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Neurologists should be able to recognize and treat cerebral venous thrombosis (CVT
The management recommendations for this guide are based in part on the guidelines of the American Heart Association and the American Stroke Association (AHA/ASA), as well as recent guidelines for the European Stroke Organization and the European Society of Neurology (ESO-EAN
Compiled and sorted out, please do not reprint
CTV diagnosis
Patients with suspected CVT require urgent neuroimaging to confirm the diagnosis, and CT or MR can directly show thrombosis and/or venous flowA non-enhanced CT scan of the head is a valuable first test (and the first in many hospitals for suspected stroke or acute headache): about 1/3 of patients show specific signs, such as venous sinuses or deep vein hyperdensity signs (Figure 4C), sometimes referred to as dense triangular signs (high attenuation of the sagittal sinuses or deep veins of the brain) or cord signs (high attenuation due to thrombosis in the transverse sinuses).
Figure 5 Empty δ signs
MRI is the most sensitive technique to demonstrate the presence of thrombotic substances, using T2* weighted gradient echo or magnetosensitive weighted imaging (SWI) (Figure 2D, Figure 4D); The manifestation of blood clots on different MRI sequences varies by age, so it is also helpful to determine the date of onset of CVT (Table 4
Once the CVT is confirmed, it should be treated immediately, including rapid anticoagulation, etiological treatment (eg, dehydration, sepsis, cessation of thrombotic drugs), seizure control, and intracranial hypertension (if necessary).
CVT usually has a good prognosis, with about 75% of patients fully functioning; About 15% of patients die or are in a state of
☑ A Practical Guide to Intracranial Vein Thrombosis (CVT) (I)
