Cerebral venous thrombosis syndromes

The clinical presentation of cerebral venous thrombosis (CVT) can be highly variable. The onset and progression of symptoms may be insidious and highly variable. Symptoms and signs may progress over days or weeks, clinically resembling idiopathic intracranial hypertension.

CVT might arise as a complication of (and be masked by) another disease process such as meningitis, encephalitis, cerebral abscess or tumor.

CVT is more prevalent in women.

CVT occasionally complicates serious systemic disease in children and carries a high mortality. The prognosis is worse in older children.

CVT should be suspected in patients with signs of increased intracranial pressure (headache, vomiting, papilledema, altered consciousness), focal neurologic deficits and/or generalized or focal seizures.

• ~75% of patients present with headache. The headache is nonspecific in character and may be sudden onset (“thunderclap”).
• ~50% of patients present with papilledema.
• A third of patients present with focal neurologic deficit.
• A third of patients present with seizures.
• A third of patients present with mental state disturbance.

Unusual presentations include:

• Psychiatric disorders (psychosis)
• Subarachnoid hemorrhage
• TIA
• Cranial nerve palsies
• Pulsatile tinnitus
• Migrainous phenomena

Frequency of affected sinuses

• Superior sagittal sinus: 72%
• Transverse sinus: 70%
• Straight sinus: 15%
• Cavernous sinus: 3%
• Vein of Galen: 3%
• Isolated in superior sagittal sinus: 13%
• Isolated in transverse sinus: 9%
• Isolated cortical venous thrombosis: 2%