General description

Cerebral venous and sinus thrombosis (CVST) is a rare but serious condition more commonly affecting women and young adults, often associated with pregnancy, the puerperium, and oral contraceptive use. CVST can result in significant years of life lost despite being less prevalent than arterial stroke.

Causes

Predisposing factors can be classified as:

• Transient: Pregnancy, puerperium, oral contraceptive use, trauma, and dehydration.
• Permanent: Coagulopathies, malignancies, vasculitis, hematologic disorders, and systemic infections (e.g., COVID-19, HIV).
  In children, perinatal complications and head/neck infections are significant causes.

Symptoms and Manifestations

CVST presents with diverse symptoms due to elevated venous pressure, venous outflow obstruction, or venous infarction and hemorrhage:

• Common symptoms: Headache (90%), seizures, focal neurological deficits (e.g., hemiparesis), altered consciousness, and cranial nerve palsies.
• Syndromes: Raised intracranial pressure (ICP) syndrome, stroke-like syndrome, isolated headache, and encephalopathy. These syndromes may overlap.

Pathophysiology

Blood clots in the venous sinuses elevate venous pressure, causing headaches, nausea, and vomiting. Venous outflow obstruction may lead to mental status changes, seizures, decreased consciousness, or motor deficits. If untreated, venous infarction or hemorrhage can occur, resulting in hemiparesis or other severe neurological deficits.

Clinical Considerations

In young adults, acute-onset psychiatric symptoms or personality changes should raise suspicion for CVST. Early recognition and treatment are critical to prevent severe outcomes.