- Definitions and Descriptions
- 1. Diagnosis and Initial Clinical Assessment of Symptomatic Cerebral Venous Thrombosis (CVT)
- 2. Acute Treatment of Symptomatic Cerebral Venous Thrombosis
- 3. Post-Acute Management of Cerebral Venous Thrombosis and Person-centered Care
- 4. Special Considerations in the Longterm Management of Individuals with Cerebral Venous Thrombosis
- 5. Considerations related to Cerebral Venous Thrombosis in Special Circumstances
Definitions and Descriptions
Cerebral Venous Thrombosis (CVT): Thrombosis of the veins of the brain, including the dural venous sinuses and/or cortical or deep veins.
Individuals with CVT may present with neurological deficits due to increased intracranial pressure with or without mass effect, from parenchymal venous congestion, intracranial hemorrhage, or some combination. In the mildest circumstance, individuals with CVT may present with headache only. Compared with ischemic stroke and primary intracerebral hemorrhage, CVT is a less common cerebrovascular disorder, accounting for <1% of all stroke syndromes.
Acute Stroke: An episode of symptomatic neurological dysfunction caused by focal brain, retinal or spinal cord ischemia or hemorrhage, and regardless of symptomatic duration. In general, “stroke” is a clinical term that refers to persistent neurological deficits due to a cerebrovascular cause that could be arterial or venous. Although stroke is commonly associated with changes on imaging, such as infarction or hemorrhage in the brain, sometimes individuals may have persistent symptoms in the absence of imaging findings. CVT may not always be associated with focal deficits in that some individuals may only have symptoms in keeping with increased intracranial pressure, such as headache, nausea/vomiting or visual changes. Thus, the distinction between not having versus having a “stroke” from CVT can be somewhat arbitrary.
Venous Thromboembolism (VTE): VTE is a general term that refers to thrombosis (commonly called blood clots) in the veins. Common VTE types include deep vein thrombosis (DVT - thrombosis of the deep veins in the leg or arm), or pulmonary embolism (PE – a thrombus that begins elsewhere [typically as a DVT] and embolizes, lodging in one or more of the arteries of the lung). CVT is a type of VTE affecting veins in the brain.
Etiology: Risk factors for CVT can be classified as transient (e.g. oral contraceptive use, puerperium, infection) or persistent (e.g. active cancer, inherited/acquired thrombophilia). An event without any apparent identified transient or persistent precipitant is referred to as “unprovoked; also referred to in the literature as “idiopathic” (Kearon et al. 2016). Common risk factors associated with CVT, both transient (e.g. oral contraceptive use, puerperium, infection) and persistent (e.g. active cancer, inherited/acquired thrombophilia) are listed in Figure 1.
