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Anticoagulation and Hemostasis in Neurosurgery pp 269–284Cite as

Cerebral Venous Sinus Thrombosis

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Abstract

Cerebral venous sinus thrombosis (CVST) is a relatively rare but potentially devastating entity that mainly affects young adults and children and represents between 0.5 and 1 % of all strokes (Saposnik et al., Stroke 42(4):1158–1192, 2011). Despite significant improvements in outcomes (Coutinho et al., Stroke 45(5):1338–1341, 2014), CVST is a heterogeneous stroke subtype that can be challenging to diagnose and effectively treat and, as a result, is still a significant cause of death and disability (Coutinho et al., Stroke 45(5):1338–1341, 2014; Ferro et al., Stroke 35(3):664–670, 2004). Anticoagulation is currently the mainstay of treatment (Coutinho et al., Cochrane Database Syst Rev (8):CD002005, 2011; Einhaupl et al., Eur J Neurol 17(10):1229–1235, 2010; Weimar, Curr Neurol Neurosci Rep 14(1):417, 2014), but a multidisciplinary approach is usually required to achieve optimal outcomes. Expertise in neurologic diagnosis, medical/surgical management of intracranial hypertension and cerebral edema, neuro-endovascular therapy and critical care often places the neurosurgeon at the center of this multidisciplinary team. And as an integral part of this team, modern neurosurgeons must have an excellent understanding of this complex and interesting stroke subtype. The purpose of this chapter is to provide a basic review of CVST and its treatment with a focus on the role of systemic anticoagulation as a part of the overall treatment methodology. The specific objectives are to review the epidemiology and clinical significance of CVST, discuss the pathophysiology of CVST and its relation to clinical subtypes and potential treatments, provide evidence based review of modern treatment options for CVST with a focus on anticoagulation, offer a clinical algorithm for care of the CVST patient and highlight future directions for management of CVST. As awareness improves and more is known about how and why CVST affects certain groups, more can be done to prevent or eliminate CVST. The neurosurgeon is an integral part of the modern multidisciplinary approach to CVST and thus must maintain a high clinical awareness for CVST and be familiar with the use of anticoagulation and other treatment options for CVST.

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Authors and Affiliations

  1. Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, USA

    William W. Ashley Jr M.D., Ph.D., M.B.A.

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  1. William W. Ashley Jr M.D., Ph.D., M.B.A.
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Correspondence to William W. Ashley Jr M.D., Ph.D., M.B.A. .

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  1. Stritch School of Medicine, Loyola University, Maywood, Illinois, USA

    Christopher M. Loftus

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Ashley, W.W. (2016). Cerebral Venous Sinus Thrombosis. In: Loftus, C. (eds) Anticoagulation and Hemostasis in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27327-3_20

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  • DOI: https://doi.org/10.1007/978-3-319-27327-3_20

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