Intracranial venous disease Flashcards Preview

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Flashcards in Intracranial venous disease Deck (24):
1

 

 

What are the different types of intracranial venous thrombosis?

 

  • Dural sinus thrombosis
  • Cortical vein thrombosis

2

 

 

What are the different dural venous sinuses that are most commonly affected by thrombosis?

 

  • Sagittal sinus thormbosis
  • Transverse sinus thrombosis
  • Sigmoid sinus thrombosis
  • Inferior petrosal sins thrombosis
  • Cavernous sinus thrombosis

 

3

 

 

What are causes of intracranial venous thrombosis?

  • Pregnancy/puerperium
  • Combined OCP
  • Head injury
  • Dehydration
  • Blood dyscarias
  • tumours
  • Extracranial malignancy
  • Recent LP
  • Infection 
  • Drugs
  • SLE/Vasculitis
  • IBD

4

 

 

What infections can lead to intracranial sinus thrombosis?

 

  • Meningitis
  • Orbital cellulitis
  • Otitis media
  • Cerebral malaria
  • TB

5

 

 

What is the most commonly affected (and most clinically significant) type of venous sinuse thrombosis?

 

 

Cavernous sinus thrombosis

6

 

 

What are features of sagittal sinus thrombosis?

 

  • Headache
  • Vomiting
  • Seizures
  • Decreased visual acuity
  • Papilloedema

7

 

 

What are features of transverse sinus thrombosis?

 

  • Headache +/- mastoid pain
  • Focal CNS signs
  • Seizures
  • Papilloedema

8

 

 

What are featurs of sigmoid sinus thrombosis?

 

  • Cerebellar signs
  • Lower cranial nerve palsies

9

 

 

What are features of inferior petrosal sinus thrombosis?

 

  • CNV palsy
  • CNVI palsy
  • Temporal + Retro-orbital pain

10

 

 

What are features of cavernous sinus thrombosis?

 

  • Headache
  • Facial pain - may affect trigeminal branches
  • Chemosis
  • Oedematous eyelids
  • Proptosis - may be pulsatile if internal carotid aneurysm
  • Painful opthalmoplegia
  • Fever
  • Horner's syndrome - post-ganglionic sympathetic nerve fibre compression

11

 

 

What are features of cortical vein thrombosis?

Usually occurs with sinus thrombosis which extends into cortical veins, producing infarcts:

  • Focal neurological signs - develop over days
  • Seizures
  • Thunderclap headache

12

 

 

If someone presented with symptoms of an intracranial venous thrombosis, what would you differential diagnosis be?

 

  • SAH
  • Meningitis
  • Encephalitis
  • Intracranial abscess
  • Ischaemic Stroke

13

 

 

What would you initially want to exclude in someone presenting with symptoms of intracranial venous thrombosis?

 

  • Meningitis
  • SAH

14

 

 

What investigations would you consider doing in someone presenting with symptoms of an intracranial venous thrombosis?

 

  • Bloods - Thrombophilia screen
  • Imaging - CT/MRI venography
  • LP - if no contraindications

15

 

 

What will CT/MRI vnographyt show in investigation of intracranial venous thrombosis?

 

 

Absence of a sinus

16

 

 

What weighting of MRI can diretly visualise a thrombus in intracranial venous thrombosis?

 

 

T2-weighted MRI gradient echo sequence

17

 

 

What area  of the brain does the superior sagittal sinus drain from?

 

Diagram shows rough area - a lot of variation between indiviuals

18

 

 

What area of the brain does the transverse sinus drain from?

 

Diagram below is rough guide - lot of variation between individuals

19

 

 

Why might you do an LP in someone with venous sinus thrombosis?

 

  • Raised opening pressure
  • RBC's/xanthochromia - SAH

20

 

 

How would you manage someone with an intracranial venous thrombosis?

Seek expert help

  • Anticoagulation - LMWH, then followed by warfarin after 2-3 weeks
  • Endovascular Thrombolysis/Mechanical thrombectomy - limited benefit
  • Manage raised ICP - immediate management/hemicraniectomy

21

 

 

When would you not consider vascular thrombolysis/mechanical thrombectomy in someone with intracranial thrombosis?

 

 

Those with large infarcts and impending herniation

22

 

 

What are predictors of a poor prognosis in someone with intracranial venous thrombosis?

 

  • GCS <9 on admission
  • Deep CVT location
  • CNS infection
  • Malignancy
  • Intracranial haemorrhage
  • Mental status abnormality
  • Age > 37 years
  • Female

23

 

 

What INr would you aim for when treating intracrnail venous thrombosis

 

 

2-3

24

 

 

How long would you give someone warfarin therapy for an intracranial venous thrombosis?

 

 

6 months