Annals of Indian Academy of Neurology
ORIGINAL ARTICLE
Year
: 2016  |  Volume : 19  |  Issue : 3  |  Page : 307--311

Intrasinus thrombolysis in cerebral venous sinus thrombosis: Experience from a university hospital, India


Neeharika L Mathukumalli1, Ram Murti Susarla2, Mridula R Kandadai1, Suryaprabha Turaga1, Jabeen A Shaik1, Suvarna Alladi1, Meena A Kanikannan1, Rupam Borgohain1, Subhash Kaul1 
1 Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
2 Department of Radiology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India

Correspondence Address:
Subhash Kaul
Department of Neurology, Nizam«SQ»s Institute of Medical Sciences (NIMS), Hyderabad, Telangana
India

Background: Intrasinus thrombolysis (IST) is believed to improve outcome in patients of cerebral venous sinus thrombosis (CVST) unresponsive to heparin. Purpose: The purpose of this article is to describe our experience with IST in patients of CVST unresponsive to heparin. Materials and Methods: Hospital databases were searched, and patients with CVST who underwent IST from May 2011 to March 2014 were identified. Data on clinical presentation, duration of symptoms, and indications and dosage of IST were retrieved and outcomes analyzed. Results: Twenty-four patients received IST. The presenting symptoms included headache (n = 19), seizures (n = 16), and altered sensorium (n = 14); signs included papilledema (n = 20) and hemiparesis (n = 15). Nineteen patients received unfractionated heparin (UFH), four received low-molecular-weight heparin (LMWH), and one received both. In one patient, microcatheter could not be passed, two patients bled intracranially, and three had nonintracranial bleeds. Among four deaths, none was due to iatrogenic bleeding. On discharge, 10 patients (43.5%) had good improvement with the modified Rankin Scale (score; mRS) ≤2 and eight (34.8%) had partial improvement with mRS = 3, 4. Seventeen patients (73.9%) had mRS ≤2 at 6 months follow-up. Bleeding complications of urokinase were less than those of alteplase. Recanalization of the involved sinuses was achieved in all. Early intervention led to successful recanalization. Functional recanalization decreased intracranial bleeding. Conclusion: Till date, our study is the largest series of IST in CVST reported from India. IST may be more effective than systemic heparin anticoagulation in moribund and unresponsive patients despite the potential for bleeding manifestations. Functional recanalization is adequate for good results. However, a randomized prospective study comparing heparin anticoagulation with IST is warranted.


How to cite this article:
Mathukumalli NL, Susarla RM, Kandadai MR, Turaga S, Shaik JA, Alladi S, Kanikannan MA, Borgohain R, Kaul S. Intrasinus thrombolysis in cerebral venous sinus thrombosis: Experience from a university hospital, India.Ann Indian Acad Neurol 2016;19:307-311


How to cite this URL:
Mathukumalli NL, Susarla RM, Kandadai MR, Turaga S, Shaik JA, Alladi S, Kanikannan MA, Borgohain R, Kaul S. Intrasinus thrombolysis in cerebral venous sinus thrombosis: Experience from a university hospital, India. Ann Indian Acad Neurol [serial online] 2016 [cited 2021 Sep 17 ];19:307-311
Available from: https://www.annalsofian.org/article.asp?issn=0972-2327;year=2016;volume=19;issue=3;spage=307;epage=311;aulast=Mathukumalli;type=0