Cerebral venous sinus thrombosis overview: Difference between revisions
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==Overview== | ==Overview== | ||
[[Cerebral venous thrombosis]](CVT)is [[thrombosis]] of [[cerebral veins]], a rare form of [[stroke]] which is different from [[arterial]] [[strokes]]. CVT incidence is 1.3 in per 1,00,000/year in developed countries. Young children and women especially [[pregnant]]/[[puerperium]] have a higher frequency of CVT. Due to the wide spectrum of [[clinical]] features, CVT frequently gets misdiagnosed as other strokes. Commonly known risk factors and causes of [[cerebral venous thrombosis]] are [[venous thromboembolism]], [[thrombophilia]] (especially [[antithrombin deficiency]], [[protein C]] and S deficiency and [[factor V Leiden]] mutation), [[pregnancy]], [[oestrogen]] [[therapy]]/[[oral contraceptives]], [[hypercoagulability]] as part of [[inflammatory disease]], [[head trauma]], local [[infections]] and underlying [[cancer]]. [[Pathophysiology]] of CVT includes two mechanisms including [[thrombosis]] of [[cerebral]] [[veins]] creating local [[edema]] and [[venous]] [[infarction]]; [[intracranial hypertension]] created by increased [[venous]] [[pressure]] and decreased [[absorption]] of [[CSF]]. [[Clinical]] presentations of CVT can be categorized into 4 categories as isolated [[intracranial hypertension]], [[neurological]] deficits, [[encephalopathy]] and [[seizure]]. [[Symptoms]] related to increased [[intracranial hypertension]] are [[headache]], [[diplopia]], [[papilledema]], [[sixth nerve palsy]] and decreased [[consciousness]]; focal [[neurological]] deficits present as motor and sensory impairments, [[aphasia]]. Though in 90% of patients with [[CVT]] , [[headache]] is the most common [[symptom]], followed by [[seizures]] in 40% [[patients]] and 20 % [[patients]] with [[seizure]]. [[Superior sagittal sinus]] is the most commonly involved sinus approximately 62% of [[patients]] and [[transverse sinus]] is the next common site (40-45%). [[Internal cerebral vein]] and [[straight sinus]] are less commonly involved in CVT but associated with worse outcomes. [[Diagnosis]] of CVT is based on [[clinical]] findings and [[neuroimaging]]. [[D-dimer]] level is more than 500 μg/L in most of the [[patients]] with CVT. Per recommendation of [[American Heart Association]] (AMA) and the [[European Federation of Neurological Societies]] (EFNS), [[MRI]]/MRV is preferred | [[Cerebral venous thrombosis]](CVT)is [[thrombosis]] of [[cerebral veins]], a rare form of [[stroke]] which is different from [[arterial]] [[strokes]]. CVT incidence is 1.3 in per 1,00,000/year in developed countries. Young children and women especially [[pregnant]]/[[puerperium]] have a higher frequency of CVT. Due to the wide spectrum of [[clinical]] features, CVT frequently gets misdiagnosed as other strokes. Commonly known risk factors and causes of [[cerebral venous thrombosis]] are [[venous thromboembolism]], [[thrombophilia]] (especially [[antithrombin deficiency]], [[protein C]] and S deficiency and [[factor V Leiden]] mutation), [[pregnancy]], [[oestrogen]] [[therapy]]/[[oral contraceptives]], [[hypercoagulability]] as part of [[inflammatory disease]], [[head trauma]], local [[infections]] and underlying [[cancer]]. [[Pathophysiology]] of CVT includes two mechanisms including [[thrombosis]] of [[cerebral]] [[veins]] creating local [[edema]] and [[venous]] [[infarction]]; [[intracranial hypertension]] created by increased [[venous]] [[pressure]] and decreased [[absorption]] of [[CSF]]. [[Clinical]] presentations of CVT can be categorized into 4 categories as isolated [[intracranial hypertension]], [[neurological]] deficits, [[encephalopathy]] and [[seizure]]. [[Symptoms]] related to increased [[intracranial hypertension]] are [[headache]], [[diplopia]], [[papilledema]], [[sixth nerve palsy]] and decreased [[consciousness]]; focal [[neurological]] deficits present as motor and sensory impairments, [[aphasia]]. Though in 90% of patients with [[CVT]] , [[headache]] is the most common [[symptom]], followed by [[seizures]] in 40% [[patients]] and 20 % [[patients]] with [[seizure]]. | ||
[[File:Presentation of CVT.jpeg|center|thumb|512x512px|Clinical presentations of CVT]] | |||
[[Superior sagittal sinus]] is the most commonly involved sinus approximately 62% of [[patients]] and [[transverse sinus]] is the next common site (40-45%). [[Internal cerebral vein]] and [[straight sinus]] are less commonly involved in CVT but associated with worse outcomes. [[Diagnosis]] of CVT is based on [[clinical]] findings and [[neuroimaging]]. [[D-dimer]] level is more than 500 μg/L in most of the [[patients]] with CVT. Per recommendation of [[American Heart Association]] (AMA) and the [[European Federation of Neurological Societies]] (EFNS), [[MRI]]/MRV is preferred | |||
