Feasibility of glucocorticoid for severe cerebral venous sinus thrombosis_West China Medical Journal

Authors：

ZHAO Tingyu ^1,2 ,  DUAN Jiangang ^1,2 , XIAO Lipo ² , JI Xunming ²

1. Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;
2. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding author：

DUAN Jiangang, Email: duanjiangang@xwhosp.org

Keywords：

Cerebral venous sinus thrombosis; Critically ill; Inflammation; Glucocorticoid

DOI：

10.7507/1002-0179.202004362

Video：

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Abstract Full text Figures/Tables Video References Cited by

In recent years, with the development of neuroimaging and the improvement of people’s awareness, the incidence of cerebral venous sinus thrombosis (CVST) has been increasing year by year. CVST with venous infarction or haemorrhage is severe, accounting for about 60% of CVST, and its clinical manifestations are serious. The current therapies including anticoagulation and intravascular treatment have not significantly improved the prognosis of severe CVST patients. The incidence of long-term poor prognosis (modified Rankin scale score≥2) is up to 56.1%. Recent research indicates that inflammation may be an important factor leading to severe CVST and is significantly associated with poor prognosis. Anti-inflammatory treatment with glucocorticoids may provide a novel method for severe CVST, but further clinical studies are needed to verify it. This paper introduces the relationship between inflammation and severe CVST in order to explore the feasibility of glucocorticoid for severe CVST.

Citation： ZHAO Tingyu, DUAN Jiangang, XIAO Lipo, JI Xunming. Feasibility of glucocorticoid for severe cerebral venous sinus thrombosis. West China Medical Journal, 2020, 35(6): 642-645. doi: 10.7507/1002-0179.202004362 Copy

1.	Devasagayam S, Wyatt B, Leyden J, et al. Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke, 2016, 47(9): 2180-2182.
2.	Silvis SM, de Sousa DA, Ferro JM, et al. Cerebral venous thrombosis. Nat Rev Neurol, 2017, 13(9): 555-565.
3.	Kowoll CM, Kaminski J, Weiß V, et al. Severe cerebral venous and sinus thrombosis: clinical course, imaging correlates, and prognosis. Neurocrit Care, 2016, 25(3): 392-399.
4.	Stam J, Majoie CB, van Delden OM, et al. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke, 2008, 39(5): 1487-1490.
5.	Wang L, Duan J, Bian T, et al. Inflammation is correlated with severity and outcome of cerebral venous thrombosis. J Neuroinflammation, 2018, 15: 329.
6.	Ferro JM, Canhão P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke, 2004, 35(3): 664-670.
7.	Coutinho JM, Ferro JM, Zuurbier SM, et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int J Stroke, 2013, 8(2): 135-140.
8.	Coutinho JM, Zuurbier SM, Bousser MG, et al. Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: the TO-ACT randomized clinical trial. JAMA Neurol, 2020: e201022.
9.	Piazza G. Cerebral venous thrombosis. Circulation, 2012, 125(13): 1704-1709.
10.	Nagai M, Terao S, Yilmaz G, et al. Roles of inflammation and the activated protein C pathway in the brain edema associated with cerebral venous sinus thrombosis. Stroke, 2010, 41(1): 147-152.
11.	Gao L, Dong Q, Song Z, et al. NLRP3 inflammasome: a promising target in ischemic stroke. Inflamm Res, 2017, 66(1): 17-24.
12.	Wang Z, Zhang S, Xiao Y, et al. NLRP3 inflammasome and inflammatory diseases. Oxid Med Cell Longev, 2020, 2020: 4063562.
13.	Rashad S, Niizuma K, Sato-Maeda M, et al. Early BBB breakdown and subacute inflammasome activation and pyroptosis as a result of cerebral venous thrombosis. Brain Res, 2018, 1699: 54-68.
14.	Thal SC, Luh C, Schaible EV, et al. Volatile anesthetics influence blood-brain barrier integrity by modulation of tight junction protein expression in traumatic brain injury. PloS One, 2012, 7(12): e50752.
15.	Nitta T, Hata M, Gotoh S, et al. Size-selective loosening of the blood-brain barrier in claudin-5-deficient mice. J Cell Biol, 2003, 161(3): 653-660.
16.	Rosenberg GA, Yang Y. Vasogenic edema due to tight junction disruption by matrix metalloproteinases in cerebral ischemia. Neurosurg Focus, 2007, 22(5): E4.
17.	Grimnes G, Isaksen T, Tichelaar YIGV, et al. C-reactive protein and risk of venous thromboembolism: results from a population-based case-crossover study. Haematologica, 2018, 103(7): 1245-1250.
18.	Duan J, Leng X, Han Z, et al. Identifying biomarkers associated with venous infarction in acute/subacute cerebral venous thrombosis. Aging and Disease. (2020-04-05)[2020-06-02]. http://www.aginganddisease.org/EN/10.14336/AD.2020.0405.
19.	Saghazadeh A, Sina Hafizi S, Rezaei N. Inflammation in venous thromboembolism: cause or consequence?. Int Immunopharmacol, 2015, 28(1): 655-665.
20.	Brotman DJ, Girod JP, Posch A, et al. Effects of short-term glucocorticoids on hemostatic factors in healthy volunteers. Thromb Res, 2006, 118(2): 247-252.
21.	Isidori AM, Minnetti M, Sbardella E, et al. Mechanisms in endocrinology: the spectrum of haemostatic abnormalities in glucocorticoid excess and defect. Eur J Endocrinol, 2015, 173(3): R101-R113.
22.	van Giezen JJ, Jansen JW. Inhibition of fibrinolytic activity in-vivo by dexamethasone is counterbalanced by an inhibition of platelet aggregation. Thromb Haemost, 1992, 68(1): 69-73.
23.	Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Diagnosis and Management of Cerebral Venous Thrombosis: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2011, 42(4): 1158-1192.
24.	Ferro JM, Bousser MG, Canhão P, et al. European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the european academy of neurology. Eur Stroke J, 2017, 2(3): 195-221.
25.	范玉华, 陈红兵, 余剑, 等. 中国脑血管病临床管理指南(节选版)——脑静脉系统血栓形成临床管理. 中国卒中杂志, 2019, 14(8): 819-822.
26.	Canhão P, Cortesão A, Cabral M, et al. Are steroids useful to treat cerebral venous thrombosis?. Stroke, 2008, 39(1): 105-110.
27.	宁军, 段建钢, 吉训明. 伴静脉性脑出血的重症颅内静脉窦血栓形成一例. 中国现代神经疾病杂志, 2018, 18(11): 813-817.

