DIRECT THROMBOLYTIC TREATMENT OF EXTENSIV E SINUS VENOUS THROMBOSIS USING SELECTIVE CATHETERIZATION AND UROKINASE

A 37 year-old man had headaches for 10 days, then a single tonic-cloni c seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic t reatment was then performed using transvenous catheterization and inst illation of Urokinase (2.6 MU over 4 days). A near complete repermeabi lization of the sinuses was obtained and the patient improved dramatic ally in a few days. The only adverse effect of Urokinase was hematuria . Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relativ ely safe procedure. This treatment should be considered in a patient w ith extensive dural sinus thrombosis which fails to respond to heparin treatment.