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What causes cerebral venous sinus thrombosis (CVST)?
Cerebral venous sinus thrombosis is caused by clot formation in large draining veins or dural sinuses.
Congenital or acquired hypercoagulable states, dehydration, and oral contraceptive use are associated with cerebral venous sinus thrombosis.
How is cerebral venous sinus thrombosis diagnosed?
Cerebral venous sinus thrombosis usually present with continuous headache, worse in the morning or after lying down.
If intracranial pressure is elevated, patients may experience impaired consciousness or blurry vision due to cerebral edema and subsequent papilledema.
Venous infarctions are frequently hemorrhagic and can result in focal neurologic signs and symptoms that do not respect typical arterial distributions.
Seizures are common and may be a presenting symptom. A high index of suspicion is needed to diagnose and appropriately treat CVST, as cases may be easily missed during the course of a standard ischemic or hemorrhagic stroke workup.
Cerebral venous sinus thrombosis is diagnosed with CT or MR venogram.
How is cerebral venous sinus thrombosis treated?
Venous sinus thrombosis is most commonly managed by anticoagulation, which may be counterintuitive in cases of venous infarction with hemorrhage.
Other options include mechanical thrombectomy and intrasinus thrombolysis, especially if the patient is worsening despite anticoagulation.
This is a fairly uncommon condition, so no RCTs have been performed to compare treatment strategies.
