Cerebral Vein Thrombosis

Exam Cram

• Cerebral Vein thrombosis is clot in the cerebral venous system, associated with the COCP

• Presentation: raised ICP- headache worse in morning, leaning forward & with coughing; papilloedema, decreased consciousness, cranial nerve VI palsy

• Diagnosis: CT- Venogram

• Management: LMWH heparin

Definitions

• Cavernous Sinus Thrombosis is a type of Cerebral Vein Thrombosis, occurring in cavernous sinus.

Outline

Background

• 10% of IIH (Idiopathic Intracranial Hypertension) may have cerebral vein thrombosis

Assessment

Presentation

• Headache

• Seizures

• Mildly febrile 

• Dehydration from recent GE

• Risk factors: COCP, post partum/ pregnancy

Examination

• Papilloedema

• Focal neurology

• Cranial nerve VI palsy (bilateral)

Investigations

• CT-H: rule out ICH, absent delta sign

• CT-V: sensitivity 95%,

• MR-Venogram: sensitivity > 95%,

• Cerebral Angiography gold standard but rarely used

Diagnosis 

Diagnostic criteria: image findings (CT/MR- Venogram)

Differentials: IIH (Idiopathic Intracranial Hypertension) , Subdural / Extra Dural Haematoma , Subarachnoid Haemorrhage 

Classification (aetiology)

1. Idiopathic/ primary

2. Secondary

1. Septic

   • Otitis media

   • Facial Cellulitis

   • Meningitis

2. Non-septic 

   • Pregnancy

   • Thrombophilia

   • Behcet's Disease

Management

Acute

• LMW Heparin

Med Reg Notes

Management

Acute

1. Initially LMW Heparin (increase APPT to twice upper limit of normal)

2. Consider endovascular thrombolysis if severe neurological impairment (little evidence for this)

Long Term

3. Transfer to DOAC for 3 month

References and Resources

1. Gaillard F, Sharma R, Zhou E, et al. Cerebral venous thrombosis. Reference article, Radiopaedia.org (Accessed on 07 Feb 2025) https://doi.org/10.53347/rID-4449

Written 2024