Thrombosis of the cerebral veins and sinuses (CVT) is often challenging to diagnose owing to the broad spectrum and variability of clinical symptoms and signs on initial presentation. Delayed diagnosis of CVT can have devastating consequences, while early diagnosis can facilitate timely initiation of effective treatment to improve the prognosis. This chapter highlights the pathogenesis and risk factors for CVT, clinical and radiologic diagnosis, and treatment strategies and options.

CVT AS A DISTINCT CEREBROVASCULAR DISEASE

The estimated incidence of CVT is three to four cases per one million people per year, much less common than its arterial counterpart. In contrast to arterial occlusions:

1. ▪ Patients with CVT tend to be younger (mean age is mid-30s to 40s). However, CVT can also develop in elderly patients with debilitating diseases and neonates and infants suff ering from dehydration.

2. ▪ Women are more likely than men to develop CVT, especially at a young age. Th is is attributed to puerperium, pregnancy, and use of oral contraceptives.

3. ▪ Patients with CVT have lower frequencies of traditional risk factors, such as hypertension, diabetes, and cardiac disease.

4. ▪ The clinical course and evolution of CVT is often slow and indolent, and progression of symptoms is the rule.

CAUSES AND PATHOPHYSIOLOGY OF CVT

Table 12.1 lists the conditions that can cause or predispose to CVT. The presence of any of these conditions should alert physicians and raise suspicion to the possibility of CVT. These conditions predispose to CVT by inducing:

1. ▪ Hypercoagulability

2. ▪ Low-flow state within the affected sinus or vein

3. ▪ Extrinsic compression or invasion of a venous sinus

4. ▪ Intravascular volume depletion