Cerebral Venous Thrombosis

Abstract

Cerebral venous thrombosis (CVT) is a rare form of stroke that often affects younger age groups, especially reproductive age group females. CVT is a potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. Headache is the most common presenting symptom. However, a wide range of symptoms can be present and the symptom onset can be acute, subacute, or chronic. Neuroimaging is mandatory in cases where CVT is suspected. Both magnetic resonance venography and computed tomography venography can confirm a diagnosis of CVT. Anticoagulation with low-molecular-weight heparin is the mainstay of treatment. Intracranial hemorrhage is not considered a contraindication to the use of anticoagulants in CVT. Endovascular intervention is still controversial but can be a treatment option for patients with neurological deterioration or thrombus progression, despite the use of anticoagulation or with development of new or worsening intracerebral hemorrhage. Patients with CVT have an increased risk of recurrence of CVT and other types of venous thromboembolism. This review provides an overview of the epidemiology, diagnosis, and treatment of CVT in adults. Commentary about increased presentation of CVT in patients with coronavirus disease 2019 (COVID-19), or after immunization against COVID-19, is also provided.

Keywords

cerebral venous thrombosis - anticoagulants - endovascular intervention - cerebral hemorrhage

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022

• References

• 1 Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F. ISCVT Investigators. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke 2005; 36 (09) 1927-1932
• 2 Silvis SM, de Sousa DA, Ferro JM, Coutinho JM. Cerebral venous thrombosis. Nat Rev Neurol 2017; 13 (09) 555-565
• 3 Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005; 352 (17) 1791-1798
• 4 Devasagayam S, Wyatt B, Leyden J, Kleinig T. Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke 2016; 47 (09) 2180-2182
• 5 Proulx ST. Cerebrospinal fluid outflow: a review of the historical and contemporary evidence for arachnoid villi, perineural routes, and dural lymphatics. Cell Mol Life Sci 2021; 78 (06) 2429-2457
• 6 Eide PK, Vatnehol SAS, Emblem KE, Ringstad G. Magnetic resonance imaging provides evidence of glymphatic drainage from human brain to cervical lymph nodes. Sci Rep 2018; 8 (01) 7194
• 7 Ringstad G, Eide PK. Cerebrospinal fluid tracer efflux to parasagittal dura in humans. Nat Commun 2020; 11 (01) 354
• 8 Kristoffersen ES, Harper CE, Vetvik KG, Zarnovicky S, Hansen JM, Faiz KW. Incidence and mortality of cerebral venous thrombosis in a Norwegian population. Stroke 2020; 51 (10) 3023-3029
• 9 Ruuskanen JO, Kytö V, Posti JP, Rautava P, Sipilä JOT. Cerebral venous thrombosis: Finnish nationwide trends. Stroke 2021; 52 (01) 335-338
• 10 Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke 2012; 43 (12) 3375-3377
• 11 Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6 (02) 162-170
• 12 Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35 (03) 664-670
• 13 Dentali F, Poli D, Scoditti U. et al; CErebral VEin Thrombosis International Study Investigators. Long-term outcomes of patients with cerebral vein thrombosis: a multicenter study. J Thromb Haemost 2012; 10 (07) 1297-1302
• 14 Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral venous thrombosis: a comprehensive review. Eur Neurol 2020; 83 (04) 369-379
• 15 de Bruijn SF, Stam J, Koopman MM, Vandenbroucke JP. The Cerebral Venous Sinus Thrombosis Study Group. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in [correction of who are] carriers of hereditary prothrombotic conditions. BMJ 1998; 316 (7131): 589-592
• 16 Cantú C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke 1993; 24 (12) 1880-1884
• 17 Brunori A, Vagnozzi R, Giuffrè R. Antonio Pacchioni (1665-1726): early studies of the dura mater. J Neurosurg 1993; 78 (03) 515-518
