Cerebral venous thrombosis: a diagnostic and treatment update.

Resumen Introduccion La trombosis venosa cerebral (TVC) representa hasta la fecha tanto un reto diagnostico como terapeutico, debido principalmente a la alta variabilidad de presentacion y a la falta de un consenso terapeutico claro. Fuentes Se realizo la busqueda de literatura medica en PubMed con el termino TVC y epidemiologia (428 resultados), fisiopatologia (504 resultados), etiologia (2714 resultados), diagnostico (2.802 resultados), tratamiento (2.173 resultados) y pronostico (648 resultados). Se seleccionaron las publicaciones originales y de revision consideradas como mas utiles para la revision. Se incluyeron tambien textos clasicos o historicos. Desarrollo En la presente revision se destacan los aspectos epidemiologicos, fisiopatologicos y etiologicos fundamentales de la TVC. Se comparan las manifestaciones clinicas iniciales mas frecuentes de acuerdo a diferentes series y se exponen las pruebas neurorradiologicas de eleccion actual para su diagnostico. Asimismo, se analiza la evidencia disponible hasta el momento en lo que corresponde al tratamiento y pronostico, con el proposito de brindar una herramienta solida para la practica clinica y la investigacion. Conclusiones La TVC representa alrededor del 0,5% de todos los casos de enfermedad vascular cerebral a nivel mundial. La cefalea, los deficits focales y las crisis convulsivas constituyen las manifestaciones iniciales mas comunes con el 89, 50 y 35% de frecuencia respectivamente. El diagnostico neurorradiologico mas sensible y especifico es la imagen por resonancia magnetica (IRM) combinada con venorresonancia. La venografia por tomografia computarizada constituye una buena alternativa debido a resultados equiparables a los de la IRM. El tratamiento con heparina es en la actualidad el mas aceptado. Tiene una mortalidad del 10% y la recurrencia se situa en 2,8 por cada 100 casos a pesar de terapia anticoagulante.

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