Overview
Recognise cerebral venous sinus thrombosis across headache, seizure and focal-deficit presentations, confirm it with venous imaging, and start anticoagulation and raised-pressure management safely in specialist care.
CVST blocks venous drainage, raising venous and capillary pressure. This causes vasogenic oedema, reduced absorption of cerebrospinal fluid, venous infarction and sometimes intraparenchymal or subarachnoid bleeding. Unlike a typical arterial stroke, symptoms may evolve over days, involve both hemispheres or combine headache, papilloedema and seizures. The superior sagittal, transverse, sigmoid, straight and cortical veins produce different patterns, and multiple segments are often involved.
The history should include pregnancy stage or days postpartum, contraception and hormone therapy, cancer, inflammatory bowel or systemic inflammatory disease, recent infection of ear, sinus, face or mastoid, dehydration, anaemia, thrombocytosis, nephrotic syndrome, previous VTE and family history. Examination includes consciousness, focal neurology, visual fields, fundi, eye movements and signs of sepsis. A convincing risk constellation justifies venous imaging even when arterial stroke screening and unenhanced CT are normal.
Anticoagulation prevents thrombus propagation and supports recanalisation. Haemorrhage caused by venous congestion is part of the disease and is not usually a reason to withhold therapeutic heparin, unlike an unrelated active bleed. Management also addresses seizures, vision-threatening intracranial pressure, infection and mass effect. Later work includes deciding whether the event was provoked, whether thrombophilia testing will change management, contraception or pregnancy counselling and the safe duration and agent for secondary prevention.