Cerebral venous and sinusthrombosis

Abstract. Cerebral venous and sinus thrombosis (CVST) can presentwith a variety of clinical symptoms ranging from isolatedheadache to deep coma. Prognosis is better than previouslythought and prospective studies have reported an independentsurvival of more than 80% of patients. Although it may bedifficult to predict recovery in an individual patient, clinicalpresentation on hospital admission and the results ofneuroimaging investigations are—apart from the underlyingcondition—the most important prognostic factors. Comatosepatients with intracranial haemorrhage (ICH) on admission brainscan carry the highest risk of a fatal outcome. Availabletreatment data from controlled trials favour the use ofanticoagulation (AC) as the first-line therapy of CVST becauseit may reduce the risk of a fatal outcome and severe disabilityand does not promote ICH. A few patients deteriorate despiseadequate AC which may warrant the use of more aggressivetreatment modalities such as local thrombolysis. The risk ofrecurrence is low (< 10%) and most relapses occur within thefirst 12 months. Analogous to patients with extracerebral venousthrombosis, oral AC is usually continued for 3 months afteridiopathic CVST and for 6–12 months in patients with inheritedor acquired thrombophilia but controlled data proving thebenefit of long-term AC in patients with CVST are notavailable.Abbreviations CVST cerebral venous and sinus thrombosis - aPTT activated partial thromboplastin time - IU international units - INR international normalized ratio - AED antiepileptic drug - ICP intracranial pressure - mOsm/kg milliosmole per kilogram