Management of Cortical Venous and Dural Sinus Thrombosis

In this article, we will discuss the Management of Cortical Venous and Dural Sinus Thrombosis. So, let’s get started.

Management

1. Supportive treatment
• Correction of fluid and electrolyte balance to correction dehydration.
• Care of unconscious patient (coma).
glycerol, steroids, dexamethasone 4 mg
• Decongestive therapy (mannitol,
4 times a day I.V.) may be used to lower raised intracranial pressure.
• Antibiotic therapy for infection or sepsis.
Antibiotic chosen on the basis of bacteria responsible for the predisposing or associated condition is continued for 4-6 weeks or until there is radiographic resolution of thrombosis.
• Seizures should be controlled by
anti-convulsants.
• Ventilatory support may be needed.
• Gynaecological examination for sepsis and postpartum status: Retained products of conception if detected should be removed.
2. Specific therapy with anticoagulants: Unless there are major contraindication (e.g. septic shock), anticoagulant therapy
with low molecular heparin may prove helpful provided haemorrhage is not prominent feature of infarction. Heparin therapy is followed by oral warfarin (2.5-5 mg) for 6 months monitored by INR 2-3 times.
Successful management of aseptic
venous sinus thrombosis has been reported with catheter directed urokinase therapy and with a combination of recombinant tissue plasminogen activator (rtPA) in patients refractory to heparin. Thrombectomy has to be performed sometimes in these cases.

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