Search
Cerebral Venous Sinus Thrombosis (CVST)
An uncommon but very serious entity that leads to three distinct types of presentations:
- Headache
- Seizures
- Stroke
Caused by thrombosis of one of the intracerebral venous sinuses (most commonly the transverse sinus) The major risk factor is hypercoagulable disease. May be the underlying cause of a majority of cases of idiopathic intracranial hypertension.
When to suspect:
- Headache with negative CT, negative LP, but high opening pressure
- In any patient with new onset idiopathic intracranial hypertension (i.e. pseudotumor cerebri). Can't be formally diagnosed without a negative MRI.
- Stroke syndrome that doesn't quite fit. May see bilateral infarcts in the posterior regions. These are actually venous infarcts secondary to the sinus thrombosis.
Diagnosis:
- Just like a lot of other things in medicine, "If you don't think about it, you can't diagnose it."
- 1 in 3 head CT scans will be normal
- MRI with MRV (venous phase) is the diagnostic standard
Treat:
- Anticoagulation with heparin then warfarin