Talk:Cerebral venous sinus thrombosis

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Good article Cerebral venous sinus thrombosis has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it.
April 17, 2008 Good article nominee Listed
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Expansion[edit]

I have expanded the article with some sources at my disposition, including the quick review in the BMJ 2007. However, I am trying to get my hands on two further sources that I think seriously deserve consideration:

Thanks to Arcadian, Davidruben and indirectly Dave Iberri for starting this. JFW | T@lk 21:46, 24 October 2007 (UTC)

And: Dentali F, Gianni M, Crowther MA, Ageno W (2006). "Natural history of cerebral vein thrombosis: a systematic review". Blood. 108 (4): 1129–34. PMID 16609071. doi:10.1182/blood-2005-12-4795.  JFW | T@lk 14:35, 26 October 2007 (UTC)
And: Kimber J (2002). "Cerebral venous sinus thrombosis". QJM : monthly journal of the Association of Physicians. 95 (3): 137–42. PMID 11865168.  (FREE) JFW | T@lk 20:38, 28 October 2007 (UTC)

Argh[edit]

Just lost about 30 minutes work due to a caching problem typical of internet explorer. Have no time to continue further, but will do so tomorrow evening. JFW | T@lk 15:28, 26 October 2007 (UTC)

GA nom[edit]

Nominated for GA. Let's see. JFW | T@lk 18:31, 13 April 2008 (UTC)

Case reports[edit]

I have temporarily removed the following:

Other less well understood situations that increase the risk for cerebral sinus thrombosis are hyperthyroidism[1] and myelodysplastic syndrome.[2]

Both these states (hyperthyroidism and MDS) are only mentioned on the basis of case reports in a relatively low-impact factor publication. While I have not seen the fulltext, I don't think either of them demonstrate causality beyond "wow, our patient has two rare conditions, they must be related". JFW | T@lk 19:49, 13 April 2008 (UTC)

Images[edit]

I have asked our radiology spy Glitzy queen00 (talk · contribs) for some neuroimaging. JFW | T@lk 21:21, 13 April 2008 (UTC)

Kids[edit]

More about CVST in kids: PMID 11496852 (NEJM) and PMID 15699061 (Brain).

Obstetric prognosis of CVST: does it come back? PMID 12754362. JFW | T@lk 22:20, 13 April 2008 (UTC)

Good article?[edit]

It is indeed. Application has been successful, congratulations to all contributors. CycloneNimrod (talk) 11:53, 17 April 2008 (UTC)

Success[edit]

It took a little while to find one so this is the best I can get for now! I hope it meets all standards? As always, I'm happy to help! Heather 11:03, 25 April 2008 (UTC)Glitzy_queen00

Cheers! See your talkpage. JFW | T@lk 06:02, 29 April 2008 (UTC)

History[edit]

It is interesting that the history of CVST is hard to disentangle from idiopathic intracranial hypertension. A single case from 1887 and some from the 1930s seem to have led to the recognition that CVST is an independent entity. Does everyone with possible IIH still undergo a venogram? PMC 2011899 has some historical content. JFW | T@lk 17:22, 27 May 2008 (UTC)

According to eMedicine, CT is now the central diagnostic technique in most disorders of cerebral venous drainage. However, it also says that "venography is worthwhile". Also: "Although CT is certainly adequate in most instances, MRI and magnetic resonance venography are effective in ruling out both a mass lesion and a potential dural sinus thrombosis." Regards, CycloneNimrod talk?contribs? 08:40, 1 June 2008 (UTC)

Thanks. I was more interested in the historical question of when IIH and CVST became distinct clinical entities. We now know that IIH is not usually caused by infections, so was otitic hydrocephalus perhaps a missed case of otitis causing a sinus thrombosis? I will have a look at Emedicine to see if they provide historical context. JFW | T@lk 12:28, 1 June 2008 (UTC)

Thank heavens for PubMed Central:
PMC 2011899 - child, 1956
PMC 1026412 - 1980, a rather thorough summary of 795 cases, mostly post-mortem
PMC 1802934 - Ray & Dunbar on using cerebral venography to distinguish from IIH
Problematically, no case has actually been labeled "first described" by any sources. JFW | T@lk 11:53, 15 June 2008 (UTC)

Reordering per MEDMOS[edit]

I'm not sure but I'm pretty sure risk factors come under epidemiology but currently they are listed under signs and symptoms. I'll wait for a reply before I change it (or before anyone else should change it) but I think it makes more sense to be in epidemiology. Regards, CycloneNimrod talk?contribs? 16:14, 6 June 2008 (UTC)

Perhaps a brief summary in the intro (e.g. postpartum) and then moving it? JFW | T@lk 12:21, 8 June 2008 (UTC)

Outcome[edit]

Much recent work in Europe has been done in The Netherlands by the Cerebral Venous Sinus Thrombosis Study Group and more recently by the ISCVT. There are some highly relevant recent studies that are not cited in Stam (because the review predates these studies). PMID 10762517, however, appeared in 2000 but is not discussed prominently by the reviewer - it discusses functional outcomes, surely worth mentioning in a neurological condition previously diagnosed mostly after death.... JFW | T@lk 13:26, 15 June 2008 (UTC)

