Diagnosis and treatment of cerebral venous thrombosis

Abstract

Dural sinus or cerebral venous thrombosis (CVT) is a frequently unrecognized cause of stroke affecting predominantly young women. Typical clinical signs include headache, visual problems and seizures. Both computed tomography and magnetic resonance venous angiography are suitable for the detection of CVT, although magnetic resonance angiography is more sensitive to detect small cortical venous thrombosis. Evidence for efficacy of initial treatment with heparin in acute CVT comes from two randomized placebo-controlled studies that together included 79 patients. Although not evidence-based, postacute treatment with oral anticoagulation is recommended for up to 12 months after CVT. Long-term anticoagulation is recommended only in patients suffering from a severe coagulopathy or with recurrent CVT.

Keywords::

• anticoagulation
• cerebral hemorrhage
• cerebral venous thrombosis
• factor Xa inhibitors
• secondary prevention
• sinus thrombosis
• thrombin inhibitors
• venous infarction
• warfarin

Financial & competing interests disclosure

C Weimar has received honoraria for participation in clinical ­trials, contribution to advisory boards or oral presentations from: Bayer Pharma, Boehringer Ingelheim, Bristol-Myers Squibb, CoAxia, D-Pharm, Daiichi Asubio, GlaxoSmithKline, Lundbeck, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk and Sanofi-Aventis. C Weimar has no ownership interest and does not own stocks of any pharmaceutical company exceeding €10,000. F Masuhr received honoraria for oral presentations from: Bayer Pharma, Boehringer Ingelheim, Daiichi Sankyo and Sanofi-Aventis. F Masuhr has no ownership interest and does not own stocks of any pharmaceutical company exceeding €10,000. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.