Cerebral Venous Thrombosis in the Users of Hormonal Contraceptives


Authors: M. Procházka 1;  V. Procházka 2 ;  M. Lubušký 1;  J. Procházková 3;  T. Hrbáč 4
Authors‘ workplace: Porodnicko-gynekologická klinika LF UP a FN Olomouc 1;  Radiodiagnostický ústav FN Ostrava-Poruba 2;  Hemato-onkologická klinika LF UP a FN Olomouc 3;  Neurochirurgická klinika FN Ostrava-Poruba 4
Published in: Cesk Slov Neurol N 2007; 70/103(6): 678-684
Category: Short Communication

Poděkování: Autoři si dovolují poděkovat školiteli a příteli doc. MUDr. Pavlu Drábkovi z Neurochirurgické kliniky Fakultní nemocnice Ostrava-Poruba za odbornou pomoc a podporu při zpracovávání tohoto náročného tématu.

Overview

Cerebral venous thrombosis (CVT) is a dangerous disease with a difficult diagnosis. We present a retrospective analysis of 8 cases of CVT in young women who were hospitalised between April 2004 and October 2005. Thrombophilic markers were examined in all patients. The most common symptoms included headache (100%), vertigo (87.5%), hemiparesis or quadruparesis (62.5%). CT and MRI showed different types of parenchymal lesion infarction or vasogenic inflation in 62.50% and petechial haemorrhage in 25%. DSA venography confirmed the site of occlusion in the lateral and sigmoide sinus in 75%, and superior sagittal sinus (62.5%). We found 3 cases of the homozygous form of methylenetetrahydrofolate reductase (MTHFR-C677T), two patients had a plasminogen activator inhibitor-1 (PAI-1) homozygous mutation. Coexisting thrombophilic risk factors are usually involved in the onset of CVT. Early diagnosis and application of thrombolytic therapy can improve the clinical outcome.

Key words:
cerebral venous thrombosis – hormonal contraception – thrombophilia – local fibrinolysis


Sources

1. Berenstein A, Lasjaunias P, Ter Brugge KG, Venous Occlusive Disease. In: Surgical Neuroangiography vol. 2.1 Clinical and Endovascular Treatment Aspects in Adults. 2nd ed. Berlin-Heidelberg: Springer-Verlag 2004: 135-152.

2. Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F. For the ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis, results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35: 664-670.

3. Forbes PNK, Pipe JG, Heiserman JE. Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. AJNR Am J Neuroradiology 2001; 22: 450-455.

4. Peeters E, Stadnik T, Bissay F, Schmedding E, Osteaux M. Diffusion-weighted MR imaging of an acute venous stroke. AJNR Am J Neuroradiology 2001; 22: 1949-1952.

5. Ducreux D, Oppenheim C, Vandamme X, Dormont D, Samson Y, Rancurel G et al. Diffusion-weighted imaging patterns of brain damage associated with cerebral venous thrombosis. AJNR Am J Neuroradiology 2001; 22: 261-268.

6. Liang L, Korogi Y, Sugahara T, Onomichi M, Shigematsu Y, Yang D et al. Evaluation of the Intracranial Dural sinuses with a 3D contrast-enhanced MP-RAGE sequence: prospective comparison with 2D-TOF MR venography and digital subtraction angiography. AJNR Am J Neuroradiology 2001; 22: 481-492.

7. Majoie CHB, van Straten M, Venema HW. Multisection CT Venography of the dural sinuses and cerebral veins by using matched mask bone elimination. AJNR Am J Neuroradiology 2004; 25: 787-791.

8. Rael JR, Orrison WW Jr., Baldwin N, Sell J. Direct thrombolysis of superior sagittal sinus thrombosis with coexisting intracranial hemorrhage. AJNR Am J Neuroradiology 1997; 18: 1238-1242.

9. Spearman MP, Jungreis ChA, Wehner JJ, Gerszten PC, Welch WC. Endovascular thrombolysis in deep cerebral venous thrombosis. AJNR Am J Neuroradiology 1997; 18: 502-506.

