Cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. It is very often unrecognised a t initial presentation. All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Extensive coll ateral circulation within the cerebral venous system allows for a significa nt degree of compensation in the early stages of thrombus formation. System ic inflammatory diseases and inherited as well as acquired coagulation diso rders are frequent causes, although in up to 30% of cases no underlying cau se can be identified. The oral contraceptive pill appears to be an importan t additional risk factor. The spectrum of clinical presentations ranges fro m headache with papilloedema to focal deficit, seizures and coma. Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. It has now been c onclusively shown that intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis because of its efficacy; safety and feasab ility. Local thrombolysis may be indicated in cases of deterioration, despi te adequate heparinisation. This should be followed by oral anticoagulation for 3-6 months. The prognosis of cerebral venous sinus thrombosis is gener ally favourable. A high index of clinical suspicion is needed to diagnose t his uncommon condition so that appropriate treatment can be initiated.