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Cerebral Venous Sinus Thrombosis

An uncommon cerebrovascular condition caused by thrombosis of the dural venous sinuses or cortical veins, presenting with headache, focal neurologic deficits, seizures, or encephalopathy, requiring rapid imaging diagnosis and anticoagulation.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

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What is Cerebral Venous Sinus Thrombosis?

Cerebral venous sinus thrombosis (CVST) is a thrombotic occlusion of dural venous sinuses (most commonly transverse, sigmoid, or superior sagittal sinus) or cortical veins, causing impaired venous drainage, increased intracranial pressure, and parenchymal venous infarction or hemorrhage.

The annual incidence is 1 to 2 per 100,000 in the general population, with higher rates in women of reproductive age, in the peripartum period, and in users of oral contraceptives; CVST accounts for less than 1 percent of all strokes but is more frequent in young adults.

Diagnostic imaging includes magnetic resonance venography or CT venography; treatment requires therapeutic-dose anticoagulation (heparin then oral) for at least 3 to 6 months, with endovascular thrombectomy in selected severe cases, decompressive craniectomy in malignant venous infarction, and management of seizures and intracranial hypertension.

Symptoms

Severe new-onset headache, often subacute and progressive, sometimes thunderclap
Focal neurologic deficits: hemiparesis, sensory loss, aphasia, or visual field defects
Seizures, often focal motor, sometimes presenting as the initial symptom
Encephalopathy with decreased level of consciousness or confusion
Symptoms of intracranial hypertension: papilledema, sixth nerve palsy, transient visual obscurations
Cavernous sinus thrombosis features: orbital pain, chemosis, ophthalmoplegia, proptosis

Risk Factors

Pregnancy and the postpartum period (peak risk in the third trimester and first 6 weeks postpartum)
Oral contraceptive use, particularly combined formulations
Inherited thrombophilias: factor V Leiden, prothrombin G20210A, protein C/S deficiency, antithrombin deficiency
Acquired thrombophilias: antiphospholipid syndrome, malignancy, paroxysmal nocturnal hemoglobinuria
Mechanical or infectious local factors: head trauma, otitis media, mastoiditis, sinusitis
Vaccine-induced immune thrombotic thrombocytopenia (VITT) following adenoviral COVID-19 vaccines (rare)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New, severe, and persistent headache especially in a young woman or pregnancy/postpartum
  • Acute focal neurologic deficit, seizure, or decreased level of consciousness
  • Combination of headache with new-onset seizures or focal symptoms — emergency neuroimaging
  • Painful proptosis, ophthalmoplegia, and chemosis suggesting cavernous sinus thrombosis
  • Established CVST with worsening neurologic status or new symptoms during treatment

Treatment Methods

01
Urgent neuroimaging with magnetic resonance venography or CT venography to confirm diagnosis and assess parenchymal involvement
02
Therapeutic anticoagulation with low molecular weight or unfractionated heparin acutely, then transition to a vitamin K antagonist (target INR 2 to 3) or direct oral anticoagulant for 3 to 12 months based on cause
03
Endovascular thrombectomy with mechanical or pharmacologic thrombolysis in selected patients with severe disease and clinical deterioration despite anticoagulation
04
Decompressive craniectomy for malignant venous infarction with mass effect and impending herniation
05
Management of complications: antiseizure medications, intracranial pressure control, treatment of underlying cause (infection, thrombophilia, oral contraceptive cessation), and long-term thrombophilia evaluation

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.