Cerebral venous and dural sinus thrombosis

From EyeWiki


Cerebral venous and dural sinus thromboses (CVT) are uncommon blood clots. When these clots occur in locations causing altered blood flow to the orbit, a cascade of vision-threatening results may ensue. Congestion of orbital venous drainage results in elevated episcleral venous and intraocular pressure, which can compromise vision. Thus, the Ophthalmologist must be aware of the basic presentation and initial management.

Disease Entity

Cerebral venous and dural sinus thrombosis (CVT), also known as “dural venous sinus thrombosis”, is a blood clot within the dural venous sinuses [1]. The dural venous sinuses are: superior sagittal, inferior sagittal, transverse, straight, straight, cavernous and petrosal.

Disease

ICD-9 437.6 Nonpyogenic thrombosis of intracranial venous sinus

ICD-10 I67.6 Nonpyogenic thrombosis of intracranial venous system

Etiology

French physician Ribes described the first case of CVT in 1825, which was attributed to systemic malignancy. Currently, the most likely causes depend on world location and economic status. Prior to the advent and widespread use of antibiotics in developed nations, CVT was largely due to infectious etiologies such as mastoiditis, orbital cellulitis, and facial cellulitis[2].

Risk Factors

Table 1. Risk factors associated with CVT (adapted from [1, 3, 6])

TRANSIENT RISK FACTORS
 Infection
  CNS
  Ears, sinus, mouth, face, neck
  Other locations
 Pregnancy & puerperium
 Mechanical Precipitants
  Lumbar puncture, myelography, intrathecal medications, spinal anesthesia
  Head trauma
  Radical neck surgery
  Neurosurgical procedures
 Medications
  Oral contraceptives
  Hormone replacement therapy
  Cytotoxic (L-asparaginase, cisplatin)
  Steroids
  Lithium
 Other conditions
  Dehdration
  Diabetic ketoacidosis
  
PERMANENT RISK FACTORS
 Thrombophilia
  Inherited (Protein C, S, antithrombin III deficiencies; Factor V Leiden and prothrombin mutations) 
  Acquired (Antiphospholipid antibody, Nephrotic syndrome, Hyperhomocysteinemia, Cyanotic congenital heart disease)
 Malignancy
  CNS
  Solid tumor outside CNS (Colorectal, Dysgerminoma, Ewing’s sarcoma) 
  Hematological (Hodgkin’s lymphoma, Bone marrow transplant)
 Hematological condition
  Polycythemia, Thrombocytosis
  Anemia
  Paroxysmal nocturnal hemoglobinuria
 CNS Disorders
  Dural fistulae
  Venous anomaly
  Arteriovenous malformation
 Inflammatory disease
  Behçet’s disease
  Antiphospholipid antibody syndrome
  Systemic lupus erythematosus
  Rheumatoid arthritis
  Granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) 
  Churg-Strauss syndrome
  Thromboangiitis obliterans
  Inflammatory bowel disease
  Sarcoidosis
 Other disorders
  Thyroid disease (thyroiditis, hyperthyroidism, hypothyroidism)

General Pathology

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