Venous disease of the central nervous system

Cerebral venous thrombosis (CVT) is characterized by an extreme variability in its clinical presentation and mode of onset. The combination of magnetic resonance imaging and magnetic resonance venography is currently the best method for diagnosis of CVT. It can also be done by computed tomography venography. Catheter angiography is only rarely necessary. Numerous causes have been described, and an extensive work-up is required. The prognosis, although better than previously thought, remains unpredictable, and should be initiated emergently in all cases. It is based on the combination of the treatment of the etiology, symptomatic treatment of seizures and intracranial hypertension, and antithrombotics. Heparin remains the first-line antithrombotic treatment for CVT. Recent studies have confirmed its safety even in patients with hemorrhagic parenchymal lesions. Local thrombolysis or mechanical thrombectomy are indicated in the rare cases of deterioration despite adequate anticoagulation.