Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Cerebral venous thrombosis

Nature Reviews Neurology volume 13, pages 555–565 (2017)Cite this article

Subjects

Key Points

  • Cerebral venous thrombosis (CVT) is an important cause of stroke in young and middle-aged adults, with a sex ratio heavily skewed towards women

  • Manifestations of CVT can be grouped into four distinct clinical syndromes: isolated intracranial hypertension, focal syndrome, diffuse encephalopathy and cavernous sinus syndrome

  • First-line treatment for CVT is heparin, even in the presence of an intracerebral haemorrhage

  • In a trial completed in 2017, endovascular therapy did not improve the clinical outcome of patients with severe CVT

  • Mortality among patients with CVT has declined in the past few decades to ∼8–10%; although 80% of patients recover without physical disability, many experience residual chronic symptoms

Abstract

Cerebral venous thrombosis (CVT) is an important cause of stroke in young adults. Data from large international registries published in the past two decades have greatly improved our knowledge about the epidemiology, clinical manifestations and prognosis of CVT. The presentation of symptoms is highly variable in this disease, and can range from a patient seen at the clinic with a 1-month history of headache, to a comatose patient admitted to the emergency room. Consequently, the diagnosis of CVT is often delayed or overlooked. A variety of therapies for CVT are available, and each should be used in the appropriate setting, preferably guided by data from randomized trials and well-designed cohort studies. Although deaths from CVT have decreased in the past few decades, mortality remains ∼5–10%. In this Review, we provide a comprehensive and contemporary overview of CVT in adults, with emphasis on advancements made in the past decade on the epidemiology and treatment of this multifaceted condition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Anatomy of the cerebral venous system.
Figure 2: Imaging findings in a patient with cerebral venous thrombosis.
Figure 3: Illustrative brain parenchymal lesions in patients with cerebral venous thrombosis.
Figure 4: Schematic overview of diagnostic and therapeutic steps in CVT.

Similar content being viewed by others

References

  1. Kalbag, R. M. & Woolf, A. L. Cerebral Venous Thrombosis (Oxford Univ. Press, 1967).

    Google Scholar 

  2. Ribes, M. F. Des recherches faites sur la phlebite. Revue Medicale Française et Etrangère et Journal de Clinique de l'Hôtel-Dieu et de la Charité de Paris. 3, 5–41 (1825).

    Google Scholar 

  3. Abercrombie, J. Pathological and Practical Researches on Diseases of the Brain and Spinal Cord (Waugh and Innes, 1828).

    Book  Google Scholar 

  4. Huhn, A. Clinical aspects of intracranial venous thrombosis [German]. Radiologe 11, 377–390 (1971).

    CAS  PubMed  Google Scholar 

  5. Krayenbuhl, H. A. Cerebral venous and sinus thrombosis. Clin. Neurosurg. 14, 1–24 (1966).

    Article  CAS  PubMed  Google Scholar 

  6. Bansal, B. C., Gupta, R. R. & Prakash, C. Stroke during pregnancy and puerperium in young females below the age of 40 years as a result of cerebral venous/venous sinus thrombosis. Jpn. Heart J. 21, 171–183 (1980).

    Article  CAS  PubMed  Google Scholar 

  7. Bousser, M. G., Chiras, J., Bories, J. & Castaigne, P. Cerebral venous thrombosis — a review of 38 cases. Stroke 16, 199–213 (1985).

    Article  CAS  PubMed  Google Scholar 

  8. Bousser, M. G. Cerebral venous thrombosis. Report of 76 cases [French]. J. Mal. Vasc. 16, 249–254 (1991).

    CAS  PubMed  Google Scholar 

  9. Goldberg, A. L. et al. Computed tomography of dural sinus thrombosis. J. Comput. Assist. Tomogr. 10, 16–20 (1986).

    Article  CAS  PubMed  Google Scholar 

  10. Mattle, H. P. et al. Cerebral venography with MR. Radiology 178, 453–458 (1991).

    Article  CAS  PubMed  Google Scholar 

  11. Ferro, J. M. et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 35, 664–670 (2004).

    Article  PubMed  Google Scholar 

  12. Pai, N., Ghosh, K. & Shetty, S. Hereditary thrombophilia in cerebral venous thrombosis: a study from India. Blood Coagul. Fibrinolysis 24, 540–543 (2013).

