Symptoms range from headache to coma with cerebral edema and intracranial hypertension depending on the veins and sinuses involved.
Superior sagittal sinus is most frequently affected (62%) and can cause headache, hemiparesis, hemisensory loss, hemianopia, and seizures.
Transverse sinus is also commonly involved (45%) and can cause headache, aphasia, and seizures.
Thrombosis of the deep veins is seen in 18% of cases and can cause altered mental status, coma, and gaze palsy.
Management includes anticoagulation, treatment of underlying cause, seizures, and intracranial hypertension.
LMWH is preferred unless in patients with renal dysfunction or need for rapid reversal of anticoagulation.
Endovascular intervention may be considered in severe cases that do not improve or deteriorate despite anticoagulation.
Poor prognostic factors are:
2 points each - malignancy, coma, deep venous thrombosis
1 point each - mental status disturbances, male, intracranial hemorrhage
Score ≥3 suggests high risk of poor outcome
Bottom Line: 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.
References
Ulivi L, Squittirei M, Cohen H, et al. Cerebral venous thrombosis - a practical guide. Pract Neurol. 2020;20(5):256-67.
Ferro JM, Bacelar-Nicolau H, Rodrigues T, et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2009;28:39-44.
