Cerebral venous sinus thrombosis
Who gets cerebral venous thrombosis, the four clinical patterns, why a normal CT and D-dimer don't exclude it, anticoagulating through venous haemorrhage, DOACs after the acute phase, and when to call for endovascular treatment or craniectomy.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Thrombosis of the dural sinuses or cerebral veins. It causes 0.5 to 3% of strokes, mostly in young adults and women of reproductive age.
- Suspect it with headache plus papilloedema, seizures, focal signs or drowsiness, particularly with oestrogen, pregnancy, thrombophilia or infection.
- Non-contrast CT and D-dimer can both be normal. Ask for venography.
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Sources
- Eliquis (apixaban) and Pradaxa (dabigatran) Australian Product Information, section 4.1 (no cerebral venous thrombosis indication)AU/NZmedsinfo.com.au (sponsor Product Information), November 2026
- Therapeutic Guidelines: NeurologyAU/NZTherapeutic Guidelines Limited
- Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association (Saposnik G et al. Stroke 2024;55(3):e77-e90)American Heart Association, 2024
- European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis (Ferro JM et al. Eur Stroke J 2017;2(3):195-221)European Stroke Organisation, endorsed by the European Academy of Neurology, 2017
- New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline (Neurol Res Pract 2024)German Society of Neurology, with Austrian and Swiss societies, 2024
- Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: RE-SPECT CVT (Ferro JM et al. JAMA Neurol 2019;76(12):1457-1465)JAMA Neurology, 2019
- Direct oral anticoagulants versus warfarin in the treatment of cerebral venous thrombosis: ACTION-CVT (Yaghi S et al. Stroke 2022;53(3):728-738)Stroke, 2022
- Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: TO-ACT (Coutinho JM et al. JAMA Neurol 2020;77(8):966-973)JAMA Neurology, 2020
- Direct oral anticoagulants versus vitamin K antagonists for cerebral venous thrombosis: systematic review and meta-analysis of randomised trials (Thromb Res 2026;263:109769)Thrombosis Research, 2026
- Last updated
- 14 November 2026
What changed
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