Cerebral venous thrombosis: a practical review

The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases. Lay summary: Cerebral venous thrombosis (CVT) is the clot formation in the brain's veins and blood-draining channels, which are located between the brain and skull. CVT is more common in women and young people. The risk factors of CVT are pregnancy, after-childbirth period, the pills, head injury dehydration, cancers, infections, inflammation of the vessels, and blood disorders that enhance clot formation. The association of CVT and COVID-19 vaccines has been very rare. Suppose you have sudden, severe, and ongoing headaches. In that case, particularly if they become worse with lying down and coughing or breath-holding, it is better to be seen by a medical professional for the exclusion of CVT. Other symptoms of CVT are seizures, blurred vision, and weakness or numbness of one or both sides of the body. CT, MRI, and some blood tests make the diagnosis of CVT. The management of CVT includes treatment of underlying diseases, easing the symptoms, and blood thinners. Surgery is indicated in the most severe forms with the danger of impending death.