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Cerebral Venous Sinus Thrombosis

CVST is a thrombotic obstruction of the cerebral venous system, leading to ischaemic lesions or haemorrhages in the brain.

Types

  • Transverse sinus thrombosis

  • Superior sagittal sinus thrombosis

  • Septic cerebral venous thrombosis - a subtype of CVST of infectious origin

  • Cavernous sinus thrombosis - a rare subtype of CVST, typically septic in origin, that is associated with cavernous sinus syndrome


Causes

  • Hypercoagulable state

  • Head injury

  • Neurosurgical procedures e.g. LP

  • Sepsis due to infections in mid-face, sinuses, ears, teeth, or mouth - acute sinusitis is the most common preceding infection


Presentation

  • Headache - most common symptom, and tends to be more progressive than sudden/acute

  • Signs of raised intracranial pressure - Bilateral papilloedema, Visual impairment (diplopia, vision loss), N+V, Seizures

  • Cavernous sinus syndrome - Diplopia, tinnitus, unilateral deafness, facial palsy

  • Meningism - headache, vomiting, and nuchal rigidity


N.B. Must be differentiated from meningitis. Abx should be started immediately once suspected in either case as it has the greatest effect on prognosis.


Investigations

  • MRI - 1st line

  • CT

  • Blood cultures

“Sinus vein thrombosis in computed tomography without contrast agent (left) and in magnetic resonance imaging T1 with contrast agent (right) same case.” © Hellerhoff CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Management

  • Anticoagulation w/UFH

  • Abx if septic (1st line is Vancomycin + Ceftriaxone)

  • Surgical intervention



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