1. Devasagayam S, Wyatt B, Leyden J, et al. Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke, 2016, 47(9): 2180-2182.
2. Silvis SM, de Sousa DA, Ferro JM, et al. Cerebral venous thrombosis. Nat Rev Neurol, 2017, 13(9): 555-565.
3. Kowoll CM, Kaminski J, Weiß V, et al. Severe cerebral venous and sinus thrombosis: clinical course, imaging correlates, and prognosis. Neurocrit Care, 2016, 25(3): 392-399.
4. Stam J, Majoie CB, van Delden OM, et al. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke, 2008, 39(5): 1487-1490.
5. Wang L, Duan J, Bian T, et al. Inflammation is correlated with severity and outcome of cerebral venous thrombosis. J Neuroinflammation, 2018, 15: 329.
6. Ferro JM, Canhão P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke, 2004, 35(3): 664-670.
7. Coutinho JM, Ferro JM, Zuurbier SM, et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int J Stroke, 2013, 8(2): 135-140.
8. Coutinho JM, Zuurbier SM, Bousser MG, et al. Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: the TO-ACT randomized clinical trial. JAMA Neurol, 2020: e201022.
9. Piazza G. Cerebral venous thrombosis. Circulation, 2012, 125(13): 1704-1709.
10. Nagai M, Terao S, Yilmaz G, et al. Roles of inflammation and the activated protein C pathway in the brain edema associated with cerebral venous sinus thrombosis. Stroke, 2010, 41(1): 147-152.
11. Gao L, Dong Q, Song Z, et al. NLRP3 inflammasome: a promising target in ischemic stroke. Inflamm Res, 2017, 66(1): 17-24.
12. Wang Z, Zhang S, Xiao Y, et al. NLRP3 inflammasome and inflammatory diseases. Oxid Med Cell Longev, 2020, 2020: 4063562.
13. Rashad S, Niizuma K, Sato-Maeda M, et al. Early BBB breakdown and subacute inflammasome activation and pyroptosis as a result of cerebral venous thrombosis. Brain Res, 2018, 1699: 54-68.
14. Thal SC, Luh C, Schaible EV, et al. Volatile anesthetics influence blood-brain barrier integrity by modulation of tight junction protein expression in traumatic brain injury. PloS One, 2012, 7(12): e50752.
15. Nitta T, Hata M, Gotoh S, et al. Size-selective loosening of the blood-brain barrier in claudin-5-deficient mice. J Cell Biol, 2003, 161(3): 653-660.
16. Rosenberg GA, Yang Y. Vasogenic edema due to tight junction disruption by matrix metalloproteinases in cerebral ischemia. Neurosurg Focus, 2007, 22(5): E4.
17. Grimnes G, Isaksen T, Tichelaar YIGV, et al. C-reactive protein and risk of venous thromboembolism: results from a population-based case-crossover study. Haematologica, 2018, 103(7): 1245-1250.
18. Duan J, Leng X, Han Z, et al. Identifying biomarkers associated with venous infarction in acute/subacute cerebral venous thrombosis. Aging and Disease. (2020-04-05)[2020-06-02]. http://www.aginganddisease.org/EN/10.14336/AD.2020.0405.
19. Saghazadeh A, Sina Hafizi S, Rezaei N. Inflammation in venous thromboembolism: cause or consequence?. Int Immunopharmacol, 2015, 28(1): 655-665.
20. Brotman DJ, Girod JP, Posch A, et al. Effects of short-term glucocorticoids on hemostatic factors in healthy volunteers. Thromb Res, 2006, 118(2): 247-252.
21. Isidori AM, Minnetti M, Sbardella E, et al. Mechanisms in endocrinology: the spectrum of haemostatic abnormalities in glucocorticoid excess and defect. Eur J Endocrinol, 2015, 173(3): R101-R113.
22. van Giezen JJ, Jansen JW. Inhibition of fibrinolytic activity in-vivo by dexamethasone is counterbalanced by an inhibition of platelet aggregation. Thromb Haemost, 1992, 68(1): 69-73.
23. Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Diagnosis and Management of Cerebral Venous Thrombosis: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2011, 42(4): 1158-1192.
24. Ferro JM, Bousser MG, Canhão P, et al. European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the european academy of neurology. Eur Stroke J, 2017, 2(3): 195-221.
25. 范玉华, 陈红兵, 余剑, 等. 中国脑血管病临床管理指南(节选版)——脑静脉系统血栓形成临床管理. 中国卒中杂志, 2019, 14(8): 819-822.
26. Canhão P, Cortesão A, Cabral M, et al. Are steroids useful to treat cerebral venous thrombosis?. Stroke, 2008, 39(1): 105-110.
27. 宁军, 段建钢, 吉训明. 伴静脉性脑出血的重症颅内静脉窦血栓形成一例. 中国现代神经疾病杂志, 2018, 18(11): 813-817.

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