• 18 Yesilot N, Bahar S, Yilmazer S. et al. Cerebral venous thrombosis in Behçet's disease compared to those associated with other etiologies. J Neurol 2009; 256 (07) 1134-1142
• 19 Duman T, Uluduz D, Midi I. et al; VENOST Study Group. A multicenter study of 1144 patients with cerebral venous thrombosis: the VENOST study. J Stroke Cerebrovasc Dis 2017; 26 (08) 1848-1857
• 20 Röttger C, Bachmann G, Gerriets T. et al. A new model of reversible sinus sagittalis superior thrombosis in the rat: magnetic resonance imaging changes. Neurosurgery 2005; 57 (03) 573-580 , discussion 573–580
• 21 Gotoh M, Ohmoto T, Kuyama H. Experimental study of venous circulatory disturbance by dural sinus occlusion. Acta Neurochir (Wien) 1993; 124 (2-4): 120-126
• 22 Liang J, Chen H, Li Z. et al. Cortical vein thrombosis in adult patients of cerebral venous sinus thrombosis correlates with poor outcome and brain lesions: a retrospective study. BMC Neurol 2017; 17 (01) 219
• 23 Schaller B, Graf R, Sanada Y. et al. Hemodynamic changes after occlusion of the posterior superior sagittal sinus: an experimental PET study in cats. AJNR Am J Neuroradiol 2003; 24 (09) 1876-1880
• 24 Kurokawa Y, Hashi K, Okuyama T, Uede T. Regional ischemia in cerebral venous hypertension due to embolic occlusion of the superior sagittal sinus in the rat. Surg Neurol 1990; 34 (06) 390-395
• 25 Brioschi S, Wang WL, Peng V. et al. Heterogeneity of meningeal B cells reveals a lymphopoietic niche at the CNS borders. Science 2021; 373 (6553): eabf9277
• 26 Engelhardt B. Private immune protection at the border of the central nervous system. Nature 2021; 596 (7870): 38-40
• 27 Rustenhoven J. A privileged brain. Science 2021; 374 (6567): 548
• 28 Coutinho JM, Stam J, Canhão P, Barinagarrementeria F, Bousser MG, Ferro JM. ISCVT Investigators. Cerebral venous thrombosis in the absence of headache. Stroke 2015; 46 (01) 245-247
• 29 Saposnik G, Barinagarrementeria F, Brown Jr RD. et al; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (04) 1158-1192
• 30 Mehta A, Danesh J, Kuruvilla D. Cerebral venous thrombosis headache. Curr Pain Headache Rep 2019; 23 (07) 47
• 31 Headache Classification Committee of the International Headache Society (IHS).. The International Classification of Headache Disorders. 3rd ed. Cephalalgia. 2018; 38 (01) 1-211
• 32 Leavell Y, Khalid M, Tuhrim S, Dhamoon MS. Baseline characteristics and readmissions after cerebral venous sinus thrombosis in a nationally representative database. Cerebrovasc Dis 2018; 46 (5-6): 249-256
• 33 Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F. ISCVT Investigators. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke 2008; 39 (04) 1152-1158
• 34 De Herdt V, Dumont F, Hénon H. et al. Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome. Neurology 2011; 77 (20) 1794-1800
• 35 Kalita J, Misra UK, Singh VK, Dubey D. Predictors and outcome of status epilepticus in cerebral venous thrombosis. J Neurol 2019; 266 (02) 417-425
• 36 Ferro JM, Bousser MG, Canhão P. et al; European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24 (10) 1203-1213
• 37 Bushnell C, Saposnik G. Evaluation and management of cerebral venous thrombosis. Continuum (Minneap Minn) 2014; 20 (2 Cerebrovascular Disease): 335-351
• 38 Nepal G, Kharel S, Bhagat R. et al. Safety and efficacy of direct oral anticoagulants in cerebral venous thrombosis: a meta-analysis. Acta Neurol Scand 2022; 145 (01) 10-23
• 39 Bose G, Graveline J, Yogendrakumar V. et al. Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review. BMJ Open 2021; 11 (02) e040212
• 40 Soyer B, Rusca M, Lukaszewicz AC. et al. Outcome of a cohort of severe cerebral venous thrombosis in intensive care. Ann Intensive Care 2016; 6 (01) 29
• 41 Kowoll CM, Kaminski J, Weiß V. et al. Severe cerebral venous and sinus thrombosis: clinical course, imaging correlates, and prognosis. Neurocrit Care 2016; 25 (03) 392-399
