New Insights on Diagnosis and Treatment of Cerebral Venous Thrombosis – A Narrative Review


  •   Thomas Gabriel Schreiner


Cerebral venous thrombosis (CVT), although accounting for only 0.5-1% of all strokes, remains a potentially fatal neurological emergency, which must be promptly diagnosed and treated. Consisting of two parts, this review aims to highlight the most important data from recent years regarding diagnosis and treatment of CVT, illustrating both the current modern therapeutic approach and the future research directions in the field. Regarding the clinical diagnosis, the neurologist may sometimes have difficulties in recognizing this pathology, given the diverse clinical picture of the acute stage of CVT that can mimic various neurological disorders. In addition, although most risk factors (procoagulation status, infections, trauma, systemic diseases) are known and can be easily detected, in a significant percentage of cases the etiology remains uncertain. For paraclinical diagnosis, among the imaging investigations essential to support the diagnosis, CT angiography and MRI venography are reliable alternatives to digital subtraction angiography which represent the gold standard nowadays. In terms of treatment, international guidelines provide general directions for anticoagulation, with low molecular weight heparin being highly recommended. Regarding invasive treatment methods (thrombolysis, thrombectomy) that could be used in severe cases where anticoagulation has been shown to be insufficient, as well as symptomatic therapy, the evidence is often insufficient, new randomized clinical trials with large cohorts of patients being required.

Keywords: Cerebral venous thrombosis, etiology, diagnosis, treatment


Danwang C, Mazou TN, Tochie JN, et al. Global epidemiology and patterns of cerebral venous thrombosis: a systematic review and meta-analysis protocol. BMJ Open 2018;8:e019939.

Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost 2018; 16: 1918– 31.

Ibrahim N, El-Shahawy A, Elshabacy A. Risk of cerebral venous thrombosis in oral contraceptives pills users. The Egyptian Journal of Radiology and Nuclear Medicine. 2018; 49. 10.1016/j.ejrnm.2018.02.002.

Stack CA & Cole JW (November 5th, 2018). Cerebral Venous Thrombosis: A Clinical Overview, Ischemic Stroke of Brain, Pratap Sanchetee, IntechOpen, DOI: 10.5772/intechopen.79049. Available from:

Tadi P, Behgam B, Baruffi S. Cerebral Venous Thrombosis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

Lee S, Mokin M, Hetts SW on behalf of the Society of NeuroInterventional Surgery, et al. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee. Journal of NeuroInterventional Surgery 2018;10:803-810.

Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, di Minno M, Maino A, Martinelli I, Masuhr F, Aguiar de Sousa D, Stam J; European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol. 2017 Oct;24(10):1203-1213.

Gogu AE, Jianu DC, Dumitrascu V, Ples H, Stroe AZ, Docu Axelerad D, Docu Axelerad A. MTHFR Gene Polymorphisms and Cardiovascular Risk Factors, Clinical-Imagistic Features and Outcome in Cerebral Venous Sinus Thrombosis. Brain Sci. 2020 Dec 27;11(1):E23.

Bostan A, Tapoi LC, Barcan MN, Florea L. Cerebral vein thrombosis associated with MTHFR A1289C mutation gene in a young postpartum woman. Arch Clin Cases 2019; 6(1):26-30.

Carrier M, Lazo-Langner A, Shivakumar S, et al. SOME Investigators. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med 2015; 20:697–704.

Kristoffersen ES, Harper CE, Vetvik KG, Zarnovicky S, Hansen JM, Faiz KW. Incidence and Mortality of Cerebral Venous Thrombosis in a Norwegian Population. Stroke. 2020 Oct;51(10):3023-3029.

Ferro JM, Aguiar de Sousa D. Cerebral Venous Thrombosis: An Update. Curr Neurol Neurosci Rep. 2019 Aug 23;19(10):74.

