45 - Cerebral Venous Thrombosis

Abstract

There is a trend in declining frequency of cerebral venous thrombosis (CVT) patients presenting with focal deficits or coma and a decrease in mortality over time. The clinical presentation of CVT is highly variable, and a high suspicion rate is needed to identify CVT. Confirmation of the diagnosis of CVT requires magnetic resonance (MR) imaging or computed tomography venography. The more frequent risk factors for CVT are prothrombotic condition, either genetic or acquired, oral contraceptives, puerperium or pregnancy, infection, and malignancy. Anemia and obesity were also more recently identified as risk factors for CVT. The management of CVT patients includes treatment of associated conditions, anticoagulation with parenteral heparin, prevention of recurrent seizures, and decompressive neurosurgery in patients with large venous infarcts/hemorrhages with impending herniation. The only available randomized trial comparing endovascular treatment with standard medical care versus standard medical care only in patients with severe CVT was terminated prematurely for futility. With appropriate management, one third of comatose patients can have a full recovery. After the acute phase, patients should be anticoagulated for 3–12 months. Both warfarin and dabigatran are efficacious and safe to prevent recurrent venous thrombosis after acute CVT.