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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
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