From the Guidelines
Clinical signs of venous sinus thrombosis include headache, seizures, focal neurological deficits, altered mental status, and papilledema, with headache being the most common symptom, present in about 90% of cases. The clinical presentation can be highly variable, ranging from isolated headache to coma, and symptoms may evolve gradually over days to weeks, unlike the sudden onset typical of arterial strokes 1. Headache is often severe and progressive, and may be accompanied by nausea and vomiting. Seizures occur in approximately 40% of patients, and focal deficits vary depending on the affected sinus, including hemiparesis, aphasia, or visual disturbances 1. Some patients develop increased intracranial pressure, leading to papilledema and sixth nerve palsies.
- Key clinical features of venous sinus thrombosis include:
- Headache: often severe and progressive, present in about 90% of cases
- Seizures: occur in approximately 40% of patients
- Focal neurological deficits: vary depending on the affected sinus, including hemiparesis, aphasia, or visual disturbances
- Altered mental status: can range from mild confusion to coma
- Papilledema: due to increased intracranial pressure
- Risk factors for venous sinus thrombosis include hypercoagulable states, pregnancy, oral contraceptive use, infection, and dehydration 1. The variability in presentation often leads to delayed diagnosis, so a high index of suspicion is needed, particularly in young to middle-aged patients with unusual headaches or stroke-like symptoms without typical vascular risk factors. The most recent and highest quality study on this topic is from 2011, which provides a comprehensive overview of the clinical signs and symptoms of venous sinus thrombosis 1.
From the Research
Clinical Signs of Venous Sinus Thrombosis
The clinical signs of venous sinus thrombosis can vary, but common symptoms include:
- Headache 2, 3, 4, 5
- Seizures 2, 3, 4, 6
- Behavioral disturbances 3
- Consciousness disturbances 3
- Language deficits 3
- Focal neurological deficits 5
- Mental state changes 5
- Papilledema 5
- Intracranial hypertension 6
- Hemiparesis 6
- Generalized seizures 6
Specific Clinical Presentations
Some patients may present with more specific clinical signs, such as:
- Hemorrhagic infarct, which can cause advanced age, headache, behavioral disturbances, consciousness disturbances, seizures, and language deficits 3
- Non-lesional sinus-venous thrombosis, which can have no disability at 3-month follow-up 3
- Intracerebral hemorrhage, which can cause high blood pressure at admission, puerperium, sigmoid and straight sinus thrombosis, and multiple sinus and vein involvement 3
Diagnosis and Treatment
Diagnosis of venous sinus thrombosis can be made using imaging techniques such as magnetic resonance venography 4, 5 and computed tomography 5, 6. Treatment options include symptomatic treatment, anticoagulation, thrombolysis, and thrombectomy 4, 5, 6.