Cerebral venous thrombosis: A guide to diagnosis and drug treatment

Cerebral venous thrombosis (CVT) is a relatively rare pathological condition. The clinical presentations can be nonspecific and quite variable, frequently resulting in delayed or missed diagnosis. The symptoms include headache, nausea, vomiting, visual disturbance, altered consciousness and seizures. These symptoms are believed to be caused by increased intracranial pressure secondary to impeded venous drainage. The diagnosis can be made with computed tomography (CT), magnetic resonant imaging (MRI) and cerebral angiography. CT is usually the initial diagnostic test that may show dense clot in the cerebral veins along with hemorrhagic venous infarctions. Empty delta sign can be seen on contrast-enhanced CT. MRI has become the preferred modality for detecting CVT; magnetic resonance angiography (MRA) and venography (MRV) are the best methods for detecting the condition. Angiography, once the standard, is now only indicated when MRI has resulted in an uncertain diagnosis or when endovascular intervention is desired. Therapy should be directed at treating the underlying causative process and symptoms secondary to elevated intracranial pressure. Although there is no consensus regarding antithrombotic treatment, the current trend is to use intravenous heparin initially, followed by warfarin. A newer approach has been developed using interventional endovascular modalities. Local infusion of thrombolytics can be achieved by transvenous catheterisation and catheter navigation. This may offer potential advantages over the established systemic antithrombotic therapy.