Skip to main content Accessibility help
  • Print publication year: 2009
  • Online publication date: May 2010

11 - Cerebral venous thrombosis

from Section III - Diagnostics and syndromes



Acute thrombosis of the cerebral sinuses and veins (cerebral venous thrombosis, CVT) is considered to be the cause of an acute stroke in approximately 1% of all stroke patients. However, the incidence of CVT is not known, as population-based studies are lacking. It has been estimated that annually about five to eight cases of CVT are identified among stroke patients of tertiary care hospitals [1]. Historically, CVT was considered a severe, almost inevitably fatal disease, as diagnosis in the pre-angiograph era was usually made post-mortem. However, modern neuroimaging techniques allow the diagnosis of CVT at an early stage and document that CVT is more frequent than was traditionally assumed, and that its prognosis is much better than is generally accepted, provided that the diagnosis is suspected, the respective neuroimaging examinations are performed in a timely manner, and therapy is initiated early, i.e. often with the diagnosis being clinically suspected only. The variety of clinical signs and symptoms renders the diagnosis of CVT a challenge to the physician. Diagnosis is still frequently overlooked or delayed due to the wide spectrum of clinical symptoms and the often subacute or lingering disease onset.

It is important to keep the diagnosis of CVT in mind in stroke cases that present with a fluctuating course, headache, epileptic seizures or disturbances of the level of consciousness. With timely therapeutic intervention, CVT has a favorable prognosis, with an overall mortality rate of about 8% in recent studies [2].

Einhaupl, K, Bousser, MG, Bruijn, SFTM, et al. Guidelines on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol 2006; 13:553–9.
Ferro, JM, Canhao, 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; 35:664–70.
Amery, A, Bousser, MG. Cerebral venous thrombosis. Clin Neurol 1992; 19:87–111.
Stam, J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005; 352:1791–8.
Schmiedek, P, Einhaupl, KM, Moser, E. Cerebral blood flow in patients with sinus venous thrombosis. In: Einhaupl, KM, Kempski, O, Baethmann, A, eds. Cerebral Sinus Thrombosis: Experimental and Clinical Aspects. New York: Plenum Press; 1990: 75–83.
Bruijn, SFTM, Stam, J, for the Cerebral Venous Sinus Thrombosis Study Group. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 1999; 30:484–8.
Cantu, C, Barinagarrementiera, F. Cerebral venous thrombosis associated with pregnancy and puerperium: a review of 67 cases. Stroke 1993; 24:1880–4.
Einhaupl, K, Villringer, A, Meister, W, et al. Heparin treatment in sinus venous thrombosis. Lancet 1991; 338:597–600.
Bergh, WM, Schaaf, I, Gijn, J. The spectrum of presentations of deep venous infarction caused by deep cerebral vein thrombosis. Neurology 2005; 65:192–6.
Renowden, S. Cerebral venous sinus thrombosis. Eur Radiol 2004; 14:215–26.
Tsitouridis, I, Papapostolou, P, Rudolf, J, et al. Non-neoplastic dural sinus thrombosis: An MRI and MRV evaluation. Riv Neuroradiologia 2005; 18:581–8.
Baumgartner, RW, Studer, A, Arnold, M, et al. Recanalization of cerebral venous thrombosis. J Neurol Neurosurgery Psychiatry 2003; 74:459–61.
Bono, F, Lupo, MR, Lavano, A, et al. Cerebral MR venography of transverse sinuses in subjects with normal CSF pressure. Neurology 2003; 61:1267–70.
Bousser, MG, Ferro, J. Cerebral venous thrombosis: an update. Lancet Neurology 2007; 6:162–70.
Lalive, PH, Moerloose, P, Lovblad, K, et al. Is measurement of D-dimer useful in the diagnosis of cerebral venous thrombosis?Neurology 2003; 61:1057–60.
Sacco, RL, Adams, R, Albers, G, et al. Guidelines for the prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke 2006; 37:577–617.
Stam, J, Bruijn, SFTM, Veber, G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev 2002; 4:CD002005.
Donden, CJJ, Belt, AGM, Prins, HM, et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2004; 4:CD001100.
Buller, HR, Agnelli, G, Hull, RH, et al. Antithrombotic therapy for venous thromboembolic disease. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126:401–28.
Canhao, P, Falcao, F, Ferro, JM. Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovasc Dis 2003; 15:159–66.
Ciccone, A, Canhao, P, Falcao, F, Ferro, JM, Sterzi, R. Thrombolysis for cerebral vein and dural sinus thrombosis. Stroke 2004; 35:2428.
Ferro, JM, Correia, M, Rosas, MJ, et al. Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc Dis 2003; 15:78–83.
Canhao, P, Cortesao, A, Cabral, M, et al. Are steroids useful for the treatment of cerebral venous thrombosis? ISCVT results. Cerebrovasc Dis 2004; 17(Suppl. 5):16.
Rudolf, J, Hilker, R., Terstegge, K, et al. Extended haemorrhagic infarction following isolated cortical venous thrombosis. Eur Neurol 1999; 41:115–16.
deVeber, G, Chan, A, Monagle, P, et al. Anticoagulation therapy in pediatric patients with sinovenous thrombosis: a cohort study. Arch Neurol 1998; 55:1533–7.
Golomb, MR. Sinovenous thrombosis in neonates. Semin Cerebrovasc Dis Stroke 2001; 1:216–24.
Ferro, JM, Canhao, P, Bousser, M-G, Barinagarrementeria, F. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke 2005; 36:1927–32.