What causes a cerebellar venous stroke (cerebellar venous infarction)?

From the Guidelines

A venous cerebellar stroke occurs when there is a blockage or disruption in the veins that drain blood from the cerebellum, leading to venous congestion, tissue damage, and infarction, typically due to cerebral venous thrombosis (CVT) as described in the American Heart Association/American Stroke Association statement 1. The pathophysiology of venous cerebellar stroke involves the formation of blood clots in the venous sinuses that drain the cerebellum, leading to increased intracranial pressure, reduced perfusion, and eventually tissue damage. Several factors can precipitate venous cerebellar strokes, including hypercoagulable states, dehydration, infections, and inflammatory conditions. Some key points to consider in the diagnosis and management of cerebral venous thrombosis include:

• Clinical findings in CVT usually fall into two major categories: 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 in CVT, present in nearly 90% of patients, and is typically described as diffuse and often progresses in severity over days to weeks 1.
• Focal brain injury can occur due to venous ischemia or hemorrhage, leading to neurological signs and symptoms referable to the affected region, such as hemiparesis and aphasia 1.
• The location of the thrombosis can also influence the clinical manifestations of CVT, with the superior sagittal sinus being the most commonly involved, leading to headache, increased intracranial pressure, and papilledema 1.
• Treatment typically involves anticoagulation with heparin initially, followed by warfarin or direct oral anticoagulants for 3-12 months depending on the underlying cause, as well as early recognition and treatment to prevent progression of the stroke 1.

From the Research

Causes of Venous Cerebellar Stroke

• Venous cerebellar stroke, also known as cerebral venous thrombosis (CVT), is a rare condition that accounts for 0.5% to 3% of all strokes 2.
• The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state 2.
• CVT can be caused by a variety of factors, including hypertension, prothrombotic states, and vascular malformations 3.

Clinical Presentation

• The clinical presentation of CVT is diverse and can include symptoms such as headaches, seizures, and focal neurological deficits 2, 4.
• The condition can be difficult to diagnose due to its nonspecific presentation, and a high level of clinical suspicion is required 2, 4.

Diagnosis

• The diagnosis of CVT is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography 2, 4.
• MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis 4.

Treatment

• Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment for CVT 5, 2, 4.
• Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy 5, 2, 4.
• Favorable outcomes have been reported in patients who receive early diagnosis and treatment 4.