Cerebral venous thrombosis - Revision history

Benalexander: /* Neurodefecits */ correct typo

2025-08-22T18:23:22Z

Neurodefecits: correct typo

← Older revision		Revision as of 18:23, 22 August 2025
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	[[File:sinus thrombosis.jpg\|thumbnail]]		[[File:sinus thrombosis.jpg\|thumbnail]]

	===[[focal neuro deficits\|~~Neurodefecits~~]]===		===[[focal neuro deficits\|Neurodeficits]]===
	Although presentation can be highly variable, neuro deficits can be correlated with the location of the occlusion<ref name=NEJM></ref>		Although presentation can be highly variable, neuro deficits can be correlated with the location of the occlusion<ref name=NEJM></ref>
	*'''Superior Sagital sinus'''		*'''Superior Sagital sinus'''

Jonrako: /* Neurodefecits */

2021-07-29T20:32:10Z

Neurodefecits

← Older revision		Revision as of 20:32, 29 July 2021
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	===[[focal neuro deficits\|Neurodefecits]]===		===[[focal neuro deficits\|Neurodefecits]]===
	Although presentation can be highly variable, neuro deficits can be correlated with the location of the occlusion<ref name=NEJM></ref>		Although presentation can be highly variable, neuro deficits can be correlated with the location of the occlusion<ref name=NEJM></ref>
	*'''Superior Sagital sinus''' -		*'''Superior Sagital sinus'''
	**[[weakness\|motor deficits]]		**[[weakness\|motor deficits]]
	***Paresis of one or both legs or hemiparesis from infarction in the frontoparietal regions surrounding the vein of Trolard<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>		***Paresis of one or both legs or hemiparesis from infarction in the frontoparietal regions surrounding the vein of Trolard<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>
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	***CN palsy of 3,4, and 6 as well as the ophthalmic and maxillary divisions of the 5th cranial nerve.		***CN palsy of 3,4, and 6 as well as the ophthalmic and maxillary divisions of the 5th cranial nerve.
	*'''Deep venous sinus'''		*'''Deep venous sinus'''
	**Drowsiness or stupor from bilateral thalamic dysfunction and obstructive hydrocephalus.		**Drowsiness or stupor from bilateral thalamic dysfunction and obstructive hydrocephalus.

