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Cerebral venous thrombosis

Key sources
The following summarized guidelines for the evaluation and management of cerebral venous thrombosis are prepared by our editorial team based on guidelines from the American Society of Hematology (ASH 2023), the European Stroke Organisation (ESO 2017), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014), and the American Heart Association (AHA/ASA 2011).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging
As per ESO 2017 guidelines:
Consider obtaining MRV or CTV as reliable alternatives to digital subtraction angiography for diagnostic confirmation in patients with suspected CVT.
C
Consider obtaining CTV as a reliable alternative to MRV for diagnostic confirmation in patients with suspected CVT.
C
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  • Laboratory tests

  • D-dimer testing

  • Screening for thrombophilia

  • Screening for occult malignancy

2.Medical management

Setting of care: consider admitting patients with CVT to a stroke unit for treatment and for prevention of clinical complications.
C

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  • Anticoagulant therapy (initiation)

  • Anticoagulant therapy (duration)

  • Acetazolamide

  • Corticosteroids

  • Antiepileptic drugs

3.Therapeutic procedures

Endovascular interventions
As per ESO 2017 guidelines:
Insufficient evidence to recommend thrombolysis in patients with CVT.
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Avoid performing thrombolysis in patients with acute CVT with a pretreatment low risk of poor outcome.
D

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  • Therapeutic lumbar puncture

4.Surgical interventions

Shunting
As per ESO 2017 guidelines:
Avoid performing routine shunting (without other surgical treatment) to prevent death in patients with acute CVT and impending brain herniation due to parenchymal lesions.
D
Insufficient evidence to recommend shunting to prevent death or improve outcomes in patients with acute or recent CVT and hydrocephalus.
I

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  • Decompressive hemicraniectomy

  • Optic nerve decompression

5.Specific circumstances

Patients with bacterial infection: administer appropriate antibiotics in patients with suspected bacterial infection and perform surgical drainage of purulent collections of infectious sources associated with CVT when appropriate.
B

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  • Patients with recurrent disease

  • Pregnant patients

6.Follow-up and surveillance

Monitoring for vision loss: monitor patients with CVT and increased ICP for progressive visual loss. Treat increased ICP urgently when vision loss is observed.
B

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  • Indications for specialist consultation