Cerebral venous thrombosis: modern management and clinical case presentation

Cerebral venous thrombosis is a fairly rare type of cerebral circulatory disorder; there is a thrombus in the venous sinuses of the dura mater and veins of the brain. Cerebral venous thrombosis is most common in young patients, more often in women. Risk factors for cerebral venous thrombosis can be transient or chronic. The key ones include sex-specific hormonal changes: oral contraception and hormonal (mainly estrogen) therapy, pregnancy, infections, dehydration, cancer, hematologic and autoimmune diseases. The most common symptom of venous sinus thrombosis is intense headache, which is a reflection of the development of intracranial hypertension; other symptoms may be focal neurological deficit, epileptic seizures, loss or change of consciousness up to coma, visual impairment, meningeal syndrome. Magnetic resonance imaging and magnetic resonance venography are the most accurate and highly sensitive methods for diagnosing cerebral venous sinus thrombosis, but to increase the reliability of the diagnosis, the results of using other research methods should be taken into account such as computed tomography and computed tomography angiography. Thrombi are present in the form of filling defects. The recurrence rate of venous sinus thrombosis ranges from 1 to 4 % per year, but the risk may be higher in individuals with severe thrombophilia, as well as malignant neoplasms. Treatment of the acute phase begins with parenteral administration of low-molecular-weight heparins followed by a transition to oral anticoagulants for 3–12 months to enhance recanalization and prevent recurrence. Women with cerebral venous sinus thrombosis resulting from the use of combined hormonal contraceptives or pregnancy should refrain from continuing or resuming hormonal contraception due to an increased risk of recurrence. We also present a clinical case of extensive superior sagittal sinus thrombosis with the spread of the thrombus to the left transverse, sigmoid sinuses and internal jugular vein in a young woman on the background of taking hormonal estrogen-containing drugs, with a favorable outcome.