Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis and Treatment of Cerebral Venous and Sinus Thrombosis

  • Stroke (H Adams, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Cerebral venous and sinus thrombosis is a still underdiagnosed cause of stroke, with an incidence of about 2.8 events per 100,000 person-years in young women and about 1.3 events per 100,000 person-years in the general population. Puerperium, oral hormonal contraception, and coagulation disorders remain the most frequently identified risk factors. Initial treatment with heparin is the only proven therapy, although the evidence is based on only two randomized placebo-controlled trials which together included 79 patients. In the case of clinical deterioration under anticoagulation, local thrombolysis and mechanical thrombectomy may be considered, but clinical efficacy is supported only by case reports. Patients with imminent lateral herniation due to large hemorrhagic infarctions should be treated with prompt surgical decompression. Following the acute phase, oral anticoagulation is recommended for 3–12 months, and only patients suffering from a severe coagulopathy or with recurrent cerebral venous and sinus thrombosis should be considered for long-term anticoagulation. Only insufficient experience is available for novel anticoagulants such as thrombin inhibitors or factor Xa antagonists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Weimar C, Masuhr F, Hajjar K. Diagnosis and treatment of cerebral venous thrombosis. Expert Rev Cardiovasc Ther. 2012;10:1545–53.

    Article  CAS  PubMed  Google Scholar 

  2. • Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012;43:3375–7. This hospital-based, cross-sectional study in two Dutch provinces serving 3.1 million people indicates a considerably higher incidence of CVT than previously believed.

    Article  PubMed  Google Scholar 

  3. • Nasr DM, Brinjikji W, Cloft HJ, et al. Mortality in cerebral venous thrombosis: results from the national inpatient sample database. Cerebrovasc Dis. 2013;35:40–4. This study from the US Nationwide Inpatient Sample database comprises 11,400 patients hospitalized with CVT between 2001 and 2008 and reports a low in-hospital mortality rate of 1.5% in patients aged 15-49 years.

    Article  CAS  PubMed  Google Scholar 

  4. Bugnicourt JM, Guegan-Massardier E, Roussel M, et al. Cognitive impairment after cerebral venous thrombosis: a two-center study. J Neurol. 2013;260:1324–31.

    Article  PubMed  Google Scholar 

  5. Saposnik G, Barinagarrementeria F, Brown Jr RD, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.

    Article  PubMed  Google Scholar 

  6. Bousser MG, Crassard I. Cerebral venous thrombosis, pregnancy and oral contraceptives. Thromb Res. 2012;130 Suppl 1:S19–22.

    Article  PubMed  Google Scholar 

  7. Dentali F, Crowther M, Ageno W. Thrombophilic abnormalities, oral contraceptives, and risk of cerebral vein thrombosis: a meta-analysis. Blood. 2006;107:2766–73.

    Article  CAS  PubMed  Google Scholar 

  8. Pai N, Ghosh K, Shetty S. Hereditary thrombophilia in cerebral venous thrombosis: a study from India. Blood Coagul Fibrinolysis. 2012;24:540–3.

    Article  Google Scholar 

  9. Kenet G, Lutkhoff LK, Albisetti M, et al. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation. 2010;121:1838–47.

    Article  PubMed  Google Scholar 

  10. Khealani BA, Wasay M, Saadah M, et al. Cerebral venous thrombosis: a descriptive multicenter study of patients in Pakistan and Middle East. Stroke. 2008;39:2707–11.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Gameiro J, Ferro JM, Canhao P, et al. Prognosis of cerebral vein thrombosis presenting as isolated headache: early vs. late diagnosis. Cephalalgia. 2012;32:407–12.

    Article  PubMed  Google Scholar 

  13. Wetzel SG, Kirsch E, Stock KW, et al. Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography. AJNR Am J Neuroradiol. 1999;20:249–55.

    CAS  PubMed  Google Scholar 

  14. Chik Y, Gottesman RF, Zeiler SR, et al. Differentiation of transverse sinus thrombosis from congenitally atretic cerebral transverse sinus with CT. Stroke. 2012;43:1968–70.

    Article  PubMed  Google Scholar 

  15. Urban PP, Muller-Forell W. Clinical and neuroradiological spectrum of isolated cortical vein thrombosis. J Neurol. 2005;252:1476–81.

    Article  PubMed  Google Scholar 

  16. Selim M, Fink J, Linfante I, et al. Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging. Arch Neurol. 2002;59:1021–6.

    Article  PubMed  Google Scholar 

  17. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006;26 Suppl 1:S19–41. discussion S42-3.

    Article  PubMed  Google Scholar 

  18. Saindane AM, Mitchell BC, Kang J, et al. Performance of spin-echo and gradient-echo t1-weighted sequences for evaluation of dural venous sinus thrombosis and stenosis. AJR Am J Roentgenol. 2013;201:162–9.

    Article  PubMed  Google Scholar 

  19. Kosinski CM, Mull M, Schwarz M, et al. Do normal D-dimer levels reliably exclude cerebral sinus thrombosis? Stroke. 2004;35:2820–5.

