Unifying Concepts

Cerebral Venous Thrombosis (CVT) and Location of Probable Lesion

Cerebral venous thrombosis (CVT) is an important cause of stroke in young adults (mean age 33 years with a two-thirds female preponderance) caused by complete or partial occlusion of the cerebral major cerebral venous sinuses (cerebral venous sinus thrombosis) or the smaller feeding cortical veins (cortical vein thrombosis).

Signs and symptoms of cerebral venous thrombosis (CVT) and location of probable lesion

Signs and symptoms Probable lesion
Headache Migraine Any venous occlusion/focal lesion
Raised ICP a Large venous or sinus occlusion/large mass lesion
Thunderclap Any venous occlusion/subarachnoid haemorrhage
Ear/mastoid pain Transverse sinus with/without infection
Focal neurological deficits Hemiparesis Infarction/haemorrhage/venous oedema
Cranial nerve palsy
III, IV Cavernous sinus
V Cavernous sinus/superior petrosal sinus
VI Cavernous sinus/inferior petrosal sinuses/raised ICP
VII Transverse/sigmoid sinus
VIII Transverse/sigmoid sinus/raised ICP
IX, X, XI Posterior cavernous sinus/internal jugular vein/deep venous system
Aphasia Focal infarction/haemorrhage/superficial or deep venous system
Sensory disturbance Focal infarction/haemorrhage/superficial or deep venous system
Inattention/neglect Focal infarction/haemorrhage/superficial venous system
Ataxia Cerebellar veins/raised ICP
Seizures Focal Focal infarction/haemorrhage
Generalised Focal infarction/haemorrhage/severely raised ICP
Visual disturbance Reduced acuity Raised ICP
Reduced/altered visual field Raised ICP/Posterior infarction/haemorrhage/raised ICP (false localising sign)
Diplopia Cavernous sinus/petrosal sinus/raised ICP
Papilloedema Raised ICP
Meningism Neck pain/stiffness Suggests infectious or inflammatory aetiology
Reduced consciousness Drowsiness Deep venous system/straight sinus/raised ICP/non-convulsive status epilepticus
Cognitive impairment Encephalopathy Deep venous system/temporal-parietal lesion (vein of Labbe)/seizures
Reduced concentration

a Raised intracranial pressure (ICP) can result from a combination of a large venous/sinus occlusion or from large infarction/haemorrhage.



  1. Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous thrombosis: a practical guide. Pract Neurol. 2020 Oct;20(5):356-367. [Medline]
  2. Behrouzi R, Punter M. Diagnosis and management of cerebral venous thrombosis. Clin Med (Lond). 2018 Feb;18(1):75-79. [Medline]


Created Nov 02, 2023.


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