Cerebral Venous Sinus Thrombosis (1)

Question 1

What is it?

What are the types of it?

What are the causes?

Answer 1

➊ A thrombotic obstruction of the cerebral venous system, leading to ischaemic lesions or hemorrhages in the brain.

➋ * Transverse sinus thrombosis
* Superior sagittal sinus thrombosis
* Septic cerebral venous thrombosis - a subtype of CVST of infectious origin
* Cavernous sinus thrombosis - a rare subtype of CVST, typically septic in origin, that is associated with cavernous sinus syndrome

➌ * Hypercoagulable state
* Head injury
* Neurosurgical procedures e.g. LP
* Sepsis due to infections in mid-face, sinuses, ears, teeth, or mouth - acute sinusitis is the most common preceding infection

Question 2

How does it present?

Answer 2

• Headache - most common symptom, and tends to be more progressive than sudden/acute
• Signs of raised intracranial pressure - Bilateral papilloedema, Visual impairment (diplopia, vision loss), N+V, Seizures
• Cavernous sinus syndrome - Diplopia, tinnitus, unilateral deafness, facial palsy
• Meningism - headache, vomiting, and nuchal rigidity

N.B. Must be differentiated from meningitis. Abx should be started immediately once suspected in either case as it has the greatest effect on prognosis

Question 3

How is it investigated?

How is it managed?

Answer 3

➊ * MRI - 1st line
* CT
* Blood cultures

➋ * Anticoagulation w/UFH
* Abx if septic (1st line is Vancomycin + Ceftriaxone)
* Surgical intervention