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Near-Infrared Spectroscopy Monitored Cerebral Venous Thrombolysis

Published online by Cambridge University Press:  05 August 2019

Timothy F. Witham
Affiliation:
Department of Neurological Surgery, University of Calgary, Calgary
Edwin M. Nemoto
Affiliation:
Department of Neurological Surgery, University of Calgary, Calgary
Charles A. Jungreis
Affiliation:
Division of Neuroradiology, University of Calgary, Calgary
Anthony M. Kaufmann
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania and Department of Clinical Neurosciences, University of Calgary, Calgary
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Abstract:

Background:

Cerebral venous thrombosis is a clinical entity which is readily diagnosed with the advent of modern imaging techniques. Anticoagulation is now a standard therapy, but more recent treatment strategies have included endovascular thrombolysis. While the endpoint of this intervention both clinically and radiographically has not been defined, noninvasive monitoring techniques may add further objective measures of treatment response.

Clinical Presentation:

We present a patient with a four day history of worsening headache and papilledema on exam. Superior sagittal, straight, and bilateral transverse sinus thromboses were identified on computed tomography and angiography.

Intervention:

Emergent endovascular thrombolysis by a transvenous approach re-established venous patency and resulted in immediate resolution of the patient's symptoms. Cerebral oximetry by near-infrared spectroscopy was utilized during the procedure, and changes in chromophore concentrations correlated directly with angiographic and clinical resolution of the thrombosis.

Conclusion:

Near-infrared spectroscopy can provide continuous feedback during thrombolytic therapy in cerebral venous thrombosis and may help define endpoints of such intervention.

Résumé:

Résumé: <span class='italic'>Introduction:</span>

La thrombose veineuse cérébrale est une entité clinique dont le diagnostic est facile depuis l'avènement des techniques modernes d'imagerie. L'anticoagulation est maintenant le traitement standard, mais il existe des stratégies de traitement plus récentes, dont la thrombolyse endovasculaire. Bien qu'au point de vue clinique ou radiologique les critères de succès de cette intervention n'aient pas été définis, les techniques non invasives de suivi peuvent fournir des mesures objectives de la réponse au traitement.

<span class='italic'>Présentation clinique:</span>

Nous présentons le cas d'une patiente qui s'est présentée avec une histoire de céphalée de plus en plus sévère depuis quatre jours et un oedème papillaire. Des thromboses du sinus longitudinal supérieur, du sinus droit et des sinus latéraux ont été identifiées à la tomodensitométrie et à l'angiographie.

<span class='italic'>Intervention:</span>

Une thrombolyse endovasculaire d'urgence par voie endoveineuse a réétabli la perméabilité veineuse et amené une résolution immédiate des symptômes. L'oxymétrie cérébrale par spectroscopie de proche infrarouge a été utilisée pendant l'intervention et les changements de concentrations chromophores étaient en corrélation directe avec la résolution angiographique et clinique de la thrombose.

<span class='italic'>Conclusion:</span>

Dans la thrombose veineuse cérébrale, la spectroscopie de proche infrarouge peut fournir des informations continues pendant la thrombolyse et peut aider à définir les critères de succès de telles interventions.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 1999

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