    Article  PubMed  Google Scholar 

  13. Dentali, F. et al. Long-term outcomes of patients with cerebral vein thrombosis: a multicenter study. J. Thromb. Haemost. 10, 1297–1302 (2012).

    Article  CAS  PubMed  Google Scholar 

  14. Wasay, M. et al. Cerebral venous thrombosis: analysis of a multicenter cohort from the United States. J. Stroke Cerebrovasc. Dis. 17, 49–54 (2008).

    Article  PubMed  Google Scholar 

  15. Roach, E. S. et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 39, 2644–2691 (2008).

    Article  PubMed  Google Scholar 

  16. Stam, J. Cerebral venous and sinus thrombosis: incidence and causes. Adv. Neurol. 92, 225–232 (2003).

    PubMed  Google Scholar 

  17. Devasagayam, S., Wyatt, B., Leyden, J. & Kleinig, T. Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke 47, 2180–2182 (2016).

    Article  PubMed  Google Scholar 

  18. Coutinho, J. M., Zuurbier, S. M., Aramideh, M. & Stam, J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke 43, 3375–3377 (2012).

    Article  PubMed  Google Scholar 

  19. Khealani, B. A. et al. Cerebral venous thrombosis: a descriptive multicenter study of patients in Pakistan and Middle East. Stroke 39, 2707–2711 (2008).

    Article  PubMed  Google Scholar 

  20. Janghorbani, M. et al. Cerebral vein and dural sinus thrombosis in adults in Isfahan, Iran: frequency and seasonal variation. Acta Neurol. Scand. 117, 117–121 (2008).

    CAS  PubMed  Google Scholar 

  21. Ferro, J. M. et al. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke 36, 1927–1932 (2005).

    Article  PubMed  Google Scholar 

  22. de Bruijn, S. F., Stam, J., Koopman, M. M. & Vandenbroucke, J. P. Case–control study of risk of cerebral sinus thrombosis in oral contraceptive users who are carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group. BMJ 316, 589–592 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Cantu, C. & Barinagarrementeria, F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke 24, 1880–1884 (1993).

    Article  CAS  PubMed  Google Scholar 

  24. Zuurbier, S. M. et al. Risk of cerebral venous thrombosis in obese women. JAMA Neurol. 73, 579–584 (2016).

    Article  PubMed  Google Scholar 

  25. Lauw, M. N., Barco, S., Coutinho, J. M. & Middeldorp, S. Cerebral venous thrombosis and thrombophilia: a systematic review and meta-analysis. Semin. Thromb. Hemost. 39, 913–927 (2013).

    Article  CAS  PubMed  Google Scholar 

  26. Stam, J. Thrombosis of the cerebral veins and sinuses. N. Engl. J. Med. 352, 1791–1798 (2005).

    Article  CAS  PubMed  Google Scholar 

  27. Coutinho, J. M. Cerebral venous thrombosis. J. Thromb. Haemost. 13 (Suppl. 1), S238–S244 (2015).

    Article  PubMed  Google Scholar 

  28. Zuurbier, S. M. et al. Clinical outcome of anticoagulant treatment in head or neck infection-associated cerebral venous thrombosis. Stroke 47, 1271–1277 (2016).

    Article  CAS  PubMed  Google Scholar 

  29. Yesilot, N. et al. Cerebral venous thrombosis in Behcet's disease compared to those associated with other etiologies. J. Neurol. 256, 1134–1142 (2009).

    Article  CAS  PubMed  Google Scholar 

  30. Ueda, K., Nakase, H., Miyamoto, K., Otsuka, H. & Sakaki, T. Impact of anatomical difference of the cerebral venous system on microcirculation in a gerbil superior sagittal sinus occlusion model. Acta Neurochir. (Wien) 142, 75–82 (2000).

    Article  CAS  Google Scholar 

  31. Gotoh, M., Ohmoto, T. & Kuyama, H. Experimental study of venous circulatory disturbance by dural sinus occlusion. Acta Neurochir. (Wien) 124, 120–126 (1993).

    Article  CAS  Google Scholar 

  32. Ungersbock, K., Heimann, A. & Kempski, O. Cerebral blood flow alterations in a rat model of cerebral sinus thrombosis. Stroke 24, 563–569 (1993).

    Article  CAS  PubMed  Google Scholar 

  33. Schaller, B. et al. Hemodynamic changes after occlusion of the posterior superior sagittal sinus: an experimental PET study in cats. AJNR Am. J. Neuroradiol. 24, 1876–1880 (2003).

