An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Background and Aim: Cerebral venous thrombosis (CVT) is a relatively rare disorder of the cerebral venous system accounting for less than ۱% of all strokes with a higher prevalence in Iran. Despite the considerable advances in recent years, the diagnosis and treatment of CVT is still challenging predominantly in the emergency setting. Therefore, the present study sought to provide an update on the diagnosis and treatment of CVT. Materials and Methods: PubMed, Web of Science, Google Scholar, Scopus, Elsevier, and Iranian domestic scientific databases were searched within January ۱, ۲۰۰۰, to July ۱, ۲۰۲۰. In all the electronic databases, the keywords (in the title/abstract) of “cerebral vein thrombosis” OR “CVT” OR “Cerebral venous sinus thrombosis” OR “CVST” AND “risk factor”, “diagnosis”, “treatment”, and “prognosis” were searched. The unrelated articles, studies not concerning humans or pediatric population, and case reports were excluded from the study. In addition, the articles related to CVT in association with coronavirus disease ۲۰۱۹ were excluded. Results: According to the findings of the present study, CVT can present with a multitude of signs and symptoms, making it difficult to distinguish from other neurological conditions. While the diagnosis is typically based on brain magnetic resonance imaging and magnetic resonance venography, there is evidence suggesting that the plain computed tomography markers with an attenuation value of > ۶۰.۴ Hounsfield unit (HU) and Hounsfield-hematocrit (H: H) ratio of > ۱.۴۲ are specific enough to make a definite diagnosis. In terms of therapeutic aspects, although warfarin is still the mainstay of treatment, there is increasing interest toward new oral anticoagulants with promising results in both thrombus recanalization and excellent functional recovery. Balloon angioplasty and mechanical thrombectomy might also be considered in severely progressive cases without response to conventional treatments. Even for those achieving favorable outcomes, CVT can remain a disabling condition leading to at least neuropsychiatric complaints. Conclusion: CVT is a rare and important cause of stroke accounting for less than ۱% of all strokes mainly affecting young females. With regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.      

کلیدواژه ها:

Intracranial ، Neuroimaging ، Sinus thrombosis ، Therapeutics ، Venous thrombosis