Diagnosis and Management of Cerebral Venous Thrombosis
Вставка
- Опубліковано 2 сер 2024
- 00:00 - Intro
00:56 - Objectives
01:22 - Case
03:43 - Clinical Presentation
05:13 - Venous Vascular Territories
09:39 - Diagnostic Studies
13:07 - CT Venography
15:40 - MRI and MR Venography
20:48 - Summary of Imaging Signs
24:50 - D-Dimer
26:20 - Treatments
27:35 - Anticoagulation
32:12 - Endovascular Therapy
35:02 - Post Acute Care and Outcomes
40:40 - Summary: Treatment Algorithm
This video is intended for residents and fellows to understand the clinical presentation, diagnosis, treatment and prognosis of cerebral venous thrombosis.
Slides: drive.google.com/file/d/13vOR...
Created by:
Igor Rybinnik MD
Produced and narrated by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Images adapted from, and redrawn whenever possible:
Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
Hacking C, Radiopaedia.org, rID: 80107
Stam J. NEJM 2005;352:1791-8
Smith D, Radiopaedia.org, rID: 74568
Ghoneim A, et al. Clinical Rad 2020;75:254-64
Lee SK, et al on behalf of SNIS. J NeuroIntervent Surg 2018;10:803-810.
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, or Rutgers University as a whole.
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Just an outsider here - family member has just been diagnosed and is being treated. Your video has given me a lot of hope - thank you! (She presented with a 4 day headache behind right eye followed by an apparent stroke losing cognitive ability and speech). ❤
I'm sorry to hear of your troubles. I hope your family member gets better soon.
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Thank you! I am glad you found this useful. Good luck on the boards.
Thank you 🙏🏼
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You are a genius!! We can read about CSVT from multiple different sources, but we will never ever find a practical presentation like this. Thank you very much!
Thank you! That was the point of this presentation.
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I enjoyed and learned a lot from you video, thanks. As a 62 male with no history of headaches and contracted covid thanksgiving 2021, I have been suffering not post covid, but (maybe coincidental) post booster and flu shot, I have been suffering ever since. I have had a head CT scan that did not show any smoking guns and scheduled for an MRI on 14 March. I recently started a two week course of amoxicillin. I have also started again on baby aspirin and ginger consumption as to help in the event of thrombosis (figure it can't hurt and only help). P.S. As a magician who uses comedy, I much appreciated your method of presentation despite my predicament. Thanks!!
Thank you for the nice comments. I am sorry to hear about your troubles. I hope you fell better soon.
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Fascinating. My case is almost identical to this. Experienced CVT at 28 attributed to birth control.
I'm sorry to hear that. I hope you have recovered well.
awesome video ever !!!! btw,
what is the color that you have used on your slide doc??
Thank you for information...
Currently admitted in hospital with transverse sinus thrombosis with venous infarction and under LMWH and Mannitol for raised icp..improving symptomatically..lets hope it will recanalize with no recurrence..
I'm sorry to hear that. I hope you get better soon.
@@theneurophile thank you..
Thank you for the video. The pdf that is linked to the video is not working very well after p.66
Sir, it shall be very useful if u start sharing pdf of your lectures too.... thank you
Sure. Slides are hyperlinked in the video description.
thank you for sharing this video, one question: how long should we continue warfarin?
Usually 3-6 months, but ultimate duration depends on the results of follow-up imaging and thrombophia workup
What program do you use to create your presentations? They are so high quality.
I use PowerPoint and the Adobe Creative Cloud.
Brilliant!! thanks a lot !!
Which slide software do you use for the presentation sir?
The latest version of PowerPoint
I'm also recently diagnosed with CVST
I am sorry to hear that. I hope that you recover quickly.
Hiii, greetings from India. Very useful presentation!! I am a resident physician of Int Medicine. We start Inj Lmwh and on the second day, we start warfarin. What is the ideal time to add Warf.??
The time to start warfarin depends on patient stability (both clinical and radiographical on follow-up imaging).
Great video! The picture in 8:40 (cavernous sinus) is incorrect. V2 is not inside the cavernous sinus.
I beg to differ. Maxillary division is inside the cavernous sinus according to Netter's Anatomy atlas.
Think you very much. Could you please indicate the relevant references?
The references are in small font on the relevant slides, but I can add them to the description.
