Cerebral Venous Sinus Thrombosis (CVT)

Your Path

  • Cerebral Venous sinus thrombosis (CVT)


  • 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


  • 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
  • From increased ICP: papiledema, CN6 palsy
  • CN 3, 4, 6 palsy with cavernous sinus thrombosis
  • Focal (more common) or generalized seizures