Cerebral vein thrombosis

Advances in neuroimaging have modified our knowledge on cerebral vein thrombosis (CVT). This disease is now diagnosed more frequently, and increasing evidence as to what are the most common risk factors and on the natural history of the disease is becoming available. Most patients with CVT have a benign prognosis: only a minority of patients die during the acute phase or in the following months. Most patients surviving CVT recover completely, or have only mild functional or cognitive deficits. Unfractionated or low-molecular weight heparin is widely used as a first-line therapy of CVT, despite the absence of conclusive evidence about the safety and efficacy in this setting. Vitamin K antagonists are usually prescribed for secondary prevention, but the optimal duration of treatment remains unknown. Because most patients with CVT have partial or complete recanalization of the vessels within the first few months after the index event, and because recurrences of CVT after a first episode appear to be uncommon, routine use of long-term therapy or event life-long secondary prevention seem to be unnecessary.