Cerebral venous thrombosis: A diagnostic and treatment update

Cerebral venous thrombosis (CVT) is still a significant diagnostic and therapeutic challenge, due to its high variability of clinical manifestations and its lack of a clear therapeutic consensus. A search of the medical literature was made through PubMed using the conjoined terms of CVT and epidemiology (428 results), pathophysiology (504 results), aetiology (2714 results), diagnosis (2802 results), treatment (2173 results) and outcome (648 results). Original and review publications deemed to be useful for this review were selected. Classical and historical works on CVT were also included. The present paper reviews the fundamental aspects of the epidemiology, pathophysiology and aetiology of CVT. There is a comparison of the most common initial clinical manifestations along with a description of the most important neuroradiological studies needed to establish a diagnosis, all based on multiple published series. Moreover, in order to serve as an important tool in both clinical practice and continuing research, there is also an analysis of recent evidence on treatment and prognosis. CVT represents approximately 0.5% of all stroke cases worldwide. Headache, focal deficits and seizures are the most frequent initial clinical manifestations, representing 89%, 50%, and 35% of appearances, respectively. Magnetic resonance imaging (MRI) in combination with magnetic resonance venography has proved to have the highest sensitivity and specificity in establishing a diagnosis. An equal alternative to MRI is computed tomography venography due to similar diagnostic results. Pharmacological treatment with heparin is widely accepted today. Recurrence and mortality rates of CVT are 2.8 per 100 cases and 10%, respectively, despite of anticoagulation treatment. La trombosis venosa cerebral (TVC) representa hasta la fecha tanto un reto diagnóstico como terapéutico, debido principalmente a la alta variabilidad de presentación y a la falta de un consenso terapéutico claro. Se realizó la búsqueda de literatura médica en PubMed con el término TVC y epidemiología (428 resultados), fisiopatología (504 resultados), etiología (2714 resultados), diagnóstico (2.802 resultados), tratamiento (2.173 resultados) y pronóstico (648 resultados). Se seleccionaron las publicaciones originales y de revisión consideradas como más útiles para la revisión. Se incluyeron también textos clásicos o históricos. En la presente revisión se destacan los aspectos epidemiológicos, fisiopatológicos y etiológic