Evaluation and management of cerebral venous thrombosis

Thrombosis of the dural sinus and/or cerebral veins (CVT) is a rare but potentially devastating type of stroke that tends to occur in young adults, especially women. In this article, the abbreviation CVT refers to either cerebral venous thrombosis or dural sinus thrombosis. The purpose of this review is to review the most up-to-date literature on the epidemiology, diagnosis, management, and prognosis of CVT. In addition, illustrative cases that represent the spectrum of CVT are provided.

CVT represents about 0.5% of all strokes and can be challenging to diagnose because headache, rather than focal neurologic symptoms, is the prominent feature. The diagnosis is confirmed with MRI and magnetic resonance venogram (MRV). The mainstay of acute management is anticoagulation, although, in the cases of severe hemorrhagic conversion of a venous infarction, endovascular mechanical thrombectomy may be potentially lifesaving. The evaluation of underlying causes from transient triggers, eg, pregnancy, oral contraceptives, or infection, versus chronic triggers, eg, cancer and thrombophilia, will often influence the duration of anticoagulation. The outcomes after CVT are generally favorable, and the risk of recurrence is low.

CVT is an important diagnosis to keep in mind when evaluating patients with headache in the emergency department, and it is important that it not be overlooked because it is treatable.