Cerebral vein thrombosis: causes, treatment and diagnosis

Cerebral vein thrombosis (CVT) occurs when a blood clot forms in a vein in the brain. This can cause blood vessels to rupture, causing blood to leak into brain tissue.

Cerebral veins are a network of blood vessels that drain blood out of the brain. These veins connect to the dural sinuses, which are blood channels that carry blood to the heart.

Without treatment, CVT can cause permanent disability or death. However, if a person receives treatment early, CVT has a positive prognosis.

This article explains CVT and its causes, symptoms, and treatments.

CVT, also known as cerebral venous sinus thrombosis (CVST), occurs when a blood clot develops in a cerebral vein. This blood clot most often occurs between the cerebral veins and the larger cerebral sinuses.

A blood clot can increase the pressure inside blood vessels, which can eventually cause blood vessels to rupture. This can cause blood to leak into a person’s brain tissue, leading to internal bleeding or severe swelling.

CVT is a rare disease, with an annual occurrence rate of 3 to 4 cases per million people. CVT causes about 0.5% of all strokes.

Symptoms of CVT can vary from person to person and depend on which sinuses and veins are affected by the condition.

Up to 90% of people with CVT may have headaches. These headaches may resemble migraine, but their intensity increases within a few days. They can also start suddenly and be immediately severe.

Other symptoms of CVT may include:

  • vomiting
  • nausea
  • eye pain or irritation

More serious symptoms of CVT can include:

  • fever, if the cause is an infection
  • speech or language difficulties
  • pressure buildup on the brain
  • partial weakness or paralysis
  • loss of balance or coordination
  • blurred vision or loss of vision
  • loss of half of the visual field
  • loss of sensation on one side of the body
  • pain at the base of the skull, behind the ears
  • impaired brain function
  • coma
  • stroke
  • seizures
  • protruding eyeballs

Neuroimaging scans are usually the first tests a healthcare professional will order when diagnosing a CVT. They may also ask a person about their symptoms and medical history.

CVT scans can to understand:

Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV)

An MRI uses magnetic fields and radio waves to create a detailed picture of the inside of a person’s body.

Doctors can also use MRV during an MRI. For MRV, a medical professional injects a special dye into a person’s blood vessels. This dye shows up on imaging scans and helps show any blockages.

MRIs are more sensitive than CT scans and when combined with MRV are the gold standard for diagnosing CVT.

Computed tomography (CT) and CT venography (CTV) without contrast

CT scans use X-rays to create an image of a cross-section of a person’s body. A healthcare professional can use a CT scan to look for signs of CVT in a person’s brain.

A healthcare professional may use CTV during a CT scan. CTV is similar to MRV.

A person may also have blood tests to check their blood’s ability to clot and look for markers of inflammation.

Learn more about the difference between MRIs and CT scans here.

There are several options for treating CVT, including:

Medication

A 2018 research review found that anticoagulant therapy was the most common treatment for CVT. Anticoagulants, such as low molecular weight heparin, are drugs that prevent a person’s blood from clotting. This treatment can help prevent the blood clot from growing.

A person will also receive treatment for additional symptoms such as seizures or increased brain pressure.

Thrombolysis

Thrombolysis is a procedure that breaks up blood clots inside a person’s blood vessels. Doctors use it if CVT drugs have not worked.

Thrombolysis involves a doctor injecting anti-clot medication into a person’s blood vessels. Doctors may recommend catheter-directed thrombolysis for people with CVT. This is a procedure in which a healthcare professional inserts a catheter into a person’s blood vessel to deliver anti-clot medication directly into the clot.

Operation

Doctors may recommend surgery if other treatment options aren’t effective. During CVT surgery, a surgeon removes the blood clot and repairs the vein. The surgeon may insert a balloon or mesh into the vein to keep it open.

A person may receive additional treatment for the cause of their CVT. They may also have another imaging test 3 to 6 months after treatment to check for new clots.

CVT is easier to treat if doctors diagnose it earlier. Without treatment, CVT can lead to:

  • a permanent disability
  • stroke
  • coma
  • death

If a person has symptoms of CVT, they should see a doctor immediately. A person with CVT needs treatment as soon as possible.

Once a person has received treatment for CVT, they may need to take a blood thinner such as warfarin. This helps prevent further blood clots from forming.

The treatment can last 3 to 6 months in people with induced CVT or 6 to 12 months in people with unprovoked CVT. If a person has recurrent CVT or a condition that predisposes them to recurrent CVT, they may require lifelong treatment.

Is cerebral venous thrombosis fatal?

Without treatment, CVT can be fatal. However, research from 2017 found that the death rate is 8–10%.

How long can you live with cerebral venous thrombosis?

On average, the time between the onset of CVT and death is 13 days. The average time between diagnosis and death is 5 days. If a person suspects they have CVT, they should seek medical attention immediately.

What should I do in a CVT emergency?

If a person has symptoms of CVT, they should call 911 immediately. Symptoms include eye irritation or pain, difficulty speaking or speaking, weakness or partial paralysis, loss of balance or coordination, and blurred vision or loss of vision.

Without treatment, CVT can be fatal. If doctors treat the disease quickly, 80% of people with CVT recover without physical disability. Some people may experience residual chronic symptoms.

CVT is a rare condition that occurs when a blood clot forms in a person’s veins in the brain. Without treatment, CVT can lead to serious complications such as stroke or death.

CVT can result from many factors, such as oral contraceptives, recent pregnancy, and infection. CVT is most common in women between the ages of 30 and 41.

A medical professional may use various scanners to diagnose CVT. After diagnosis, several treatment options are available, including medication, thrombolysis, and surgery.

If a person experiences unusual headaches in addition to CVT symptoms, they should seek medical attention immediately.

About Antoine L. Cassell

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