Cerebral venous thrombosis (CVT)
- common presentations: symptoms secondary to elevated intracranial hypertension, focal deficit, encephalopathy
- risk factors: same risk factors for dvt, including pregnancy
- head CT w/o IV contrast normal in 30% of CVT cases; better sensitivity with CT/A/V and even more so with MRI/A/V. Note that IV contrast (Iohexol) has category B risk during pregnancy and that gadolinium has category C risk. Discuss imaging modality w/ consultants.
- treat w/ low molecular weight heparin or heparin; thrombolysis or thrombectomy may be considered at certain tertiary care centers; in patients w/ intracranial hypertension whose vision is being threatened by papilledema, a lumbar puncture to remove CSF is required
Source
Bousser, MG. "Cerebral venous thrombosis: an update" Lancet Neurology. v 6. Feb 2007.