• 42 Medhi G, Parida S, Nicholson P, Senapati SB, Padhy BP, Pereira VM. Mechanical thrombectomy for cerebral venous sinus thrombosis: a case series and technical note. World Neurosurg 2020; 140: 148-161
• 43 Xu Z, Li X, Feng D. et al. Endovascular therapy versus anticoagulation for treatment of cerebral venous sinus thrombosis: a meta-analysis. Neurologist 2021; (e-Pub ahead of print)
• 44 Coutinho JM, Ferro JM, Zuurbier SM. et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int J Stroke 2013; 8 (02) 135-140
• 45 Coutinho JM, Zuurbier SM, Bousser MG. et al; TO-ACT investigators. Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: the TO-ACT randomized clinical trial. JAMA Neurol 2020; 77 (08) 966-973
• 46 Lechanoine F, Janot K, Herbreteau D, Maldonado IL, Velut S. Surgical thrombectomy combined with bilateral decompressive craniectomy in a life-threatening case of coma from cerebral venous sinus thrombosis: case report and literature review. World Neurosurg 2018; 120: 485-489
• 47 Wang Y, Wang Y, Zhang J, Du S, Wu J. Cerebral venous sinus incision for surgical thrombectomy combined with thrombolysis during decompressive craniectomy for malignant cerebral venous sinus thrombosis complicated with cerebral hernia. J Stroke Cerebrovasc Dis 2019; 28 (06) e60-e63
• 48 Garg A, Rajendram P, Muccilli A, Noel de Tilly L, Micieli JA. Dural venous sinus thrombosis after lumbar puncture in a patient with idiopathic intracranial hypertension. Eur J Ophthalmol 2020; 1120672120970406
• 49 Kate MP, Thomas B, Sylaja PN. Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature. F1000 Res 2014; 3: 41
• 50 Kashkoush AI, Ma H, Agarwal N. et al. Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review. J Clin Neurosci 2017; 39: 9-15
• 51 Ferro JM, Bousser MG, Canhão P. et al; European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - Endorsed by the European Academy of Neurology. Eur Stroke J 2017; 2 (03) 195-221
• 52 Schultz NH, Sørvoll IH, Michelsen AE. et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination. N Engl J Med 2021; 384 (22) 2124-2130
• 53 Wiedmann M, Skattør T, Stray-Pedersen A. et al. Vaccine induced immune thrombotic thrombocytopenia causing a severe form of cerebral venous thrombosis with high fatality rate: a case series. Front Neurol 2021; 12: 721146
• 54 Schulz JB, Berlit P, Diener HC. et al; German Society of Neurology SARS-CoV-2 Vaccination Study Group. COVID-19 vaccine-associated cerebral venous thrombosis in Germany. Ann Neurol 2021; 90 (04) 627-639
• 55 Palaiodimou L, Stefanou MI, Katsanos AH. et al. Cerebral venous sinus thrombosis and thrombotic events after vector-based COVID-19 vaccines: a systematic review and meta-analysis. Neurology 2021; 97 (21) e2136-e2147
• 56 Favaloro EJ, Pasalic L, Lippi G. Review and evolution of guidelines for diagnosis of COVID-19 vaccine induced thrombotic thrombocytopenia (VITT). Clin Chem Lab Med 2021; 60 (01) 7-17
• 57 Ferro JM, de Sousa DA, Coutinho JM, Martinelli I. European Stroke Organization interim expert opinion on cerebral venous thrombosis occurring after SARS-CoV-2 vaccination. Eur Stroke J 2021; 6 (03) CXVI-CXXI
• 58 Pawlowski C, Rincón-Hekking J, Awasthi S. et al. Cerebral venous sinus thrombosis is not significantly linked to COVID-19 vaccines or non-COVID vaccines in a large multi-state health system. J Stroke Cerebrovasc Dis 2021; 30 (10) 105923
• 59 Yagi Y, Asami Y, Kyoya M, Yokota T. Cerebral venous sinus thrombosis after mRNA-based COVID-19 vaccination. Neurol Sci 2022; 43 (01) 41-43
• 60 Nasr DM, Brinjikji W, Cloft HJ, Saposnik G, Rabinstein AA. Mortality in cerebral venous thrombosis: results from the national inpatient sample database. Cerebrovasc Dis 2013; 35 (01) 40-44
• 61 Lindgren E, Jood K, Tatlisumak T. Vocational outcome in cerebral venous thrombosis: Long-term follow-up study. Acta Neurol Scand 2018; 137 (03) 299-307