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Diagnosis and management of cerebral venous thrombosis

Roya Behrouzi and Martin Punter
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DOI: https://doi.org/10.7861/clinmedicine.18-1-75
Clin Med February 2018
Roya Behrouzi
AManchester University NHS Trust, Manchester, UK
Roles: academic foundation doctor
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Martin Punter
BSalford Royal NHS Foundation Trust, and the Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
Roles: consultant neurologist and stroke physician
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    Fig 1.

    Non-contrast computerised tomography (CT) scans of brain. Demonstrating (a) hyperdensity over the right parietal cortex signifying subarachnoid haemorrhage (blue circle); (b) right occipital lobe haemorrhagic infarction with additional intraventricular haemorrhage (orange circle); (c) extensive and bilateral cerebral infarction (yellow arrows); and (d) hyperdensity in right transverse sinus demonstrating thrombosis (red arrow). (e) CT venogram demonstrating multiple areas of failed opacification of the superior sagittal sinus, representing thrombotic occlusion (green arrows)

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    Table 1.

    Signs and symptoms of cerebral venous thrombosis (CVT) and location of probable lesion

    Signs and symptomsProbable lesion
    HeadacheMigraineAny venous occlusion/focal lesion
    Raised ICP aLarge venous or sinus occlusion/large mass lesion
    ThunderclapAny venous occlusion/subarachnoid haemorrhage
    Ear/mastoid painTransverse sinus with/without infection
    Focal neurological deficitsHemiparesisInfarction/haemorrhage/venous oedema
    Cranial nerve palsy
    III, IVCavernous sinus
    VCavernous sinus/superior petrosal sinus
    VICavernous sinus/inferior petrosal sinuses/raised ICP
    VIITransverse/sigmoid sinus
    VIIITransverse/sigmoid sinus/raised ICP
    IX, X, XIPosterior cavernous sinus/internal jugular vein/deep venous system
    AphasiaFocal infarction/haemorrhage/superficial or deep venous system
    Sensory disturbanceFocal infarction/haemorrhage/superficial or deep venous system
    Inattention/neglectFocal infarction/haemorrhage/superficial venous system
    AtaxiaCerebellar veins/raised ICP
    SeizuresFocalFocal infarction/haemorrhage
    GeneralisedFocal infarction/haemorrhage/severely raised ICP
    Visual disturbanceReduced acuityRaised ICP
    Reduced/altered visual fieldRaised ICP/Posterior infarction/haemorrhage/raised ICP (false localising sign)
    DiplopiaCavernous sinus/petrosal sinus/raised ICP
    PapilloedemaRaised ICP
    MeningismNeck pain/stiffnessSuggests infectious or inflammatory aetiology
    Photophobia
    Reduced consciousnessDrowsinessDeep venous system/straight sinus/raised ICP/non-convulsive status epilepticus
    Stupor
    Coma
    Cognitive impairmentEncephalopathyDeep venous system/temporal-parietal lesion (vein of Labbe)/seizures
    Disorientation
    Reduced concentration
    Amnesia
    • ↵aRaised intracranial pressure (ICP) can result from a combination of a large venous/sinus occlusion or from large infarction/haemorrhage.

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    Table 2.

    Risk factors for cerebral venous thrombosis

    ThrombophiliasGenetic – eg Factor V Leiden
    Acquired – eg antiphospholipid syndrome
    InfectionIntracranial
    Regional eg ear, nose, throat, head, neck
    Systemic
    TraumaHead injury
    Cranial surgery
    Lumbar puncture
    Endovascular intervention
    ReproductivePregnancy
    Puerperium
    MalignancyIntracranial
    Extracranial
    MedicationsOral contraceptives
    Steroids
    Anti-neoplastic drugs (particularly L-asparaginase)
    InflammatoryVasculitis eg Behçet’s disease
    Systemic lupus erythematosus
    Inflammatory bowel disease
    Sarcoidosis
    HaematologicalIron deficiency anaemia
    Polycythaemia
    EndocrineHyperthyroidism
    SystemicDehydration
    Sepsis
    Intracranial abnormalitiesDural fistulaeVenous anomalies
    Arteriovenous malformations
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Diagnosis and management of cerebral venous thrombosis
Roya Behrouzi, Martin Punter
Clinical Medicine Feb 2018, 18 (1) 75-79; DOI: 10.7861/clinmedicine.18-1-75

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Diagnosis and management of cerebral venous thrombosis
Roya Behrouzi, Martin Punter
Clinical Medicine Feb 2018, 18 (1) 75-79; DOI: 10.7861/clinmedicine.18-1-75
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  • Article
    • ABSTRACT
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    • Introduction
    • Clinical features of CVT
    • Risk factors for CVT
    • Radiological diagnosis of CVT
    • Management of CVT
    • Conclusion
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