Acute cerebral venous stroke

Abstract

Cerebral venous thrombosis (CVT) is a rare and likely underdiagnosed vascular cause of acute neurological deterioration that requires a high index of suspicion, accurate history, and proper imaging interpretation for prompt diagnosis. Clinical signs and symptoms are often nonspecific and are secondary to increased intracranial pressure and/or focal injury from venous stasis or occlusion. Numerous risk factors have been associated with the development of cerebral venous thrombosis and infarction, with the most common being puerperium, certain medications, and thrombophilia. Magnetic resonance imaging (MRI) with a venogram (MRV) is currently the diagnostic imaging modality of choice given its higher sensitivity in CVT detection. Acute therapy includes anticoagulation with IV heparin or subcutaneous low-molecular-weight heparin, which is later transitioned to oral anticoagulation therapy of variable duration. Refractory cases may require catheter-directed thrombolysis or thrombectomy. Multiple complications are possible, especially during the early stages of the disease, including seizures, increased intracranial pressure, and hydrocephalus. This chapter reviews the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of this relatively uncommon, but potentially disabling and life-threatening condition.