Cerebral (brain) venous thrombosis is uncommon occurring in 1/lac population
- It is more common in neonates and children than in adults. In adults it is more common in women than men.
- The mean age of onset is 39 years old.
- Thrombosis of cerebral veins or dural sinus leads to increased venous and capillary pressure, which in turn leads to brain swelling, venous hemorrhage, and/or ischemia with cytotoxic edema.
- Occlusion of dural sinus causes decreased brain cerebrospinal fluid absorption and elevated brain pressure.
- Risk factors are hypercoagulable states, oral contraceptives, pregnancy, cancer, infection and head injury.
- The onset can be acute, subacute, or chronic.
- Headache is the most frequent symptom, occurring in 90% cases
- Other symptoms are focal neurologic deficits, focal or generalized fits, altered mental status, stupor, or coma.
- Brain MRI with MR venography is diagnostic
- Head CTscan is normal in up to 30 percent of cases
- CT venography is a useful alternative to MR venography.
- There is complete recovery in 80 percent of patients.
- 5% die in acute illness and 10% die over a period of time
- The main cause of acute death is brain herniation.
- Recurrence rate is 2 to 4 percent.
- Treatment is blood thinners initially with subcutaneous low molecular weight heparin or intravenous heparin followed with oral warfarin for 3-12 months