Intracranial Venous Thrombosis Flashcards
What is an intracranial venous thrombosis?
Thrombosis in the cerebral sinuses or veins causes cerebral infarction but much less commonly than arterial blocks do. Death usually occurs due to transtentorial herniation from mass effect of oedema.
What are the symptoms of an intracranial venous thrombosis?
Generalised symptoms – raised ICP, headache, nausea and vomiting, seizures and focal neurological signs.
How does a sagittal venous thrombosis present?
Sagittal is most common presenting with headache, vomiting, seizures, hemiplegia, reduced vision and Papilloedema
How does a transverse venous thrombosis present?
Transverse presents with headache, mastoid pain, focal CNS signs, seizures and Papilloedema
How does a sigmoid venous thrombosis present?
Sigmoid presents with cerebellar signs and lower cranial nerve palsies
How does an inferior petrosal venous thrombosis present?
Inferior petrosal sinus presents with CNV and CNVI palsies with temporal and retro-orbital pain
How does a cavernous sinus venous thrombosis present?
Cavernous sinus – often due to spread from facial pustules or folliculitis presenting with headache, chemosis, proptosis, painful ophthalmoplegia and fever. 6th nerve damage usually occurs before 3rd and 4th.
How does a cortical venous thrombosis present?
Causes stroke like focal symptoms that come about over days. Often seizures and an associated headache which may come on suddenly e.g. thunderclap headache.
Most commonly presents with raised ICP, seizures and focal neurological signs
What is the most common cause of a cortical vein thrombosis?
Usually occurs due to a sinus thrombosis as it extends into the veins.
What causes large thrombosis formation in the brain?
Usually due to being in a prothrombotic state e.g. Thrombophilia, pregnancy/puerperium, combined OCP, head injury, dehydration, tumours, extracranial malignancy, infections (meningitis, abscesses, otitis media, cerebral malaria and TB), drugs, SLE and vasculitis.
How should a suspected venous sinus thrombosis be investigated?
CT/MRI venography
D-dimer
Thrombophilia screen
How are intracranial venous thrombosis managed?
Anticoagulation
Rarely thrombolysis or thrombectomy
