From the Guidelines
Evaluation for sinus thrombosis is warranted when patients present with severe, persistent headaches, seizures, altered mental status, focal neurological deficits, and papilledema, as these symptoms can indicate increased intracranial pressure and brain tissue damage, as noted in the American Heart Association/American Stroke Association statement 1. The diagnosis of cerebral venous thrombosis (CVT) is typically based on clinical suspicion and imaging confirmation, with clinical findings falling into two major categories: those related to increased intracranial pressure and those related to focal brain injury from venous ischemia/infarction or hemorrhage 1. Key signs and symptoms that warrant evaluation for sinus thrombosis include:
- Severe, persistent headaches that worsen when lying down or with Valsalva maneuvers
- Nausea, vomiting, and visual disturbances such as double vision or blurred vision
- Seizures, altered mental status, and focal neurological deficits (such as weakness or numbness on one side of the body)
- Papilledema (swelling of the optic disc)
- Neck pain, ear pain, or fever, particularly if the thrombosis is associated with infection Risk factors that should heighten suspicion include recent head trauma, pregnancy or postpartum state, use of oral contraceptives, known thrombophilia, dehydration, and local infections like mastoiditis or sinusitis 1. According to the most recent guidelines from the American College of Radiology 1, imaging focuses on the direct identification of clot, as well as the assessment for complications such as venous infarction and hemorrhage, with CT head without IV contrast and MRI head without or with IV contrast being alternative procedures for direct parenchymal assessment. Immediate medical attention is crucial as early treatment with anticoagulation significantly improves outcomes, with the goal of preventing further clot formation and reducing the risk of complications such as venous infarction and hemorrhage 1.
From the Research
Signs and Symptoms of Sinus Thrombosis
The signs and symptoms that warrant evaluation for sinus thrombosis include:
- Non-descriptive headache, which is the most common presenting symptom 2
- Papilledema, which can be bilateral 2, 3
- Seizures 3, 4
- Focal neurological deficits 3, 4
- Mental state changes 3
- Headache over the temporal and occipital region 3
- Disorientation 3
- Neurological deficits, such as coma 4
- Sudden-onset localized headaches, which may or may not be accompanied by focal or generalized neurological deficits or seizures 5
Underlying Conditions
Certain underlying conditions can increase the risk of sinus thrombosis, including:
- Prothrombotic conditions, such as isolated antithrombin III deficiency 2
- Genetic and acquired prothrombotic states 3
- Infections, such as mastoiditis 4
- Inflammatory disease 3
- Trauma 3
- Hormonal contraception, pregnancy, puerperium, and smoker status 5
Diagnostic Evaluation
Evaluation and diagnosis of sinus thrombosis should include a combination of: