Cerebral Venous Thrombosis incidence - 1/100 000 inhabitants accounts for 0.5% to 1% of all

strokes Cerebral venous infarkt – due to

occlusion of cerebral veins or sinuses and consequent tissue congestion

it disproportionally affects women who are pregnant or taking oral contraceptives and people 45 years and younger.

Cerebral Venous Thrombosis

Infection etiology (70% of patients - Staphylococcus aureus, Streptococcus pneumoniae, gramnegative bacterias). Focal head infections - sinusitis, meningitis,

teeth diseases, otitis, tonsilitis, furunkul, open head injury

Generalized infections - endokarditis, tuberkulosis, pneumonia, hepatitis, aspergilosis, AIDS.

Cerebral Venous Thrombosis Non infections factors

Generalized – contraception, dehydratation malignancy Systemic diseases - SLE, Wegener granulomatosis, Crohn

disease Thrombophilia Pregnancy and puerperium

Cerebral Venous Thrombosisclinical findings

Subacute onset, symptoms from the teritory in which thrombosis is present

cefalea, nauzea s vomitus Hemiparesis, paraparesis, (sinus sagitalis superior) Aphasia, ataxia, chorea, hemianopsy, epileptic seazure

(42-79% of patients) Oedema of the n.II papila, cranial nerves lesions (n.VI,

VII, VIII) bulbus jugularis - foramen jugulare syndrom (lesion of

IX-XII nerves)

Cerebral Venous Thrombosis sinus cavernous (SC)

trombosis Trias: conjuctival

chemosis, ptosis, painful ophtalmoparesis

Fewer Visual disturbances exophtalmus

Venous thrombosis

Cerebral Venous Thrombosis

Sinus cavernosus Exophtamus

Cerebral Venous Thrombosis

Sinus transversus

Cerebral Venous Thrombosis

sinus sagitalis superior thrombosis Unilateral hemiparesis, later bilateral Central monoparesis of lower extremity or central

paraparesis of lower extremities

cortical vein thrombosis Rare Focal deficit – aphasia, hemiparesis,

hemihypestesia, hemianopsy, etc.

Cerebral Venous Thrombosis

Sinus sagitalis

Cerebral Venous Thrombosis

CSF - proteino-cytologic association asociácia

Proteins, erytrocytes, monocytes and polynuclears

10% - normal CSF MRI

Cerebral Venous ThrombosisTherapy

Anticoagulants (heparin or LWMH) Later - p.o. anticoagulants (warfarin) - INR 2,0-

2,5 Usually 6 months, in coagulopathy – long time Antibiotics (3rd generation cephalosporins) and

symptomatic therapy (Manitol, antiepileptics)