Cerebral Venous Thrombosis: A Comprehensive Review

Abstract

<b><i>Background:</i></b> Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword “Cerebral sinus venous thrombosis” was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease. <b><i>Summary:</i></b> The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment. <b><i>Conclusion:</i></b> CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.

US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021

“…A subacute presentation of headache is present in 90% of patients with typical CVST. 7,29 An advisory released by the American Heart Association on April 15, 2021, describes symptoms including headache that should increase concern for CVST or other thrombosis. 30 In the phase 3 study of Ad26.COV2.S vaccine, headaches occurred in 44% of patients younger than 60 years in the first week following vaccination; most patients' symptoms appeared within 2 days and resolved within 2 days.…”

“…CVST risk factors were defined as described in a review. 7 Case information was also reviewed with physician investigators from CDC's CISA Project, including specialists in infectious diseases, neurology, and hematology. Cases were also reviewed to determine if they satisfied Brighton Collaboration interim case definition 9.2 for TTS, which includes new-onset thrombocytopenia (platelet count <150 ×10 3 /μL) without evidence of platelet clumping, venous or arterial thrombosis, and absence of prior exposure to heparin.…”

Tromboflebite séptica de seio cavernoso com formação de pseudoaneurisma em criança de sete anos

“…A sintomatologia varia de acordo com o seio da face afetado e o principal sinal de alerta para complicações é a cefaleia, concomitante ao caso, visto que, a paciente apresentava cefaléia holocraniana de forte intensidade, devido à pressão intracraniana elevada que pode ocorrer como resultado de uma grande trombose de seio venoso (Idiculla et al, 2020).…”

“…Os estudos da órbita, sela e região paraselar desempenham um papel importante no diagnóstico (Henderson & Miller, 2017). Sendo que a angiografia cerebral foi considerada o procedimento diagnóstico primário usado para o diagnóstico de anomalias venosas intracranianas (Idiculla et al, 2020).…”

Cerebral Venous Sinus Thrombosis in COVID-19: An Unusual Presentation

“…Computed tomography venography (CTV) is a reliable option when MRI is contraindicated. The gold standard cerebral angiography is performed when other modalities are inconclusive or unavailable [2]. Early identification and prompt treatment with anticoagulation and/or endovascular therapies are critical to prevent progression to cerebral edema, thus improving outcomes.…”