CEREBRAL VENOUS CEREBRAL VENOUS THROMBOSISTHROMBOSIS

HISTORYHISTORY

1828, Abercrombie1828, Abercrombie 1873, Parrot1873, Parrot 1888, Sir William Gowers1888, Sir William Gowers 1915, Holmes and Sargent1915, Holmes and Sargent Quincke, MeningitisQuincke, Meningitis

MAJOR VENOUS MAJOR VENOUS DRAINING PATHWAYS DRAINING PATHWAYS OF THE CRANIUMOF THE CRANIUM

DURAL SINUSESDURAL SINUSES

• Superior sagittal sinusSuperior sagittal sinus• Inferior sagittal sinusInferior sagittal sinus• Straight sinusStraight sinus• Torcular Herophili(sinus confluens)Torcular Herophili(sinus confluens)• Transverse sinusTransverse sinus• Sigmoid sinusSigmoid sinus• Occipital sinusOccipital sinus• Inferior petrous sinusInferior petrous sinus• Superior petrous sinusSuperior petrous sinus• CavernousCavernous

SUPERFICIAL SUPERFICIAL CORTICAL VEINSCORTICAL VEINS• Sylvian veinsSylvian veins• Trolard’s veins and Labbe’s veinsTrolard’s veins and Labbe’s veins• Frontal ascending/ descending cortical veinsFrontal ascending/ descending cortical veins• Occipital cortical veinsOccipital cortical veins• Sphenoparietal veinSphenoparietal vein

DEEP CEREBRAL VEINSDEEP CEREBRAL VEINS

• Subependymal veinsSubependymal veins• Thalamostriate veinsThalamostriate veins• Septal veinsSeptal veins• Internal cerebral veinsInternal cerebral veins• Basal vein( Rosenthal’s vein)Basal vein( Rosenthal’s vein)• Galen’s veinGalen’s vein• Anterior pontomesencephalic veinsAnterior pontomesencephalic veins• Precentral cerebellar veinPrecentral cerebellar vein• Superior and inferior vermian veinsSuperior and inferior vermian veins

DURAL VEINSDURAL VEINS

• Meningeal veinsMeningeal veins• Emissary veins(connection Emissary veins(connection

between sinus and scalp)between sinus and scalp)

SCALP VEINSSCALP VEINS

• Occipital veinsOccipital veins• Temporal veinsTemporal veins

CERVICAL VEINSCERVICAL VEINS

• Jugular bulbJugular bulb• Internal jugular veinInternal jugular vein• External jugular veinExternal jugular vein

AETIOLOGYAETIOLOGY

Changes in the vessel WallChanges in the vessel Wall Changes in the blood flowChanges in the blood flow Changes in the coagulability of Changes in the coagulability of

bloodblood

AETIOLOGY(GROUP)AETIOLOGY(GROUP)

• Endocrinological disturbances:Endocrinological disturbances:Oral Oral contraceptives, Pregnancycontraceptives, Pregnancy

• Haematological/immunological abnormalities:Haematological/immunological abnormalities: Protein C, APLA SyndromeProtein C, APLA Syndrome

• Connective tissue and other inflammatory Connective tissue and other inflammatory disorders:Systemic lupus erythematosus disorders:Systemic lupus erythematosus (SLE)(SLE)

• Neoplastic: Cerebral metatasesNeoplastic: Cerebral metatases• Infective: EndocarditisInfective: Endocarditis• Miscellaneous:High altitud, cardiac failureMiscellaneous:High altitud, cardiac failure

Neurological Features Neurological Features of CVTof CVT

Signs and Symptoms Signs and Symptoms Features(%)Features(%)Recent Headaches 95Recent Headaches 95

Focal Deficits 46Focal Deficits 46

Paresis 40Paresis 40

Dysphasia 22Dysphasia 22

Visuospatial disorder 09Visuospatial disorder 09

Homonymous hemianopia 06Homonymous hemianopia 06

Generalized seizures 37Generalized seizures 37

Neurological Features Neurological Features of CVTof CVTSigns and Symptoms Signs and Symptoms Features(%)Features(%)Focal Seizures onlyFocal Seizures only 10 10

Pappilloedema 41Pappilloedema 41

Impaired Consciousness(GCS<14) 39Impaired Consciousness(GCS<14) 39

Coma(GCS<5) 15Coma(GCS<5) 15

Isolated intracranial hypertension 20Isolated intracranial hypertension 20

Transient neurological symptoms 14Transient neurological symptoms 14

Brainstem/cerebellar signs 12Brainstem/cerebellar signs 12

Visual impairment 10Visual impairment 10

Frequency of Frequency of involvement of the involvement of the various sinuses in CVTvarious sinuses in CVTStructure ICVST(%) Our Structure ICVST(%) Our Study(%)Study(%)Cortical Veins 17 6.33Cortical Veins 17 6.33

Superior sagittal sinus 62 71.7Superior sagittal sinus 62 71.7

Straight sinus 18 ----Straight sinus 18 ----

Tranverse Sinus 36 33.3Tranverse Sinus 36 33.3

Sigmoid sinus ---- 15Sigmoid sinus ---- 15

Jugular veins 12 ----Jugular veins 12 ----

Vein of Galen and Vein of Galen and

Internal Cerebral vein 11 ----Internal Cerebral vein 11 ----

Cavernous sinus ---- 1.67Cavernous sinus ---- 1.67

CLINICAL FEATURESCLINICAL FEATURES

• Lateral Sinus ThrombosisLateral Sinus Thrombosis• Cavernous Sinus ThrombosisCavernous Sinus Thrombosis• Superior Sagittal Sinus Superior Sagittal Sinus

ThrombosisThrombosis• Thrombosis of the other dural Thrombosis of the other dural

sinusessinuses

INVESTIGATIONSINVESTIGATIONS

• Computerized tomographyComputerized tomography• Magnetic resonance imagingMagnetic resonance imaging• AngiographyAngiography• Lumbar punctureLumbar puncture• Aetiological diagnosisAetiological diagnosis