    PubMed  Google Scholar 

  34. Rottger, C. et al. A new model of reversible sinus sagittalis superior thrombosis in the rat: magnetic resonance imaging changes. Neurosurgery 57, 573–580 (2005).

    Article  PubMed  Google Scholar 

  35. Schaller, B. & Graf, R. Cerebral venous infarction: the pathophysiological concept. Cerebrovasc. Dis. 18, 179–188 (2004).

    Article  CAS  PubMed  Google Scholar 

  36. Barboza, M. A., Mejias, C., Colin-Luna, J., Quiroz-Compean, A. & Arauz, A. Intracranial venous collaterals in cerebral venous thrombosis: clinical and imaging impact. J. Neurol. Neurosurg. Psychiatry 86, 1314–1318 (2015).

    Article  PubMed  Google Scholar 

  37. Kurokawa, Y., Hashi, K., Okuyama, T. & Uede, T. Regional ischemia in cerebral venous hypertension due to embolic occlusion of the superior sagittal sinus in the rat. Surg. Neurol. 34, 390–395 (1990).

    Article  CAS  PubMed  Google Scholar 

  38. Lovblad, K. O. et al. Diffusion-weighted MR in cerebral venous thrombosis. Cerebrovasc. Dis. 11, 169–176 (2001).

    Article  CAS  PubMed  Google Scholar 

  39. Mullins, M. E., Grant, P. E., Wang, B., Gonzalez, R. G. & Schaefer, P. W. Parenchymal abnormalities associated with cerebral venous sinus thrombosis: assessment with diffusion-weighted MR imaging. AJNR Am. J. Neuroradiol. 25, 1666–1675 (2004).

    PubMed  Google Scholar 

  40. Coutinho, J. M. et al. Small juxtacortical hemorrhages in cerebral venous thrombosis. Ann. Neurol. 75, 908–916 (2014).

    Article  PubMed  Google Scholar 

  41. Pollay, M. The function and structure of the cerebrospinal fluid outflow system. Cerebrospinal Fluid Res. 7, 9 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Brunori, A., Vagnozzi, R. & Giuffre, R. Antonio Pacchioni (1665–1726): early studies of the dura mater. J. Neurosurg. 78, 515–518 (1993).

    Article  CAS  PubMed  Google Scholar 

  43. Leach, J. L., Meyer, K., Jones, B. V. & Tomsick, T. A. Large arachnoid granulations involving the dorsal superior sagittal sinus: findings on MR imaging and MR venography. AJNR Am. J. Neuroradiol. 29, 1335–1339 (2008).

    Article  CAS  PubMed  Google Scholar 

  44. Coutinho, J. M. et al. Cerebral venous thrombosis in the absence of headache. Stroke 46, 245–247 (2015).

    Article  PubMed  Google Scholar 

  45. Ferro, J. M. et al. Cerebral vein and dural sinus thrombosis in Portugal: 1980–1998. Cerebrovasc. Dis. 11, 177–182 (2001).

    Article  CAS  PubMed  Google Scholar 

  46. de Bruijn, S. F., Stam, J. & Kappelle, L. J. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. Lancet 348, 1623–1625 (1996).

    Article  CAS  PubMed  Google Scholar 

  47. Ferro, J. M. et al. Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc. Dis. 15, 78–83 (2003).

    Article  CAS  PubMed  Google Scholar 

  48. Davoudi, V., Keyhanian, K. & Saadatnia, M. Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis. Seizure 23, 135–139 (2014).

    Article  PubMed  Google Scholar 

  49. Kalita, J., Chandra, S. & Misra, U. K. Significance of seizure in cerebral venous sinus thrombosis. Seizure 21, 639–642 (2012).

    Article  PubMed  Google Scholar 

  50. Lamy, C. et al. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology 60, 400–404 (2003).

    Article  CAS  PubMed  Google Scholar 

  51. Bladin, C. F. et al. Seizures after stroke: a prospective multicenter study. Arch. Neurol. 57, 1617–1622 (2000).

    Article  CAS  Google Scholar 

  52. Passero, S., Rocchi, R., Rossi, S., Ulivelli, M. & Vatti, G. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 43, 1175–1180 (2002).

