Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is a blood clot in one of your brain’s veins. When this blockage happens, blood can’t flow away from your brain. This can increase the pressure in your brain and cause it to swell. The clot can also increase pressure inside the vein, causing it to break. This can lead to a brain bleed.

This rare condition makes up about 1% of all stroke cases. Most strokes block blood flow in arteries, not veins.

CVST happens more often in females. It can develop at any age — even in infancy. Most cases affect people under 55 years old.

Symptoms of cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis symptoms depend on the size of the clot and its location. They tend to come on more slowly than symptoms of other stroke types.

CVST symptoms may include:

• Severe headache (most common symptom)
• Dizziness
• Nausea and vomiting
• Vision changes, like blurred or double vision
• Seizures
• A change in mental function (altered mental status)
• Leg weakness or weakness on one side of your body
• Confusion and difficulty with language (aphasia)
• Pain in the bone behind your ear
• Issues with how parts of your face move or function (cranial nerve palsies)

Get help right away if you have these symptoms. Prompt diagnosis and treatment give you the best chance of avoiding complications.

Cerebral venous sinus thrombosis causes

Cerebral venous sinus thrombosis happens when there’s a blood clot in a vein in your brain. Certain conditions or situations can make your body more likely to form blood clots (thrombophilia).

Major risk factors for CVST include:

• Pregnancy and the six-week period after giving birth (postpartum)
• Using oral birth control pills, especially those containing estrogen
• Obesity
• Antithrombin deficiency
• Protein C deficiency and protein S deficiency
• Antiphospholipid syndrome
• Factor V Leiden thrombophilia
• Prothrombin gene change
• Abnormally high levels of homocysteine in your blood

Other risk factors for CVST include:

• Cancer
• Head or brain trauma or surgery
• Hyperthyroidism
• Infections, like COVID-19
• Inflammatory bowel disease
• Neuro-Behçet syndrome
• Systemic lupus erythematosus (SLE)

Complications of this condition

Acute (short-term) complications of CVST may include:

• Increased pressure inside your brain
• Brain bleed
• Coma

Long-term complications may include:

• Chronic headaches
• Depression
• Difficulty moving parts of your body
• Fatigue
• Issues with mental functioning
• Vision loss from swelling of the nerve of your eye (papilledema)

How doctors diagnose this condition

Healthcare providers use brain imaging tests to diagnose CVST, like:

• Brain MRI
• Brain CT scan
• MR venography or CT venography

They’ll also do blood tests to check for a clotting disorder.

How is it treated?

Treatment of CVST involves treating the clot, the condition that led to it and any complications. Your healthcare team will work quickly to manage this condition.

To get rid of the clot, your healthcare provider may use:

• Anticoagulants, as an IV and then as pills
• Surgery (thrombectomy) for severe cases

If you have increased pressure in your brain, your provider may use acetazolamide or medical procedures to lower it. They may give you medications to manage any seizures.

You may need to take warfarin or another oral anticoagulant for three to 12 months, depending on the cause. If you have a blood clotting disorder, you may need to take warfarin for the rest of your life.

When should I see my healthcare provider?

You’ll need to see your healthcare provider regularly (every few months) while you’re taking anticoagulants. Contact your provider if you miss a dose.

You may need to have another imaging test six months later to check on the area where the blood clot was.

If you’re planning for a pregnancy, be sure to let your provider know. You may need to take medication or adjust your dose to prevent CVST from happening again.

What can I expect if I have this condition?

Compared to other types of stroke, the outlook for cerebral venous sinus thrombosis is generally good. About 8 to 9 out of 10 people with CVST can go back to their activities of daily living after treatment. But it’s common to have long-lasting symptoms, like headaches and fatigue.

Each case is different. Your provider can give you a better idea of what to expect. CVST can happen again. So, your provider will prescribe medication to try to prevent this.