SHM's Clinical Quick Talks-Cerebral Venous Thrombosis

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Cerebral Venous Thrombosis (CVT) is a rare form of stroke involving a blood clot in the venous sinuses, leading to obstructed blood flow and elevated intracranial pressure. CVT accounts for 1% of all strokes and predominantly affects women, despite a worse prognosis in men. The average age of onset is 40, but it can occur at any age.<br /><br />Signs and symptoms commonly include headaches, papilledema, vision problems such as diplopia and vision loss, nausea, vomiting, seizures, and tinnitus. The primary types of CVT are classified by location: dural sinus thrombosis (most commonly affecting the superior sagittal sinus), isolated cortical vein thrombosis, deep cerebral vein thrombosis, and cavernous sinus thrombosis.<br /><br />CVT is precipitated by conditions that promote hypercoagulability, such as malignancies, pregnancy or postpartum states, certain blood disorders, and conditions like antiphospholipid antibody syndrome. Other risk factors include head trauma, neurosurgical procedures, and lumbar punctures.<br /><br />Diagnosis typically involves imaging techniques such as computed tomography venography (CTV) and magnetic resonance venography (MRV), the latter being more sensitive.<br /><br />Management includes immediate anticoagulation with heparin, even if intracranial hemorrhage is present, followed by warfarin treatment for 3-6 months or longer if idiopathic. Surgical interventions may be necessary for severe cases exhibiting large infarcts or high intracranial pressure, with thrombectomy or angioplasty and stenting as potential options.<br /><br />Clinically, adults in specific situations—such as pregnancy, clotting disorders, malignancy, and inflammatory bowel disease—are more likely to develop CVT. Current research shows that treatments like steroids, mannitol, and acetazolamide have not demonstrated clear benefits for managing raised intracranial pressure associated with CVT.

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Nicole Buleza, Nicole Terrigno

Keywords

Cerebral Venous Thrombosis

CVT

stroke

venous sinuses

intracranial pressure

dural sinus thrombosis

hypercoagulability

anticoagulation

computed tomography venography

magnetic resonance venography