EFNS - TVC

Question 1

Qual o tratamento principal para TVC?

Answer 1

Current evidence shows that patients with CVST without contraindications for AC should be treated either with body weight-adjusted subcutaneous LMWH (180 anti-factor Xa U/kg/24 h administered by two subcutaneous injections daily) or dose-adjusted intravenous heparin with an at least doubled activated partial thromboplastin time. Concomitant ICH related to CVST is not a contraindication for heparin therapy. For the reasons mentioned above, LMWH should be preferred in uncomplicated CVST cases.

Question 2

Quando fazer trombolise local na TVC?

Answer 2

There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate AC and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without ICH. The optimal substance (urokinase or rtPA), dosage, route (systemic or local), or method of administration (repeated bolus or bolus plus infusion) are not known

Question 3

Qual o tempo da anticoagulação na TVC?

Answer 3

There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate AC and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without ICH. The optimal substance (urokinase or rtPA), dosage, route (systemic or local), or method of administration (repeated bolus or bolus plus infusion) are not known

Question 4

Quando devemos utilizar drogas antiepilépticas?

Answer 4

Prophylactic antiepileptic therapy may be an therapeutic option in patients with focal neurological deficits and focal parenchymal lesions on admission CT/MRI. The optimal duration of treatment for patients with seizures is unclear.
Pelo guideline da ESO, devemos manter por 1 ano.

Question 5

Qual o manejo da hipertensão intracraniana na TVC?

Answer 5

In patients with IIH and threatened vision possible therapeutic measures may include one or more lumbar punctures, acetazolamide and incidentically CSFshunting procedures. There are no controlled data about the risks and benefits of certain therapeutic measures (e.g. steroids and decompressive surgery) to reduce an elevated intracranial pressure (with brain displacement) in patients with CVST. Antioedema treatment should be carried out according to general principles of therapy of raised intracranial pressure. In a very small subgroup of patients who deteriorate especially in the presence of large intracerebral haemorrhages, decompressive craniectomy might be an alternative treatment option in the future. Now, this therapy needs further investigation and should be regarded as experimental.