1(E): Intracranial Venous Thrombosis Flashcards
What is intracranial venous thrombosis also called
Central venous sinus thrombosis
How does intracranial venous thrombosis compare to arterial
Less common
In which gender is intracranial venous thrombosis more common
Females (3:1)
Why is intracranial venous thrombosis more common in women
COCP
HRT
In which age group does intracranial venous thrombosis tend to occur
Under 40’s
What causes intracranial venous thrombosis
- High coagulable states
- Head Injury
- Malignancy
- LP
- Infection
- Vasculitis
- IBD
What intracranial venous thrombosis does otitis media cause
Inferior petrosal
What intracranial venous thrombosis does folliculitis cause
Cavernous
What intracranial venous thrombosis does sinusitus cause
Cavernous
What factors increase risk of intracranial venous thrombosis
Hyper-coagulable state
Name 5 factors that cause hyper coagulable state
COCP HRT Factor V Leiden Pregnancy Antiphospholipid syndrome
Where is dural venous sinus thrombosis more common
Saggital sinus (50%)
If in the sagittal sinus how symptoms present
Raised ICP:
- Vomitting
- Papilloedema
- Seizures
- Headache
If in the transverse sinus how symptoms present
Headache
MASTOID PAIN
Seizures
Focal CNS Signs
If in the sigmoid sinus how symptoms present
Cerebellar Signs
If in the inferior petrosal siinus how symptoms present
CN5 and CN6 palsies
What is gradengio’s syndrome
Inferior petrosal venous thrombosis secondary to otitis media that presents with temporal and retro-orbital pain
What causes gradenigo’s syndrome
Otitis media
what predominantly causes cavernous sinus thrombosis
Folliculitis
what are the symptoms of cavernous sinus thrombosis
- Headache
- Peri-orbital oedema and chemosis
- Fever
- CN6 damage (Prior to CN3 and CN4)
in cavernous sinus thrombosis what CN is damaged first and what follows
CN6
Then: CN3 and CN4
what can cavernous sinus thrombosis cause
Central retinal vein thrombosis
what is cavernous sinus syndrome
Congestion of blood in superior and inferior opthalmic veins that drain into cavernous sinus
what is a typical symptom of intracranial venous sinus thrombosis
Pulsatile tinnitus = can hear CSF flow
Explain consequences of venous sinus thrombosis
Occlusion dural venous sinuses - causes back flow of pressure to cerebral veins which then causes infarction of venous territory. Also prevents cerebral drainage causing increase in ICP and symptoms
What is first-line for suspected intracranial venous thrombosis cases
Fundoscopy - to assess for papilloedema
What other investigation should be ordered for intracranial venous thrombosis
CT or MRI
What is CT sign of intracranial venous thrombosis
Delta sign: presence of thrombosis of the superior sagittal sinus
What will be seen on LP in intracranial venous thrombosis
high opening pressure
How is intracranial venous thrombosis managed
warfarin - with bridging LMWH
If individual deteriorates despite warfarin, what do they qualify for
intravascular thrombolysis
If individual with cranial venous thrombosis has raised ICP what is performed
decompressive hemiectomy
What are two risks of intracranial venous thrombosis
- Raised ICP can cause herniation
- If untreated, clot may break off and cause a PE
What is gold-standard to identify thrombosis
MR Venogram