	==Differential Diagnosis==		==Differential Diagnosis==

Jonrako at 20:29, 29 July 2021

2021-07-29T20:29:45Z

← Older revision		Revision as of 20:29, 29 July 2021
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	**Sickle cell		**Sickle cell
	**Factor V Lediden		**Factor V Lediden
	**Protein S & ~~protein~~ C deficiency		**Protein S & C deficiency
	**Hyperhomocysteinemia		**Hyperhomocysteinemia
	**Behcets syndrome		**Behcets syndrome
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	*[[Headache]] 74-92%		*[[Headache]] 74-92%
	**Usually progresses during a period of hours or days to severe aching or throbbing over the entire cranium, bifrontally, or at the vertex.		**Usually progresses during a period of hours or days to severe aching or throbbing over the entire cranium, bifrontally, or at the vertex.
	***Pain at the vertex of the cranium is infrequent but more specific.<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545~~</ref>~~</ref>		***Pain at the vertex of the cranium is infrequent but more specific.<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>
	**Coughing, bending over, or head movements tend to worsen headaches.		**Coughing, bending over, or head movements tend to worsen headaches.
	*[[Seizures]] 35-50%		*[[Seizures]] 35-50%
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	*Focal neurologic sequelae		*Focal neurologic sequelae
	**Occurs hours to days after headache in about half of patients		**Occurs hours to days after headache in about half of patients
	**Paresis of one or both legs or hemiparesis from infarction in the frontoparietal regions surrounding the vein of Trolard
	**Aphasia and confusion from infarction in the temporal lobe surrounding the vein of Labbe
	**CN palsy of 3,4, and 6 as well as the ophthalmic and maxillary divisions of the 5th cranial nerve.
	**[[dizziness]]) 25-71%		**[[dizziness]]) 25-71%
	*[[Encephalopathy]]		*[[Encephalopathy]]
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	===[[focal neuro deficits\|Neurodefecits]]===		===[[focal neuro deficits\|Neurodefecits]]===
	Although presentation can be highly variable, ~~neurodefecits~~ can be correlated with the location of the occlusion<ref name=NEJM></ref>		Although presentation can be highly variable, neuro deficits can be correlated with the location of the occlusion<ref name=NEJM></ref>
	*'''Superior Sagital sinus''' - [[weakness\|motor deficits]], ~~seizures~~		*'''Superior Sagital sinus''' -
	*'''Left transverse sinus''' ~~- aphasia~~		**[[weakness\|motor deficits]]
	*'''[[cavernous sinus thrombosis\|Cavernous sinus]]''' - [[eye pain\|ocular pain]], [[proptosis]], oculomotor palsies'''		***Paresis of one or both legs or hemiparesis from infarction in the frontoparietal regions surrounding the vein of Trolard<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>
	*'''Deep venous sinus''' -thalamic and ~~basal ganglia related symptoms such as [[altered mental status]]~~		**Seizures
			*'''Left transverse sinus'''
			**Aphasia and confusion from infarction in the temporal lobe surrounding the vein of Labbe<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>
			*'''[[cavernous sinus thrombosis\|Cavernous sinus]]'''
			**[[eye pain\|ocular pain]], [[proptosis]], oculomotor palsies'''
			***CN palsy of 3,4, and 6 as well as the ophthalmic and maxillary divisions of the 5th cranial nerve.
			*'''Deep venous sinus'''
			**Drowsiness or stupor from bilateral thalamic dysfunction and obstructive hydrocephalus.

	==Differential Diagnosis==		==Differential Diagnosis==

Jonrako at 20:17, 29 July 2021

2021-07-29T20:17:10Z

← Older revision		Revision as of 20:17, 29 July 2021
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	*[[Headache]] 74-92%		*[[Headache]] 74-92%
	**Usually progresses during a period of hours or days to severe aching or throbbing over the entire cranium, bifrontally, or at the vertex.		**Usually progresses during a period of hours or days to severe aching or throbbing over the entire cranium, bifrontally, or at the vertex.
	***Pain at the vertex of the cranium is infrequent but more specific. ~~<ref>~~<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref></ref>		***Pain at the vertex of the cranium is infrequent but more specific.<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref></ref>
	**Coughing, bending over, or head movements tend to worsen headaches.		**Coughing, bending over, or head movements tend to worsen headaches.
	*[[Seizures]] 35-50%		*[[Seizures]] 35-50%

Jonrako: /* Common Symptoms */

2021-07-29T20:15:01Z

Common Symptoms

← Older revision		Revision as of 20:15, 29 July 2021
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	''Symptoms are variable and may not all be present<ref name="NEJM>Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005;352:1791–8.</ref>		''Symptoms are variable and may not all be present<ref name="NEJM>Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005;352:1791–8.</ref>
	*[[Headache]] 74-92%		*[[Headache]] 74-92%
	** ~~Progressive~~, ~~diffuse~~		**Usually progresses during a period of hours or days to severe aching or throbbing over the entire cranium, bifrontally, or at the vertex.
			***Pain at the vertex of the cranium is infrequent but more specific. <ref><ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref></ref>
			**Coughing, bending over, or head movements tend to worsen headaches.
	*[[Seizures]] 35-50%		*[[Seizures]] 35-50%
			**Usually focal convulsions
	*[[Papilledema]] 28-45%		*[[Papilledema]] 28-45%
	*Focal neurologic sequelae ~~(seizures~~, [[dizziness]]) 25-71%		*Focal neurologic sequelae
			**Occurs hours to days after headache in about half of patients
			**Paresis of one or both legs or hemiparesis from infarction in the frontoparietal regions surrounding the vein of Trolard
			**Aphasia and confusion from infarction in the temporal lobe surrounding the vein of Labbe
			**CN palsy of 3,4, and 6 as well as the ophthalmic and maxillary divisions of the 5th cranial nerve.
			**[[dizziness]]) 25-71%
	*[[Encephalopathy]]		*[[Encephalopathy]]
	[[File:sinus thrombosis.jpg\|thumbnail]]		[[File:sinus thrombosis.jpg\|thumbnail]]

