UMEM Educational Pearls

Category: Vascular

Title: Cerebral Venous Sinus Thrombosis (CVST)

Keywords: Thrombosis, Cerebral (PubMed Search)

Posted: 10/13/2008 by Rob Rogers, MD (Updated: 10/14/2019)
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Cerebral Venous Sinus Thrombosis (CVST)

An uncommon but very serious entity that leads to three distinct types of presentations:

  • Headache
  • Seizures
  • Stroke

Caused by thrombosis of one of the intracerebral venous sinuses (most commonly the transverse sinus) The major risk factor is hypercoagulable disease. May be the underlying cause of a majority of cases of idiopathic intracranial hypertension.

When to suspect:

  • Headache with negative CT, negative LP, but high opening pressure
  • In any patient with new onset idiopathic intracranial hypertension (i.e. pseudotumor cerebri). Can't be formally diagnosed without a negative MRI.
  • Stroke syndrome that doesn't quite fit. May see bilateral infarcts in the posterior regions. These are actually venous infarcts secondary to the sinus thrombosis.

Diagnosis:

  • Just like a lot of other things in medicine, "If you don't think about it, you can't diagnose it."
  • 1 in 3 head CT scans will be normal
  • MRI with MRV (venous phase) is the diagnostic standard

Treat:

  • Anticoagulation with heparin then warfarin