    Article  PubMed  Google Scholar 

  53. De Herdt, V. et al. Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome. Neurology 77, 1794–1800 (2011).

    Article  CAS  Google Scholar 

  54. Ferro, J. M. et al. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke 39, 1152–1158 (2008).

    Article  PubMed  Google Scholar 

  55. Bousser, M. G. & Ferro, J. M. Cerebral venous thrombosis: an update. Lancet Neurol. 6, 162–170 (2007).

    Article  CAS  PubMed  Google Scholar 

  56. Kalita, J., Bhoi, S. K., Chandra, S. & Misra, U. K. Reversible parkinsonian features in deep cerebral venous sinus thrombosis. Can. J. Neurol. Sci. 40, 740–742 (2013).

    Article  PubMed  Google Scholar 

  57. Bushnell, C. et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45, 1545–1588 (2014).

    Article  PubMed  Google Scholar 

  58. Saposnik, G. et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42, 1158–1192 (2011).

    Article  PubMed  Google Scholar 

  59. Canhao, P. et al. Safety of lumbar puncture in patients with cerebral venous thrombosis. Eur. J. Neurol. 20, 1075–1080 (2013).

    Article  CAS  PubMed  Google Scholar 

  60. Leach, J. L., Fortuna, R. B., Jones, B. V. & Gaskill-Shipley, M. F. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 26 (Suppl. 1), S19–S41 (2006).

    Article  PubMed  Google Scholar 

  61. Lafitte, F. et al. MRI and MRA for diagnosis and follow-up of cerebral venous thrombosis (CVT). Clin. Radiol. 52, 672–679 (1997).

    Article  CAS  PubMed  Google Scholar 

  62. Liang, L. et al. Evaluation of the intracranial dural sinuses with a 3D contrast-enhanced MP-RAGE sequence: prospective comparison with 2D-TOF MR venography and digital subtraction angiography. AJNR Am. J. Neuroradiol. 22, 481–492 (2001).

    CAS  PubMed  Google Scholar 

  63. Qu, H. & Yang, M. Early imaging characteristics of 62 cases of cerebral venous sinus thrombosis. Exp. Ther. Med. 5, 233–236 (2013).

    Article  PubMed  Google Scholar 

  64. Siddiqui, F. M. et al. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke 46, 1263–1268 (2015).

    Article  PubMed  Google Scholar 

  65. Coutinho, J. M., Gerritsma, J. J., Zuurbier, S. M. & Stam, J. Isolated cortical vein thrombosis: systematic review of case reports and case series. Stroke 45, 1836–1838 (2014).

    Article  PubMed  Google Scholar 

  66. Conforto, A. B. et al. Dural arteriovenous fistula and cerebral venous thrombosis. Arq. Neuropsiquiatr. 73, 548 (2015).

    Article  PubMed  Google Scholar 

  67. Roland, T. et al. Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis. Clin. Radiol. 65, 34–39 (2010).

    Article  CAS  PubMed  Google Scholar 

  68. Buyck, P. J. et al. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am. J. Neuroradiol. 34, 1568–1572 (2013).

    Article  PubMed  Google Scholar 

  69. Virapongse, C., Cazenave, C., Quisling, R., Sarwar, M. & Hunter, S. The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology 162, 779–785 (1987).

    Article  CAS  PubMed  Google Scholar 

  70. Ford, K. & Sarwar, M. Computed tomography of dural sinus thrombosis. AJNR Am. J. Neuroradiol 2, 539–543 (1981).

    CAS  PubMed  Google Scholar 

  71. Rizzo, L. et al. Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting. Radiol. Med. 115, 313–325 (2010).

    Article  CAS  PubMed  Google Scholar 

  72. Black, D. F., Rad, A. E., Gray, L. A., Campeau, N. G. & Kallmes, D. F. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR Am. J. Neuroradiol. 32, 1354–1357 (2011).

    Article  CAS  PubMed  Google Scholar 

  73. Linn, J. et al. Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses. AJNR Am. J. Neuroradiol. 28, 946–952 (2007).

    CAS  PubMed  Google Scholar 

  74. Ozsvath, R. R. et al. Cerebral venography: comparison of CT and MR projection venography. AJR Am. J. Roentgenol. 169, 1699–1707 (1997).

    Article  CAS  PubMed  Google Scholar 

  75. Wetzel, S. G. et al. Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography. AJNR Am. J. Neuroradiol. 20, 249–255 (1999).

