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For further information, see CMDT Part 24-08: Stroke

Key Features

  • May occur in association with

    • Intracranial or maxillofacial infections

    • Hypercoagulable states

    • Polycythemia

    • Sickle cell disease

    • Cyanotic congenital heart disease

  • May also occur in pregnancy or during the puerperium

  • Genetic factors are also important

Clinical Findings

  • Headache

  • Focal or generalized convulsions

  • Drowsiness

  • Confusion

  • Increased intracranial pressure

  • Focal neurologic deficits

  • Meningeal irritation (less common)

Diagnosis

  • Confirmed by CT, MR venography, or angiography

Treatment

  • Anticonvulsant drugs if seizures have occurred

  • If necessary, measures to reduce intracranial pressure

  • Anticoagulation with dose-adjusted intravenous heparin or weight-adjusted subcutaneous low-molecular-weight heparin followed by oral warfarin for 6 months reduces morbidity and mortality of venous sinus thrombosis

  • Concomitant intracranial hemorrhage related to the venous thrombosis does not contraindicate heparin therapy

  • In cases refractory to heparin, endovascular techniques including catheter-directed thrombolytic therapy (urokinase) and thrombectomy are sometimes helpful but may increase risk for major hemorrhage

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