Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) is a thrombotic obstruction of the cerebral venous system that can lead to ischemic lesions (or hemorrhages) in the brain. The condition can occur at any age and is often associated with a hypercoagulable state, a trigger (e.g., delivery, head injury, CNS instrumentation) or an infection (i.e., as in septic CVT). Women are affected more frequently than men, possibly as a result of the additional risk factors of pregnancy and oral contraceptive use. Cavernous sinus thrombosis is a rare subset of CVT that is most often due to infections in the paranasal region. Headache is the most common symptom of CVT and, depending on the size and location of the clot, may be accompanied by visual impairment, focal neurological deficits, seizures, or signs of raised intracranial pressure. Neuroimaging (MRI or CT venography) of the cerebral veins and dural sinus is used to establish the diagnosis. The mainstay of management is anticoagulation alongside the treatment of any potential underlying cause (e.g., antibiotics for septic CVT). Surgical intervention (e.g., endovascular thrombolysis or decompressive craniectomy) may be necessary in patients with significant symptoms who do not respond to anticoagulation.