HWN Suggests

Cerebral Venous Sinus Thrombosis: The Forgotten Headache

Cerebral venous sinus thrombosis (CVST) is becoming recognized as a more common and treatable disorder in young patients. Unfortunately, headaches are overwhelmingly common complaints in the emergency department (ED), so CVST can be easy to miss since it has confusing clinical and imaging findings... While it only represents about 1% of all strokes, its higher proportion of stroke in young patients makes it more relevant to the EM provider. Interestingly, an incidence of 9.3% of CVST was found on a pathology study, suggesting it is very under diagnosed in the ED.

Risk factors

The most clear cut risk factors for CVST are hypercoagulable states. This category…

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Featured

  CNS Compartment Syndrome: Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) is a thrombotic disease of the cerebral veins and major dural sinuses. It is a rare kind of venous thromboembolism and can also be thought of as a type of stroke. Recently, thromboembolic events, including CVT, have been increasingly reported in COVID-19 patients. They tended to have thrombosis of deeper veins and sinuses and many had fatal outcomes.

  Treatment and Management of Venous Sinus Thrombosis

MRI in combination with time-of-flight or contrast enhanced MR venography (MRV)  highly sensitive for the diagnosis CVST. CT Venography (CTV) - Suboptimal for thrombosis in deep venous structures and cortical veins

  Cerebral Venous Thrombosis: A rapid review

Cerebral venous thrombosis tends to present in younger patients, with a mean age of 39 years, and 80% of patients presenting under the age of 50. It is 3 times more common in females than males, although that disparity disappears in older patients, in whom cancer is the primary risk factor. Up to 90% of patients with cerebral vein thrombosis have at least one risk factor for venous thromboembolism.

 AstraZeneca Vaccine and Blood Clots: What Is Known So Far

In rare cases, an immune reaction has led to antibodies that caused a serious clotting disorder. But public health experts maintain the vaccine’s benefits far outweigh the risks for most people.

 Headache post AZ vaccine. How do we spot cerebral venous thrombosis?

CVT will most commonly present with a headache due to raised intracranial pressure and this is present in 90% of cases. It may be the only manifestation in 25% of cases. Unfortunately, CVT related headache does not have specific diagnostic features, although it is usually gradual onset and progressive.

 Johnson & Johnson Vaccine And Blood Clots: What You Need To Know

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Articles of Interest

CVST in Pregnancy

The significantly increased risk during pregnancy and in the peripartum period can be explained by pregnancy-induced hematologic changes, which continue for 6 to 8 weeks postpartum.

Staying Positive Through My Experience With CVST: Maddie's Story

I tell my story nearly two years and two brain surgeries later to remind patients to advocate for themselves when visiting the ER,

Cerebral Venous Sinus Thrombosis: An Uncommon Etiology of Stroke

Cerebral venous sinus thrombosis (CVST) accounts for ~1% of cases of stroke. More common in women, CVST is of particular interest because pregnancy and the puerperal period place women at increased risk.

Cerebral Venous Thrombosis Across the Ages

Amongst the clinical symptoms from CVT, headaches retained the majority among both age groups. However, the report of headache at presentation was not as common in the older patients (62.9%) as compared with the younger patients (87.4%). The remainder of symptoms like neurological deficits, seizures or coma were not significantly different. Another notable difference between the age groups was increased use of hormonal therapy in the older patients. Lastly, history of cancer was markedly more in the older patients...

How to Spot and Treat Cerebral Venous Sinus Thrombosis

There is a female predominance, with roughly a 3:1 female-to-male ratio, which is influenced by gender-specific factors such as oral contraceptive use, pregnancy, puerperium, and hormonal replacement therapy. Also, women have a better prognosis when CVST is attributable to those factors.

Reflecting on Cerebral Venous Sinus Thrombosis, and the U.S. Presidential Election

The most common initial symptoms of CVST are headache, visual changes, and/or seizure. A headache that continues to escalate for days to weeks, especially in a patient taking birth control pills, who is pregnant, or who has a history of abnormal clotting should undergo MRI of the brain.

Septic venous thrombosis as an unexpected complication of acute suppurative otitis media. case report

Thrombosis of cerebral venous sines (CVT) is considered difficult to diagnose due to the wide variety of signs and symptoms that can simulate a large number of other entities, it is important to have this diagnosis always present, and it is essential that after the diagnostic suspicion we can carry out a timely study through non-invasive imaging studies

Resources

Core EM

CVT often presents with non-specific symptoms making it difficult to diagnose. On first presentation, patients often do not have any physical exam findings.

EMCrit Project

Gadolinium allows for direct visualization of luminal filling, similar to a CT venogram. Thus, contrast MR venography is highly accurate, on par with CT venogram.

Life in the Fastlane

CVT is a rare condition (~1% of all strokes) that is more common in females (x3 risk) and younger adults (80% <50 years-old)

Pediatric EM Morsels

Thinking a patient has idiopathic intracranial hypertension (i.e., pseudotumor), check MRV when you get the MRI… there may be an associated Cerebral Venous Thrombosis!

Taming the SRU

CVT accounts for approximately 1% of all neurovascular disease and is three times more likely in women. This female predominance is likely due to hypercoagulability secondary to pregnancy/puerperium and oral contraceptives. CVT is more common in young patients, with 80% of patients under the age of 50 and a median age of 39 years.

CVST in Pregnancy

The significantly increased risk during pregnancy and in the peripartum period can be explained by pregnancy-induced hematologic changes, which continue for 6 to 8 weeks postpartum.