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72%
70%
Straight sinus
13%
Aetiology
A. Post-infective CVT18,19,19A
In pre-antibiotic era, pyogenic infections in the
catchment area were the commonest cause of
CVT. Infective organism reaches the draining sinus
via emissary veins. Though any sinus can be
involved, still, commonly involved in order of
frequency, are cavernous sinus, lateral sinus and
superior sagittal sinus. With the advent of
antibiotics, incidence of post-infective CVT has
markedly reduced but still otitic hydrocephalus as
a result of lateral sinus thrombosis is a common
sequelae of chronic suppurative otitis media.
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contraceptive.
c) Malignancy Associated CVT
CVT is commonly associated with advanced
malignancy. Thrombotic propensity may
accelerate due to infiltration of vessel walls,
and/or generation of abnormal coagulant
factors. CVT as a paraneoplastic manifestation
also has been described28.
Pathology29
Pathological findings observed in central nervous
system as a result of CVT are determined by a)
underlying disease pathology; b) nature of sinus/
cerebral vein involved; c) interval between the onset
and pathological examination.
Cortical vein thrombosis usually presents as a cord
like swelling with minimal or absent haemorrhagic
infarction of the brain. This discrepancy has been
explained on the presence of frequent
intercommunications between various cortical veins
and sinuses.
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Clinical Picture
Clinical profile is determined by a) underlying sinus/
venous system involved; b) mode of onset, i.e., acute,
subacute or chronic; c) time interval between onset
of disease and clinical presentation; d) nature of
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Investigations
Objectives of investigations are a) diagnosis of
cerebral vein/sinus thrombosis; b) identification of vein
or sinus involved; c) identification of underlying
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c. C.T. Scan 36,37: During CT Scan, both nonenhanced and enhanced films are required.
Various abnormalities on C.T. Scan are as follows:
i)
Treatment
As the patients consciousness is impaired and
underlying neuropathology is still progressing, he is
to be admitted in intensive care unit and needs
treatment accordingly. Specific measures include
institution of nursing care, prevention of pressure sores
and urinary tract infection, anti-cerebral oedema
therapy and anti convulsant therapy for seizures. A
close watch for dehydration secondary to excessive
use of diuretics and other anti-cerebral oedema
measures is essential as the resultant
haemoconcentration increases thrombotic tendency.
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Prognosis
Early clinical diagnosis, three dimensional MR flow
imaging studies, and early institution of therapy
specially heparin or thrombolytic therapy followed by
oral anticoagulants have improved the prognosis of
CVT. Srinivasan observed that mortality has been
reduced from 50.6% to 10% in the last three
decades10.
Factors adversely affecting prognosis are early
appearance of the convulso-paralytic state,
impairment of consciousness, and presence of
haemorrhagic infarcts demonstrated by CT or MRI.
Usually recovery is either complete or associated with
minimal neurological deficit because of recanalisation
and dissolution of thrombosis. The risk of future
recurrence appears to be very infrequent, rather
unknown.
8.
9.
References
19a.
1.
2.
3.
4.
5.
6.
7.
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21. Dalal PM. Stroke in India. Jap Heart Jour 1982; 46: 621-5.
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