Cerebral Venous Thrombosis

 

Epidemiology: 

  *Incidence:0.22/100000

  *Frequent in neonates

  *Risk factor:

        # Pregnancy and puerperium

        # Oral contraceptive pill

        # ENT infection

        # Cancer

        # Prothrombitic states

        # Dural AV fistula

Clinical features:

  *Increased ICP as IIH

         # Headche

         # Visual obscurations

         # Papilloedema

         # CN VI palsy

  *Focal neurological defecit:

         # Hemiparesis

         # Dysphasia

         # Seizures

   *Diffuse Encephalopathy:

          # Delirium

          # Coma

          # Seizures

          # Multifocal neurological defecit

   *Cavernous Sinus Syndrome:

           # CN III,IV,VI,V

           # Proptosis

Investigations:

    *Imaging: CT+ CT venogram or MRI+MR venogram

    * Lumber puncture:

            # After exclusion of mass lesion

            # OP > 20 cm CSF

            # Not necessary if diagnosis is definite after imaging

Management:

   * Treat associated infection

   *Anticoagulation with heparin followed by warfarin for 6 months.Lifelong if Prothrombitic conditions exist.

   * If not responding or deteriorating,consider local thrombolysis therapy.

  * Treatment of raised ICP:

             # Repeated Lumber puncture or external lumber drain or lumboperitoneal shunt

             # Mannitol

             # If not Responding or deteriorating consider sedation, ventilation,and decompression craniectomy.

  * Seizures:IV phenytoin or valproate

Reference:

1.Manji H, Connolly S, Kitchen N, Lambert C,Metha. Oxford handbook of Neurology: Neurological disorders.2nd edition. Oxford. Oxford University Press.2014