Vaskulárna medicína 1/2023

Cerebral venous thrombosis

Cerebral venous thrombosis (CVT) is a rare thrombotic venous event in atypical localization. It accounts for 0.5-1.0% of all stroke events. Its etiology is multifactorial. Clinical and neurological manifestations are non-specific, with headache, signs of intracranial hypertension, and variable neurological deficits (focal deficits, quantitative consciousness changes, secondary epilepsy) being most prevalent. The clinical variability commonly leads to delayed diagnostics. Contrast CT/MR combined with venography is a crucial diagnostic procedure. Treatment relies on endovascular procedures, thrombolysis, and anticoagulation therapy. Heparins and vitamin K antagonists remain the first-choice antithrombotics; the data on newer anticoagulants (DOACs) are encouraging but limited. Prognosis is favorable in most (4/5) cases except for specific subgroups (nervous system infections, craniotomy, and anticoagulant undertreatment). The presented work aims to summarize the up-to-date diagnostic and therapeutic approaches and point out the remaining clinical issues.

Keywords: cerebral venous thrombosis, cerebral venous sinus thrombosis, thrombophilia, direct oral anticoagulants, D-dimers