Cerebral Venous Thrombosis in Adults

Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease in which thrombus forms in the dural sinuses and cortical cerebral veins. Raised venous pressure causes venous infarction, intracranial haemorrhage and the syndrome of intracranial hypertension. The inconsistent speed of onset and overlap of clinical syndromes mean that presentation is highly variable but often includes headache, focal neurological deficits and encephalopathy. Although a variety of congenital and acquired precipitants have been implicated, gender-specific risk factors including pregnancy, the puerperium and oral contraceptive use lead to CVT being more common in younger females. Neuroimaging is required for diagnosis, with magnetic resonance venography (MRV) and computed tomography venography (CTV) both being viable options, each with advantages and disadvantages. Anticoagulation is the mainstay of treatment with emerging evidence of benefit from randomised controlled trials. Endovascular intervention also offers therapeutic options for patients with a poor prognosis and surgery for impending cerebral herniation may result in good functional outcomes. Prognosis is good with the majority of patients making a full recovery and with a low recurrence rate.