On March 5th, Dr. Abhishek Man Shrestha gave a highly interesting presentation on the often-overlooked yet critical condition, Cerebral Venous Thrombosis (CVT). Dr. Shrestha emphasized that CVT, unlike more common ischemic strokes, results from the formation of blood clots in the cerebral venous sinuses, impeding normal blood drainage and increasing intracranial pressure. While rare, it disproportionately affects younger individuals, particularly women under 55 years of age.
The presentation highlighted several risk factors that predispose individuals to CVT: The use of oral contraceptives and hormone therapy, pregnancy and the postpartum period, genetic conditions that promote excessive clotting, malignancies and systemic illnesses such as iron deficiency anemia, COVID-19 infections and even certain vaccines linked to vaccine-induced thrombotic thrombocytopenia (VITT)
One of the key takeaways from the lecture was the broad and sometimes misleading presentation of CVT. According to Dr. Shrestha, headache is the most common symptom, occurring in 90% of cases. Other signs include: Seizures, neurological deficits such as weakness or speech impairment, altered consciousness, or symptoms of increased intracranial pressure, including nausea, visual disturbances, and papilledema. Dr. Shrestha also noted that in some cases, CVT may mimic a subarachnoid hemorrhage due to a sudden and severe thunderclap headache.
Diagnosing CVT can be challenging, but imaging including non-contrast CT scans, MRI with MR Venography (MRV) and CT venography play a crucial role. When it comes to treatment, Dr. Shrestha highlighted the primary objective: preventing clot progression, facilitating recanalization, and reducing the risk of recurrent thrombosis. Treatment options include anticoagulation therapy with low-molecular-weight heparin (LMWH) followed by oral anticoagulation (warfarin or direct oral anticoagulants), endovascular therapy, or decompressive surgery as a last-resort life-saving procedure for cases with extensive brain swelling.
Despite its severity, CVT generally has a favorable prognosis. Up to 90% of patients achieve full functional recovery (mRS 0-2), though some experience long-term symptoms such as chronic headaches, cognitive impairments, and mood disturbances.
Dr. Shrestha’s lecture underscored the importance of recognizing and diagnosing CVT promptly. Advances in imaging and treatment have significantly improved patient outcomes, but continued research is needed—especially in understanding risk factors. The lecture served as a powerful reminder that while CVT is rare, early recognition and intervention can be life-saving. Thank you, Dr. Abhishek!
