Current Management of Cerebral Venous Thrombosis

Cerebral venous thrombosis is a rare stroke type that primarily affects younger women. Contemporary large international efforts have improved our understanding of the natural history and management of this rare disease, yet important evidence gaps persist across the disease continuum. Management of cerebral venous thrombosis can be conceptualized into multiple phases: acute management, post-acute management (including primary anticoagulation and secondary prevention), and recovery. Acute treatment centers on anticoagulation, including in the presence of intracranial hemorrhage. Endovascular therapy and decompressive craniectomy are reserved for selected severe cases. Direct oral anticoagulants appear comparable to vitamin K antagonists for most patients during primary treatment, though optimal lead-in duration and treatment length remain uncertain. Decisions regarding extended anticoagulation for secondary prevention require individualized assessment of recurrence and bleeding risk. Patients with cancer, antiphospholipid antibody syndrome, prior venous thromboembolism, and idiopathic events are at the highest thromboembolic risk. Long-term sequelae, including fatigue, headache, cognitive and mood disturbances, epilepsy, and intracranial hypertension, contribute substantially to morbidity despite high rates of functional independence. Heavy menstrual bleeding may impact young women on anticoagulation. Recognition and management of these outcomes are essential for comprehensive care.