Venous Thrombosis, Intracranial

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

• Dabigatran showed similar efficacy to warfarin in one randomized trial and may be an acceptable alternative

• 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