UMEM Educational Pearls

Category: Neurology

Title: Cerebral Venous Thrombosis (CVT)

Keywords: headache, seizure, stroke, neurological deficit, thrombogenic (PubMed Search)

Posted: 12/27/2017 by Danya Khoujah, MBBS (Updated: 9/27/2022)
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Cerebral venous thrombosis is a rare (but dangerous) cause of headaches and strokes in patients below the age of 50. It includes thrombosis of the cerebral veins and major dural sinuses. 
A d-dimer can NOT be used to rule it out, as it would be falsely negative in up to 40% of patients. A dry head CT is completely normal in 30% of patients, with nonspecific changes present in another 30%.

Take home: If you are considering the diagnosis, obtain a CT venography (95% sensitive) and don’t rely on a negative dimer or dry head CT.

 

References

Long B, Koyfman A, Runyon MS. Cerebral Venous Thrombosis: A Challenging Neurologic Diagnosis. Emerg Med Clin N Am 35 (2017) 869–878