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Cerebral Venous Thrombosis Differential Diagnoses

  • Author: W Alvin McElveen, MD; Chief Editor: Helmi L Lutsep, MD  more...
Updated: Oct 30, 2015
Contributor Information and Disclosures

W Alvin McElveen, MD Director, Stroke Unit, Lakewood Ranch Medical Center; Neurologist, Manatee Memorial Hospital

W Alvin McElveen, MD is a member of the following medical societies: American Academy of Neurology, Southern Clinical Neurological Society, American Stroke Association, American Medical Association, American Society of Neuroimaging

Disclosure: Nothing to disclose.


Andrew P Keegan, MD Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Manatee Memorial Hospital, Lakewood Ranch Medical Center, Blake Medical Center

Andrew P Keegan, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.


Ralph F Gonzalez, MD Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Blake Hospital, Lakewood Ranch Medical Center, Manatee Memorial Hospital

Ralph F Gonzalez, MD is a member of the following medical societies: American Academy of Neurology and Florida Medical Association

Disclosure: Nothing to disclose.

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Norman C Reynolds Jr, MD Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

  1. [Guideline] Bushnell C, McCullough LD, Awad IA, Chireau MV, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. National Guideline Clearinghouse. Available at Accessed: November 21, 2014.

  2. Cesarman-Maus G, Cantú-Brito C, Barinagarrementeria F, Villa R, Reyes E, Sanchez-Guerrero J. Autoantibodies against the fibrinolytic receptor, annexin A2, in cerebral venous thrombosis. Stroke. 2011 Feb. 42(2):501-3. [Medline].

  3. Schievink WI, Maya MM. Cerebral venous thrombosis in spontaneous intracranial hypotension. Headache. 2008 Nov-Dec. 48(10):1511-9. [Medline]. [Full Text].

  4. Canhão P, Batista P, Falcão F. Lumbar puncture and dural sinus thrombosis--a causal or casual association?. Cerebrovasc Dis. 2005. 19(1):53-6. [Medline].

  5. Ennaifer R, Moussa A, Mouelhi L, et al. Cerebral venous sinus thrombosis as presenting feature of ulcerative colitis. Acta Gastroenterol Belg. 2009 Jul-Sep. 72(3):350-3. [Medline].

  6. Towbin A. The syndrome of latent cerebral venous thrombosis: its frequency and relation to age and congestive heart failure. Stroke. 1973 May-Jun. 4(3):419-30. [Medline].

  7. Daif A, Awada A, al-Rajeh S, et al. Cerebral venous thrombosis in adults. A study of 40 cases from Saudi Arabia. Stroke. 1995 Jul. 26(7):1193-5. [Medline].

  8. Ameri A, Bousser MG. Cerebral venous thrombosis. Neurol Clin. 1992 Feb. 10(1):87-111. [Medline].

  9. Galarza M, Gazzeri R. Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery. Neurosurg Focus. 2009 Nov. 27(5):E5. [Medline].

  10. Smith AG, Cornblath WT, Deveikis JP. Local thrombolytic therapy in deep cerebral venous thrombosis. Neurology. 1997 Jun. 48(6):1613-9. [Medline].

  11. Ferro JM, Crassard I, Coutinho JM, Canhão P, Barinagarrementeria F, Cucchiara B. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke. 2011 Oct. 42(10):2825-31. [Medline].

  12. Ferro JM, Lopes MG, Rosas MJ, et al. Long-Term Prognosis of Cerebral Vein and Dural Sinus Thrombosis. results of the venoport study. Cerebrovasc Dis. 2002. 13(4):272-8. [Medline].

  13. Buccino G, Scoditti U, Patteri I, et al. Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis. Acta Neurol Scand. 2003 May. 107(5):330-5. [Medline].

