What is cerebral venous thrombosis?

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CVT, also known as cerebral venous sinus thrombosis (CVST), occurs when a blood clot develops in a cerebral vein. This blood clot most commonly occurs between the cerebral veins and the larger brain sinuses.

A blood clot can increase pressure inside the blood vessels, which can eventually cause the blood vessels to rupture. This may cause blood to leak into a person’s brain tissues, leading to internal bleeding or severe swelling.

CVT is a rare condition, with an annual occurrence rate of 3–4 cases per million people. CVT causes around 0.5% of all strokes.

CVT can have several causes. These causes can vary depending on a person’s age.

According to the American Heart Association (AHA), CVT in children can be the result of an infection such as sinusitis or tonsillitis.

In adults, CVT can be the result of:

• oral contraceptives
• prothrombotic genetic or acquired conditions such as protein C or S deficiency
• infections of the ears, sinuses, mouth, nose, and neck
• malignancy, which is when a condition causes abnormal cells to multiply without control
• head trauma
• conditions that cause blood cells to grow abnormally in the bone marrow
• inflammatory bowel disease
• lupus
• Behçet’s disease, a condition that causes blood inflammation
• neurosarcoidosis, which is inflammation of the nervous system
• surgery
• neurosurgery
• lumbar puncture
• iron deficiency anemia
• severe dehydration
• thyroid disease
• obesity

According to a 2018 research review, females are 3.7–5.3 times more likely to develop CVT than males. Pregnancy and oral contraceptives can also be risk factors for CVT.

CVT is most common in newborns and females ages 30–41.

Other risk factors for CVT include:

• postpartum status
• hormone replacement therapy
• genetic conditions such as antiphospholipid syndrome, hyperhomocysteinaemia, and nephrotic syndrome
• drugs such as cytotoxic drugs, lithium, vitamin A, ecstasy, and intravenous immunoglobulin
• vascular abnormalities

Learn more about the increased risk of blood clots in the postpartum period.

Symptoms of CVT can vary from person to person and depend on the sinuses and veins the condition affects.

Up to 90% of people with CVT may experience headaches. These headaches may appear similar to migraine but increase in severity over a few days. They can also start suddenly and be immediately severe.

Other symptoms of CVT can include:

• vomiting
• nausea
• eye pain or irritation

More serious symptoms of CVT can include:

• fever, if the cause is an infection
• difficulties with speech or language
• buildup of pressure on the brain
• partial weakness or paralysis
• loss of balance or coordination
• blurred vision or vision loss
• loss of half the visual field
• loss of sensation on one side of the body
• pain at the base of the skull, behind the ears
• altered brain function
• coma
• stroke
• seizures
• protruding eyeballs

Neuroimaging scans are generally the first tests a healthcare professional will order when diagnosing CVT. They may also ask a person about their symptoms and medical history.

Scans for CVT can include:

Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) scans

An MRI scan uses magnetic fields and radio waves to build a detailed picture of the inside of a person’s body.

Doctors may also use MRV during an MRI scan. For MRV, a healthcare professional injects a special dye into a person’s blood vessels. This dye shows up on imaging scans and helps show any blockages.

MRI scans are more sensitive than CT scans and, when combined with MRV, are the gold standard for diagnosing CVT.

Non-contrast computerized tomography (CT) and CT venography (CTV) scans

CT scans use X-rays to create an image of a cross section of a person’s body. A healthcare professional can use a CT scan to check for signs of CVT inside a person’s brain.

A healthcare professional may use CTV during a CT scan. CTV is similar to MRV.

A person may also have blood tests to check their blood’s ability to clot and to look for markers of inflammation.

Learn about the difference between MRI and CT scans here.

There are several options for treating CVT, including:

Medication

A 2018 research review found that anticoagulant therapy was the most common treatment for CVT. Anticoagulants, such as low molecular weight heparin, are medications that prevent a person’s blood from clotting. This treatment can help prevent the blood clot from growing.

A person will also receive treatment for additional symptoms such as seizures or increased brain pressure.

Thrombolysis

Thrombolysis is a procedure that breaks up blood clots inside a person’s blood vessels. Doctors use this if CVT medication has not worked.

Thrombolysis involves a doctor injecting clot-busting medication into a person’s blood vessels. Doctors may recommend catheter-directed thrombolysis for people with CVT. This is a procedure in which a healthcare professional inserts a catheter into a person’s blood vessel to deliver clot-busting medication directly into the clot.

Surgery

Doctors may recommend surgery if other treatment options are not effective. During CVT surgery, a surgeon removes the blood clot and repairs the vein. The surgeon may insert a balloon or mesh into the vein to keep it open.

A person may receive additional treatment for the cause of their CVT. They may also have another imaging scan 3–6 months after treatment to check for new clots.

CVT is easier to treat if doctors diagnose it sooner. Without treatment, CVT can lead to:

• permanent disability
• stroke
• coma
• death

CVT can be the result of genetic factors beyond a person’s control. However, certain factors may help reduce the chances of developing CVT. These include:

• not smoking
• maintaining a moderate weight
• avoiding the use of oral contraceptives
• avoiding dehydration

Learn more about the risks to some people of intense exercise.

If a person has any symptoms of CVT, they should seek immediate medical attention. A person with CVT needs treatment as quickly as possible.

Once a person has had treatment for CVT, they may need to take a blood thinner such as warfarin. This helps prevent further blood clots from forming.

Treatment can last 3–6 months in people with provoked CVT or 6–12 months in people with unprovoked CVT. If a person has recurring CVT or a condition that predisposes them to recurrent CVT, they may require lifelong treatment.

Is cerebral venous thrombosis fatal?

Without treatment, CVT can be fatal. However, research from 2017 found that the mortality rate is 8–10%.

How long can you live with cerebral venous thrombosis?

On average, the time from CVT onset to death is 13 days. The average time from diagnosis to death is 5 days. If a person suspects that they have CVT, they should seek medical attention immediately.

What should I do in a CVT emergency?

If a person has symptoms of CVT, they should call 911 immediately. Symptoms include eye irritation or pain, difficulties with speech or language, partial weakness or paralysis, loss of balance or coordination, and blurred vision or vision loss.

Without treatment, CVT can be fatal. If doctors treat the condition quickly, 80% of people with CVT recover without physical disability. Some people may experience residual chronic symptoms.

CVT is a rare disorder that happens when a blood clot forms in a person’s cerebral veins. Without treatment, CVT can cause serious complications such as stroke or death.

CVT can result from many factors, such as oral contraceptives, recent pregnancy, and infection. CVT is most common in females ages 30–41.

A healthcare professional can use various scans to diagnose CVT. After diagnosis, several treatment options are available, including medication, thrombolysis, and surgery.

If a person experiences unusual headaches alongside symptoms of CVT, they should seek immediate medical attention.