Cerebral Venous Thrombosis: Reviewing Pathophysiology, Diagnosis, and Treatment Strategies

Abstract

This review discusses cerebral venous thrombosis (CVT), including diagnosis and treatment strategies, a rare class of stroke that, if unrecognized or untreated, can have devastating effects. Thrombosis of one or many cerebral veins leads to propagation of thrombosis and impaired cerebral venous drainage. Diagnosis is made using a combination of history and imaging, particularly computed tomography (CT) venogram, which demonstrates thrombosis. Currently, acute treatment consists of heparin infusion with transition to long-term oral anticoagulation. Further research, especially on prevention, endovascular therapy, and the role of newer anticoagulants (direct oral anticoagulants [DOACs]) is necessary and ongoing.

Keywords

cerebral venous thrombosis - anticoagulation - venous hemorrhage

• References

• 1 Ferro JM, Canhao P. Cerebral Venous Thrombosis: Treatment and Prognosis. Up to Date. Available at: https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis?search=cerebral%20venous%20 thrombosis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Accessed December 19, 2018
• 2 Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet 2009; 3739658: 155-166
• 3 Yousem DM, Grossman RI. Neuroradiology: The Requisites. 3rd ed.. Philadelphia, PA: Mosby Elsevier; 2010
• 4 Devenney E, Neale H, Forbes RB. A systematic review of causes of sudden and severe headache (thunderclap headache): should lists be evidence based?. J Headache Pain 2014; 15: 49
• 5 Saposnik G, Barinagarrementeria F, Brown Jr RD. et al; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (04) 1158-1192
• 6 Kang MK, Cho YD, Kang HS, Jung KH. Development of a dural arteriovenous fistula subsequent to cerebral venous thrombosis by venous hypertension. eNeurological Sci 2018; 14: 24-27
• 7 Gelston CD, Durairaj VD, Simoes EA. Rhino-orbital mucormycosis causing cavernous sinus and internal carotid thrombosis treated with posaconazole. Arch Ophthalmol 2007; 125 (06) 848-849
• 8 Skuza A, Polak M, Undas A. Elevated lipoprotein(a) as a new risk factor of cerebral venous sinus thrombosis: association with fibrin clot properties. J Thromb Thrombolysis 2019; 47 (01) 8-15
• 9 Greenberg MS. Handbook of Neurosurgery. 7th ed.. New York, NY: Thieme Medical Publishers; 2010
• 10 Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35 (03) 664-670
• 11 Linn J, Pfefferkorn T, Ivanicova K. et al. Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. AJNR Am J Neuroradiol 2009; 30 (04) 728-735
• 12 Coutinho JM, Stam J. How to treat cerebral venous and sinus thrombosis. J Thromb Haemost 2010; 8 (05) 877-883
• 13 Torbey MT, Bösel J, Rhoney DH. et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care 2015; 22 (01) 146-164
• 14 Mokin M, Lopes DK, Binning MJ. et al. Endovascular treatment of cerebral venous thrombosis: contemporary multicenter experience. Interv Neuroradiol 2015; 21 (04) 520-526
• 15 Nimjee SM, Powers CJ, Kolls BJ, Smith T, Britz GW, Zomorodi AR. Endovascular treatment of venous sinus thrombosis: a case report and review of the literature. J Neurointerv Surg 2011; 3 (01) 30-33
• 16 Ferro JM, Crassard I, Coutinho JM. et al; Second International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT 2) Investigators. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 2011; 42 (10) 2825-2831
• 17 Ferro JM, Bousser MG, Canhão P. et al; European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24 (10) 1203-1213
• 18 Cappellari M, Bovi P. Direct oral anticoagulants in patients with cervical artery dissection and cerebral venous thrombosis. A case series and review of the literature. Int J Cardiol 2017; 244: 282-284
• 19 Covut F, Kewan T, Perez O, Flores M, Haddad A, Daw H. Apixaban and rivaroxaban in patients with cerebral venous thrombosis. Thromb Res 2019; 173: 77-78
• 20 Ferro JM, Dentali F, Coutinho JM. et al. Rationale, design, and protocol of a randomized controlled trial of the safety and efficacy of dabigatran etexilate versus dose-adjusted warfarin in patients with cerebral venous thrombosis. Int J Stroke 2018; 13 (07) 766-770
• 21 Piatek C, O'Connell CL, Liebman HA. Treating venous thromboembolism in patients with cancer. Expert Rev Hematol 2012; 5 (02) 201-209
• 22 Silvis SM, Hiltunen S, Lindgren E. et al. Cancer and risk of cerebral venous thrombosis: a case-control study. J Thromb Haemost 2018; 16 (01) 90-95
• 23 Lip GYH, Keshishian A, Li X. et al. Effectiveness and safety of oral anticoagulants among nonvalvular atrial fibrillation patients. Stroke 2018; 49 (12) 2933-2944