  14. Flores-Barragan JM, Hernandez-Gonzalez A, Gallardo-Alcaniz MJ, Del Real-Francia MA, Vaamonde-Gamo J. [Clinical and therapeutic heterogeneity of cerebral venous thrombosis: a description of a series of 20 cases.]. Rev Neurol. 2009 Dec 1-15. 49(11):573-6. [Medline].

  15. Oppenheim C, Domigo V, Gauvrit JY, et al. Subarachnoid hemorrhage as the initial presentation of dural sinus thrombosis. AJNR Am J Neuroradiol. 2005 Mar. 26(3):614-7. [Medline].

  16. Farb RI, Vanek I, Scott JN, et al. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. 2003 May 13. 60(9):1418-24. [Medline].

  17. Wasay M, Kojan S, Dai AI, Bobustuc G, Sheikh Z. Headache in Cerebral Venous Thrombosis: incidence, pattern and location in 200 consecutive patients. J Headache Pain. 2010 Apr. 11(2):137-9. [Medline].

  18. Tardy B, Tardy-Poncet B, Viallon A, et al. D-dimer levels in patients with suspected acute cerebral venous thrombosis. Am J Med. 2002 Aug 15. 113(3):238-41. [Medline].

  19. Lalive PH, de Moerloose P, Lovblad K, et al. Is measurement of D-dimer useful in the diagnosis of cerebral venous thrombosis?. Neurology. 2003 Oct 28. 61(8):1057-60. [Medline].

  20. Kosinski CM, Mull M, Schwarz M, et al. Do normal D-dimer levels reliably exclude cerebral sinus thrombosis?. Stroke. 2004 Dec. 35(12):2820-5. [Medline].

  21. Ozsvath RR, Casey SO, Lustrin ES, et al. Cerebral venography: comparison of CT and MR projection venography. AJR Am J Roentgenol. 1997 Dec. 169(6):1699-707. [Medline].

  22. Mas JL, Meder JF, Meary E, Bousser MG. Magnetic resonance imaging in lateral sinus hypoplasia and thrombosis. Stroke. 1990 Sep. 21(9):1350-6. [Medline].

  23. Adams WM, Laitt RD, Beards SC, et al. Use of single-slice thick slab phase-contrast angiography for the diagnosis of dural venous sinus thrombosis. Eur Radiol. 1999. 9(8):1614-9. [Medline].

  24. Ayanzen RH, Bird CR, Keller PJ, et al. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol. 2000 Jan. 21(1):74-8. [Medline].

  25. Medel R, Monteith SJ, Crowley RW, Dumont AS. A review of therapeutic strategies for the management of cerebral venous sinus thrombosis. Neurosurg Focus. 2009 Nov. 27(5):E6. [Medline].

  26. Bentley JN, Figueroa RE, Vender JR. From presentation to follow-up: diagnosis and treatment of cerebral venous thrombosis. Neurosurg Focus. 2009 Nov. 27(5):E4. [Medline].

  27. Einhaupl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet. 1991 Sep 7. 338(8767):597-600. [Medline].

  28. de Bruijn SF, Stam J, Vandenbroucke JP. Increased risk of cerebral venous sinus thrombosis with third- generation oral contraceptives. Cerebral Venous Sinus Thrombosis Study Group. Lancet. 1998 May 9. 351(9113):1404. [Medline].

  29. Rahman M, Velat GJ, Hoh BL, Mocco J. Direct thrombolysis for cerebral venous sinus thrombosis. Neurosurg Focus. 2009 Nov. 27(5):E7. [Medline].

  30. Ekseth K, Bostrom S, Vegfors M. Reversibility of severe sagittal sinus thrombosis with open surgical thrombectomy combined with local infusion of tissue plasminogen activator: technical case report. Neurosurgery. 1998 Oct. 43(4):960-5. [Medline].

  31. Alonso-Canovas A, Masjuan J, Gonzalez-Valcarcel J, et al. [Cerebral venous thrombosis: when etiology makes the difference.]. Neurologia. 2009 Sep. 24(7):439-45. [Medline].

