{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/21\\\/14\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/21\\\/14\u0022}],\u0022ac\u0022:{\u0022spmdc;15\\\/21\\\/14\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;15\\\/21\\\/14\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThrombosis in the small veins is not trivial and requires treatment. Fondaparinux in superficial vein thrombosis of the legs decreases the risk of recurrence, deep vein thrombosis, and pulmonary embolism. Treatment of cerebral vein thrombosis with low molecular weight heparin initially, followed by oral anticoagulation, reduces the risk of death and dependency.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esuperficial vein thrombosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebral venous thrombosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eanticoagulation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003ERecommendations for treatment of superficial vein thrombosis (SVT) of the legs now include anticoagulation; however, the low quality of evidence to support this recommendation and the uncertainty of cost-effectiveness have resulted in the question: Do patients with SVT require treatment? Herv\u00e9 D\u00e9cousus, MD, CHU de Saint-Etienne, Saint Etienne, France, discussed the management of spontaneous acute SVT of the legs.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESeveral studies have demonstrated that deep vein thrombosis (DVT) and pulmonary embolism (PE) are present in 25% to 29% of patients who present with primary or secondary SVT [Frapp\u00e9 P et al. \u003Cem\u003EJ Thromb Haemost\u003C\/em\u003E. 2014; Galanaud JP et al. \u003Cem\u003EThromb Haemost\u003C\/em\u003E. 2011; D\u00e9cousus H et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E. 2010]. In addition, patients with isolated SVT are at an increased risk of developing a subsequent DVT or PE between 3 and 6 months, with rates of up to 3.1% and 0.9% for DVT and PE, respectively [D\u00e9cousus H et al. \u003Cem\u003EJ Thromb Haemost\u003C\/em\u003E. 2015]. Patients with SVT are at risk of SVT extension, with 3.6% of extensions occurring \u2264\u20053 cm from the saphenous-femoral junction and 3.7% occurring farther away [Leizorovicz A et al. \u003Cem\u003EBlood\u003C\/em\u003E. 2013]. Importantly, SVT extension is associated with the development of a subsequent DVT or PE. Therefore, Prof D\u00e9cousus recommends that patients who present with SVT should be evaluated for PE symptoms and an ultrasound should be conducted to determine if DVT is present.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPatients with SVT should receive anticoagulation therapy to prevent symptomatic thromboembolism. The randomized, double-blind STENOX trial [Superficial Thrombophlebitis Treated by Enoxaparin Study Group. \u003Cem\u003EArch Intern Med\u003C\/em\u003E. 2003] demonstrated that low molecular weight heparin (LMWH) for 12 days reduced the rate of DVT and SVT for over 80 days; however, most events occurred after LMWH was stopped. This indicates that anticoagulation is effective, but 12 days is not adequate in duration. Furthermore, the VESALIO [VESALIO Investigators Group. \u003Cem\u003EJ Thromb Haemost\u003C\/em\u003E. 2005] and STEFLUX trials [Cosmi B et al. \u003Cem\u003EJ Thromb Haemost\u003C\/em\u003E. 2012] demonstrated that 30 days of LMWH is also insufficient. By contrast, the CALISTO trial [D\u00e9cousus H et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2010] demonstrated that 2.5 mg of fondaparinux for 45 days reduced the risk of death or symptomatic thromboembolism without increasing the risk of bleeding and did not cause catch-up phenomena to occur. In addition, fondaparinux for 45 days reduced the risk of PE, DVT, SVT recurrence, and SVT extension \u2264\u20053 cm from the saphenous-femoral junction (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In the CALISTO trial, even patients with no known risk factors for thromboembolism derived benefit from fondaparinux therapy for 45 days.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/21\/14.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of 45 Days of Fondaparinux on Thromboembolism Risk After SVTSome patients had more than one event. Death: fondaparinux, n\u0026#x2005;=\u0026#x2005;2 (cancer); placebo, n\u0026#x2005;=\u0026#x2005;1 (acute heart failure).DVT, deep vein thrombosis; PE, pulmonary embolism; RRR, relative risk reduction; SFJ, saphenous-femoral junction; SVT, superficial vein thrombosis.Source: D\u0026#xE9;cousus H et al. N Engl J Med. 2010.Reproduced with permission from H D\u0026#xE9;cousus, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-21995720\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Effect of 45 Days of Fondaparinux on Thromboembolism Risk After SVTSome patients had more than one event. Death: fondaparinux, n\u0026#x2005;=\u0026#x2005;2 (cancer); placebo, n\u0026#x2005;=\u0026#x2005;1 (acute heart failure).DVT, deep vein thrombosis; PE, pulmonary embolism; RRR, relative risk reduction; SFJ, saphenous-femoral junction; SVT, superficial vein thrombosis.Source: D\u0026#xE9;cousus H et al. \u0026amp;lt;em\u0026amp;gt;N Engl J Med\u0026amp;lt;\/em\u0026amp;gt;. 2010.Reproduced with permission from H D\u0026#xE9;cousus, MD.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/21\/14.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/21\/14.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/21\/14.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16829\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EEffect of 45 Days of Fondaparinux on Thromboembolism Risk After SVT\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ESome patients had more than one event. Death: fondaparinux, n\u2005=\u20052 (cancer); placebo, n\u2005=\u20051 (acute heart failure).