Rare Form of Stroke Strikes More Often Than Thought:
THURSDAY, Feb. 3 (HealthDay News) -- A rare form of stroke that
involves veins instead of arteries occurs more often than thought,
according to a new American Heart Association/American Stroke
Association scientific statement.
This type of stroke -- cerebral venous thrombosis (CVT) -- is
caused by a clot in the dural venous sinuses, which are veins that
drain blood from the brain toward the heart. It is most common in
women who are pregnant or taking oral contraceptives, and in people
age 45 and younger.
The incidence of CVT among pregnant women and those who have
recently given birth ranges from one in 2,500 to one in 10,000. The
risk is greatest during the third trimester of pregnancy and in the
first four weeks after giving birth. Up to 73 percent of CVT cases
occur immediately after childbirth.
But women who've suffered CVT have a low risk of complications
during future pregnancies, according to the scientific
Patients with suspected CVT should have blood tests to determine
if they have an inherited or acquired factor in the blood that
increases the risk of blood clots (prothrombotic factor).
In addition, patients should be screened for conditions that
increase the risk of CVT, such as the use of oral contraceptives,
inflammatory disease and infection.
"The most common symptoms of patients with CVT include headaches that progress in severity over days or weeks, and seizures. Some patients may develop a focal neurological deficit (weakness affecting the extremities, double vision, etc.)," Dr. Gustavo Saposnik, chair of the statement writing group and an assistant professor of medicine at Saint Michael's Hospital, University of Toronto, said in an American Heart Association news release.
Diagnosis of CVT can be challenging. For example, 30 percent to
40 percent of patients with CVT may develop an intracranial
hemorrhage (bleeding within the skull).
"It's important to distinguish a hemorrhage caused by a ruptured brain artery from those associated with CVT. The mechanisms -- and treatment -- of the bleeding are quite different," Saposnik said.
The statement outlined the approach doctors should take to
diagnose and manage CVT:
- Clinical suspicion of CVT.
- MRI, or alternative imaging technique at hospitals/medical
centers with fewer resources.
- Confirm CVT.
- Begin anticoagulation therapy (IV Heparin).
- Continue anticoagulation therapy, lasting three to 12 months to
Other options may be considered in patients who continue to
experience neurological deterioration despite medical treatment.
These options include surgery to temporarily remove a section of
skull to relieve pressure on the brain (hemicraniectomy), or
minimally invasive surgery to remove clots in the affected veins
The scientific statement, published in the Feb. 3 issue of
Stroke, is endorsed by a number of organizations, including the American Academy of Neurology and the American Academy of Neurological Surgeons.
The U.S. National Institute of Neurological Disorders and Stroke
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