CEREBRAL VENOUS THROMBOSIS: AN OVERVIEW OF CLINICAL FEATURES, DIAGNOSIS, AND TREATMENT

This narrative review synthesizes current evidence from 2016-2025 articles on cerebral venous thrombosis (CVT), a rare cerebrovascular condition accounting for 0.5-1% of all strokes that predominantly affects young adults, particularly women (3:1 ratio) due to hormonal risk factors. The COVID-19 pandemic introduced novel dimensions including SARS-CoV-2-associated CVT (0.08% incidence) and vaccine-induced immune thrombotic thrombocytopenia (VITT) requiring specific management protocols. Clinical presentation remains heterogeneous, with headache occurring in 60-95% of cases, though 6-25% present with isolated headache without focal signs, necessitating high clinical suspicion and advanced neuroimaging (MRI/MRV as gold standard) for diagnosis. Anticoagulation represents the treatment cornerstone, with accumulating evidence from randomized trials (RE-SPECT CVT, ACTION-CVT, EINSTEIN-Jr CVT) demonstrating that direct oral anticoagulants offer safe and effective alternatives to warfarin, though optimal duration remains debated. Contemporary management has dramatically improved prognosis, reducing mortality from historical 30-50% to current 5-10%, with approximately 80% of patients achieving functional independence, with recurrence risk of ~4% annually and substantial minorities suffer persistent headache, cognitive difficulties, or seizures. Future research priorities include defining optimal anticoagulation duration, standardizing endovascular intervention protocols, and identifying biomarkers for early diagnosis and prognostic stratification.