We read with great interest the presented case of cerebral venous sinus thrombosis
(CVST) by Torikoshi et al in the February 2016 issue of Journal of Stroke and Cerebrovascular Diseases.
1
CVST is a rare subtype of stroke. Anticoagulation and, to a lesser degree, endovascular
treatment methods in resistant cases constitute the current treatment regimens.
2
,
3
However, shunt procedures in CVST have very rarely been mentioned and utility of
this method remains unclear.
1
,
4
In this report, Torikoshi et al present a patient admitting with intracranial hypertension
symptoms secondary to CVST. The patient deteriorated on anticoagulation therapy but
improved dramatically with lumboperitoneal shunt (LPs) procedure. Although magnetic
resonance venography images demonstrated long segment thrombus formation starting
from sagittal sinus extending to transverse sinuses bilaterally, conventional magnetic
resonance imaging sections had not showed any evidence of cerebral parenchymal damage.
The authors tried to explain the underlying pathophysiological mechanism and the recovery
response to LPs via a distinct and smart hypothesis implying cerebrospinal fluid (CSF)
absorption failure due to probable arachnoid granulation dysfunction associated with
the extensive thrombosis.To read this article in full you will need to make a payment
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References
- Report of dramatic improvement after a lumboperitoneal shunt procedure in a case of anticoagulation therapy-resistant cerebral venous thrombosis.J Stroke Cerebrovasc Dis. 2016; 25: e15-e19
- Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT).Stroke. 2004; 35: 664-670
- Endovascular treatment of cerebral venous thrombosis: contemporary multicenter experience.Interv Neuroradiol. 2015; 21: 520-526
- Improvement of cerebral hemodynamic and metabolic parameters in a patient who presented intracranial hypertension due to superior sinus thrombosis after lumbo-peritoneal shunt: case report.No Shinkei Geka. 2005; 33: 281-286
- Reversibility of venous sinus obstruction in idiopathic intracranial hypertension.AJNR Am J Neuroradiol. 2007; 28: 656-659
- Reversible transverse sinus collapse in a patient with idiopathic intracranial hypertension.J NeuroIntervent Surg. 2015; https://doi.org/10.1136/neurintsurg-2014-011606.rep
- Barrier mechanisms in the brain, I. Adult brain.Clin Exp Pharmacol Physiol. 1999; 26: 11-19
Article info
Publication history
Published online: March 30, 2016
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.02.033
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
