Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Cerebral venous thrombosis

Last updated: November 18, 2020

Summarytoggle arrow icon

Cerebral venous thrombosis (CVT) is a thrombotic obstruction of the cerebral venous system that can lead to ischemic lesions (or hemorrhages) in the brain. The condition can occur at any age and is often associated with a hypercoagulable state, a trigger (e.g., delivery, head injury, CNS instrumentation) or an infection (i.e., as in septic CVT). Women are affected more frequently than men, possibly as a result of the additional risk factors of pregnancy and oral contraceptive use. Cavernous sinus thrombosis is a rare subset of CVT that is most often due to infections in the paranasal region. Headache is the most common symptom of CVT and, depending on the size and location of the clot, may be accompanied by visual impairment, focal neurological deficits, seizures, or signs of raised intracranial pressure. Neuroimaging (MRI or CT venography) of the cerebral veins and dural sinus is used to establish the diagnosis. The mainstay of management is anticoagulation alongside the treatment of any potential underlying cause (e.g., antibiotics for septic CVT). Surgical intervention (e.g., endovascular thrombolysis or decompressive craniectomy) may be necessary in patients with significant symptoms who do not respond to anticoagulation.

  • Sex: > ; 3:1 [2][3][4]
  • Age: any age group (average age ∼ 40 years)
  • Incidence: 3–4 cases per million in adults; approx. 7 cases per million in children [1]

References:[1][3][5]

Epidemiological data refers to the US, unless otherwise specified.

Noninfectious [2][5][6][7]

Infectious [2][7][8]

References:[2][5][6][7][8]

Symptoms vary depending on the size and location of the thrombosis. They are often nonspecific and may be masked by the underlying disorder(s), necessitating a high degree of clinical suspicion. Patients may have any symptoms of increased ICP or cerebral ischemia. [2][9][10]

Since the thrombus develops gradually, clinical symptoms usually appear progressively and vary in magnitude.

Diagnosis of CVT is based on neuroimaging with venography. Laboratory studies can help identify underlying conditions (e.g., infections) and to assess baseline organ function prior to therapy. [11]

Neuroimaging [11][13][14]

Additional evaluation [9][11][13]

Initial management consists of general stabilization procedures (control of seizures, administration of fluids, treatment of intracranial hypertension) and treatment of the underlying cause. All patients require anticoagulation, and those with underlying infection require antimicrobial therapy; . Surgical intervention should be considered if there is no improvement with medical therapy.

Medical management [11][13]

Invasive procedures [11][13]

