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Cerebral venous sinus thrombosis: a diagnostic challenge
1Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. jfink@caregroup.harvard.edu
Internal Medicine Journal
|October 5, 2001
Summary
Cerebral venous sinus thrombosis (CVT) is often underdiagnosed but treatable. Early recognition of symptoms like headache, neurological deficits, and seizures, especially during pregnancy or with intracerebral hemorrhage, is crucial for timely treatment with anticoagulation.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Cerebral venous sinus thrombosis (CVT) is a serious condition that has historically been underdiagnosed.
- Delayed diagnosis and treatment of CVT can lead to adverse outcomes, including mortality.
Purpose of the Study:
- To review local experiences with CVT to improve future diagnosis and treatment.
- Identify factors aiding in earlier and more accurate CVT diagnosis and management decisions.
Main Methods:
- Retrospective review of all CVT cases diagnosed or treated at Auckland Hospital from 1990 to 1999.
- Analysis of clinical presentations, diagnostic delays, and treatment outcomes.
Main Results:
- Twenty-five CVT cases were identified, with a notable increase in diagnoses in 1999.
- Common symptoms included headache (96%), focal neurological deficits (60%), seizures (40%), and papilloedema (43%).
- Delayed diagnoses occurred in specific patient groups, including pregnant/postpartum women and those with intracerebral hemorrhage; 20 patients improved with anticoagulant therapy.
Conclusions:
- Consider CVT in women with neurological symptoms during pregnancy/puerperium and in unexplained intracerebral hemorrhage.
- Suspect CVT in cases of progressive headache with focal neurological signs, seizures, or papilloedema.
- MRI with MR venography is the preferred diagnostic tool; anticoagulation is the primary treatment, even with hemorrhage.
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