Intracranial Venous Thrombosis

Question 1

What are IVT?

Answer 1

Thrombosis of the cerebral sinuses which causes cerebral infarction, less common than arterial disease

Question 2

Where is most common dural venous sinus

Answer 2

Saggital sinus

Question 3

What are features of saggital sinus thrombosis?

Answer 3

Headache, vomiting, seizures, reduced vision, papilloedema
Hemiplegia

Symptom onset is gradual (days to weeks)

Question 4

What are features of transverse sinus thrombosis?

Answer 4

Headache
Vomiting

Mastoid pain
Focal CNS signs
Seizures
Papilloedema

Question 5

What are features of sigmoid sinus thrombosis?

Answer 5

Cerebellar signs

Lower CN palsies

Question 6

What are features of cavernous sinus thrombosis?

Answer 6

Often due to spread from facial pustules or folliculitis causing
Headache, chemises, oedematous eyelids, proptosis, painful ophthalmoplegia, fever
6th nerve damage before 3rd and 4th
Trigeminal nerve involvement may lead to hyperaesthesia of upper face and eye pain
Central retinal vein thrombosis

Question 7

What are causes of IVT?

Answer 7

Hypercoagulable states
Pregnancy
COCP
Head injury
Dehydration
Blood dysacrias
Tumours
Extracranial malignancy
Recent LP

Question 8

What investigations in IVT?

Answer 8

Exclude SAH
Thrombophilia screen
CT/MRI venography may show absence of sinus
LP = Raised opening pressure, CSF may bo normal or show RBC/xanthochromina

Question 9

What management for IVT?

Answer 9

Anticoagulation with heparin and then warfarin (INR 2-3)

Endovascular thrombolysis or mechanical thrombectomy may provide limited benefit.