Incidence, diagnosis, and treatment of central nervous system thrombosis.
| Type of Thrombosis . | Incidence . | Diagnosis . | Therapy . |
|---|---|---|---|
| Abbreviations: TE, thromboembolic event; SVT, sinovenous thrombosis; MRI, magnetic resonance imaging; CT, computerized tomography; US, ultrasound; CNS, central nervous system; AIS, arterial ischemic stroke; MRA, magnetic resonance angiogram | |||
| Cerebral Venous TE SVT | 41/100,000 115 | Angiogram is the gold standard123 | |
| MRI scanning with venography123 | Four adult trials support anticoagulation therapy | ||
| Doppler flow US may be sensitive123 | Use of anticoagulants in neonates is controversial, probably not indicated in the presence of a large infarct or significant CNS hemorrhage115 | ||
| CT without contrast has decreased sensitivity and specificity115 | |||
| CT with contrast has decreased sensitivity 115 | |||
| Cerebral Arterial TE AIS | 28.6 to 98/100,000 live births125 | Diffusion weighted MRI diagnoses the early stages of infarct130 | Use of anticoagulants is controversial, and rarely indicated given negligible risk of recurrence. |
| CT is not sensitive to diagnose the early stages of infarction197 | Thrombolytic therapy is rarely, if ever, an option | ||
| MRI/MRA is more sensitive to small or early infarcts123 | |||
| US has a limited role | |||
| Complications of SVT | |||
| Mortality | 12%115 | ||
| Recurrence | <5%115 | ||
| Seizures | 20%115 | ||
| Neurological deficit | 38%115 | ||
| Complications of AIS | |||
| Mortality | <10%125 | ||
| Recurrence | <1%125 | ||
| Seizures | 15%125 | ||
| Type of Thrombosis . | Incidence . | Diagnosis . | Therapy . |
|---|---|---|---|
| Abbreviations: TE, thromboembolic event; SVT, sinovenous thrombosis; MRI, magnetic resonance imaging; CT, computerized tomography; US, ultrasound; CNS, central nervous system; AIS, arterial ischemic stroke; MRA, magnetic resonance angiogram | |||
| Cerebral Venous TE SVT | 41/100,000 115 | Angiogram is the gold standard123 | |
| MRI scanning with venography123 | Four adult trials support anticoagulation therapy | ||
| Doppler flow US may be sensitive123 | Use of anticoagulants in neonates is controversial, probably not indicated in the presence of a large infarct or significant CNS hemorrhage115 | ||
| CT without contrast has decreased sensitivity and specificity115 | |||
| CT with contrast has decreased sensitivity 115 | |||
| Cerebral Arterial TE AIS | 28.6 to 98/100,000 live births125 | Diffusion weighted MRI diagnoses the early stages of infarct130 | Use of anticoagulants is controversial, and rarely indicated given negligible risk of recurrence. |
| CT is not sensitive to diagnose the early stages of infarction197 | Thrombolytic therapy is rarely, if ever, an option | ||
| MRI/MRA is more sensitive to small or early infarcts123 | |||
| US has a limited role | |||
| Complications of SVT | |||
| Mortality | 12%115 | ||
| Recurrence | <5%115 | ||
| Seizures | 20%115 | ||
| Neurological deficit | 38%115 | ||
| Complications of AIS | |||
| Mortality | <10%125 | ||
| Recurrence | <1%125 | ||
| Seizures | 15%125 | ||