Difference between revisions of "Cerebral venous thrombosis"

(Text replacement - " ==" to "==")
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''The cavernous sinus is one of the several cerebral veins and [[cavernous sinus thrombosis]] is a specific type of cerebral venous (sinus) thrombosis.  See that article for a discussion of that specific clinical entity.''
 
''The cavernous sinus is one of the several cerebral veins and [[cavernous sinus thrombosis]] is a specific type of cerebral venous (sinus) thrombosis.  See that article for a discussion of that specific clinical entity.''
== Background ==
+
== Background==
 
[[File:Cerebral veins.jpg|thumbnail|Cerebral Veins]]
 
[[File:Cerebral veins.jpg|thumbnail|Cerebral Veins]]
 
*Occlusion of venous sinus (most commonly superior sagittal and lateral sinuses) by thrombus or compression from mass
 
*Occlusion of venous sinus (most commonly superior sagittal and lateral sinuses) by thrombus or compression from mass
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**Compression of venous sinus (tumor, abscess)
 
**Compression of venous sinus (tumor, abscess)
  
== Clinical Features ==
+
== Clinical Features==
 
*Clinical presentation varies depending on location, acuity, and severity of thrombosis
 
*Clinical presentation varies depending on location, acuity, and severity of thrombosis
 
**More gradual onset of symptoms or thrombosis allows for compensatory collateral venous system to develop  
 
**More gradual onset of symptoms or thrombosis allows for compensatory collateral venous system to develop  
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{{Headache DDX}}
 
{{Headache DDX}}
  
== Diagnosis ==
+
== Diagnosis==
 
[[File:Sagital sinus thrombus.JPG|thumbnail|Sagital sinus thrombosis on CT]]
 
[[File:Sagital sinus thrombus.JPG|thumbnail|Sagital sinus thrombosis on CT]]
 
''Suspect in patients presenting with headache, signs of increased ICP, or focal neurologic deficits in setting of any of above predisposing factors''
 
''Suspect in patients presenting with headache, signs of increased ICP, or focal neurologic deficits in setting of any of above predisposing factors''
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**D-Dimer has been proposed as a possible screening tool in low risk patients, but still needs further investigation
 
**D-Dimer has been proposed as a possible screening tool in low risk patients, but still needs further investigation
  
== Treatment ==
+
== Treatment==
 
*Anticoagulation
 
*Anticoagulation
 
**[[Heparin]] or [[low molecular weight heparin]]
 
**[[Heparin]] or [[low molecular weight heparin]]
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*Intravascular thrombolytics
 
*Intravascular thrombolytics
  
== Disposition ==
+
== Disposition==
 
*Admission
 
*Admission
 
**To a level of care capable of frequent neurologic monitoring
 
**To a level of care capable of frequent neurologic monitoring

Revision as of 06:18, 5 July 2016

The cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of cerebral venous (sinus) thrombosis. See that article for a discussion of that specific clinical entity.

Background

Cerebral Veins
  • Occlusion of venous sinus (most commonly superior sagittal and lateral sinuses) by thrombus or compression from mass
  • No precise prevalence or incidence established due to rarity of condition
  • Median Age ~ 37 years
  • Female:Male ratio 3:1
  • Predisposing factors
    • Cancer
    • Pregnancy
    • Local infections (otitis media, sinusitis, cellulitis)
    • Hypercoagulable states
    • Trauma
    • Drugs (ecstasy, androgens, OCPs)
    • Compression of venous sinus (tumor, abscess)

Clinical Features

  • Clinical presentation varies depending on location, acuity, and severity of thrombosis
    • More gradual onset of symptoms or thrombosis allows for compensatory collateral venous system to develop
    • Common Symptoms:
      • Headache 74-92%
      • Seizures 35-50%
      • Papilledema 28-45%
      • Focal Neurologic sequelae (seizures, dizziness) 25-71%
      • Encephalopathy
Sinus thrombosis.jpg

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Diagnosis

Sagital sinus thrombosis on CT

Suspect in patients presenting with headache, signs of increased ICP, or focal neurologic deficits in setting of any of above predisposing factors

  • Imaging
    • MRI/MRV considered diagnostic study of choice, now considered gold standard
    • CT venography is a reasonable alternative
      • Has been found to have similar sensitivity to MRV in recent studies
    • Non contrast CT possesses insufficient sensitivity or specificity to be of diagnostic value in the setting of high clinical suspicion
      • May see "Delta sign" dense triangle in superior sagittal sinus
  • Labs
    • D-Dimer has been proposed as a possible screening tool in low risk patients, but still needs further investigation

Treatment

  • Anticoagulation
    • Heparin or low molecular weight heparin
      • Of note, heparin initial bolus is 3000-5000U, lower than the dosing for PE/DVT
    • Eventual transition to oral anticoagulation for a 3-6 month duration
  • Seizure prophylaxis
  • Supportive care
  • Monitoring for increased ICP

Acute Decompensation

  • Consider
    • Hemicraniectomy
  • Intravascular thrombolytics

Disposition

  • Admission
    • To a level of care capable of frequent neurologic monitoring

See Also

References