Examqo › Examqo library › Neurology › Cerebrovascular disease · IMLE
Cerebral venous thrombosis (CVT)
Cerebral venous thrombosis blocks blood drainage from the brain, so it shows as raised intracranial pressure, seizures and venous infarcts that tend to bleed — and the treatment is anticoagulation even when blood is present.
Why it matters in the exam
The typical scenario is a young woman on the contraceptive pill, or after delivery, with a headache worsening over days, papilloedema and a seizure. The tests check that you choose venous imaging (MRV or CTV), not plain CT alone, and the surprising decision to give heparin despite a lobar bleed. Common distractors: calling it a primary headache, choosing systemic thrombolysis, or believing a normal D-dimer excludes it. Another clue is a bleed or infarct that does not fit a single arterial territory, often bilateral or next to a large venous sinus. Superior sagittal sinus thrombosis causes bilateral deficits and seizures. The prognosis is relatively good when treatment starts early.
Key points
- CVT occurs mainly in young women with the pill, pregnancy or the puerperium, and thrombophilia.
- Headache is the common symptom, with papilloedema, seizures and focal deficits.
- Diagnosis is by MRV or CTV; a normal plain CT and D-dimer do not exclude it.
- Treat with heparin even when venous haemorrhage is present.
- Then an oral anticoagulant for 3 to 12 months; steroids are not recommended.
Summary table
| Aspect | Findings | Note |
|---|---|---|
| Risk factors | Oral contraceptive pill, pregnancy and the puerperium, thrombophilia, malignancy, ear or sinus infection, dehydration | More common in young women |
| Presentation | Headache (the most common symptom), papilloedema, seizures, focal deficit, reduced consciousness | Deep venous thrombosis (thalamus) may cause confusion alone |
| Diagnosis | MRI with MRV or CTV; contrast CT may show the empty delta sign | A normal D-dimer does not exclude it, especially with isolated headache |
| Acute treatment | Low-molecular-weight heparin (or unfractionated heparin), even with venous haemorrhage | Deterioration despite treatment — endovascular therapy; herniation — decompressive craniectomy |
| Continued treatment | Oral anticoagulant for 3 to 12 months (warfarin with an INR of 2 to 3, or dabigatran) | Longer treatment for recurrence or severe thrombophilia; steroids are not recommended |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Neurology, Medical licensing exam (IMLE), Internal medicine, Emergency medicine, Obstetrics and gynecology.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- ESO Guideline for the Diagnosis and Treatment of Cerebral Venous Thrombosis, 2017 — Anticoagulation and duration of treatment
- AHA Scientific Statement: Diagnosis and Management of Cerebral Venous Thrombosis, 2024 — Imaging and treatment
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.