Cerebral venous thrombosis

BACKGROUND- The classical early description of cerebral venous thrombosis (CVT) was based on findings at autopsy, and bilateral or alternating focal deficits, seizures, and coma were described as constant features. In the last 30 years, progress in neuroimaging has made the diagnosis of CVT easier, and the clinical spectrum of the disease has greatly expanded. However, despite increased awareness of the disorder, CVT is still a disease in which the correct diagnosis is frequently overlooked or delayed. REVIEW SUMMARY- CVT is an infrequently recognized condition that is extremely variable in its clinical presentation, mode of onset, imaging appearance, and outcome. Its prognosis, although much better than classically thought, remains largely unpredictable. The combination of magnetic resonance imaging and magnetic resonance venography is currently the best method for diagnosis and follow-up of CVT. It should be performed as the first line of investigation in cases with a high clinical suspicion. Treatment of CVT is based primarily on symptomatic treatment of seizures and intracranial hypertension, associated with etiological treatment whenever possible, and antithrombotics. Heparin remains the first-line treatment: for CVT, and although its systematic use remains debated, recent studies have confirmed its safety even in patients with large hemorrhagic infarcts. The addition of local thrombolysis is indicated in the rare cases of worsening despite adequate anticoagulation and optimal symptomatic and etiologic treatment. CONCLUSION- The better recognition of CVT has greatly modified our knowledge of this condition, and the range of underlying causes has also expanded. Because of its large variety of presentations, its highly variable mode of onset, its numerous causes, and its unpredictable outcome, CVT remains a diagnostic and therapeutic challenge.