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Abstract
Cerebral venous thrombosis [CVT] ranges in the population from an overall adult incidence of 1.32 per 1 00 000 population.1 Often CVT symptoms can present with comorbid headache [HA] and severe pain in isolation of other signs and symptoms, which substantiates the necessity of addressing a robust differential for HA. Furthermore, use of balloon intravascular thrombectomy has been considered in some cases of CVT, however evidence based outcomes comparing best medical practices versus emergent endovascular treatment is limited to case studies and anecdotical clinical judgment.
A case study was performed which included dissecting the details of a single patient suffering from a severe CVT, who initially presented with an atypical ahead, and was successfully treated with balloon thrombectomy, with immediate improval of HA and return to baseline within two weeks. The patient was followed daily during a two week hospital course. Also, a thorough literature review on Pubmed was completed.
In review, the HA from CVT can mimic many HA types.7,51 Thus, HA history needs to clarify risk factors, oral contraceptive use, trauma, or history of hypercoagulability, as well as a select imaging in the work-up.7,31 Additionally, a balloon catheter is an advantageous hardware choice, because thrombolytic agents can be injected via the inner lumen with an inflated balloon. And, until the TO-ACT trial is completed, the use of emergent endovascular treatment is limited to case studies and judgment. Accordingly, this case demonstrates successful emergent recanalization of a severe CVT using balloon mechanical thrombectomy, specifically using a Scepter 11 intracranial balloon.
Non-contrast CT brain showing delta sign and subarachonid hemorrhage surrounding the straight sinus
Non-contrast MRV head showing complete venous occlusion and no flow of the superior sinus, straight sinus, and bilateral transverse sinuses
Disclosures A. Alvarado-Ortiz: None.