Intracranial venous disease Flashcards Preview

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Flashcards in Intracranial venous disease Deck (24):



What are the different types of intracranial venous thrombosis?


  • Dural sinus thrombosis
  • Cortical vein thrombosis




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





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




What infections can lead to intracranial sinus thrombosis?


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




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



Cavernous sinus thrombosis




What are features of sagittal sinus thrombosis?


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




What are features of transverse sinus thrombosis?


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




What are featurs of sigmoid sinus thrombosis?


  • Cerebellar signs
  • Lower cranial nerve palsies




What are features of inferior petrosal sinus thrombosis?


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




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




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




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


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




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


  • Meningitis
  • SAH




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




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



Absence of a sinus




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



T2-weighted MRI gradient echo sequence




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


Diagram shows rough area - a lot of variation between indiviuals




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


Diagram below is rough guide - lot of variation between individuals




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


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




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




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



Those with large infarcts and impending herniation




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




What INr would you aim for when treating intracrnail venous thrombosis







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



6 months