Cerebral Vein and Dural Sinus Thrombosis

Abstract

Cerebral venous thrombosis (CVT) is an uncommon disorder in the general population. At least 1 risk factor can be identified in 85% of patients with CVT. Because of the high frequency of thrombophilia among patients with CVT, screening for hypercoagulable conditions should be performed. Two pathophysiological mechanisms contribute to their highly variable clinical presentation. Four major syndromes have been described: isolated intracranial hypertension, focal neurological abnormalities, seizures, and encephalopathy. Cavernous sinus thrombosis represents the single CVT which produces a characteristic clinical syndrome. Head Computed Tomography is the most frequently performed imaging study, but Magnetic Resonance Imaging of the head combined with Magnetic Resonance venography are the most sensitive studies. Acute phase therapy for CVT focuses on anticoagulation, management of seizures, increased intracranial pressure, and prevention of cerebral herniation. The majority of patients have a complete or partial recovery, however they have an increased incidence of venous thromboembolism. Clinical and imaging follow-ups 3-6 months after diagnosis are recommended to assess for recanalization.

Management of an old woman with cavernous sinus thrombosis with two different mechanisms: case report and review of the literature

“…According to Southwick et al (1986), in addition to the clinical signs mentioned above, there can be a large spectrum of other symptoms like cranial nerve palsies, diplopia, even decreased visual acuity, seizures or focal neurological signs like motor deficits, which make the diagnosis of CST challenging [1]. Seizures and motor dysfunction can occur if the occlusion spreads to other sinuses and cortical veins [8].…”

“…As it was mentioned before in many studies, CST usually has an infectious cause. It represents the single cerebral veins and dural sinuses thrombosis which results in a distinct clinical condition that involves: chemosis, conjunctival edema, proptosis and painful ophthalmoplegia [ 8 , 9 , 10 , 11 , 12 ]. Frequently, the symptoms start with the involvement of an eye, however, within a few days the other eye tends to be affected via intracavernous sinuses.…”

Intraparenchymal hemorrhage and cerebral venous thrombosis in an adult with congenital porencephalic cyst presenting for generalized tonic-clonic seizures

“…Nicolini and colleagues reported that fetuses born with porencephaly had a higher hematocrit level than other normal fetuses [8]. It has been noted that local causes including porencephaly can determine dural sinus and cerebral sinus occlusions [9]. However, the occurrence of both hemorrhage and thrombosis in the same patient with porencephaly has not been clearly reported in the literature so far.…”

“…The diagnosis of cerebral sinus thrombosis is based on neuroimaging. A CT scan should be included in the diagnostic strategy for ruling out other acute cerebral disorders that sinus thrombosis can imitate including arterial stroke, abscess, tumors and subarachnoid hemorrhage [9]. CT venography is especially useful in the acute setting because it provides a rapid and reliable method for detection of sinus thrombosis, particularly in patients with contraindications to MRI.…”

“…CT venography is especially useful in the acute setting because it provides a rapid and reliable method for detection of sinus thrombosis, particularly in patients with contraindications to MRI. This modality can be performed immediately after brain CT scan [9]. The combination of MRI showing the thrombosed vessel and MR venography demonstrating no visualization of the same vessel is currently the most sensitive method to confirm the diagnosis of sinus thrombosis in the acute, subacute, and chronic phases [11].…”