10. Ciccone A, Canhao P, Falcao F, Ferro JM, Sterzi R. Thrombolysis for cerebral vein and dural sinus thrombosis. Cochrane Corner. Stroke 2004; 35: 000-001.

11. Frey JL, Murro GJ, McDougall CG, Dean BL, Jahnke HK. Cerebral venous thrombosis-combined intrathrombus rtPA and intravenous heparin. Stroke 1999; 30: 489-494.

12. Opatowsky MJ, Morris PP, Regan JD, Mewborne JD, Wilson JA. Rapid thrombectomy of superior sagittal sinus and transverse sinus thrombosis with a rheolytic catheter device. AJNR Am J Neuroradiology 1999; 20: 414-417.

13. Dowd ChF, Malek AM, Phatouros CC, Hemphill JC III. Application of rheolytic thrombectomy device in the treatment od dural sinus thrombosis: A new technique. AJNR Am J Neuroradiology 1999; 20: 568-570.

14. Provenzale JM, Barboriak DP, Allen NB, Ortel TL. Antiphospholipid Antibodies: Findings at Arteriography. AJNR Am J Neuroradiology 1998; 19: 611-616.

15. Reuner KH, Ruf A, Grau A, Rickmann H, Stolz E, Jüttler E et al. Prothrombin Gene G20210→A transition is a risk factor for cerebral venous thrombosis. Stroke 1998; 29: 1765-1769.

16. Lüdemann P, Nabavi DG, Junker R, Wolff E, Papke K, Buchner H et al. Factor V Leiden mutation is a risk factor for cerebral venous thrombosis. A Case – control study of 55 patients. Stroke 1998; 29: 2507-2510.

17. Cantu C, Alonso E, Jara A, Martínez L, Rios C, Fernandez ML et al. Hyperhomocysteinemia, low folate and vitamin B12 concentrations and methylene tetrahydrofolate reductase mutation in cerebral venous thrombosis. Stroke 2004; 35: 1790-94.

18. Rosendaal FR, Helmerhorst FM, Vandenbroucke JP. Oral contraceptives, hormone replacement therapy and thrombosis. Thromb Haemost 2001; 86: 112–123.

19. Bloemenkamp KWM, Helmerhorst FM, Rosendaal FR, Vandenbroucke JP. Thrombophilias and gynaecology. Best Practice&Research Clinical Obsterics & Gynaecology 2003; 3: 509-528.

20. Martinelli I, Battaglioli T, Pedotti P, Cattaneo M, Mannucci PM. Hyperhomocysteinemia in cerebral vein thrombosis. Blood 2003; 102: 1363-1366.

21. Norris LA, Bonnar J. The effect of oestrogen dose and progesteron type on haemostatic changes in women taking oral contraceptives. Br J Obstet Gynaecol 1996; 103: 261–267.

22. Kunz F, Pechlander C, Taberelli M, Solder E, Zwierzina WD. Influence of oral contraceptives on coagulation tests in native blood and plasma. Am J Obstet Gynaecol 1990; 163: 417– 420.

23. World Health Organization. Cardiovascular disease and steroid hormone contraception. Report of a WHO Scientific group. WHO Technical Report Series, no.877. Geneva: World Health Organization 1998.

24. Stolz E, Gerriets T, Bödeker RH, Penzel MH, Kaps M. Intracranial venous hemodynamics is a factor related to a favorable outcome in cerebral venous thrombosis. Stroke 2002; 33: 1645-1650.

25. Phatouros C, Halbach VV, Dowd ChF, Lempert TE, Malek AM, Meyers PM et al. Acquired pial arteriovenous fistula following cerebral vein thrombosis. Stroke 1999; 30: 2487-2490.

26. Čepický P, Cibula D, Dvořák K, Dvořák V, Fait T, Fanta M et al. Doporučení k předpisu kombinované hormonální kontracepce (CC). Aktualizace 2005. Čes Gynek 2005; 4: 320-324.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

Issue 6

2007 Issue 6

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