Presentation
Chronic presentation Could be like a pseudotumor syndrome or headaches of mild severity for months like chronic daily headache. Papilledema is usually present. Cortical vein thrombosis could present with seizures. [drrahulchakor.com]
For clinical manifestations, 56 cases (90.32%) presented headache; 16 cases (25.81%) presented choked papilla, 13 cases (20.97%) presented limited neural function defect, 11 cases (17.74%) presented epileptic seizure and 5 cases (8.06%) presented consciousness [spandidos-publications.com]
The majority of patients present under the age of 50 years (80%), with a mean age of 39 years [1,2,6]. Less than 10% of patients present over the age of 60 years [3,6]. [epmonthly.com]
The majority of patients present under the age of 50 years (80%), with a mean age of 39 years. 1-3,6 Presentation CVT can be a difficult diagnosis to make due to a wide variety of signs and symptoms. [emdocs.net]
There was no significant difference between women and men for presentation symptoms. But the most common presentation symptom (43.78%) in women was headache. And the most frequent presentation finding was ICH (34.78%) in men. [dusunenadamdergisi.org]
Neurologic
- Seizure
If a seizure does not occur, seizure prophylaxis is not necessary. 1,2,11,39 Further testing for underlying etiology is recommended, including thrombophilia. 1,2,3,6 Follow up imaging at 3-6 months is required to assess for recanalization of the affected [emdocs.net]
Seizures, including focal, generalized, and status epilepticus, are seen in 30–40% of patients [7,11]. As seizures are rare in strokes, CVT should be considered in any patient with a focal neurologic deficit and seizure [1,2]. [epmonthly.com]
Sagittal sinus thrombosis: motor deficits, bilateral deficits, seizures Lateral sinus thrombosis: isolated intracranial hypertension Left transverse sinus thrombosis: Aphasia Deep venous sinus (straight) thrombosis: behavioural symptoms (thalamic lesions [lifeinthefastlane.com]
Patients with infection, seizure or ICH have a greater risk of death. [nature.com]
Workup
An extensive workup should be done to exclude systemic vasculitis such as Behçet’s disease. [jmedicalcasereports.biomedcentral.com]
Park Neurosurgical Focus. 2018; 44(2): E12 [Pubmed] | [DOI] 2 New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments Sanjay Konakondla,Clemens M. [neurologyindia.com]
(See Workup.) Left lateral sinus thrombosis demonstrated on magnetic resonance venography (MRV). This 42-year-old woman presented with sudden onset of headache. Physical examination revealed no neurologic abnormalities. [emedicine.medscape.com]
Subsequent workup led to an angiogram, where sagittal sinus thrombosis with extensive trans-cerebral and trans-osseous emissary vein collateral channels was seen. In retrospect, these findings were present on the patient’s earlier contrast MRI. [neuroangio.org]
Treatment
Between October 2006 and June 2012, 26 CVST patients received endovascular treatment at our hospital. All had a history of progressive neurologic symptoms that did not resolve with medical treatment. [neurologyindia.com]
Treatment should begin immediately and must be done in a hospital. [hopkinsmedicine.org]
Treatment Anticoagulation, the administration of a blood thinning drug is the first line of treatment and has been shown to be very effective. [radiology.ucla.edu]
was regarded as the treatment standard. 2015 Elder [ 18 ] Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension A good treatment effect for explosive IIH with auxiliary cerebrospinal fluid drainage and diversion [medsci.org]
Ongoing controversies regarding etiology, diagnosis, treatment Treatment of neonates with AC is controversial. [clinicaladvisor.com]
Prognosis
Table 4: Predictors influencing the prognosis of pregnancy-related CVT patients. [nature.com]
& symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful information HERE. [dovemed.com]
Complications include seizures, hydrocephalus, intracranial hypertension and neurological deterioration. [ 10 ] Prognosis Long-term follow-up suggests a generally good prognosis but there may be residual pyramidal symptoms, epilepsy, visual field defects [patient.info]
[…] are associated with a poorer prognosis. [pmj.bmj.com]
Etiology
Prior to the advent and widespread use of antibiotics in developed nations, CVT was largely due to infectious etiologies such as mastoiditis, orbital cellulitis, and facial cellulitis[2]. Risk Factors Table 1. [eyewiki.aao.org]
