Cerebral Venous Sinus Thrombosis (CVST) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Is imaging confirmatory?
   Suspected CVST — is imaging confirmatory? (Dural sinus/cerebral vein thrombosis → impaired venous outflow, raised ICP, venous infarction/hemorrhage. Headache is most common (isolated headache → focal deficit/seizure/papilledema/coma), can mimic stroke/SAH/tumor. Risk: thrombophilia, pregnancy/puerperium/oral contraceptives, malignancy, infection (otitis/mastoiditis/sinusitis — septic), dehydration. NCCT is often normal (dense thrombus/cord sign in only ~1/3, do not rely on it alone).)
   • CTV or MRV confirms CVST → Confirmed → anticoagulation is the cornerstone
   • Imaging negative / not done → High suspicion → venography
2. [End] High suspicion → venography
   High clinical suspicion but imaging negative/not done: urgent CT venography (CTV) or MRI + MRV (the latter more sensitive, preferred in pregnancy). A normal NCCT does not exclude CVST. Also exclude stroke/SAH/tumor. Anticoagulate once confirmed.
3. [End] Confirmed → anticoagulation is the cornerstone
   Confirmed CVST: anticoagulation is the first-line cornerstone (LMWH or IV UFH), and should be given even with hemorrhagic venous infarction (prevents thrombus extension, promotes recanalization); manage raised ICP, antiseizure drug for seizures; add antibiotics + source control if septic; endovascular thrombectomy for severe/progressive deterioration; work up thrombophilia/cause; then transition to oral anticoagulation (VKA; DOACs under study).

Source guidelines & references

• Cerebral venous sinus thrombosis (StatPearls; AHA/ESO guidelines)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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