18 - Cerebral Venous Thrombosis

Abstract

Cerebral sinus thrombosis is an uncommon cause of cerebral ischemic and hemorrhage and constitutes less than 1% of all strokes. Cerebral venous congestion followed by hemorrhagic infarction not conforming to strict arterial territories is the hallmark of cerebral venous thrombosis. There is a predilection for younger patients and the presentation is protean with a wide range of symptoms from isolated focal neurological signs to coma. Magnetic resonance imaging with magnetic resonance venography can often confirm the diagnosis and avert cerebral angiography. Anticoagulation is the mainstay of treatment and venous hemorrhagic infarctions rarely worsen. More invasive endovascular therapy with the combined use of rheolytic mechanical thrombectomy and in situ clot thrombolysis are reserved for severe cases not responding to medical therapy. Overall prognosis is favorable although approximately 10% experience long-term complications that include chronic headaches, focal or generalized seizures, and papilledema with visual loss.