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDVT, deep vein thrombosis; PE, pulmonary embolism; RRR, relative risk reduction; SFJ, saphenous-femoral junction; SVT, superficial vein thrombosis.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ESource: D\u00e9cousus H et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2010.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EReproduced with permission from H D\u00e9cousus, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003ETherefore, the current American College of Chest Physicians recommendations for the treatment of SVT of the legs suggest a prophylactic dose of fondaparinux or LMWH for 45 days, with 2.5 mg of fondaparinux being the preferred drug [Kearon C et al. \u003Cem\u003EChest\u003C\/em\u003E. 2012]. In addition, a Cochrane review found that 2.5 mg of fondaparinux for 45 days for the treatment of SVT was a valid treatment, but the authors could not reach a conclusion regarding LMWH, unfractionated heparin, or nonsteroidal anti-inflammatory drugs [Di Nisio M et al. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EHowever, there are still unanswered questions regarding the optimal treatment of SVT. For example, the optimal dose and duration of LMWH has not yet been established, there are currently no data regarding the safety and efficacy of the new oral anticoagulants, and fondaparinux has not been tested in patients who are pregnant or in patients with cancer or a recent history of venous thromboembolism (VTE).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAnother important small vein thrombosis is that of the cerebral veins and dural sinuses. Cerebral venous thrombosis (CVT) has a much lower incidence than DVT or PE, but it occurs more frequently in children and younger adults. Jonathan M. Coutinho, MD, PhD, Academic Medical Center, Amsterdam, The Netherlands, discussed the epidemiology, clinical manifestations, and management of CVT.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003ECVT encompasses sinus thrombosis and cerebral venous thrombosis, which frequently occur in the same patient. Sinus thrombosis causes intracranial hypertension due to decreased cerebrospinal fluid absorption (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). By contrast, cerebral venous thrombosis causes site-specific congestion leading to edema, and potentially infarction and hemorrhage.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16830\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16830\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16830\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ECommon Signs and Symptoms of Cerebral Venous Thrombosis\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EThe risk factors of CVT are partly similar to those of VTE, such as thrombophilia, cancer, and pregnancy [Lauw MN et al. \u003Cem\u003ESemin Thromb Haemost\u003C\/em\u003E. 2013]. However, CVT-specific risk factors include neurosurgery, head trauma, lumbar puncture or epidural anesthesia, and local infections [Saposnik G et al. \u003Cem\u003EStroke\u003C\/em\u003E. 2011]. Diagnosis requires magnetic resonance imaging (MRI) and magnetic resonance venography (MRV), or computed tomography (CT) venography in centers without access to MRV or for patients who cannot undergo an MRI scan. MRI is superior to CT for detection of concomitant brain parenchymal lesions (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16831\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16831\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16831\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \u003Cp id=\u0022p-18\u0022 class=\u0022first-child\u0022\u003EPotential Concomitant Parenchymal Lesions Due to Cerebral Venous Thrombosis\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-21\u0022\u003EAnticoagulation with LMWH is currently the standard treatment to reduce the risk of death or dependency. This is based on data from 2 small trials that, when taken together, resulted in a risk ratio of 0.46, albeit with a wide confidence interval (95% CI, 0.16 to 1.31) and lack of statistical significance (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.12) [Coutinho J et al. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E. 2011]. However, Dr Coutinho pointed out that in the heparin arm, none of the patients developed a new intracerebral hemorrhage despite many having hemorrhage at baseline, and 2 patients in the placebo arm developed probable PE. Endovascular treatment should be used only in severe cases; however, the ongoing TO-ACT trial should answer the question of when thrombolysis or thrombectomy should be used [Coutinho JM et al. \u003Cem\u003EInt J Stroke\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003EThe standard treatment for ambulatory patients after CVT is a vitamin K antagonist. Although international guidelines recommend oral anticoagulation for 3 to 6 months in provoked cases and 6 to 12 months for unprovoked cases, the optimal duration is still not established [Saposnik G et al. \u003Cem\u003EStroke\u003C\/em\u003E. 2011; Einh\u00e4upl K et al. \u003Cem\u003EEur J Neurol\u003C\/em\u003E. 2010]. There are little data for use of nonwarfarin oral anticoagulants in CVT, although case series on this topic were recently published (PubMed ID 25070963).\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003EWith adequate treatment, the prognosis of patients with CVT is quite good, with only 15% to 20% having permanent disability and 5% to 10% experiencing death.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/21\/14.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}