Cerebral venous sinus thrombosis is a rare but serious type of cerebrovascular disease that can cause stroke and disability. It is caused by a blood clot in the venous sinuses of the brain and can be diagnosed through imaging modalities such as CT and MRI. Treatment involves medical stabilization and thrombolytic therapy. Risk factors include inflammatory bowel disease, corticosteroid use, and blood disorders. MRV is the imaging of choice for diagnosis. Treatment involves medical and surgical management, including anticoagulant or thrombolytic therapy.
Cerebral venous sinus thrombosis is a type of cerebrovascular disease in which there is an obstruction of one of the venous sinuses by a blood clot, resulting in a heart attack or death of brain cells. This heart attack is more commonly known as a stroke. Although symptoms depend on the site of the sinus thrombosis, commonly reported symptoms include headache, blindness, and weakness. Diagnosis is confirmed through imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI). Treatment of cerebral venous sinus thrombosis involves medical stabilization and thrombolytic therapy.
There are two main types of thrombosis based on the type of blood vessel affected. An arterial thrombosis involves an artery and a venous thrombosis involves veins and sinuses or dural spaces. In arterial thromboembolic strokes, a blood clot from the heart is thrown into the arterial circulation, travels to the middle cerebral artery (MCA), and causes a stroke. This is in contrast to cerebral venous sinus thrombosis, in which a blood clot forms in the sinus spaces.
Although cerebral venous sinus thrombosis is significantly less common than arterial thrombosis, it is an important consideration because it causes disability. Several causes of this disease have been identified. Lateral or sagittal sinus vein thrombosis can occur as a complication of long-term use of oral contraceptives and pregnancy. Another cause is infection of the paranasal and frontal sinuses, usually with Staphylococcus. Trauma, due to accidents or neurosurgical procedures, can also cause thrombosis of the cerebral venous sinus.
Other factors that increase the risk of cerebral venous sinus thrombosis include inflammatory bowl disease and corticosteroid use, anticoagulant protein deficiencies, and blood disorders. People who have systemic lupus erythematosus or nephrotic syndrome are also at increased risk. Other factors include dehydration and living at high altitudes. All of these risk factors generally produce a hypercoagulable state and make the blood more prone to clot formation.
The primary modality for diagnosing cerebral venous sinus thrombosis is imaging. A CT scan is often the first imaging modality requested, but it provides limited information and is usually normal unless bleeding is present. However, it is important to eliminate suspicion of other conditions. Magnetic resonance venography (MRV) offers a better view of the infarct pattern and can show the absence of normal blood flow in the cerebral venous channels. MRV is generally the imaging of choice for dural venous sinuses and cerebral veins.
Treatment of cerebral venous sinus thrombosis involves medical and surgical management. In the emergency department, the patient’s head is elevated at an angle of approximately 30 to 40 degrees to reduce intracranial pressure. If seizures are present, an anticonvulsant, such as fosphenytoin, sodium valproate, or phenobarbital, is injected. Anticoagulant or thrombolytic therapy is then started to restore venous blood flow and reduce intracranial pressure.
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