Background and Aims
Thrombosis of cerebral vessels with a complication can be a life-threatening condition. Anticoagulation treatment has its limits and endovascular treatment is the last option. We present a case of a combined approach to the management of extensive intracranial thrombosis.
Methods
A patient (female, 45 years old) with a history of schizophrenia was admitted after an epileptic seizure. There was deterioration into aphasia and right lateralization. According to the CT, massive bleeding was found (subarachnoid hemorrhage, and small intracerebral hematomas and small hemocephalus). Ct venography showed occlusion of the sigmoid sinus, right transversus sinus, superior sagittal sinus. Despite the bleeding, anticoagulation therapy with low-molecular-weight heparin was used as the only therapeutic option. The patient was treated with continuous heparinization and partial embolectomy of all vessels was performer. A microcatheter was inserted for local application of Actilyse 20mg/20h. At an interval of 20 hours, a second endovascular intervention was performed, and in another 10 hours, a third one with complete recanalization of all sinus. Continuous heparinization was carried out at the same time. On follow-up CT, a small right temporal ischemia developed, without a hemorrhagic complication.
Results
The clinical condition has completely returned to normal. The patient was discharged home on anticoagulation therapy. The etiology of the thrombosis has not yet been established.
Conclusion
Thrombosis of cerebral venous sinus with complications is an emergency condition that must be addressed. Endovascular treatment can be more effective when divided into several procedures in combination with prolonged local action of thrombolytics.