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  • Venous Sinus Thrombosis
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a.k.a. Cerebral Venous Thrombosis


  • Hypercoagulable states
    • Pregnancy
    • Malignancy
    • Dehydration
    • OCPs
  • Altitude
  • Idiopathic


  • Symptoms vary, so must have a high index of suspicion
  • Common symptoms include:
    • Headache
    • Seizure
    • Elevated ICP
    • Focal findings
  • Fundoscopic exam shows papilledema in many but not all cases
  • Noncontrast head CT may show bilateral hemorrhagic infarcts.
  • Contrast-enhanced CT: look for empty delta sign, generated by enhancing meninges surrounding dural sinus filled with clot (35% sensitivity for clot).
  • MRV and CTV have equivalent sensitivity and specificity by literature, but our radiologists read MRV¿s more frequently.
  • Venous angiogram is gold standard.
  • Most sigmoid sinus narrowing is congenital and not clot-related.


  • Treat the underlying cause (ie hypercoagulability)
  • Manage ICP
  • Antiepileptics if appropriate.
  • Anticoagulation with IV heparin (preferred over low molecular weight heparin). Small studies suggest that heparin is beneficial even with hemorrhagic conversion of venous infarct, but call stroke team before initiating heparin in patients with hemorrhagic conversion of infarcts.