    CAS  PubMed  Google Scholar 

  76. Rodallec, M. H. et al. Cerebral venous thrombosis and multidetector CT angiography: tips and tricks. Radiographics 26 (Suppl. 1), S5–S18 (2006).

    Article  PubMed  Google Scholar 

  77. Ayanzen, R. H. et al. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am. J. Neuroradiol. 21, 74–78 (2000).

    CAS  PubMed  Google Scholar 

  78. Idbaih, A. et al. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images. Stroke 37, 991–995 (2006).

    Article  PubMed  Google Scholar 

  79. Boukobza, M., Crassard, I., Bousser, M. G. & Chabriat, H. MR imaging features of isolated cortical vein thrombosis: diagnosis and follow-up. AJNR Am. J. Neuroradiol. 30, 344–348 (2009).

    Article  CAS  PubMed  Google Scholar 

  80. Robinson, R. J. & Bhuta, S. Susceptibility-weighted imaging of the brain: current utility and potential applications. J. Neuroimaging 21, e189–e204 (2011).

    Article  PubMed  Google Scholar 

  81. Farb, R. I. et al. Intracranial venous system: gadolinium-enhanced three-dimensional MR venography with auto-triggered elliptic centric-ordered sequence — initial experience. Radiology 226, 203–209 (2003).

    Article  PubMed  Google Scholar 

  82. Niu, P. P. et al. Diagnosis of non-acute cerebral venous thrombosis with 3D T1-weighted black blood sequence at 3T. J. Neurol. Sci. 367, 46–50 (2016).

    Article  PubMed  Google Scholar 

  83. Bakac, G. & Wardlaw, J. M. Problems in the diagnosis of intracranial venous infarction. Neuroradiology 39, 566–570 (1997).

    Article  CAS  PubMed  Google Scholar 

  84. Ferro, J. M. et al. Cerebral venous thrombosis with nonhemorrhagic lesions: clinical correlates and prognosis. Cerebrovasc. Dis. 29, 440–445 (2010).

    Article  PubMed  Google Scholar 

  85. Bushnell, C. & Saposnik, G. Evaluation and management of cerebral venous thrombosis. Continuum (Minneap. Minn.) 20, 335–351 (2014).

    Google Scholar 

  86. Masuhr, F. et al. Risk and predictors of early epileptic seizures in acute cerebral venous and sinus thrombosis. Eur. J. Neurol. 13, 852–856 (2006).

    Article  CAS  PubMed  Google Scholar 

  87. Einhaupl, K. et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur. J. Neurol. 17, 1229–1235 (2010).

    Article  CAS  PubMed  Google Scholar 

  88. Stansfield, F. R. Puerperal cerebral thrombophlebitis treated by heparin. Br. Med. J. 1, 436–438 (1942).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Krayenbuhl, H. A. Cerebral venous and sinus thrombosis. Neurol. Med. Chir. (Tokyo) 10, 1–24 (1968).

    Article  CAS  Google Scholar 

  90. Gettelfinger, D. M. & Kokmen, E. Superior sagittal sinus thrombosis. Arch. Neurol. 34, 2–6 (1977).

    Article  CAS  PubMed  Google Scholar 

  91. Coutinho, J. M. & Stam, J. How to treat cerebral venous and sinus thrombosis. J. Thromb. Haemost. 8, 877–883 (2010).

    CAS  PubMed  Google Scholar 

  92. Einhaupl, K. M. et al. Heparin treatment in sinus venous thrombosis. Lancet 338, 597–600 (1991).

    Article  CAS  PubMed  Google Scholar 

  93. de Bruijn, S. F. & Stam, J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 30, 484–488 (1999).

    Article  CAS  PubMed  Google Scholar 

  94. Coutinho, J., de Bruijn, S. F., Deveber, G. & Stam, J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst. Rev. 8, CD002005 (2011).

    Google Scholar 

  95. Erkens, P. M. & Prins, M. H. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst. Rev. 9, CD001100 (2010).

    Google Scholar 

  96. Coutinho, J. M. et al. Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke 41, 2575–2580 (2010).

    Article  CAS  PubMed  Google Scholar 

  97. Misra, U. K., Kalita, J., Chandra, S., Kumar, B. & Bansal, V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur. J. Neurol. 19, 1030–1036 (2012).

    Article  CAS  PubMed  Google Scholar 

  98. Afshari, D. et al. The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis. Neurosciences (Riyadh) 20, 357–361 (2015).

