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Demonstration of Significant Resolution of Cerebral Sino‐Venous Thrombosis Associated with Intravenous Recombinant Tissue Plasminogen Activator
Author(s) -
Misra Vivek,
Elliott Debra G.,
GonzalezToledo Eduardo,
Kelley Roger E.
Publication year - 2007
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2007.00074.x
Subject(s) - medicine , thrombolysis , venous thrombosis , heparin , middle cerebral artery , recombinant tissue plasminogen activator , tissue plasminogen activator , anesthesia , magnetic resonance imaging , thrombosis , hemiparesis , radiology , ischemia , surgery , angiography , cardiology , ischemic stroke , myocardial infarction , modified rankin scale
BACKGROUND Cerebral sino‐venous thrombosis (CVT) is commonly treated with anticoagulant therapy. There are reports of response to endovascular thrombolysis with or without mechanical aspiration in patients with clinical deterioration.CASE We present a 29‐year‐old man with acute onset of severe headache, found to have extensive CVT by magnetic resonance venography (MRV). His atypical presentation led to cerebral angiography that was complicated by global aphasia and right hemiparesis from left middle cerebral artery distribution ischemia. He received intravenous rt‐PA (recombinant tissue plasminogen activator) within an hour of the procedure followed, 24 hours later, by intravenous heparin infusion with significant clinical improvement. The headache severity and CVT, on follow‐up MRV, resolved significantly within 2 days.CONCLUSIONS We demonstrate clinical and neuroimaging response to systemic rt‐PA in CVT. Thrombolysis may have a role in CVT management with an extended therapeutic window.