cerebral Venous Thrombosis



Background

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 vii 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


Content by Dr Íomhar O' Sullivan 01/02/2012. Last review Drs. Chris Luke & ÍOS 15/06/21.