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 |
| Photophobia | ||
| Reduced consciousness | Drowsiness | Deep venous system/straight sinus/raised ICP/non-convulsive status epilepticus |
| Stupor | ||
| Coma | ||
| Cognitive impairment | Encephalopathy | Deep venous system/temporal-parietal lesion (vein of Labbe)/seizures |
| Disorientation | ||
| Reduced concentration | ||
| Amnesia | ||
a Raised intracranial pressure (ICP) can result from a combination of a large venous/sinus occlusion or from large infarction/haemorrhage.
References:
- 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]
- 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.
