From the Guidelines
Venous sinus thrombosis is a serious condition that requires prompt anticoagulation therapy with either low molecular weight heparin or unfractionated heparin, followed by warfarin or direct oral anticoagulants for 3-6 months, as recommended by the most recent guidelines 1. The symptoms of cerebral venous sinus thrombosis (CVST) include severe headache, visual disturbances, seizures, and focal neurological deficits, and can result from prothrombotic states, infections, or inflammatory conditions. Early diagnosis through MRI venography or CT venography is crucial for preventing permanent neurological damage or death, as the clots impair blood drainage from the brain, leading to increased pressure and potential brain tissue damage. Some key points to consider in the management of CVST include:
- Anticoagulation therapy is the primary treatment, even in the presence of intracranial hemorrhage, as it can help prevent thrombus propagation and increase recanalization 1.
- The duration of anticoagulation therapy is typically 3-6 months, but may be longer in patients with inherited thrombophilia or other underlying conditions that increase the risk of recurrence 1.
- Supportive care, such as managing increased intracranial pressure with acetazolamide, treating seizures with anticonvulsants, and addressing headaches with appropriate analgesics, is also important in the management of CVST.
- Endovascular thrombolysis or thrombectomy may be necessary in cases with severe symptoms or deterioration despite anticoagulation 1. It is essential to note that the management of CVST should be individualized, and the treatment plan should be based on the patient's specific condition and underlying risk factors. Regular follow-up with serial imaging is recommended to assess for recanalization of the occluded cortical vein/sinuses and to monitor for potential complications, such as dural arteriovenous fistula 1.
From the Research
Symptoms of Cerebral Venous Sinus Thrombosis (CVST)
- The symptoms of CVST can vary and may include headache, seizures, and elevated intracranial pressure 2, 3.
- The clinical presentation of CVST can be subacute or lingering, making diagnosis frequently overlooked or delayed 2, 3.
Treatment Options for CVST
- Anticoagulation with dose-adjusted intravenous heparin or body weight-adjusted subcutaneous low-molecular-weight heparin (LMWH) is recommended for patients with CVST without contraindications for anticoagulation 2, 4, 3.
- Concomitant intracranial haemorrhage related to CVST is not a contraindication for heparin therapy 2, 4, 3.
- Oral anticoagulation may be given for 3-12 months, depending on the underlying cause of CVST and the presence of hereditary thrombophilia 5, 2, 3.
- Direct oral anticoagulants (DOACs) could be an alternative to vitamin K antagonists (VKA) in CVST patients 5.
- Thrombolysis may be a therapeutic option in selected cases, possibly in those without large intracranial haemorrhage and threatening herniation 6, 2, 3.
- Symptomatic therapy, including control of seizures and elevated intracranial pressure, is also important in the management of CVST 2, 3.
- In severe cases with impending herniation, craniectomy can be used as a life-saving intervention 2, 3.