for [[brain]] [[imaging]]. But [[CT]] can be considered if [[MRI]] is unavailable. [[Treatment]] of CVT includes early initiation of [[anticoagulant]] [[therapy]] and [[treatment]] of other underlying causes as [[sepsis]], [[dehydration]], [[discontinuation]] of prothrombotic [[medications]]; [[seizure]] and [[intracranial hypertension]] [[management]]. | for [[brain]] [[imaging]]. But [[CT]] can be considered if [[MRI]] is unavailable. [[Treatment]] of CVT includes early initiation of [[anticoagulant]] [[therapy]] and [[treatment]] of other underlying causes as [[sepsis]], [[dehydration]], [[discontinuation]] of prothrombotic [[medications]]; [[seizure]] and [[intracranial hypertension]] [[management]]. | ||
==Historical Perspective== | ==Historical Perspective== | ||
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===Medical Therapy=== | ===Medical Therapy=== | ||
=== Interventions === | ===Interventions=== | ||
===Surgery=== | ===Surgery=== | ||
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===Secondary Prevention=== | ===Secondary Prevention=== | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Revision as of 18:09, 25 July 2021
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Cerebral venous sinus thrombosis Microchapters |
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Differentiating Cerebral venous sinus thrombosis from other Diseases |
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Diagnosis |
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Treatment |
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Cerebral venous sinus thrombosis overview On the Web |
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Directions to Hospitals Treating Cerebral venous sinus thrombosis |
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Risk calculators and risk factors for Cerebral venous sinus thrombosis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Sharmi Biswas, M.B.B.S
Overview
Cerebral venous thrombosis(CVT)is thrombosis of cerebral veins, a rare form of stroke which is different from arterial strokes. CVT incidence is 1.3 in per 1,00,000/year in developed countries. Young children and women especially pregnant/puerperium have a higher frequency of CVT. Due to the wide spectrum of clinical features, CVT frequently gets misdiagnosed as other strokes. Commonly known risk factors and causes of cerebral venous thrombosis are venous thromboembolism, thrombophilia (especially antithrombin deficiency, protein C and S deficiency and factor V Leiden mutation), pregnancy, oestrogen therapy/oral contraceptives, hypercoagulability as part of inflammatory disease, head trauma, local infections and underlying cancer. Pathophysiology of CVT includes two mechanisms including thrombosis of cerebral veins creating local edema and venous infarction; intracranial hypertension created by increased venous pressure and decreased absorption of CSF. Clinical presentations of CVT can be categorized into 4 categories as isolated intracranial hypertension, neurological deficits, encephalopathy and seizure. Symptoms related to increased intracranial hypertension are headache, diplopia, papilledema, sixth nerve palsy and decreased consciousness; focal neurological deficits present as motor and sensory impairments, aphasia. Though in 90% of patients with CVT , headache is the most common symptom, followed by seizures in 40% patients and 20 % patients with seizure.
Superior sagittal sinus is the most commonly involved sinus approximately 62% of patients and transverse sinus is the next common site (40-45%). Internal cerebral vein and straight sinus are less commonly involved in CVT but associated with worse outcomes. Diagnosis of CVT is based on clinical findings and neuroimaging. D-dimer level is more than 500 μg/L in most of the patients with CVT. Per recommendation of American Heart Association (AMA) and the European Federation of Neurological Societies (EFNS), MRI/MRV is preferred
for brain imaging. But CT can be considered if MRI is unavailable. Treatment of CVT includes early initiation of anticoagulant therapy and treatment of other underlying causes as sepsis, dehydration, discontinuation of prothrombotic medications; seizure and intracranial hypertension management.