Hi sir I got same problem. What must I do
I am sorry to hear that. The first step is to reach out to a neurologist to be evaluated.
👍🌸💗
Thanks for this amazing informative lecture..
May i know the app used in this presentation 😅
Sure. This was made in PowerPoint.
@@theneurophile thank you, I’m an intensivist I gained a lot from knowledge from this amazing channel
My 17 yr old suffererd a stroke 2 years ago from this CVST. They weren’t able to treat it after being in the ICU for 16 hours before she suffered the stroke.
I am very sorry to hear that. Kids are usually resilient, so I am hopefully that she has recovered well.
33:17 "a decade ago" i was thinking more like 1990s 😂😂 not 2012...
How your making ppt sir
I just use the usual PowerPoint that comes with Office 365. Nothing special.
I hope you can answer me. Does narrowing or blockage of a vein in the head cause nerve spasms?
I’m not sure what you mean by “nerve spasms”
@@theneurophile nervous breakdown
It’s hard to answer that question without more information. Significant clotting in the venous system can rarely cause stroke, which may cause behavioral difficulties. But narrowing in the venous system without clotting or stroke typically does not.
Sir, I had CVST and still I am taking oral anticoagulant with Debigat , levoacitrom. Around 5 years I have been taking...I have checked no genetically disorders... But my doctor advises me to take life long.... Is it needed to take the anticoagulant for life long
I’m sorry that you are experiencing this illness. It is difficult to make appropriate treatment recommendations in an internet post without properly evaluating a person and reviewing all the data. So, I recommend following with your doctor who knows your specific situation for the discussion regarding duration of anticoagulation.
Yes sir I understand the situation. Actually it happened in 2018. After two years, my doctor instructed me to give up the anti coagulation tablet acitrom and reduced my dosage 250g levitracitrom . During Covid pandemic he passed away. His successor who is also neurologist but not that experience of the former, asked to continue the tablet dabigat with increased dosage. In my case CVST on left and it was partially canalized with slight siderosis due to hemorrhage and now doing good. After 2018 there was no issue that has raised . But its been more than 5 years I have been taking the tablets. That's why I asked sir. At least your experience may guide me for further.
What about vaccine induced as in the J & J side effects listed by them? Are you seeing more of this now?
Not really. CVT is reasonably rare, so even if the risk goes up a few percent, the absolute case numbers are still low.
U haven't discussed about blurred vision of patients?
There is a long list of non-specific symptoms that CVT patients get. Blurred vision is one of those symptoms, but unfortunately it does not help in the diagnosis.
iam a patient of CVT..am having this problem since from 2years..it was attacked at the time of delivery with hypertension..as I want know this problem.. will not cure..am taking medicines till now
I'm sorry to hear that you have cerebral venous thrombosis. There is a chance that medications can curing this condition but those chances are best discussed with your doctor.
How can I contact u sir.. I want to discuss my MRV report plz
For us doctors, it is very challenging to interpret a report or make any recommendations without interviewing and examining the patient. Scans must be interpreted in the context of the clinical story. So, I recommend that you either discuss the MRV with the doctor that ordered it (who presumably examined you) or make an appointment to see us for a full evaluation.
How can I talk to you? Where to contact u... I want to discuss my all symptoms with you plz..
@@BeenaKaKitchen I am sorry but I cannot comment on your symptoms or MRI report without evaluating you in our clinic. If you are in New Jersey, I encourage you to make an appointment by calling 732-235-7733.
I live in Pakistan.. can I talk to you on call?
What Happened with the Secret Study?
It hasn’t been completed yet.
@@theneurophile i was on call and we had this sagittal sinus thrombosis patient. (Proved on MRV)
And this video helped me pick up the findings after watching it.
SO INCREDIBLY HELPFUL. Thank you!
So ct is not penifishial vib earl
Can you please clarify your question?
I am with uncertain mood could speak not well sometime wonderful orator but suddenly not affording to speak satisfactorily .no rel as tin of connectivity in see ntence.lstene they also fail to to pick me afte one or two talks.toic also tuning off my grasp.feling s if my mind utter ly chained.and sleeping and if confront with new situation get taken by fear could not write also
Vision is alsobluring.hadache barly bearable
Fickle minds
What I should eat prescribe me
Unfortunately, I cannot make any prescriptions for patients I have not personally seen.
Hey can we speak?