Transcranial color-coded duplex sonography in patients with cerebral venous thrombosis

Cerebral venous thrombosis (CVT) is a relatively uncommon form of stroke. The
estimated incidence is 13 per million/year. CVT occurs in similar clinical
circumstances as the more common conditions of leg-vein thrombosis and
pulmonary embo¬lism, such as thrombophilia (acquired or genetic), pregnancy,
oral contraceptives and in patients with hematological diseases or cancer. In
addition, CVT can be the result of local conditions, such as head trauma,
infections, and meningitis. Similar to deep vein thrombosis, the treatment of
choice in CVT is heparin. The prognosis is generally good, especially compared
to other types of stroke, although approximately 20% of patients remain
disabled or die1.

Most patients with CVT have increased intracranial pressure (ICP) due to
venous obstruction and impaired drainage of the cerebrospi¬nal fluid. Symptoms
associated with intracranial hypertension are headache and impaired vision.2,3
In rare situations, severe intracranial hypertension may result in decreased
cerebral perfusion and coma.
Although intracranial pressure is an important parameter in CVT, the ICP is
rarely measured because it requires an invasive procedure (lumbar puncture or
shunting procedure). All patients with CVT are treated with anticoagulation and
therefore these invasive procedures carry the risk of hemorrhagic
complications. A non-invasive method to measure the intracranial pressure in
patients with CVT would enable us to monitor the ICP, learn about the
pathophysiology of the disease, its complications and prognosis and might
provide a basis for future treatment decisions to reduce intracranial
pressure.

Transcranial color- coded duplex sonography (TCCS) through the transtemporal
acoustic window might be a good non-invasive tool for assessment of
intracranial pressure. The pulsatility index (PI), a parameter calculated form
TCCS derived flow velocities, has been found to be associated with intracranial
pressure in various neurological conditions.4 The usefulness of PI has been
studied most widely in traumatic brain injury. Although the strength of the
association with ICP varies between studies, it seems that PI may be useful to
monitor changes in intracranial pressure over time. Recently a case-report was
published, demonstrating successful intracranial pressure monitoring with
serial transcranial Doppler observations in a patient with CVT.5
Because assessment of PI with TCCS is a quick, easy and non-invasive tool which
can be repeatedly performed, it is worth investigating its value in patients
with CVT.

to evaluate the feasibility, time-course and association with clinical
manifestations of the pulsatility index (PI) in patients with cerebral venous
thrombosis.

single centre, observational study

There are no risks associated with participation to this study. Transcranial
sonograpy is non-invasive and carries no risk. No extra visits to the hospital
are needed for participation in this study. Therefore, the patient burden of
participation is small.
Individual patients will not benefit from participation in this study.