Title: CVT Presentation and Management<br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><ul>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">We've talked about the <a href="https://em.umaryland.edu/educational_pearls/3807/">rising incidence of cerebral venous thrombosis (CVT)</a> and <a href="https://em.umaryland.edu/educational_pearls/2968/">choice of neuroimaging studies</a> before, now let’s talk about presentation and treatment.</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Symptoms range from headache to coma with cerebral edema and intracranial hypertension depending on the veins and sinuses involved.</span></span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Superior sagittal sinus is most frequently affected (62%) and can cause headache, hemiparesis, hemisensory loss, hemianopia, and seizures.</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Transverse sinus is also commonly involved (45%) and can cause headache, aphasia, and seizures.</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Thrombosis of the deep veins is seen in 18% of cases and can cause altered mental status, coma, and gaze palsy.</span></span></li>
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                <span style="font-family: arial, helvetica, sans-serif; font-size: 14px;">Management includes anticoagulation, treatment of underlying cause, seizures, and intracranial hypertension.</span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">LMWH is preferred unless in patients with renal dysfunction or need for rapid reversal of anticoagulation.</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Endovascular intervention may be considered in severe cases that do not improve or deteriorate despite anticoagulation.<span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><img alt="" src="http://umem.org/files/uploads/content/pearls/neuro/20200923_Figure.JPG" style="width: 365px; height: 472px;" /></span></span></span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Poor prognostic factors are: </span></span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">2 points each - malignancy, coma, deep venous thrombosis</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">1 point each - mental status disturbances, male, intracranial hemorrhage</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Score ≥3 suggests high risk of poor outcome</span></span></li>
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        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><u>Bottom Line</u>:</strong> Severity of CVT presentation depends on the location and clot burden. Anticoagulation is key, though consider endovascular intervention if patient does not improve or deteriorates despite anticoagulation.</span></span></p>
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<fieldset><legend>References</legend>

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                Ulivi L, Squittirei M, Cohen H, <em>et al</em>. Cerebral venous thrombosis - a practical guide. <em>Pract Neurol</em>. 2020;20(5):256-67.</li>
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                Ferro JM, Bacelar-Nicolau H, Rodrigues T, <em>et al</em>. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. <em>Cerebrovasc Dis</em>. 2009;28:39-44.</li>
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<p style="text-align: center;">
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