Update on the Acute Management of Cerebral Venous Thrombosis

Abstract

Cerebral venous thrombosis (CVT) is a rare but increasingly recognized cause of stroke with highly variable clinical presentations. Early diagnosis relies on CT or MR venography, as symptoms often range from headache to seizures, focal deficits, or coma. Anticoagulation remains the cornerstone of therapy, even in patients with intracranial hemorrhage. Low-molecular-weight heparin is preferred in the acute phase, while unfractionated heparin is reserved for patients requiring imminent neurosurgical intervention. Transition to oral anticoagulation is traditionally achieved with vitamin K antagonists, although recent randomized and observational studies suggest that direct oral anticoagulants provide similar efficacy with fewer major bleeding complications. Neurocritical care is vital for patients with severe CVT, focusing on seizure management, intracranial hypertension control, and systemic stabilization. Decompressive craniectomy is a life-saving option in cases of malignant cerebral edema. Endovascular therapy has not demonstrated superiority over standard anticoagulation and is currently reserved for refractory cases. Overall, timely diagnosis, tailored anticoagulation, and multidisciplinary critical care remain the key determinants of outcome in patients with CVT.