Difference between revisions of "Cerebral venous thrombosis"

(Created page with "== Background == *No precise prevalence or incidence established due to rarity of condition *Median Age ~ 37 years *Female:Male ratio 3:1 *Predisposing factors **Cancer **Pregnan...")
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== DDx ==
== DDx ==
[[Headache DDX]]
== Treatment ==
== Treatment ==

Revision as of 03:49, 22 October 2011


  • 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

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
  • Labs
    • D-Dimer has been proposed as a possible screening tool in low risk patients, but still needs further investigation


Headache DDX


  • Due to the low incidence of disease, evidence-based recommendations on treatment are lacking
  • Currently accepted that treatment of choice is anticoagulation with heparin or low molecular weight heparin, with eventual transition to oral anticoagulation for a 3-6 month duration
  • Seizure prophylaxis should be considered in patients with CVT presenting with seizures
  • Supportive care and close monitoring for increased ICP with consideration of hemicraniectomy for acute decompensation
  • Intravascular thrombolytics can be considered in patients who acutely decompensate, have symptoms of increased ICP, or decreased level of consciousness


  • 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