Li J, Zhang F, Liang C, Ye Z, Chen S, Cheng J. The Diagnostic Efficacy of Age-Adjusted D-Dimer Cutoff Value and Pretest Probability Scores for Deep Venous Thrombosis. Clin Appl Thromb Hemost. 2019;25:1076029619826317.

Heldner MR, Zuurbier SM, Li B, Von Martial R, Meijers JCM, Zimmermann R, Volbers B, Jung S, El-Koussy M, Fischer U, Kohler HP, Schroeder V, Coutinho JM, Arnold M. Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels. Neurology. 2020 Aug 18;95(7):e898-e909.

Qureshi A, Perera A. Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: A systematic review and meta-analysis. Ann Med Surg (Lond). 2017;17:22-26.

Field TS, Hill MD. Cerebral Venous Thrombosis. Stroke. 2019 Jun;50(6):1598-1604. doi: 10.1161/STROKEAHA.119.025334. Epub 2019 May 16. PMID: 31092159.

Coutinho JM, Zuurbier SM, Bousser MG, Ji X, Canhão P, Roos YB, Crassard I, Nunes AP, Uyttenboogaart M, Chen J, Emmer BJ, Roosendaal SD, Houdart E, Reekers JA, van den Berg R, de Haan RJ, Majoie CB, Ferro JM, Stam J; TO-ACT investigators. Effect of Endovascular Treatment with Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial. JAMA Neurol. 2020 Aug 1;77(8):966-973.

Beiruti K, Shadi J, Shahien R, Keigler G. Critical management of cerebral venous sinus thrombosis (CVST) concomitant with high intracranial pressure (ICP). J Neurol Sci 2017; 1103: 381, SUPPLEMENT 398.

Sorgun MH, Rzayev S, Kural MA, Erdoğan S, Yücesan C. Cerebral Venous Thrombosis in Behçet's Disease Patients Compared to Other Causes of Cerebral Venous Thrombosis: A Retrospective Study. Arch Rheumatol. 2016 May 17;31(3):248-253.

Lobo S, Ferro JM, Barinagarrementeria F, Bousser MG, Canhão P, Stam J; ISCVT Investigators. Shunting in acute cerebral venous thrombosis: a systematic review. Cerebrovasc Dis. 2014;37(1):38-42.

Mehvari Habibabadi J, Saadatnia M, Tabrizi N. Seizure in cerebral venous and sinus thrombosis. Epilepsia Open. 2018;3(3):316-322.

Stam JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis: endorsed by the European Academy of Neurology. Eur J Neurol. 2017; 24(10): 1203–13.

Sundar K, Paulraj S, Choudhury SR, Hassan H, Sengupta J, Pattari SK. Successful Endovascular Treatment of Cerebral Venous Thrombosis with a Novel, Larger Aspiration Catheter (REACT): A Case Report. Neurointervention. 2020 Dec 28. doi: 10.5469/neuroint.2020.00304. Epub ahead of print. PMID: 33355855.

Cellerini M, Francavilla R, Testoni C, Maffei M, Zucchelli M, Ghizzi C. Dural sinus mechanical thrombectomy and continuous local rt-PA infusion in a child with refractory intracranial hypertension and progressive visual loss: A case report. Surg Neurol Int. 2020 Aug 21;11:253.

Zelenak K, Uhrikova Z, Mikler J, Zibolen M. Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis in a Neonate. Indian Pediatr. 2020 Sep 15;57(9):862-863. PMID: 32999120.

Wang Y, Zhao C, Huang D, Sun B, Wang Z. Stent retriever thrombectomy combined with long-term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis. Exp Ther Med. 2020 Nov;20(5):66.

Lewis W, Saber H, Sadeghi M, Rajah G, Narayanan S. Transvenous Endovascular Recanalization for Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis. World Neurosurg. 2019 Oct;130:341-350.


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How to Cite
Schreiner, T. G. (2021). New Insights on Diagnosis and Treatment of Cerebral Venous Thrombosis – A Narrative Review. European Journal of Medical and Health Science, 3(2), 17-20.