosis in most cases in adeauate management is provided. We here report the case of one female patient under oral contraceptive therapy who consulted at the Emergency Outpatient Clinic because of caphalea and was diagnosed of superior longitudinal and straight sinus venosus thrombosis through emergency CT scan and angio-CT scan. Anticoagulation therapy was thereupon initiated with intravenous heparin sodium, with a favourable evolution and outcome. Based on this case, a bibliographic review of cerebral venous thrombosis, its diagnosis and its controverted therapy is carried out (AU)

Trombosis de los senos venosos cerebrales en una gestante en el primer trimestre de embarazo / Cerebral venous sinus thrombosis in the first trimester of pregnancy

La trombosis venosa cerebral es una enfermedad poco frecuente durante el embarazo. En un 25-40% de los casos es de causa desconocida. Los factores predisponentes más frecuentes relacionados con esta enfermedad son: infección, embarazo, puerperio, deshidratación, anticonceptivos orales, coagulopatías, tumores y traumatismos. Un adecuado diagnóstico y un tratamiento precoz pueden proporcionar un buen pronóstico. Presentamos un caso de trombosis de seno sagital superior y seno transverso izquierdo cerebral en una paciente de 30 años de edad, gestante de 12 semanas

Cerebral venous thrombosis is an uncommon disease during pregnancy. In 25-40% of cases, the etiology is unknown. Risk factors are infectious diseases, pregnancy, puerperium, dehydration, oral contraception use, hypercoagulative states, tumors, and traumatism. With correct diagnosis and early treatment, outcome is usually favorable. We present a case of venous sinus thrombosis in a 30-year-old woman at 12 weeks' gestation

Trombosis venosa cerebral. tratamiento mediante fibrinolisis local con alteplasa / Cerebral venous thrombosis: treatment with local fibrinolysis plus alteplase

La trombosis venosa cerebral es una rara entidad con manifestaciones clínicas muy diversas, por lo que su diagnóstico requiere un alto índice de sospecha. Afecta a los senos durales con o sin extensión a las venas cerebrales. Tradicionalmente el diagnóstico se ha basado en el estudio angiográfico, aunque en la actualidad, se imponen nuevas técnicas de imagen no invasivas como la tomografía computarizada (TC), la resonancia magnética (RM) y la angio-RM.El tratamiento debe comprender una terapia sintomática y etiológica. Aunque parece razonable anticoagular a estos pacientes, esto es fuente de controversia. Al igual que en otros procesos como el tromboembolismo pulmonar y la trombosis coronaria, la aparición de nuevos y cada vez más seguros fármacos fibrinolíticos, junto con innovaciones técnicas en el campo de la neurorradiología intervencionista, permiten una nueva perspectiva en el manejo de estos pacientes. Presentamos un caso de una paciente de 43 años de edad con trombosis del seno recto que fue tratada mediante trombolisis local con alteplasa (activador tisular del plasminógeno). Se describe la técnica realizada y se revisa la bibliografía al respecto (AU)