Role of local thrombolysis in cerebral hemorrhagic venous infarct.

Background: Chemical thrombolysis in cerebral venous thrombosis (CVT) is one of the treatment options and the data is limited.

Settings And Design: Prospective observational nonrandomized study.

Subjects And Methods: This is a prospective study of 10 patients (six females and four males) admitted between May 2007 and June 2013. Grading system proposed by Department of Interventional Neuroradiology (INR), King Edward Memorial Hospital (KEM), Mumbai was used to grade the clinical status at admission. There were six patients with clinical Grade 3, two with Grade 4, and two with Grade 5. Patients with either Grade less than 3 or more than Grade 5 were excluded. Those patients, who were diagnosed with Cerebral venoussinous thrombosis (CSVT) but without hemorrhagic venous infarct and treated  according to INR KEM criteria, were excluded from the study. Average duration of thrombolysis was 13 hours (range 10-18 hours). Average dose of urokinase was 12.2 lakh units (range 9.2-16.8 lakh units).

Results: Six patients presented with clinical Grade 3 had modified Rankin Scale (mRS) sore of 1 at 30-day follow-up. Of the two patients with Grade 4, one had mRS 1 and the other had mRS 2 at 30-day follow-up. Of the two patients with Grade 5, one had mRS 2 at 30-day follow-up and the other did not respond to local thrombolysis and succumb to intracranial hemorrhagic infarct within 48 hours.

Conclusion: This small prospective single-center study showed local dural venous thrombolysis significantly improves clinical and radiological outcome in patients with CVT. A randomized control trial with large sample size is needed to substantiate our findings.