    Article  PubMed  Google Scholar 

  20. Dentali F, Squizzato A, Marchesi C, et al. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost. 2012;10:582–9.

    Article  CAS  PubMed  Google Scholar 

  21. Einhäupl K, Stam J, Bousser MG, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010;17:1229–35.

    Article  PubMed  Google Scholar 

  22. Einhäupl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet. 1991;338:597–600.

    Article  PubMed  Google Scholar 

  23. de Bruijn SF, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke. 1999;30:484–8.

    Article  PubMed  Google Scholar 

  24. Stam J, de Bruijn S, deVeber G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev. 2008:CD002005.

  25. Misra UK, Kalita J, Chandra S, et al. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur J Neurol. 2012;19:1030–6.

    Article  CAS  PubMed  Google Scholar 

  26. Coutinho JM, Ferro JM, Canhao P, et al. Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke. 2010;41:2575–80.

    Article  CAS  PubMed  Google Scholar 

  27. • Lebas A, Chabrier S, Fluss J, et al. EPNS/SFNP guideline on the anticoagulant treatment of cerebral sinovenous thrombosis in children and neonates. Eur J Paediatr Neurol. 2012;16:219–28. This presents the current guidelines for management of pediatric CVT.

    Article  PubMed  Google Scholar 

  28. Dentali F, Squizzato A, Gianni M, et al. Safety of thrombolysis in cerebral venous thrombosis. A systematic review of the literature. Thromb Haemost. 2010;104:1055–62.

    Article  CAS  PubMed  Google Scholar 

  29. Stam J, Majoie CB, van Delden OM, et al. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke. 2008;39:1487–90.

    Article  PubMed  Google Scholar 

  30. Borhani Haghighi A, Mahmoodi M, Edgell RC, et al. Mechanical thrombectomy for cerebral venous sinus thrombosis: a comprehensive literature review. Clin Appl Thromb Hemost. 2013. doi:10.1177/1076029612470968.

    Google Scholar 

  31. Coutinho JM, Ferro JM, Zuurbier SM, et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int J Stroke. 2013;8:135–40.

    Article  PubMed  Google Scholar 

  32. • Rajan Vivakaran TT, Srinivas D, Kulkarni GB, Somanna S. The role of decompressive craniectomy in cerebral venous sinus thrombosis. J Neurosurg. 2012;117:738–44. This is the largest case series, demonstrating a favorable outcome in 26 of 34 patients after decompressive craniectomy despite clinical and radiological findings of herniation.

    Article  PubMed  Google Scholar 

  33. Baumgartner RW, Studer A, Arnold M, Georgiadis D. Recanalisation of cerebral venous thrombosis. J Neurol Neurosurg Psychiatry. 2003;74:459–61.

    Article  CAS  PubMed  Google Scholar 

  34. Albers GW, Amarenco P, Easton JD, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:630S–69.

    Article  CAS  PubMed  Google Scholar 

  35. Kenet G, Kirkham F, Niederstadt T, et al. Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study. Lancet Neurol. 2007;6:595–603.

    Article  PubMed Central  PubMed  Google Scholar 

  36. • Dentali F, Poli D, Scoditti U, et al. Long-term outcomes of patients with cerebral vein thrombosis: a multicenter study. J Thromb Haemost. 2012;10:1297–302. This study reports a low long-term risk of recurrent CVT and venous thromboembolism in a cohort of 706 patients with a first CVT.

    Article  CAS  PubMed  Google Scholar 

  37. Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:887S–968.

    Article  CAS  PubMed  Google Scholar 

  38. • Ciron J, Godeneche G, Vandamme X, et al. Obstetrical outcome of young women with a past history of cerebral venous thrombosis. Cerebrovasc Dis. 2013;36:55–61. This study confirms that the occurrence of CVT in young women is not a contraindication for subsequent pregnancy, although most patients were receiving preventive antithrombotic medication.

    Article  PubMed  Google Scholar 

  39. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227–76.

    Article  PubMed  Google Scholar 

  40. Miranda B, Ferro JM, Canhao P, et al. Venous thromboembolic events after cerebral vein thrombosis. Stroke. 2010;41:1901–6.

    Article  PubMed  Google Scholar 

  41. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007;6:162–70.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Christian Weimar has received honoraria for participation in clinical trials and for contributions to advisory boards or oral presentations from Bayer Pharma, Boehringer Ingelheim, Bristol-Myers Squibb, CoAxia. D-Pharm, Daiichi Asubio, GlaxoSmithKline, Lundbeck, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, and Sanofi-Aventis.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Department of Neurology and Stroke Center, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany

    Christian Weimar

Authors
  1. Christian Weimar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Weimar.

Additional information

This article is part of the Topical Collection on Stroke

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weimar, C. Diagnosis and Treatment of Cerebral Venous and Sinus Thrombosis. Curr Neurol Neurosci Rep 14, 417 (2014). https://doi.org/10.1007/s11910-013-0417-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-013-0417-5

Keywords

Search

Navigation