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Abstract
Cerebral venous sinus thrombosis (CVST) is Cerebral venous sinus thrombosis (CVST) is a rare and potentially deadly condition. Common etiologies include hypercoagulable diseases, low flow states, dehydration, adjacent infectious processes, oral contraceptives, hormonal replacement therapy, pregnancy, and puerperium. Symptoms include nausea, seizures, severe focal neurological deficits, coma, and headache (the most common presenting symptom). Anticoagulation is the mainstay of treatment for CVST. Transvenous clot lysis can be performed using injected thrombolytic agents and specialized catheters for clot retrieval.
Introduction
Cerebral venous sinus thrombosis (CVST) is a rare and potentially deadly condition. Known conditions that increase the risk of CVST include hypercoagulable states, dehydration, adjacent infectious processes, low cerebral blood flow, oral contraceptives, hormone replacement therapy, pregnancy, and puerperium (Benamer & Bone, 2000; Buccino et al., 2001; Chaloupka, Mangla, & Huddlem, 2000; deBruijn, Budde, Teunisse, de Haan, & Stam, 2000; Ekseth, Bostrum, & Vegfors, 1998; Frey, Muro, McDougall, Dean, & Jahnke, 1999; Patel et al., 2003; Soleau, Schmidt, Stevens, Osborn, & MacDonald, 2003). Each of these conditions is associated with a higher risk of venous thrombus formation, but exactly why the cerebral venous sinus system is involved over other veins is unclear (Chaloupka et al.). A specific age group has not been identified as at risk in the literature, and it is not uncommon that a precipitating condition will not be identified (Baker, Opatowsky, Wilson, Glazier, & Morris, 2001; Chaloupka et al.).
As the thrombus enlarges, it causes venous congestion and leads to cerebral edema with mass effect and a resultant increase of intracranial pressure. If the thrombus is untreated, the intracranial pressure continues to rise and the vascular supply is compromised, leading to ischemia. This contributes to worsening of neurological status, frequently at an unpredictable and accelerated rate. Complete obstruction of the venous system can occur with exacerbation of cerebral edema, vascular compression, and brain herniation, leading to death. Monitoring in an intensive care unit (ICU) may be indicated depending on the person's neurological status and diagnostic Results (Benamer & Bone, 2000; Chaloupka et al. 1999; Frey et al., 1999). Medical management begins with systemic anticoagulation therapy with heparin and intravenous (IV) hydration (Baker et al. 2001; Chaloupka et al.; Chow et al., 2000). Direct clot lysis or clot retrieval for rapid recanalization of the affected sinus can now be considered, as a result of recent advancements in interventional neuroradiology (Baker et al.; Benamer & Bone, 2000; Buccino et al., 2001; Buccino, Scoditti, Patteri, Bertolino, & Mancia, 2003; Chaloupka et al.; Chow et al.; Ekseth et al., 1998; Frey et al.).
Intensive care techniques, such as intracranial pressure monitoring, drainage of cerebrospinal fluid, osmotic medications, and barbiturate coma, may be instituted in patients with severe cerebral edema, cerebral infarction, intracranial hypertension, unstable or deteriorating neurological status (Benamer & Bone, 2000; Ekseth et al., 1998). Supportive care is essential for these individuals, including optimizing cerebral oxygenation, promoting venous drainage, providing nutritional support, providing hemodynamic support, and preventing complications. Case studies are presented to demonstrate the range of presenting symptoms, diagnostic evaluation, medical treatment, and nursing care issues.
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