Cavernous sinus thrombosis medical therapy
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Cavernous sinus thrombosis Microchapters |
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Differentiating Cavernous sinus thrombosis from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Cavernous sinus thrombosis medical therapy On the Web |
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American Roentgen Ray Society Images of Cavernous sinus thrombosis medical therapy |
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Risk calculators and risk factors for Cavernous sinus thrombosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
- Antithrombotics
- Anticoagulation
- Standard treatment at this time, even if moderate intracranial hemorrhage present
- Controversial in the past given risk of associated hemorrhage – one small randomized study with 20 patients in each arm showed a significant benefit making anticoagulation standard of care.
- Thrombolysis – with agents like urokinase, TPA – generally given via microcatheters inserted for local infusion
- Initial infusion sometimes followed by continuous infusion for a day or more until clot clears.
- Many case reports of success, but not standard treatment at this time.
- A study of 9 patients in Korea showed successful thrombolysis in all patients
- Risk of hemorrhage
- The literature suggests that it is mostly used now in severe cases with stupor, coma, rapidly progressing course, or severely raised ICP, and only in centers experienced in the methodology. Its role may expand with more experience.
- Surgical thrombectomy – not generally performed anymore
- Antieleptics – as indicated
- Antibiotics – if infectious precipitant
- Intracranial pressure manipulation
- Medical: mannitol, steroids, acetazolamide, repeat LPs
- Shunt