Management in the subacute phase of cerebral venous thrombosis

Created 08/04/2021, last revision 11/02/2023

Anticoagulant therapy

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the optimal duration of AED therapy is unknown
risk of epilepsy is approx. 5-11% (higher in patients with parenchymal hemorrhages and focal neurological deficits)
- most late seizures occur within the first year
- late seizures are more common in patients with early symptomatic seizures
the duration of AE medication should be guided by the presence and extent of parenchymal lesions, EEG findings, and the timing of epileptic seizures (early x late)
there is no strict recommendation; proceed individually, avoid unnecessary long-term use of AEDs
- isolated symptomatic seizure (<2 weeks after CVT onset) without parenchymal lesion ⇒ AED therapy can be tapered off gradually after the acute stage within 2-4 weeks
- isolated 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

anxiety
depression (SSRI)
vascular cognitive deficit or impaired symbolic functions in patients with a parenchymal lesion

up to 14% of patients suffer from chronic headaches
in atypical presentation or intensity, thrombosis recurrence must be excluded (order CT/MR venography + D-Dimers)