CEREBRAL VENOUS THROMBOSIS

HISTORY 1828, Abercrombie 1873, Parrot 1888, Sir William Gowers 1915, Holmes and Sargent Quincke, Meningitis

MAJOR VENOUS DRAINING PATHWAYS OF THE CRANIUM

DURAL SINUSES Superior sagittal sinus Inferior sagittal sinus Straight sinus Torcular Herophili(sinus confluens) Transverse sinus Sigmoid sinus Occipital sinus Inferior petrous sinus Superior petrous sinus Cavernous

SUPERFICIAL CORTICAL VEINS Sylvian veins Trolard’s veins and Labbe’s veins Frontal ascending/ descending cortical veins Occipital cortical veins Sphenoparietal vein

DEEP CEREBRAL VEINS Subependymal veins Thalamostriate veins Septal veins Internal cerebral veins Basal vein( Rosenthal’s vein) Galen’s vein Anterior pontomesencephalic veins Precentral cerebellar vein Superior and inferior vermian veins

DURAL VEINS Meningeal veins Emissary veins(connection between sinus and scalp)

SCALP VEINS Occipital veins Temporal veins

CERVICAL VEINS Jugular bulb Internal jugular vein External jugular vein

AETIOLOGY Changes in the vessel Wall Changes in the blood flow Changes in the coagulability of blood

AETIOLOGY(GROUP) Endocrinological disturbances:Oral contraceptives, Pregnancy Haematological/immunological abnormalities: Protein C, APLA Syndrome Connective tissue and other inflammatory disorders:Systemic lupus erythematosus (SLE) Neoplastic: Cerebral metatases Infective: Endocarditis Miscellaneous:High altitud, cardiac failure

Neurological Features of CVT Signs and Symptoms Features(%) Recent Headaches 95 Focal Deficits 46 Paresis 40 Dysphasia 22 Visuospatial disorder 09 Homonymous hemianopia 06 Generalized seizures 37

Neurological Features of CVT Signs and Symptoms Features(%) Focal Seizures only 10 Pappilloedema 41 Impaired Consciousness(GCS<14) 39 Coma(GCS<5) 15 Isolated intracranial hypertension 20 Transient neurological symptoms 14 Brainstem/cerebellar signs 12 Visual impairment 10

Frequency of involvement of the various sinuses in CVT Structure ICVST(%) Our Study(%) Cortical Veins 17 6.33 Superior sagittal sinus 62 71.7 Straight sinus 18 ---- Tranverse Sinus 36 33.3 Sigmoid sinus ---- 15 Jugular veins 12 ---- Vein of Galen and Internal Cerebral vein 11 ---- Cavernous sinus ---- 1.67

CLINICAL FEATURES Lateral Sinus Thrombosis Cavernous Sinus Thrombosis Superior Sagittal Sinus Thrombosis Thrombosis of the other dural sinuses

INVESTIGATIONS Computerized tomography Magnetic resonance imaging Angiography Lumbar puncture Aetiological diagnosis