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Cerebral venous thrombosis

Guidelines

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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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

Medical management

Setting of care: as per AHA/ASA 2011 guidelines, 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

Therapeutic procedures

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

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  • Therapeutic lumbar puncture

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

Specific circumstances

Patients with bacterial infection: as per AHA/ASA 2011 guidelines, 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

Follow-up and surveillance

Monitoring for vision loss: as per AHA/ASA 2011 guidelines, 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