    Article  Google Scholar 

  99. Field, T. S., Camden, M. C., Al-Shimemeri, S., Lui, G. & Lee, A. Y. Antithrombotic strategy in cerebral venous thrombosis: differences between neurologist and hematologist respondents in a Canadian survey. Can. J. Neurol. Sci. 44, 116–119 (2017).

    Article  PubMed  Google Scholar 

  100. Coutinho, J. M. et al. Treatment variations in cerebral venous thrombosis: an international survey. Cerebrovasc. Dis. 32, 298–300 (2011).

    Article  CAS  PubMed  Google Scholar 

  101. ISRCTN registry. EXCOA-CVT study: the benefit of EXtending oral antiCOAgulation treatment after acute Cerebral Vein Thrombosis. ISRCTN http://www.isrctn.com/ISRCTN25644448 (2014).

  102. Mendonca, M. D., Barbosa, R., Cruz-e-Silva, V., Calado, S. & Viana-Baptista, M. Oral direct thrombin inhibitor as an alternative in the management of cerebral venous thrombosis: a series of 15 patients. Int. J. Stroke 10, 1115–1118 (2015).

    Article  PubMed  Google Scholar 

  103. Geisbusch, C., Richter, D., Herweh, C., Ringleb, P. A. & Nagel, S. Novel factor xa inhibitor for the treatment of cerebral venous and sinus thrombosis: first experience in 7 patients. Stroke 45, 2469–2471 (2014).

    Article  PubMed  CAS  Google Scholar 

  104. Robertson, L., Kesteven, P. & McCaslin, J. E. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of pulmonary embolism. Cochrane Database Syst. Rev. 12, CD010957 (2015).

    Google Scholar 

  105. Robertson, L., Kesteven, P. & McCaslin, J. E. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis. Cochrane Database Syst. Rev. 6, CD010956 (2015).

    Google Scholar 

  106. Chatterjee, S., Sardar, P., Biondi-Zoccai, G. & Kumbhani, D. J. New oral anticoagulants and the risk of intracranial hemorrhage: traditional and Bayesian meta-analysis and mixed treatment comparison of randomized trials of new oral anticoagulants in atrial fibrillation. JAMA Neurol. 70, 1486–1490 (2013).

    PubMed  Google Scholar 

  107. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02913326 (2017).

  108. Higashida, R. T., Helmer, E., Halbach, V. V. & Hieshima, G. B. Direct thrombolytic therapy for superior sagittal sinus thrombosis. AJNR Am. J. Neuroradiol 10, S4–S6 (1989).

    CAS  PubMed  Google Scholar 

  109. Scott, J. A., Pascuzzi, R. M., Hall, P. V. & Becker, G. J. Treatment of dural sinus thrombosis with local urokinase infusion. Case report. J. Neurosurg. 68, 284–287 (1988).

    Article  CAS  PubMed  Google Scholar 

  110. Canhao, P., Falcao, F. & Ferro, J. M. Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovasc. Dis. 15, 159–166 (2003).

    Article  CAS  PubMed  Google Scholar 

  111. Ciccone, A., Canhao, P., Falcao, F., Ferro, J. M. & Sterzi, R. Thrombolysis for cerebral vein and dural sinus thrombosis. Cochrane Database Syst. Rev. 1, CD003693 (2004).

    Google Scholar 

  112. Stam, J., Majoie, C. B., van Delden, O. M., van Lienden, K. P. & Reekers, J. A. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke 39, 1487–1490 (2008).

    Article  PubMed  Google Scholar 

  113. Frey, J. L., Muro, G. J., McDougall, C. G., Dean, B. L. & Jahnke, H. K. Cerebral venous thrombosis: combined intrathrombus rtPA and intravenous heparin. Stroke 30, 489–494 (1999).

    Article  CAS  PubMed  Google Scholar 

  114. Li, G. et al. Safety and validity of mechanical thrombectomy and thrombolysis on severe cerebral venous sinus thrombosis. Neurosurgery 72, 730–738 (2013).

    Article  PubMed  Google Scholar 

  115. Caso, V., Billeci, A. M. & Leys, D. Interventional neuroradiology in the treatment of cerebral venous thrombosis. Front. Neurol. Neurosci. 23, 144–160 (2008).

