CEREBRAL VENOUS SINUS THROMBOSIS
Management in the subacute phase of cerebral venous thrombosis
Created 08/04/2021, last revision 02/10/2022
Anticoagulant therapy
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Hormonal contraceptives and pregnancy
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Antiepileptic drugs
- the optimal duration of AED therapy is unknown
- risk of epilepsy is approx. 5-11% (higher in parenchymal hemorrhages and patients with focal neurological deficits)
- most late seizures occur within the first year
- late seizures are more common in patients with early symptomatic seizures
- duration of AE medication should be guided by the presence and extent of parenchymal lesions, EEG findings, and timing of epileptic seizures (early x late)
- there is no strict recommendation, proceed individually, avoid unnecessary long-term use of AED
- in isolated symptomatic seizure (<2 weeks from CVT onset) without parenchymal lesion ⇒ AED therapy may be tapered off gradually after the acute stage within 2-4 weeks
- solitary symptomatic seizure or multiple ASS with parenchymal lesion and/or pathological EEG ⇒ continue with AED treatment for up to 12 months
- post-CVT epilepsy (at least two seizures > 2 weeks from CVT onset) ⇒ long term AED treatment is reasonable
Neuropsychiatric disorders
- anxiety
- depression (SSRI)
- vascular cognitive deficit or impaired symbolic functions in patients with a parenchymal lesion
Chronic headaches
- up to 14% of patients suffer from chronic headaches
- in atypical presentation or intensity, thrombosis recurrence must be ruled out (order CT/MR venography + D-Dimers)