  32. Benamer HT, Bone I. Cerebral venous thrombosis: anticoagulants or thrombolyic therapy?. J Neurol Neurosurg Psychiatry. 2000 Oct. 69(4):427-30. [Medline].

  33. Cipri S, Gangemi A, Campolo C, et al. High-dose heparin plus warfarin administration in non-traumatic dural sinuses thrombosis. A clinical and neuroradiological study. J Neurosurg Sci. 1998 Mar. 42(1):23-32. [Medline].

  34. D'Alise MD, Fichtel F, Horowitz M. Sagittal sinus thrombosis following minor head injury treated with continuous urokinase infusion. Surg Neurol. 1998 Apr. 49(4):430-5. [Medline].

  35. Davis KR, Kistler JP, Buonanno FS. Clinical neuroimaging approaches to cerebrovascular diseases. Neurol Clin. 1984 Nov. 2(4):655-65. [Medline].

  36. Gold Standard Multimedia. Urokinase, Altevase, Streptokinase, Heparin, Warfarin. Clinical Pharmacology. 2000. Available at: [Full Text].

  37. Gomez CR, Misra VK, Terry JB, et al. Emergency endovascular treatment of cerebral sinus thrombosis with a rheolytic catheter device. J Neuroimaging. 2000 Jul. 10(3):177-80. [Medline].

  38. Gustafsson D, Elg M. The pharmacodynamics and pharmacokinetics of the oral direct thrombin inhibitor ximelagatran and its active metabolite melagatran: a mini-review. Thromb Res. 2003 Jul 15. 109 Suppl 1:S9-15. [Medline].

  39. Jacobs K, Moulin T, Bogousslavsky J, et al. The stroke syndrome of cortical vein thrombosis. Neurology. 1996 Aug. 47(2):376-82. [Medline].

  40. Leys D, Cordonnier C. Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management. Ann Indian Acad Neurol. 2008. 11:79-87. [Full Text].

  41. Meyer-Lindenberg A, Quenzel EM, Bierhoff E, et al. Fatal cerebral venous sinus thrombosis in heparin-induced thrombotic thrombocytopenia. Eur Neurol. 1997. 37(3):191-2. [Medline].

  42. Zweifler RM. Management of acute stroke. South Med J. 2003 Apr. 96(4):380-5. [Medline].

Left lateral sinus thrombosis demonstrated on magnetic resonance venography (MRV). This 42-year-old woman presented with sudden onset of headache. Physical examination revealed no neurologic abnormalities.
Same patient as in the previous image. One week after treatment with heparin, the magnetic resonance (MR) venogram displayed increased flow in the left lateral sinus consistent with early recanalization of the sinus; headache had resolved at this point.
Magnetic resonance venogram (MRV) - axial view; A = lateral (transverse) sinus; B = sigmoid sinus; C = confluence of sinuses; and D = superior sagittal sinus.
Magnetic resonance venogram (MRV) - sagittal view; A = lateral (transverse) sinus; C = confluence of sinuses; D = superior sagittal sinus; and E = straight sinus.
Computed tomography (CT) scan demonstrates a left posterior temporal hematoma in a 38-year-old woman on oral contraceptives (the only identified risk factor).
Contrast-enhanced magnetic resonance imaging (MRI) scan showing lack of filling of left transverse sinus.
Axial view of magnetic resonance (MR) venogram demonstrating lack of flow in transverse sinus.
Coronal view of magnetic resonance (MR) venogram demonstrating lack of flow in the left transverse and sigmoid sinuses.
Table. Patients With Cerebral Venous Thrombosis Treated With Heparin and Local Infusion of Urokinase vs Nontreated Group
 Treated Group, % (n = 12) Nontreated Group, % (n = 21)
Full recovery62.529
Mild disability12.513
Severe disability12.59.6
Fatal outcome12.548
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