CEREBRAL VENOUS SINUS THROMBOSIS

Management in the subacute phase of cerebral venous thrombosis

Created 08/04/2021, last revision 11/09/2022

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-Dimer)
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