• We've talked about the rising incidence of cerebral venous thrombosis (CVT) and choice of neuroimaging studies before, now let’s talk about presentation and treatment.
• Symptoms range from headache to coma with cerebral edema and intracranial hypertension depending on the veins and sinuses involved.
  • Superior sagittal sinus is most frequently affected (62%) and can cause headache, hemiparesis, hemisensory loss, hemianopia, and seizures.
  • Transverse sinus is also commonly involved (45%) and can cause headache, aphasia, and seizures.
  • Thrombosis of the deep veins is seen in 18% of cases and can cause altered mental status, coma, and gaze palsy.
• Management includes anticoagulation, treatment of underlying cause, seizures, and intracranial hypertension.
  • LMWH is preferred unless in patients with renal dysfunction or need for rapid reversal of anticoagulation.
  • Endovascular intervention may be considered in severe cases that do not improve or deteriorate despite anticoagulation.
• Poor prognostic factors are: 
  • 2 points each - malignancy, coma, deep venous thrombosis
  • 1 point each - mental status disturbances, male, intracranial hemorrhage
  • Score ≥3 suggests high risk of poor outcome

Bottom Line: Severity of CVT presentation depends on the location and clot burden. Anticoagulation is key, though consider endovascular intervention if patient does not improve or deteriorates despite anticoagulation.

References

• Ulivi L, Squittirei M, Cohen H, et al. Cerebral venous thrombosis - a practical guide. Pract Neurol. 2020;20(5):256-67.
• Ferro JM, Bacelar-Nicolau H, Rodrigues T, et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2009;28:39-44.

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