Cerebral Venous Thrombosis: A Comprehensive Review

BACKGROUND

Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword "Cerebral sinus venous thrombosis" was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease.

SUMMARY

The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment.

CONCLUSION

CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.

Pseudomastoiditis in lateral sinus thrombosis: a rare presentation with review of literature

Lateral sinus thrombosis due to mastoiditis, is now a relic of the past. Gone are the days when septic lateral sinus thrombosis was a common complication of unsafe suppurative otitis media. In the present era, the neurologists more commonly see cortical venous thrombosis with lateral sinus thrombosis. This entity has been termed as non-septic lateral sinus thrombosis in literature. The incidence is found to be more in females due to the use of oral contraceptives (Rosen and Scher in Laryngoscope 107(5):680-683, 1). In this manuscript, we report a series of three cases of non-septic lateral sinus thrombosis with mastoiditis, seen in a span of 1 month, which is uncommon. All the patients presented to the neurologist with intractable headache and lateral sinus thrombosis with mastoiditis, was detected by magnetic resonance imaging and magnetic resonance venogram. All the three patients were males and had involvement of the right mastoid in magnetic resonance imaging pictures. We have reviewed the literature and discussed about the etiopathogenesis, diagnostic criteria and management.