Venous Thrombosis, Intracranial

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

Headache

Focal or generalized convulsions

Drowsiness

Confusion

Increased intracranial pressure

Focal neurologic deficits

Meningeal irritation (less common)

Confirmed by CT, MR venography, or angiography

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