Cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) is a distinct cerebrovascular disorder that often affects young individuals. It has two mechanisms usually occurring simultaneously: thrombosis (clotting) of cerebral veins which can cause localised oedema of the brain and venous infarction, and thrombosis of the major sinuses which can cause intracranial hypertension.

CVST is not typical of a 'regular' stroke. Symptoms usually won't appear in a way that can be identiifed with FAST. For many patients with CVST, seizures will be a lead symptom.

No population studies have reported the incidence of CVST and very few stroke registries included cases with CVST. The overall risk of recurrence of any thrombotic event after a CVST is around 6.5%. Approximately 3% to 15% of patients die in the acute phase of the disorder. Regarding the long-term outcome, the biggest prospective study on this medical condition, International Study on Cerebral Vein and Dural Sinus Thrombosis, reported a complete recovery of 79% of the patients at last follow-up (median 16 months). However, there was an 8.3% overall death rate and a 5.1% dependency rate (mRS >2).

For current research and evidence-based recommendations see our Clinical Guidelines.

COVID-19 vaccines: A rare syndrome of immune-mediated thrombosis and thrombocytopenia, commonly with CVST, has been reported after adenovirus-vector COVID-19 vaccination (AstraZeneca and Johnson&Johnson/Janssen vaccines). Please refer to the practical information in our Clinical Guideline recommendation.