cerebral Venous Thrombosis
Background
- Clot formation within the cerebral sinuses may present with stroke, headache or cranial nerve symptoms
- Dehydration
- Most have an underlying trigger:
Prognosis
- Majority make a full recovery (if treated early)
- 10- 30% die (mainly ↑ICP with herniation in delayed Dx)
Clinical
- May present with headache (sometimes thunderclap), ↑ICP (N&V)
- May present with infarction (cortical or saggital clot) stroke
- May present with progressive headache or ocular / bulbar symptoms (cavernous sinus clot):
- Ocular symptoms
- Pulsatile tinnitus
- Unilateral deafness
- Facial N. lesion
- Occasionally bilateral lower limb weakness
Signs
- Altered mental status
- Cranial nerve palsy
- Papilloedema / retinal haemorrhages
- Focal long tract signs
differential Dx (no trauma)
- Meningitis
- Cavernous Sinus Syndromes
- Infections : CMV encephalitis, abscess/empyema
- Vasculitis (e.g. SLE)
Investigations
- CT (outrule other mass lesion), then MRI (MRV)
- D-dimers (Sensitivity 97%, Specificity 91% Ref1)
- FBC (polycythaemia or platelet abnormalities)
- Thrombophilia screen
- Sickle cell test, where appropriate
- ESR and auto-antibodies
- Urinalysis (protein)
- EEG (particularly if ? seizures)
Management
- Manage as arterial stroke
- Refer neurology
- Consider anticoagulation (LMWH or Heparin infusion)
- Seek underlying cause and treat (e.g. sinusitis, meningitis)
- Progressive unilateral herniation may be amenable to decompressive neurosurgery
Links
- Ref1. Kosinski CM, Mull M, Schwarz M, et al. Do normal D-dimer levels reliably exclude cerebral sinus thrombosis?. Stroke. Dec 2004;35(12):2820-5
Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 23/08/23.