see also: [[Headache]] see: [Dunn = Cerebral venous sinus thrombosis](x-devonthink-item://E54DB8E7-7BB1-4775-87FA-3B1A94F8E935) [Rosen - Cerebral Venous Thrombosis](x-devonthink-item://1781B09F-B327-4348-AA6F-F427FF97CA97?page=10), [Hayes' Cavernous sinus thrombosis](x-devonthink-item://0CC616AF-4EF4-4EFE-8004-610F9613150F), [Core radiology - Cerebral Venous Disease](x-devonthink-item://C1EF00FD-576C-4C41-AE08-CA966611F572?page=702) > cavernous sinus thrombosis is a *type* of cerebral venous thrombosis > ~ 50% of CVT undergo haemorrhagic transformation prior to anticoagulation # Cerebral venous thrombosis - thrombus formation in either the deep or superficial venous drainage of the brain **Risk factors:** - thrombosis risks (smoking, OCP, female) - post COVID-19 - 2/2 infection (otitis media in lateral sinus, orbital cellulitis affecting cavernous sinus), meningitis - post-traumatic - malignancy **Symptoms** 1. symptoms of ↑ ICP due to impaired venous drainage 1. diffuse ==headache== increasing in severity over days to weeks most common symptom a/w ↑ ICP 2. may have confusion 2. focal brain injury from venous occlusion resulting in ischaemia, infarction, or haemorrhage - [[Seizures]] can occur - occular findings include orbital pain, proptosis, chemosis, extraocular muscle paralysis, and [[Papilloedema|papilledema]] | location | symptoms | | --------------------- | -------------------------------------------------------------------- | | cavernous sinus | - ocular signs (orbital pain, chemosis, proptosis, oculomotor palsy) | | cortical vein | motor deficits, sensory deficits, seizures | | sagittal sinus | motor deficits, bilat deficits, seizures | | lateral sinus | isolated intracranial HTN | | left transverse sinus | aphasia | | deep venous (straigt) | behaviour symptoms (thalamic lesions) | ![[Pasted image 20240915161135.png]] ![[Pasted image 20241225133134.png|dense signal in the superior sagital sinus, called the "delta sign"]] ## Cavernous sinus venous thrombosis - often 2/2 sinusitis, facial cellulitis, OCP, post-partum this is a *type* of cerebral venous thrombosis! - facial pain and headache - fever - visual disturbance - lid oedema - cranial nerve lesions (oculomotor nerve, ophthalmic, maxillary) - [[Papilloedema]] often preceded by sinusitis mid-face infection, middle ear infection ## Sagittal sinus thrombosis - occlusion causes ↓ CSF absorption → ↑ ICP - occlusion of the posterior 1/3 of the sinus is a/w more severe disease than in the anterior 1/3 **features** - slow onset headache increasing intensity over days - often dx'd at 11 days! - stroke-like features in 40% - paresis of 1 or more legs - hemiparesis from infarction in the frontopareietal regions - visual disturbances - seizures - ==hard to differentiate from IIH without imaging== # Treatment anticoagulation eg enoxaparin 1 u/kg BD s/c address modifiable risk factors (eg OCP) treat complications