Cerebral Venous Thrombosis
This article focuses on Cerebral Venous Thrombosis (CVT), highlighting its increasing recognition due to advanced MRI technology and heightened clinical awareness. It discusses the mechanisms, risk factors, symptoms, and the crucial diagnostic procedures for CVT. The article also details the comprehensive treatment approach, which includes anticoagulation therapy and management of elevated intracranial pressure, along with long-term treatment considerations and seizure prophylaxis.
2023-12-31 19:26:32 - Editor
Recognition of Cerebral Venous Thrombosis
Cerebral venous thrombosis (CVT) is currently recognized with increasing frequency due to the widespread use of MRI and rising clinical awareness. There are at least two different mechanisms which contribute to CVT include thrombosis that obstructs blood drainage from brain tissue, leading to cerebral parenchymal dysfunction, and occlusion of dural sinus resulting in decreased cerebrospinal fluid (CSF) absorption and hence increased intracranial pressure.
Risk Factors and Symptoms of CVT
The most frequent risk factors for CVT are prothrombotic conditions (genetic or acquired thrombophilia), oral contraceptives, malignancy, pregnancy related, and head injury. Symptoms include increased intracranial pressure (headache with or without vomiting, papilledema, and visual problems), focal neurological symptoms, seizures, or encephalopathy (mental status changes, stupor, or coma). Urgent neuroimaging with brain MRI and magnetic resonance venography (MRV) are often required.
Treatment of Cerebral Venous Thrombosis
While the overall aim of treatment for CVT is to improve outcome, the immediate goals of treatment for CVT are to recanalize the occluded sinus, to prevent the propagation of the thrombus, namely to the bridging cerebral veins and to treat the underlying prothrombotic state, in order to prevent venous thrombosis in other parts of the body, particularly pulmonary embolism, and to prevent the recurrence of CVT.
Long-Term Management and Seizure Prophylaxis
For patients with recurrent CVT, long term anticoagulation is advisable with oral anticoagulation with either warfarin (dose is guided by INR 2-3), or dabigatran (150 mg twice daily). Also, elevated intracranial pressure and herniation may cause transtentorial herniation and death.
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