1(E): Intracranial Venous Thrombosis

Question 1

What is intracranial venous thrombosis also called

Answer 1

Central venous sinus thrombosis

Question 2

How does intracranial venous thrombosis compare to arterial

Answer 2

Less common

Question 3

In which gender is intracranial venous thrombosis more common

Answer 3

Females (3:1)

Question 4

Why is intracranial venous thrombosis more common in women

Answer 4

COCP

HRT

Question 5

In which age group does intracranial venous thrombosis tend to occur

Answer 5

Under 40’s

Question 6

What causes intracranial venous thrombosis

Answer 6

• High coagulable states
• Head Injury
• Malignancy
• LP
• Infection
• Vasculitis
• IBD

Question 7

What intracranial venous thrombosis does otitis media cause

Answer 7

Inferior petrosal

Question 8

What intracranial venous thrombosis does folliculitis cause

Answer 8

Cavernous

Question 9

What intracranial venous thrombosis does sinusitus cause

Answer 9

Cavernous

Question 10

What factors increase risk of intracranial venous thrombosis

Answer 10

Hyper-coagulable state

Question 11

Name 5 factors that cause hyper coagulable state

Answer 11

COCP
HRT
Factor V Leiden 
Pregnancy 
Antiphospholipid syndrome

Question 12

Where is dural venous sinus thrombosis more common

Answer 12

Saggital sinus (50%)

Question 13

If in the sagittal sinus how symptoms present

Answer 13

Raised ICP:

• Vomitting
• Papilloedema
• Seizures
• Headache

Question 14

If in the transverse sinus how symptoms present

Answer 14

Headache
MASTOID PAIN
Seizures
Focal CNS Signs

Question 15

If in the sigmoid sinus how symptoms present

Answer 15

Cerebellar Signs

Question 16

If in the inferior petrosal siinus how symptoms present

Answer 16

CN5 and CN6 palsies

Question 17

What is gradengio’s syndrome

Answer 17

Inferior petrosal venous thrombosis secondary to otitis media that presents with temporal and retro-orbital pain

Question 18

What causes gradenigo’s syndrome

Answer 18

Otitis media

Question 19

what predominantly causes cavernous sinus thrombosis

Answer 19

Folliculitis

Question 20

what are the symptoms of cavernous sinus thrombosis

Answer 20

• Headache
• Peri-orbital oedema and chemosis
• Fever
• CN6 damage (Prior to CN3 and CN4)

Question 21

in cavernous sinus thrombosis what CN is damaged first and what follows

Answer 21

CN6

Then: CN3 and CN4

Question 22

what can cavernous sinus thrombosis cause

Answer 22

Central retinal vein thrombosis

Question 23

what is cavernous sinus syndrome

Answer 23

Congestion of blood in superior and inferior opthalmic veins that drain into cavernous sinus

Question 24

what is a typical symptom of intracranial venous sinus thrombosis

Answer 24

Pulsatile tinnitus = can hear CSF flow

Question 25

Explain consequences of venous sinus thrombosis

Answer 25

Occlusion dural venous sinuses - causes back flow of pressure to cerebral veins which then causes infarction of venous territory. Also prevents cerebral drainage causing increase in ICP and symptoms

Question 26

What is first-line for suspected intracranial venous thrombosis cases

Answer 26

Fundoscopy - to assess for papilloedema

Question 27

What other investigation should be ordered for intracranial venous thrombosis

Answer 27

CT or MRI

Question 28

What is CT sign of intracranial venous thrombosis

Answer 28

Delta sign: presence of thrombosis of the superior sagittal sinus

Question 29

What will be seen on LP in intracranial venous thrombosis

Answer 29

high opening pressure

Question 30

How is intracranial venous thrombosis managed

Answer 30

warfarin - with bridging LMWH

Question 31

If individual deteriorates despite warfarin, what do they qualify for

Answer 31

intravascular thrombolysis

Question 32

If individual with cranial venous thrombosis has raised ICP what is performed

Answer 32

decompressive hemiectomy

Question 33

What are two risks of intracranial venous thrombosis

Answer 33

- Raised ICP can cause herniation | - If untreated, clot may break off and cause a PE

Question 34

What is gold-standard to identify thrombosis

Answer 34

MR Venogram