Cerebral Venous Thrombosis Diagnosis

Clinical Manifestations

The American Heart Association notes that headache is the cardinal symptom of cerebral venous thrombosis, present in almost 90% of patients, and can be the only manifestation in up to 25% of cases 1, 2
The American Stroke Association recommends considering cerebral venous thrombosis in patients with progressive headache, especially if accompanied by signs of increased intracranial pressure such as papilledema or diplopia 1, 2
Focal neurological signs such as hemiparesis and aphasia are common when cerebral infarction or hemorrhage occurs due to venous thrombosis 1, 2

The American College of Radiology recommends initial laboratory studies including complete blood count, chemistry panel, prothrombin time, and partial thromboplastin time in patients with suspected cerebral venous thrombosis 1, 3, 4
Screening for prothrombotic conditions that may predispose to cerebral venous thrombosis, such as oral contraceptive use, underlying inflammatory disease, or infectious process, is recommended in the initial clinical evaluation 1, 3, 4
A normal D-dimer level by sensitive immunoassay or rapid ELISA may be considered to help identify patients with low probability of cerebral venous thrombosis, but a normal level should not preclude further evaluation if there is strong clinical suspicion 4

Elevated opening pressure is a frequent finding in cerebral venous thrombosis, present in >80% of patients 3, 4
There are no specific cerebrospinal fluid abnormalities in cerebral venous thrombosis 1, 3, 4
Unless there is clinical suspicion of meningitis, cerebrospinal fluid examination is typically not useful in cases with focal neurological abnormalities and radiographic confirmation of diagnosis 3, 4