Intracranial venous disease Flashcards
(24 cards)
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
2-3
How long would you give someone warfarin therapy for an intracranial venous thrombosis?
6 months
