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The cerebral venous system is an unusual site of thrombosis, with a particularly high incidence in young adults. This incidence has increased in past decades because of the improvement of neuroradiological techniques. Risk factors for cerebral venous sinus thrombosis overlap with those of other venous thromboembolism sites; however, some are specific for this particular anatomical district. Prognosis is favorable in most cases if diagnosis is made rapidly and treatment is promptly initiated, even if acute complications or chronic invalidity still occur in a quarter of patients. The mainstay of treatment is anticoagulation, which is necessary in order to block clot propagation and obtain recanalization. Intracranial bleeding does not contraindicate anticoagulation. Endovascular procedures are reserved for patients with a particularly severe presentation or rapidly declining neurological symptoms despite appropriate anticoagulation, although data from clinical trials are lacking. Specifically, this review addresses the epidemiology, clinical presentation and course, risk factors, and treatment of cerebral venous sinus thrombosis, with a special focus on the pediatric population.

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High platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) are associated with an increased risk of arterial thrombosis, but their role in venous thromboembolism (VTE) has not been fully investigated. A case-control study, of 486 patients with VTE, 100 with cerebral vein thrombosis (CVT), and 299 healthy individuals, was carried out to investigate whether high PLR or NLR values are associated with an increased risk of VTE. Patients with high PLR or NLR did not have an increased risk of VTE (odds ratio [OR] 0.89, 95% confidence interval [CI]: 0.46-1.76; OR: 0.69, 95% CI: 0.34-1.39, respectively) or CVT (OR: 1.65, 95% CI: 0.68-4.00; OR: 0.39, 95% CI: 0.09-1.72, respectively). Subgroups analysis showed that high PLR values were associated with the risk of provoked CVT (OR: 2.65, 95% CI: 1.02-6.92), and there was an interaction with thrombophilia abnormalities (OR: 7.67, 95% CI: 1.67-35.27) in patients with CVT. In conclusion, high PLR and NLR values are not associated with an overall increased risk of VTE or CVT. High PLR values increase the risk of provoked CVT and interact with thrombophilia abnormalities in patients with CVT.

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Background Real‐world experience with adenoviral vector vaccines against COVID‐19 raised some safety concerns. Cases of cerebral vein thrombosis (CVT) associated with thrombocytopenia have been observed after the first dose of the adenoviral vector vaccines CHADOX1 NCOV‐19 and AD26.COV2.S. Objectives To assess the reporting rate of CVT as adverse drug reaction (ADR) for the COVID‐19 vaccines authorized in Europe. Patients and Methods This observational study assessed the CVT reporting rate attributed to four COVID‐19 vaccines authorized in Europe, namely Tozinameran (Pfizer‐Biontech), CX‐024414 (Moderna), CHADOX1 NCOV‐19 (AstraZeneca), and AD26.COV2.S (Janssen). Data on thrombotic ADRs reported on EudraVigilance database between January 1, 2021 and July 30, 2021, were collected. ADRs referring to CVT were identified. The reporting rate of CVT was expressed as 1 million individual vaccinated‐days with 95% confidence interval. Finally, an observed‐to‐expected (OE) analysis was performed. Results The reporting rate of CVT per 1 million person vaccinated‐days was 1.92 (95% confidence interval [CI], 1.71–2.12) for Tozinameran, 5.63 (95% CI, 4.74–6.64) for CX‐024414, 21.60 (95% CI, 20.16–23.11) for CHADOX1 NCOV‐19, and 11.48 (95% CI, 9.57–13.67) for AD26.COV2.S. CVT occurred alongside thrombocytopenia for the four vaccines. The OE ratio was greater than one for all four vaccines, both with the lowest and the highest CVT background incidence. Conclusions This report on EudraVigilance data strengthens anecdotal findings on CVT following COVID‐19 vaccinations. Although the European Medicines Agency released an alert only for CHADOX1 NCOV‐19 and AD26.COV2.S, Tozinameran and CX‐024414 also are complicated by CVT, albeit to lesser extent.