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Cerebral venous thrombosis (CVT) refers to clot formation within the dural venous sinuses or the cerebral venous drainage system. The most commonly affected sinuses are the superior sagittal sinus, transverse sinuses, straight sinus, cortical veins, internal jagular veins, and deep veins.
Designed for use by busy professionals who need quick answers, this revised and updated second edition of The Stroke Book is a concise and practical reference for anyone involved in managing critically ill cerebrovascular patients. Covers a wide range of common conditions such as ischemic and hemorrhagic strokes, subarachnoid hemorrhages and intracranial aneurysmsProvides focused protocols for assessing and treating stroke patients in the emergency room, intensive care unit or general hospital setting A new chapter summarizes key clinical trials for stroke therapiesUser-friendly formatPacked with algorithms, tables and summary boxes for immediate access to key informationA color plate section illustrates key pathology and diagnostic imagingWritten by experienced contributors from leading stroke centers, this is an essential companion for navigating stroke-related clinical situations successfully and making informed decisions about treatment.
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:
▪ 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.
▪ 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.
▪ Patients with CVT have lower frequencies of traditional risk factors, such as hypertension, diabetes, and cardiac disease.
▪ 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:
▪ Low-flow state within the affected sinus or vein
▪ Extrinsic compression or invasion of a venous sinus