Top Things to Know: Diagnosis and Management of Cerebral Venous Thrombosis
Published: January 29, 2024
Prepared by Anne Leonard MPH, RN, BSN, FAHA, National Senior Director Science and Medicine
- Cerebral venous thrombosis (CVT) is the presence of a blood clot in the dural venous sinuses, the cerebral veins, or both. Among those with stroke, CVT represents a global incidence of 0.5% to 3%.
- Most vulnerable populations include young individuals, women of reproductive age, and patients with/in a prothrombotic state.
- The clinical presentation of CVT can be due to increased intracranial pressure or focal parenchymal injury with or without mass effect. Signs and symptoms include headache, visual issues, seizures, encephalopathy, and coma.
- Causative agents include oral contraceptive use, pregnancy/post-partum hormone replacement therapy, head and neck infection, dehydration, sepsis, respiratory infections, medications, obesity, anemia, malignancy, autoimmune disorders, genetic disorders, and head trauma.
- Brain and vascular imaging for the diagnosis of CVT includes computed tomography (CT) and magnetic resonance imaging (MRI) as the main imaging modalities. CT venography and MR venography are the optimal tests to confirm CVT.
- Oral anticoagulation starting with parental heparin followed by either vitamin K antagonists or direct oral anticoagulants (DOACs is the mainstream treatment.
- Pregnancy induces changes in the coagulation system that continues into the puerperium period. This can result in a hypercoagulable state that increases the risk of CVT.
- CVT occurs in the pediatric population at a rate of 6.4 per100,000 per year neonates but can occur less commonly in children and adolescents. Headache, seizures, focal neurological deficits, or coma may occur as presenting symptoms.
- Vaccine-induced thrombotic thrombocytopenia and CVT have rarely occurred within days or a few weeks after receiving the adenovirus-based SARS-CoV-2 vaccine.
- Take-aways for the clinician focus on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis and the use of anticoagulation, endovascular therapies, and considerations for craniectomy in patients with acute severe CVT depending on presentation.
Citation
Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD; on behalf of the American Heart Association Stroke Council; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association. Stroke. Published online January 29, 2024. doi: 10.1161/STR.0000000000000456