Difference between revisions of "Cerebral venous thrombosis"

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== Disposition ==
== Disposition ==
*All patients with confirmed CVT should be admitted to a level of care capable of frequent neurologic monitoring
*Patients should be started on anticoagulation if there are no contraindications, and transitioned to oral therapy and continued for 3-6 months
**To a level of care capable of frequent neurologic monitoring
==See Also==
==See Also==

Revision as of 18:47, 20 October 2014

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.


  • 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


  • 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

Differential Diagnosis






Aseptic Meningitis


  • Anticoagulation
  • Seizure prophylaxis
  • Supportive care
  • Monitoring for increased ICP
    • Hemicraniectomy for acute decompensation
  • Intravascular thrombolytics
    • Considered in patients who acutely decompensate, have symptoms of increased ICP, or decreased level of consciousness


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

See Also


  • Rosen's
  • Uptodate