  1. Stam J. Thrombosis of the Cerebral Veins and Sinuses. N Engl J Med. 2005; 352 (17): p.1791-1798. doi: 10.1056/nejmra042354 . | Open in Read by QxMD
  2. Ferro JM, Canhão P, Stam J et al.. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004; 35 (3): p.664-70. doi: 10.1161/01.STR.0000117571.76197.26 . | Open in Read by QxMD
  3. Coutinho JM, Ferro JM, Canhão P, et al.. Cerebral venous and sinus thrombosis in women. Stroke. 2009; 40 (7): p.2356-61. doi: 10.1161/STROKEAHA.108.543884 . | Open in Read by QxMD
  4. Bousser M-G, Crassard I. Cerebral venous thrombosis, pregnancy and oral contraceptives. Thromb Res. 2012; 130 : p.S19-S22. doi: 10.1016/j.thromres.2012.08.264 . | Open in Read by QxMD
  5. Alvis-miranda HR, castellar-leones SM, Alcala-cerra G, moscote-salazar LR. Cerebral sinus venous thrombosis. Journal of Neurosciences in Rural Practice. 2013; 4 (4): p.427-38. doi: 10.4103/0976-3147.120236 . | Open in Read by QxMD
  6. Ferri FF. Ferri's Clinical Advisor 2015 E-Book. Elsevier Health Sciences ; 2014
  7. Goldman L, Schafer AI. Goldman-Cecil Medicine E-Book. Elsevier Health Sciences ; 2015
  8. Kate MP, Thomas B, Sylaja PN. Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature. F1000Res. 2014; 3 : p.41. doi: 10.12688/f1000research.3-41.v1 . | Open in Read by QxMD
  9. Schlossberg D. Clinical Infectious Disease. Cambridge University Press ; 2015
  10. McElveen WA. Cerebral Venous Thrombosis. In: Lutsep HL, Cerebral Venous Thrombosis. New York, NY: WebMD. http://emedicine.medscape.com/article/1162804. Updated: September 15, 2016. Accessed: December 28, 2016.
  11. Ferro JM, Canhão P. Etiology, clinical features, and diagnosis of cerebral venous thrombosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/etiology-clinical-features-and-diagnosis-of-cerebral-venous-thrombosis.Last updated: December 13, 2016. Accessed: December 28, 2016.
  12. Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology. 2016; 40 (6): p.263-276. doi: 10.1080/01658107.2016.1230138 . | Open in Read by QxMD
  13. Sasidharan PK. Cerebral Vein Thrombosis Misdiagnosed and Mismanaged. Thrombosis. 2012; 2012 : p.1-11. doi: 10.1155/2012/210676 . | Open in Read by QxMD
  14. Valeria Caso, Giancarlo Agnelli, Maurizio Paciaroni. Handbook on Cerebral Venous Thrombosis- Frontiers of Neurology and Neuroscience. Karger Medical and Scientific Publishers ; 2005
  15. Saposnik G, Barinagarrementeria F, Brown RD, et al. Diagnosis and Management of Cerebral Venous Thrombosis. Stroke. 2011; 42 (4): p.1158-1192. doi: 10.1161/str.0b013e31820a8364 . | Open in Read by QxMD
  16. Ferro JM, Canhão P, Bousser M-G, Stam J, Barinagarrementeria F. Early Seizures in Cerebral Vein and Dural Sinus Thrombosis. Stroke. 2008; 39 (4): p.1152-1158. doi: 10.1161/strokeaha.107.487363 . | Open in Read by QxMD
  17. Ferro JM, Bousser M-G, Canhão P, et al. 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): p.1203-1213. doi: 10.1111/ene.13381 . | Open in Read by QxMD
  18. Wasay M, Azeemuddin M. Neuroimaging of Cerebral Venous Thrombosis. Journal of Neuroimaging. 2005; 15 (2): p.118-128. doi: 10.1111/j.1552-6569.2005.tb00296.x . | Open in Read by QxMD
  19. Behrouzi R, Punter M. Diagnosis and management of cerebral venous thrombosis. Clin Med (Lond). 2018; 18 (1): p.75-79. doi: 10.7861/clinmedicine.18-1-75 . | Open in Read by QxMD
  20. Martin PJ, Enevoldson TP. Cerebral venous thrombosis.. Postgrad Med J. 1996; 72 (844): p.72-76. doi: 10.1136/pgmj.72.844.72 . | Open in Read by QxMD
  21. DENTALI F, SQUIZZATO A, MARCHESI C, BONZINI M, FERRO JM, AGENO W. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost. 2012; 10 (4): p.582-589. doi: 10.1111/j.1538-7836.2012.04637.x . | Open in Read by QxMD
  22. Daroff, RB; Aminoff, MJ. Encyclopedia of the Neurological Sciences. Academic Press ; 2014
  23. Xu W, Gao L, Li T, Shao A, Zhang J. Efficacy and risks of anticoagulation for cerebral venous thrombosis.. Medicine. 2018; 97 (20): p.e10506. doi: 10.1097/MD.0000000000010506 . | Open in Read by QxMD
  24. Ferro JM, Coutinho JM, Dentali F, et al. Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous Thrombosis. JAMA Neurol. 2019; 76 (12): p.1457. doi: 10.1001/jamaneurol.2019.2764 . | Open in Read by QxMD
  25. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases E-Book. Elsevier Health Sciences ; 2019
  26. Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin Therapeutic Guidelines: A Summary of Consensus Recommendations from the Infectious Diseases Society of America, the American Society of Health‐System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009; 49 (3): p.325-327. doi: 10.1086/600877 . | Open in Read by QxMD
  27. Reiss E, Shadomy HJ, Lyon GM. Fundamental Medical Mycology. John Wiley & Sons ; 2011
  28. Munjal M, Khurana AS. Fungal infections and cavernous sinus thrombosis.. Indian J Otolaryngol Head Neck Surg. 2004; 56 (3): p.235-7. doi: 10.1007/BF02974362 . | Open in Read by QxMD
  29. Schwartz MW. The 5 Minute Pediatric Consult. Lippincott Williams & Wilkins ; 2012
  30. Zuurbier SM, Coutinho JM, Majoie CBLM, Coert BA, Munckhof P, Stam J. Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series. J Neurol. 2011; 259 (6): p.1099-1105. doi: 10.1007/s00415-011-6307-3 . | Open in Read by QxMD
  31. Cerebral venous thrombosis. https://radiopaedia.org/articles/cerebral-venous-thrombosis. Updated: December 28, 2016. Accessed: December 28, 2016.
  32. Ferro JM, Canhão P. Treatment and prognosis of cerebral venous thrombosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/treatment-and-prognosis-of-cerebral-venous-thrombosis.Last updated: June 1, 2016. Accessed: December 28, 2016.
  33. Lemke DM, Hacein-Bey L. Cerebral Venous Sinus Thrombosis. Cerebral Venous Sinus Thrombosis. New York, NY: WebMD. http://www.medscape.com/viewarticle/514553_4. Updated: January 1, 2005. Accessed: December 28, 2016.
  34. Cavernous Sinus Thrombosis.
  35. Zuurbier SM, Coutinho JM, Stam J, et al. Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis. Stroke. 2016; 47 (5): p.1271-1277. doi: 10.1161/strokeaha.115.011875 . | Open in Read by QxMD
  36. Ferro JM, Canhão P. Acute treatment of cerebral venous and dural sinus thrombosis. Curr Treat Options Neurol. 2008; 10 (2): p.126-137. doi: 10.1007/s11940-008-0014-0 . | Open in Read by QxMD
  37. Einhäupl KM, Villringer A, Mehraein S, et al. Heparin treatment in sinus venous thrombosis. The Lancet. 1991; 338 (8767): p.597-600. doi: 10.1016/0140-6736(91)90607-q . | Open in Read by QxMD
  38. Hatemi G, Christensen R, Bang D, et al. 2018 update of the EULAR recommendations for the management of Behçet’s syndrome. Ann Rheum Dis. 2018 . doi: 10.1136/annrheumdis-2018-213225 . | Open in Read by QxMD
  39. David RB, MD RB. Clinical Pediatric Neurology. Demos Medical Publishing ; 2009
  40. Lin P. Treatment of Non-infectious Uveitis. Springer Nature ; 2019
  41. V. Lerma E, Sparks MA, Topf J. Nephrology Secrets E-Book. Elsevier Health Sciences ; 2018