Clinical Presentation:
An 18-year-old female student presented with a 7-day history of worsening frontal headache and 1 day history of vomiting. The patient described marked photophobia, but no fever or history of seizure. She was taking a combined oral contraceptive and had no other medical history. Physical examination showed no focal neurology, but fundoscopy revealed bilateral papilledema.
Today, let’s learn about cerebral venous sinus thrombosis.
What is it?
Clot that forms within the major cerebral veins, such as the dural sinuses (super sagittal sinus, straight sinus, and transverse sinuses), cortical veins, vein of Galen, and jugular veins.
What causes it?
Thrombosis of either the cerebral veins or of the major cerebral sinuses.
Epidemiology
More common in younger patients (median age = 38)
More common in women
Mortality of 10-30%
Risk factors:
Acquired: infections (otitis, mastoiditis), surgery, pregnancy, trauma, cancer, exogenous hormones
Genetic: inherited thrombophilia
Presentation
Non-specific stroke-like symptoms: severe HA (90% of patients) that can be gradual in onset, weakness, paresthesias, blurred or double vision
If increased ICP, can see mental status changes, lethargy, decreased consciousness, papilledema
If focal brain injury, can have seizures or focal neurological defecits
Diagnosis
Variety of imaging modalities for diagnosis, typically can start with a non-contrast CT head and then progress to CT venogram (if MRI unavailable), or perform MR venography, MRI, or cerebral angiography
Management
Manage seizures or herniations
Start anticoagulation
Unfractionated heparin (UFH)
Low molecular weight heparin (LMWH): 1 mg/kg SQ Q12 hours
Other treatment modalities: systemic thrombolytics, cather-based interventions (thrombolytics and thrombectomy), decompressive craniectomy
