Acute severe cerebral venous thrombosis (CVT) presenting with parenchymal lesions and mass effect is a neurocritical emergency. When brain imaging demonstrates midline shift, or when clinical signs of cerebral herniation are present, the immediate treatment approach is distinct and requires urgent escalation.
Acute severe CVT with parenchymal lesions causing mass effect and midline shift on brain imaging, with signs of cerebral herniation — a high-acuity presentation where timely, targeted intervention is essential.
In this setting, a surgical decompressive intervention is considered as a lifesaving approach. The complete protocol — including patient selection, timing, and full management details — is available in the structured regimen.
Complete criteria, sequencing, and accompanying management are in the full protocol.
DOI: 10.1161/STR.0000000000000456
Mass Effect with Midline Shift or Signs of Herniation — Consider decompressive hemicraniectomy.
It should be offered to patients with acute severe CVT and parenchymal lesions with impending herniation as a lifesaving therapeutic approach (Figure 4).
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