What are the clinical presentations of cerebral venous sinus thrombosis (CVST)?

From the Guidelines

Clinical Presentations of Cerebral Venous Sinus Thrombosis (CVST)

The clinical presentations of CVST are varied and can be categorized into two major groups: those related to increased intracranial pressure and those related to focal brain injury from venous ischemia/infarction or hemorrhage 1.

• Headache is the most common symptom, present in nearly 90% of patients, and is typically described as diffuse and progressive in severity over days to weeks.
• Focal neurological signs such as hemiparesis, aphasia, and seizures can occur due to venous ischemia or hemorrhage.
• Papilledema and diplopia (caused by sixth nerve palsy) can also be present, even without other neurological focal signs.
• The clinical manifestations of CVST may depend on the location of the thrombosis, with the superior sagittal sinus being the most commonly involved, leading to headache, increased intracranial pressure, and papilledema.
• Seizures are frequent, occurring in 40% of patients, and bilateral brain involvement is not infrequent, particularly in cases involving the deep venous drainage system.
• Psychosis and alterations in level of consciousness can also occur, especially in cases with bilateral thalamic involvement. The diagnosis of CVT is typically based on clinical suspicion and imaging confirmation, with CT and MRI being the primary imaging modalities used 1.

From the Research

Clinical Presentations of Cerebral Venous Sinus Thrombosis (CVST)

The clinical presentations of CVST are varied and can include:

• Headache, which is the most common symptom, present in 70-90% of patients 2, 3, 4, 5
• Focal neurologic deficits, such as numbness, weakness, and aphasia, present in 29-90% of patients 2, 3, 4
• Seizures, present in 24-72% of patients 2, 3, 4
• Altered sensorium, present in around one third of patients 2, 6
• Papilledema, present in 26% of patients 4
• Fever, present in 38% of patients 4

Demographic Characteristics

The demographic characteristics of CVST patients include:

• Female predominance, with a female to male ratio of 2.33:1 6
• Younger age, with a mean age of 31-42 years 2, 3, 4
• Pregnancy and puerperium as a common etiology, especially in females 2, 6, 4

Neuroimaging Features

The neuroimaging features of CVST include:

• Direct evidence of thrombosis on CT or MRI, present in 42-52% of cases 5
• Involvement of multiple sinuses, present in 78% of cases 5
• Superior sagittal sinus thrombosis, present in 56% of cases 6
• Sigmoid and transverse sinus thrombosis, present in 20-32% of cases 4, 5