Cerebral Venous Thrombosis: an Update

Abstract

Purpose of review: The purpose of this update is to summarize the recent advances on the management of cerebral venous thrombosis (CVT).

Recent findings: There is a trend in declining frequency of CVT patients presenting with focal deficits or coma and a decrease in mortality over time. Anemia and obesity were identified as risk factors for CVT. During pregnancy and puerperium, the higher risk of CVT occurs in the first months post-delivery. With appropriate management, 1/3 of comatose CVT patients can have a full recovery. The management of CVT patients includes treatment of associated conditions, anticoagulation with parenteral heparin, prevention of recurrent seizures, and decompressive neurosurgery in patients with large venous infarcts/hemorrhages with impending herniation. After the acute phase, patients should be anticoagulated for 3-12 months. Results of recently completed randomized controlled trials on endovascular treatment and comparing dabigatran with warfarin will improve the treatment of CVT.

Keywords: Anticoagulants; CT venography; Cerebral vein; Cerebral venous thrombosis; Dabigatran; Decompressive surgery; Dural sinus thrombosis; Hemicraniectomy; Intracranial hypertension; MR venography; MRI; Pregnancy; Prognosis; Seizures; Thrombectomy; Thrombolysis.