    PubMed  Google Scholar 

  116. Borhani Haghighi, A. et al. Mechanical thrombectomy for cerebral venous sinus thrombosis: a comprehensive literature review. Clin. Appl. Thromb. Hemost. 20, 507–515 (2014).

    Article  PubMed  Google Scholar 

  117. Coutinho, J. M. et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int. J. Stroke 8, 135–140 (2013).

    Article  PubMed  Google Scholar 

  118. Zuurbier, S. M. et al. Hydrocephalus in cerebral venous thrombosis. J. Neurol. 262, 931–937 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  119. Lobo, S. et al. Shunting in acute cerebral venous thrombosis: a systematic review. Cerebrovasc. Dis. 37, 38–42 (2014).

    Article  CAS  PubMed  Google Scholar 

  120. Canhao, P. et al. Are steroids useful to treat cerebral venous thrombosis? Stroke 39, 105–110 (2008).

    Article  CAS  PubMed  Google Scholar 

  121. Canhao, P. et al. Causes and predictors of death in cerebral venous thrombosis. Stroke 36, 1720–1725 (2005).

    Article  PubMed  Google Scholar 

  122. Ferro, J. M. et al. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 42, 2825–2831 (2011).

    Article  PubMed  Google Scholar 

  123. Aaron, S. et al. Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J. Neurol. Neurosurg. Psychiatry 84, 995–1000 (2013).

    Article  PubMed  Google Scholar 

  124. Zuurbier, S. M. et al. Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series. J. Neurol. 259, 1099–1105 (2012).

    Article  PubMed  Google Scholar 

  125. Zhang, S., Zhao, H., Li, H., You, C. & Hui, X. Decompressive craniectomy in hemorrhagic cerebral venous thrombosis: clinicoradiological features and risk factors. J. Neurosurg. http://dx.doi.org/10.3171/2016.8.JNS161112 (2016).

  126. Mohindra, S., Umredkar, A., Singla, N., Bal, A. & Gupta, S. K. Decompressive craniectomy for malignant cerebral oedema of cortical venous thrombosis: an analysis of 13 patients. Br. J. Neurosurg. 25, 422–429 (2011).

    Article  PubMed  Google Scholar 

  127. Theaudin, M. et al. Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients. Stroke 41, 727–731 (2010).

    Article  PubMed  Google Scholar 

  128. Dentali, F., Gianni, M., Crowther, M. A. & Ageno, W. Natural history of cerebral vein thrombosis: a systematic review. Blood 108, 1129–1134 (2006).

    Article  CAS  PubMed  Google Scholar 

  129. Coutinho, J. M., Zuurbier, S. M. & Stam, J. Declining mortality in cerebral venous thrombosis: a systematic review. Stroke 45, 1338–1341 (2014).

    Article  PubMed  Google Scholar 

  130. Ferro, J. M. et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc. Dis. 28, 39–44 (2009).

    Article  PubMed  Google Scholar 

  131. Zuurbier, S. M. et al. Admission hyperglycemia and clinical outcome in cerebral venous thrombosis. Stroke 47, 390–396 (2016).

    Article  CAS  PubMed  Google Scholar 

  132. Biousse, V., Ameri, A. & Bousser, M. G. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 53, 1537–1542 (1999).

    Article  CAS  PubMed  Google Scholar 

  133. Kowoll, C. M. et al. Severe cerebral venous and sinus thrombosis: clinical course, imaging correlates, and prognosis. Neurocrit. Care 25, 392–399 (2016).

    Article  PubMed  Google Scholar 

  134. Soyer, B. et al. Outcome of a cohort of severe cerebral venous thrombosis in intensive care. Ann. Intensive Care 6, 29 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  135. Koopman, K. et al. Long-term sequelae after cerebral venous thrombosis in functionally independent patients. J. Stroke Cerebrovasc. Dis. 18, 198–202 (2009).

    Article  PubMed  Google Scholar 

  136. Hiltunen, S., Putaala, J., Haapaniemi, E. & Tatlisumak, T. Long-term outcome after cerebral venous thrombosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients. J. Neurol. 263, 477–484 (2016).

    Article  PubMed  Google Scholar 

  137. Bugnicourt, J. M. et al. Cognitive impairment after cerebral venous thrombosis: a two-center study. J. Neurol. 260, 1324–1331 (2013).

    Article  PubMed  Google Scholar 

  138. Buccino, G., Scoditti, U., Patteri, I., Bertolino, C. & Mancia, D. Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis. Acta Neurol. Scand. 107, 330–335 (2003).