It is caused by a wide range of etiologies, polycythemia is one among them. Polycythemia is a myeloproliferative disorder that is caused by a variety of etiologies [ 2 ]. [j-stroke.org]
In 7 patients, the etiology remained unknown. The most common etiologic factor for women was the use of OCPs (n=7). OCPs’ users comprised the largest group (n=7) in women. We could not find the etiology in four of the men. [dusunenadamdergisi.org]
Supportive / Symptomatic treatment with IV fluids, anticonvulsants, and lowering of raised intracranial pressure, antibiotics for infective etiology. The duration of anticoagulation depends on the risk factor for thrombosis. [drrahulchakor.com]
Etiology Noninfectious Oral contraceptives, pregnancy, and postpartum period Hypercoagulable states Blot clotting disorders (e.g., factor V Leiden, protein C and S deficiencies, antiphospholipid syndrome ) Hematologic diseases (e.g., polycythemia, sickle-cell [amboss.com]
Epidemiology
Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Please refer to the article on cerebral venous thrombosis for a broad discussion on epidemiology and risk factors. Presentation is variable and can range from asymptomatic to coma and death. [radiopaedia.org]
Thromboembolism and oral contraceptives: an epidemiologic case-control study. Am J Epidemiol. 1969;90:365-80. Vessey MP, Doll R. Investigation of relation between use of oral contraceptives and thromboembolic disease. A further report. [ijrcog.org]
Epidemiology Intracranial venous thrombosis appears to have become more common in recent years. However, this has occurred as modern imaging techniques have improved diagnosis. [patient.info]
Epidemiology and risk factors for thromboembolic complications of childhood nephrotic syndrome: a Midwest Pediatric Nephrology Consortium (MWPNC) study. J Pediatr, 155 (2009), pp. 105-110 [5] M. Shoroff, G. de Veber. [revistanefrologia.com]
Pathophysiology
Pathophysiology of Cerebral Venous Thrombosis - An overview Abstract Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described.A Medline search of all articles detailing pathophysiology of CVST was done, [jpma.org.pk]
Dehydration Infectious Otogenic (e.g., after acute otitis media ) → generally infection of the lateral sinuses (transverse/sigmoid sinuses) or mastoiditis Rhinogenic (e.g., after sinusitis ) Through facial infections Meningitis References: [3] [4] [5] Pathophysiology [amboss.com]
[…] polyangiitis (formerly known as Wegener’s granulomatosis) Churg-Strauss syndrome Thromboangiitis obliterans Inflammatory bowel disease Sarcoidosis Other disorders Thyroid disease (thyroiditis, hyperthyroidism, hypothyroidism) General Pathology Add text here Pathophysiology [eyewiki.aao.org]
[…] straight sinus, and then to the internal jugular vein (IJV) Superficial venous system has numerous anastomses and predominantly drain the SSS and the LS Deep white matter and basal ganglia are drained by the deep venous system toward the vein of Galen Pathophysiology [lifeinthefastlane.com]
J Infect, 2004. 48(1): p. 86-90. 7.Filippidis, A., et al., Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurg Focus, 2009. 27(5): p. E3. 8.Karam, C. and S. [degruyter.com]
Prevention
This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage. This chain of events is part of a stroke that can occur in adults and children. [hopkinsmedicine.org]
These medications are given in order to prevent the enlargement of the blood clot inside the affected dural sinus and to prevent the formation of new blood clots which could lead to new and possibly worse strokes. [verywell.com]
[…] is poor with and the condition is known to have a high mortality rate Please find comprehensive information on Cavernous Sinus Thrombosis regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention [dovemed.com]
Prevention You can do a lot to prevent stroke by leading a heart healthy lifestyle: Eat a low-fat diet including lots of fruits and vegetables. Get daily exercise. Avoid cigarette smoke. Control chronic health conditions, such as diabetes. [womenfitness.net]
You can do a lot to prevent stroke by leading a heart healthy lifestyle: Eat a low-fat diet, including lots of fruits and vegetables. Get daily exercise. Stay away from cigarette smoke. Control chronic health conditions such as diabetes. [cedars-sinai.edu]