[Cerebral venous thrombosis. Report of 76 cases]

Abstract

Progress in neuroimaging has led to a considerable change in our knowledge of cerebral venous thrombosis (CVT). Together with a series of 76 cases, a review of literature is presented. CVT is a far from negligible variety of stroke. It may occur at any age and despite numerous causes (nowadays mostly non infective), the proportion of cases of unknown aetiology remains around 25%. Superior sagittal sinus and lateral sinus are the most frequently involved, often associated with cortical vein thrombosis. Cavernous sinus thrombosis remains the most common form of septic thrombosis. Thrombosis of the galenic system and of cerebellar veins are uncommon. The clinical picture is extremely variable with a mixture of focal signs (deficits or seizures) and symptoms of raised intracranial pressure. The mode of onset is also variable, over hours, days, weeks or months. The presentation can thus be very misleading, simulating an arterial stroke or an abscess, an encephalitis, a tumor or a pseudo-tumor cerebri. CT scan is crucial to rule out other conditions and angiography to confirm the diagnosis of cerebral venous thrombosis. MRI is very performing since it visualizes the thrombus itself and allows a non invasive follow up. Most cases have a benign course but mortality is still around 30% in infective cases and 10% in non infective ones. Although it has long been debated, the benefit of anticoagulant (heparin) is now well established.