	===[[focal neuro deficits\|Neurodefecits]]===		===[[focal neuro deficits\|Neurodefecits]]===
	Although presentation can be highly variable, neurodefecits can be correlated with the location of the occlusion<ref name=NEJM></ref>		Although presentation can be highly variable, neurodefecits can be correlated with the location of the occlusion<ref name=NEJM></ref>

Jonrako at 19:29, 29 July 2021

2021-07-29T19:29:57Z

← Older revision		Revision as of 19:29, 29 July 2021
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	*Female:Male ratio 3:1<ref name="lancet"></ref>		*Female:Male ratio 3:1<ref name="lancet"></ref>

	===Predisposing factors===~~<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>~~		===Predisposing factors===
	*Mainly a diverse group of hypercoagulable states		*Mainly a diverse group of hypercoagulable states
	**Cancer		**Cancer
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	**Behcets syndrome		**Behcets syndrome
	*Severe dehydration in infants and children, mainly in developing countries.		*Severe dehydration in infants and children, mainly in developing countries.
	*COVID-19 vaccines (rare)		*COVID-19 vaccines (rare)<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>
	**1 per 1,000,000 for the Ad26.COV2.S (Johnson & Johnson And Janssen brands)		**1 per 1,000,000 for the Ad26.COV2.S (Johnson & Johnson And Janssen brands)
	**1 per 100,000 for the ChAdOx1 nCoV-19 (AstraZeneca brand)		**1 per 100,000 for the ChAdOx1 nCoV-19 (AstraZeneca brand)

Jonrako: /* Predisposing factors */

2021-07-29T19:29:04Z

Predisposing factors

← Older revision		Revision as of 19:29, 29 July 2021
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	*Female:Male ratio 3:1<ref name="lancet"></ref>		*Female:Male ratio 3:1<ref name="lancet"></ref>

	===Predisposing factors===		===Predisposing factors===<ref>Ropper, A. H., & Klein, J. P. (2021). Cerebral Venous Thrombosis. New England Journal of Medicine, 385(1), 59–64. https://doi.org/10.1056/nejmra2106545</ref>
	*Mainly a diverse group of hypercoagulable states		*Mainly a diverse group of hypercoagulable states
	**Cancer		**Cancer
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	*Local infections ([[otitis media]], [[sinusitis]], [[cellulitis]], [[dental problems\|dental infections]])		*Local infections ([[otitis media]], [[sinusitis]], [[cellulitis]], [[dental problems\|dental infections]])
	**Mastoiditis common cause in developing countries.		**Mastoiditis common cause in developing countries.
	*Direct cranial[[Trauma]] & neurosurgical procedures		*Direct cranial [[Trauma]] & neurosurgical procedures
	*Compression of venous sinus ([[brain tumor\|tumor]], [[brain abscess\|abscess]])		*Compression of venous sinus ([[brain tumor\|tumor]], [[brain abscess\|abscess]])

