Cerebral venous sinus thrombosis
Description
- Thrombosis of dural sinuses and/or cortical veins
- Two mechanisms, often coexisting:
- Venous outflow obstruction -> venous congestion -> vasogenic + cytotoxic oedema -> venous infarction, often haemorrhagic
- Impaired CSF absorption at arachnoid granulations -> inc ICP
- Venous infarcts do not respect arterial territories, cross them, and bleed - a "stroke" with haemorrhage in an odd distribution in a young patient is CVST until proven otherwise
Sites
- Superior sagittal sinus ~60% (bilateral parasagittal infarcts, leg weakness)
- Transverse/sigmoid ~40-50% (often with mastoiditis/otitis)
- Deep venous system (straight sinus, internal cerebral veins, vein of Galen) ~10% - bilateral thalamic/basal ganglia changes, coma. Worst prognosis
- Cortical vein alone - focal deficit + seizure
- Cavernous sinus - proptosis, chemosis, painful ophthalmoplegia (III, IV, V1/V2, VI)
6 more sections, plus exam facts
Every note and exam fact is free for everyone until 9 November - just sign up.
Sign up free