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Journal of Neurosurgical Sciences 1998 March;42(1):23-32


lingua: Inglese

High-dose heparin plus warfarin administration in non-traumatic dural sinuses thrombosis. A clinical and neuroradiological study

Cipri S. 1, Gangemi A. 2, Capolo C. 1, Cafarelli F. 2, Cambardella G. 3

1 Division of Neurosurgery, Bianchi-Morelli-Melacrino Hospital, Reggio Calabria; 2 Service of Neuroradiology, Bianchi-Morelli-Melacrino Hospital, Reggio Calabria; 3 Institute of Neurological and Neurosurgical Sciences, Neurosurgical Clinic, University of Messina, Italy


Background. The man­age­ment of intra­cra­ni­al dural sinus­es throm­bo­sis is still con­tro­ver­sial and uncer­tain. The ­authors ­report the cases of 7 ­patients with non-trau­mat­ic throm­bo­sis of the dural sinus­es and ­describe the most impor­tant radio­graph­ic find­ings, the indi­ca­tion, effec­tive­ness of anti­throm­bot­ic ther­a­py, and out­come.
Methods. A ret­ro­spec­tive ­review was con­duct­ed of 7 cases of dural sinus throm­bo­sis admit­ted, ­between 1994 and 1996, to our divi­sion. All ­patients under­went full anti­co­ag­u­la­tion ther­a­py. Heparin was admin­is­tered, using a dose of 25,000 units/day for two weeks; warfarin was given using a dose of 5 mg twice daily. Treatment ­course was fol­lowed by main­te­nance treat­ment with a sin­gle admin­is­tra­tion of 5 mg/day of warfarin. All ­patients were sub­mit­ted to close titra­tion and coag­u­la­tion pro­file mon­i­tor­ing.
Results. In 4 cases Magnetic Resonance Imaging-Angiography (Angio-MRI) was per­formed for fol­low­ing up the rec­a­nal­iza­tion of the sinus­es, result­ing a per­sis­tent no paten­cy of the dural sinus­es. Three ­patients under­went con­trast-­enhanced CT scan, dem­on­strat­ed an “empty delta sign” in the sag­it­tal sinus, con­firm­ing no rec­a­nal­iza­tion. Nevertheless, six ­patients had have a good qual­ity recov­ery, and one ­patient a mod­er­ate dis­abil­ity.
Discussion. Cerebral ­venous sinus throm­bo­sis is an uncom­mon cause of cere­bral infarc­tion, and may be mis­tak­en, ­unless spe­cif­i­cal­ly ­sought. The nat­u­ral his­to­ry of the dis­ease is high­ly var­i­able, with a mor­tal­ity rates range from 10% to 20%. At ­present, in our opin­ion, the ­venous phase of Angio-MRI is the defin­i­tive exam­ina­tion, and a gold stan­dard for diag­no­sis of dural sinus throm­bo­sis. In our cases, anti­throm­bot­ic ther­a­py has been found to be a safe and effec­tive treat­ment, ­despite con­trast-CT scans and Angio-MRI ­showed no rec­a­nal­iza­tion of the sinus­es, in all ­patients.

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