Diagnosis and management of cerebral venous thrombosis

Abstract

Cerebral venous thrombosis (CVT) is rare and accounts for 0.5% of all strokes. Its clinical presentation is variable and diagnosis requires a high index of clinical suspicion in conjunction with neuroradiological diagnostic support. Treatment options are limited and are mostly based on consensus. Therefore, familiarity with international guidelines is important. Outcome is often good and most patients make a full recovery, although a small proportion suffers death or disability. Here, we describe the clinical features, risk factors, acute imaging features, management and complications of CVT.

Keywords: anticoagulation; cerebral venography and heparin; cerebral venous sinus thrombosis; cerebral venous thrombosis; imaging; stroke.

Fig 1.

Non-contrast computerised tomography (CT) scans of brain. Demonstrating (a) hyperdensity over the right parietal cortex signifying subarachnoid haemorrhage (blue circle); (b) right occipital lobe haemorrhagic infarction with additional intraventricular haemorrhage (orange circle); (c) extensive and bilateral cerebral infarction (yellow arrows); and (d) hyperdensity in right transverse sinus demonstrating thrombosis (red arrow). (e) CT venogram demonstrating multiple areas of failed opacification of the superior sagittal sinus, representing thrombotic occlusion (green arrows)