Oxford Handbook[edit]

Temporarily removed:

Progressive speech disorders, decreased cognition and decreasing visual acuity have also been reported amongst cases of CVST.[3]

This was added to the section on raised intracranial pressure. Surely, these simply reflect symptoms we are already mentioning in people who are awake and talking. I will borrow someone's OHCM at work today and see in what context these symptoms are mentioned. JFW | T@lk 06:18, 16 June 2008 (UTC)

I have reviewed OHCM 7th edition page 472. It is a very comprehensive entry: it lists a large number of associated causes including some that we are not listing (unsure what their source is!) and suggests that particular symptoms could be localising signs in CVST. It also lists cavernous sinus thrombosis amongst the other forms, even though this seems to be generally regarded as a separate condition. Other interesting points are: (1) it insists on T2-weighed gradient echo sequences to identify cortical vein thromboses, (2) it lists a number of predictors for death from a study published in Stroke on 7 July 2005 but I cannot find the relevant paper[1], (3) it is vague on the importance of anticoagulation. JFW | T@lk 18:49, 18 June 2008 (UTC)

More sources[edit]

J Roy Soc Med carried a four-article series in 2000. A bit outdated, but there we go: http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=93%5Bvolume%5D%20AND%205%5Bissue%5D%20AND%20Cerebral%20venous%20thrombosis JFW | T@lk 18:50, 26 June 2008 (UTC)

PMID 18625874 - Stam again breaking a lance for anticoagulation despite borderline statistics. Should prompt larger trials, methinks.
PMID 18340091 - slightly more data on thrombolysis, from ISCVT.
PMID 18309177 - seizures are likely to recur and one seizure + CVST therefore indicates need for antiepileptics.
Much of this is primary research, so it's time we wait for a further review. JFW | T@lk 20:25, 22 July 2008 (UTC)

Totally missed doi:10.1016/S1474-4422(07)70029-7 (Bousser in Lancet Neurol). For another time. JFW | T@lk 23:40, 10 April 2010 (UTC)

doi:10.1160/TH09-12-0827 - Italian guidelines. No new points, but in English and makes the point that warfarin should only be introduced when the patient is stable. JFW | T@lk 17:05, 17 February 2011 (UTC)
doi:10.1111/j.1538-7836.2012.04637.x - recent meta-analysis of the use of D-dimer. Could be cited instead of the primary sources we're currently dependent on. JFW | T@lk 03:04, 1 April 2012 (UTC)
doi:10.1111/j.1365-2141.2012.09249.x - new British guidelines from a haematology perspective. JFW | T@lk 07:57, 10 October 2012 (UTC)

Another doi:10.1007/s11886-014-0523-2 JFW | T@lk 08:50, 27 June 2016 (UTC)

"A rare form of stroke"[edit]

The article's lede states that cerebral venous sinus thrombosis is a form of stroke, but perhaps it may be prudent to revise that statement to allow for cases of thrombosis that occur without persistent and clinically important neurologic sequelae. U.S. Secretary of State Hillary Clinton's doctors have reported that she has been found to have experienced a transverse sinus thrombosis that was discovered on an MRI performed during "routine" follow-up a concussion sustained 2 1/2 weeks earlier. The doctors have said in their public statements that she did not have a stroke and has had no neurologic injury. Assuming their statement is correct, and that her diagnosis lies within the realm of cerebral venous sinus thrombosis, this article as it is currently written does not appear to include cases of CVST that do not involve stroke or neurologic injury, such as Clinton's. I haven't carefully reviewed sources, but my sense is that the article could be revised to say that CVST is a rare form of thrombosis that may cause stroke, assuming sources can be found that state that.Dezastru (talk) 00:51, 2 January 2013 (UTC)

I agree that in the absence of focal neurology secondary to venous infarction it would not be appropriate to refer to this as a form of stroke (although it would fit in the larger category of cerebrovascular disease). JFW | T@lk 14:26, 2 January 2013 (UTC)

Treatment of CVST in Clotting Disorders[edit]

How does one treat the CVST in a patient with a coagulopathy? Clearly anticoagulants are forbidden. (NB - repasted it because it was inserted before the footnotes of the previous section - if this happens again perhaps someone else can fix it)

  1. ^ Dai A, Wasay M, Dubey N, Giglio P, Bakshi R (2000). "Superior sagittal sinus thrombosis secondary to hyperthyroidism". Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 9 (2): 89–90. PMID 17895204. doi:10.1053/jscd.2000.0090089. 
  2. ^ Finelli PF, Harrison RB, Uphoff DF (1998). "Myelodysplastic syndrome and sagittal sinus thrombosis". Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 7 (3): 211–2. PMID 17895084. 
  3. ^ Longmore, Murray (2007). Oxford Handbook of Clinicial Medicine. Oxford. ISBN 0-19-856837-1.  Unknown parameter |coauthors= ignored (|author= suggested) (help)