Jonrako: /* Predisposing factors */

2021-07-29T19:23:36Z

Predisposing factors

← Older revision		Revision as of 19:23, 29 July 2021
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	===Predisposing factors===		===Predisposing factors===
	*Cancer		*Mainly a diverse group of hypercoagulable states
	*[[Pregnancy]] (up to 6 weeks post-partum)		**Cancer
			***Leukemia
			***Adenocarcinoma
			**[[Pregnancy]] (up to 6 weeks post-partum)
			**Polycythemia Vera
			**Sickle cell
			**Factor V Lediden
			**Protein S & protein C deficiency
			**Hyperhomocysteinemia
			**Behcets syndrome
			*Severe dehydration in infants and children, mainly in developing countries.
			*COVID-19 vaccines (rare)
			**1 per 1,000,000 for the Ad26.COV2.S (Johnson & Johnson And Janssen brands)
			**1 per 100,000 for the ChAdOx1 nCoV-19 (AstraZeneca brand)
	*Local infections ([[otitis media]], [[sinusitis]], [[cellulitis]], [[dental problems\|dental infections]])		*Local infections ([[otitis media]], [[sinusitis]], [[cellulitis]], [[dental problems\|dental infections]])
	*~~Hypercoagulable states~~		**Mastoiditis common cause in developing countries.
	*[[Trauma]]		*Direct cranial[[Trauma]] & neurosurgical procedures
	*Drugs ([[ecstasy]], androgens, OCPs)
	*Compression of venous sinus ([[brain tumor\|tumor]], [[brain abscess\|abscess]])		*Compression of venous sinus ([[brain tumor\|tumor]], [[brain abscess\|abscess]])

Elcatracho: /* Imaging */

2021-02-10T02:53:28Z

Imaging

← Older revision		Revision as of 02:53, 10 February 2021
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	**Vein Sign: After two weeks, the thrombus becomes hypoattenuated. When the thrombus is located in the deep vein it is referred to as the vein sign. <ref>Linn J, Pfefferkorn T. "Noncontrast CT in Deep Cerebral Venous Thrombosis and Sinus Thrombosis: Comparison of Its Diagnostic Value for Both Entities."AJNR Am J Neuroradiology. 2010; 30: 728-735. </ref>		**Vein Sign: After two weeks, the thrombus becomes hypoattenuated. When the thrombus is located in the deep vein it is referred to as the vein sign. <ref>Linn J, Pfefferkorn T. "Noncontrast CT in Deep Cerebral Venous Thrombosis and Sinus Thrombosis: Comparison of Its Diagnostic Value for Both Entities."AJNR Am J Neuroradiology. 2010; 30: 728-735. </ref>
	*Non contrast [[head CT\|CT]] possesses insufficient sensitivity or specificity to be of diagnostic value in the setting of high clinical suspicion		*Non contrast [[head CT\|CT]] possesses insufficient sensitivity or specificity to be of diagnostic value in the setting of high clinical suspicion
			**May see "dense delta sign" (hyperattenuation consistent with thrombus in the posterior sagittal sinus)

	===Labs===		===Labs===

Elcatracho: /* Labs */

2021-01-27T16:03:44Z

Labs

← Older revision		Revision as of 16:03, 27 January 2021
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	===Labs===		===Labs===
	*[[D-Dimer]] is not a reliable test to rule out a cerebral venous thrombosis<ref>Crassard I, Soria C, Tzourio C, Woimant F, Drouet L, Ducros A, Bousser MG. A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients. Stroke 2005;36:1716 –1719.</ref>		*[[D-Dimer]] is not a reliable test to rule out a cerebral venous thrombosis<ref>Crassard I, Soria C, Tzourio C, Woimant F, Drouet L, Ducros A, Bousser MG. A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients. Stroke 2005;36:1716 –1719.</ref><ref>Kristoffersen ES, Harper CE, Vetvik KG, Faiz KW. Cerebral venous thrombosis – epidemiology, diagnosis and treatment. Cerebral venetrombose – forekomst, diagnostikk og behandling. Tidsskr Nor Laegeforen. 2018;138(12):10.4045/tidsskr.17.1047. Published 2018 Aug 20. doi:10.4045/tidsskr.17.1047</ref>
	*In patients with a concern for [[meningitis]] then pursue diagnosis via standard workup which includes a [[CT before lumbar puncture]]		*In patients with a concern for [[meningitis]] then pursue diagnosis via standard workup which includes a [[CT before lumbar puncture]]