    Article  CAS  PubMed  Google Scholar 

  139. Purvin, V. A., Trobe, J. D. & Kosmorsky, G. Neuro-ophthalmic features of cerebral venous obstruction. Arch. Neurol. 52, 880–885 (1995).

    Article  CAS  PubMed  Google Scholar 

  140. Herweh, C. et al. Frequency and temporal profile of recanalization after cerebral vein and sinus thrombosis. Eur. J. Neurol. 23, 681–687 (2016).

    Article  CAS  PubMed  Google Scholar 

  141. Arauz, A. et al. Time to recanalisation in patients with cerebral venous thrombosis under anticoagulation therapy. J. Neurol. Neurosurg. Psychiatry 87, 247–251 (2016).

    Article  PubMed  Google Scholar 

  142. Putaala, J., Hiltunen, S., Salonen, O., Kaste, M. & Tatlisumak, T. Recanalization and its correlation to outcome after cerebral venous thrombosis. J. Neurol. Sci. 292, 11–15 (2010).

    Article  PubMed  Google Scholar 

  143. Strupp, M., Covi, M., Seelos, K., Dichgans, M. & Brandt, T. Cerebral venous thrombosis: correlation between recanalization and clinical outcome — a long-term follow-up of 40 patients. J. Neurol. 249, 1123–1124 (2002).

    Article  CAS  PubMed  Google Scholar 

  144. Kenet, G. et al. Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study. Lancet Neurol. 6, 595–603 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  145. Miranda, B. et al. Venous thromboembolic events after cerebral vein thrombosis. Stroke 41, 1901–1906 (2010).

    Article  PubMed  Google Scholar 

  146. Lim, H. Y., Ng, C., Donnan, G., Nandurkar, H. & Ho, P. Ten years of cerebral venous thrombosis: male gender and myeloproliferative neoplasm is associated with thrombotic recurrence in unprovoked events. J. Thromb. Thrombolysis 42, 423–431 (2016).

    Article  CAS  PubMed  Google Scholar 

  147. Martinelli, I. et al. Long-term evaluation of the risk of recurrence after cerebral sinus-venous thrombosis. Circulation 121, 2740–2746 (2010).

    Article  PubMed  Google Scholar 

  148. Ruiz-Sandoval, J. L. et al. Cerebral venous thrombosis in a Mexican multicenter registry of acute cerebrovascular disease: the RENAMEVASC study. J. Stroke Cerebrovasc. Dis. 21, 395–400 (2012).

    Article  PubMed  Google Scholar 

  149. Aguiar de Sousa, D., Canhao, P. & Ferro, J. M. Safety of pregnancy after cerebral venous thrombosis: a systematic review. Stroke 47, 713–718 (2016).

    Article  CAS  PubMed  Google Scholar 

  150. Cotlarciuc, I. et al. Towards the genetic basis of cerebral venous thrombosis — the BEAST Consortium: a study protocol. BMJ Open 6, e012351 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Suzanne M. Silvis and Diana Aguiar de Sousa: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands

    Suzanne M. Silvis & Jonathan M Coutinho

  2. Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, Lisbon, 1649–035, Portugal

    Diana Aguiar de Sousa & José M. Ferro

Authors
  1. Suzanne M. Silvis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diana Aguiar de Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. José M. Ferro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan M Coutinho
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S.M.S. and D.A.d.S. researched the data for the article and co-wrote the first draft. J.M.F. and J.M.C. made substantial contribution to discussion of the context an edited the manuscript before submission. J.M.C. supervised the preparation of the manuscript.

Corresponding author

Correspondence to Jonathan M Coutinho.

Ethics declarations

Competing interests

J.M.F. has received personal fees from Boehringer Ingelheim and Daiichi Sankyo. J.M.C. has received research grants for CVT from two non-profit organizations: the Dutch Thrombosis Society and the Netherlands Brain Foundation, and is a steering committee member of the RE-SPECT CVT trial, a clinical trial that evaluates the efficacy and safety of dabigatran for the treatment of CVT sponsored by Boehringer Ingelheim.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Silvis, S., de Sousa, D., Ferro, J. et al. Cerebral venous thrombosis. Nat Rev Neurol 13, 555–565 (2017). https://doi.org/10.1038/nrneurol.2017.104

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneurol.2017.104

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing