1(E): Intracranial Venous Thrombosis Flashcards

1
Q

What is intracranial venous thrombosis also called

A

Central venous sinus thrombosis

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2
Q

How does intracranial venous thrombosis compare to arterial

A

Less common

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3
Q

In which gender is intracranial venous thrombosis more common

A

Females (3:1)

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4
Q

Why is intracranial venous thrombosis more common in women

A

COCP

HRT

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5
Q

In which age group does intracranial venous thrombosis tend to occur

A

Under 40’s

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6
Q

What causes intracranial venous thrombosis

A
  • High coagulable states
  • Head Injury
  • Malignancy
  • LP
  • Infection
  • Vasculitis
  • IBD
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7
Q

What intracranial venous thrombosis does otitis media cause

A

Inferior petrosal

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8
Q

What intracranial venous thrombosis does folliculitis cause

A

Cavernous

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9
Q

What intracranial venous thrombosis does sinusitus cause

A

Cavernous

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10
Q

What factors increase risk of intracranial venous thrombosis

A

Hyper-coagulable state

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11
Q

Name 5 factors that cause hyper coagulable state

A
COCP
HRT
Factor V Leiden 
Pregnancy 
Antiphospholipid syndrome
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12
Q

Where is dural venous sinus thrombosis more common

A

Saggital sinus (50%)

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13
Q

If in the sagittal sinus how symptoms present

A

Raised ICP:

  • Vomitting
  • Papilloedema
  • Seizures
  • Headache
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14
Q

If in the transverse sinus how symptoms present

A

Headache
MASTOID PAIN
Seizures
Focal CNS Signs

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15
Q

If in the sigmoid sinus how symptoms present

A

Cerebellar Signs

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16
Q

If in the inferior petrosal siinus how symptoms present

A

CN5 and CN6 palsies

17
Q

What is gradengio’s syndrome

A

Inferior petrosal venous thrombosis secondary to otitis media that presents with temporal and retro-orbital pain

18
Q

What causes gradenigo’s syndrome

A

Otitis media

19
Q

what predominantly causes cavernous sinus thrombosis

A

Folliculitis

20
Q

what are the symptoms of cavernous sinus thrombosis

A
  • Headache
  • Peri-orbital oedema and chemosis
  • Fever
  • CN6 damage (Prior to CN3 and CN4)
21
Q

in cavernous sinus thrombosis what CN is damaged first and what follows

A

CN6

Then: CN3 and CN4

22
Q

what can cavernous sinus thrombosis cause

A

Central retinal vein thrombosis

23
Q

what is cavernous sinus syndrome

A

Congestion of blood in superior and inferior opthalmic veins that drain into cavernous sinus

24
Q

what is a typical symptom of intracranial venous sinus thrombosis

A

Pulsatile tinnitus = can hear CSF flow

25
Q

Explain consequences of venous sinus thrombosis

A

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

26
Q

What is first-line for suspected intracranial venous thrombosis cases

A

Fundoscopy - to assess for papilloedema

27
Q

What other investigation should be ordered for intracranial venous thrombosis

A

CT or MRI

28
Q

What is CT sign of intracranial venous thrombosis

A

Delta sign: presence of thrombosis of the superior sagittal sinus

29
Q

What will be seen on LP in intracranial venous thrombosis

A

high opening pressure

30
Q

How is intracranial venous thrombosis managed

A

warfarin - with bridging LMWH

31
Q

If individual deteriorates despite warfarin, what do they qualify for

A

intravascular thrombolysis

32
Q

If individual with cranial venous thrombosis has raised ICP what is performed

A

decompressive hemiectomy

33
Q

What are two risks of intracranial venous thrombosis

A
  • Raised ICP can cause herniation

- If untreated, clot may break off and cause a PE

34
Q

What is gold-standard to identify thrombosis

A

MR Venogram