Urgent intervention to remove cerebral venous thrombosis saved patient from “ death door”

17/06/2021 10:03

On May 28^th, doctors of Viet Duc University Hospital (VDUH) performed an intervention on emergency to remove cerebral venous sinus thrombosis (CVST) for L.S.T, male, 36 years old.

 

 

Mr. T. had no past medical history. In last 2 days prior to hospitalization, he suddenly had a severe, continuous headache but not controlled by pain relievers. He was soon taken to a local hospital for seeking an emergency aid. He was then transferred to VDUH with diagnosis of cerebrovascular damage. Through clinical examinations, doctors suspected a case of CVST. His ‘s MRI examination showed the thrombosis causing complete obstruction of the system of intracranial venous sinuses (these sinuses’ function is to drain most of the cerebral blood back to the heart. Sinuses obstruction can cause stagnation, congestion, hemorrhage, cerebral ischemia). The patient was treated with anticoagulants and thrombectomy on emergency.

 

 

Dr. Le Thanh Dung MD, PhD, Head of Diagnostic Imaging Department, VDUH said: “Right after receiving the patient, we conducted a multi-disciplinary consultation: interventional radiology, neurology, resuscitation and determined this was a case of acute cerebral venous occlusion which can lead to severe complications, sequelae, even death if not treated in time.” Endovascular intervention allows rapid removal of thrombus and re-establishment of cerebral circulation, thereby avoiding undesirable complications such as cerebral ischemia or cerebral bleeding. During two hours, numerous thrombus were removed. The post-interventional x ray check showed that the venous sinuses were completely re-established. The headache also quickly disappeared, motor functions and sensation of the patient were completely recovered.

 

 

According to Dr. Nguyen Anh Tuan MD, PhD, Head of Center of Neurology and Neuro Intensive Care, VDUH: Thrombosis of cerebral vein sinus is a rare disease, accounting for less than 1% of all stroke cases. In Vietnam, no official statistics on the epidemiology of CVST has been published. In developed countries, the number of cases of cerebral venous occlusion due to infection is decreasing while coagulopathy and systemic diseases are increasing. Genetic factors for hypercoagulability account for a relatively high proportion in Caucasian people, accounting for 15-30% of patients with CVST. However, in Asian countries, decreased anti-coagulability factors are not the major reason of this disease as in Western countries. Especially in our country, infection still is a very important issue.

 

The clinical and subclinical symptoms of this disease are very diverse. They can simply be pain or seizures but can also be very severe, quickly leading to coma. Therefore, the disease is often missed, or diagnosed late thus delaying the treatment process and can even leave serious complications. The aim of the treatment of CVST is to prevent further progression of the thrombosis, and to rapidly reestablish venous circulation. In the past, unfractionated heparin was the main anticoagulant used in the treatment of venous sinus thrombosis with markedly improved efficacy in most cases. However, there are many case of bleeding complications, so it is necessary to monitor the coagulation index continually. Nowadays, the invention of low molecular weight heparin and new generation oral anticoagulants helps facilitate monitoring while reducing the rate of bleeding complications. However, according to many studies, up to 13% of patients died or developed severe sequelae if they are only treated with medications. Therefore, invasive treatments should be indicated in patients with severe progression or not responding to internal treatment to prevent complications. Mr. T was indicated for intervention with mechanical endovascular thrombectomy because he presented severe headache due to diffuse thrombosis in most of his cerebral vein sinus system. After the intervention almost all the thrombus was removed, the patient progressed clinically well without any complications. Maintaining anticoagulation treatment as well as finding the cause of thrombosis is very important to avoid later recurrence – Dr. Tuan emphasized.