Educational scope notice: This is a study note for medical students, not medical advice, diagnosis, or treatment guidance. Clinical management should follow local protocols and current guidelines.
Cerebral venous thrombosis is clot in the dural sinuses or cerebral veins rather than in an artery. Blocked venous drainage congests the brain downstream, producing infarction, hemorrhage, or both without any arterial occlusion. It is an uncommon stroke form, accounting for 0.5% to 1% of all strokes, and usually affects young people. It explains about 5% of intracerebral hemorrhage cases in young people.
Diagnosis
Presentation varies with the sinus involved and may include headache, seizures, focal deficits, or hemorrhage in an atypical distribution. Diagnosis is confirmed by MR or CT venography showing the occluded sinus or vein.
Treatment
Acute treatment is parenteral anticoagulation, with low-molecular-weight heparin preferred in the acute phase. The 2017 European position did not recommend routine direct oral anticoagulants, a position stated as of that review rather than as an absolute ban. Intracranial hemorrhage caused by the venous thrombosis itself is not a contraindication to anticoagulation. The clot is the cause of the bleed, so treating the clot treats the bleed.
Evidence anchors
- AHA Statement: Diagnosis and Management of Cerebral Venous Thrombosis: https://www.ahajournals.org/doi/10.1161/str.0b013e31820a8364
- ESO 2017 Guideline: Diagnosis and treatment of cerebral venous thrombosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC6454824/