Occurs in large venous sinuses that are within the dura
Superior sagital sinus, which drains into the transverse (lateral) sinuses are largest; Can occur in other venous sinuses including cavernous sinus, straight sinus, inferior sagital sinus
Can spread from the venous sinuses to cortical veins
Risk Factors
Biochemical hypercoaguable states: factor 5 leiden and prothrombin mutations; protein S, protein C, antithrombin deficiency; Anti-phospholipid antibody
Other hypercoaguable states: P vera, some malignancies (adenocarcinoma, some leukemias), some meds (e.g. OCPs), HIT, post-partum, COVID-19 infection
Certain vaccines for COVID-19
Post neurosurgical or neuro-trauma
Adjacent inflammation (e.g. meningitis, abscess)
Adjacent sinusitus leading to cavernous sinus thombosis
Symptoms
Cause symptoms by: a. cortical venous infarcts (strokes) and/or b. increased intra-cranial pressure
Acute headache in 70-90% of patients (over hours to days)
Exam can be normal - or sometimes focal deficits (related to ischemia from venous infarcts) - but dont follow typical pattern for arterial infarct; sometime delirium
Cavernous sinus (front of face): eye pain, sinusitus symptoms
Sometimes focal seizures (~35%)
Physical Exam Findings
Often uncomfortable due to headache; exam can otherwise be normal
Focal deficits based on site of venous infarct: weakness in arm or leg, hemi-paresis, aphasia, confusion