Cerebral venous thrombosis in non-bacterial infections: a systematic review

This systematic review summarizes evidence on cerebral venous thrombosis (CVT) following non-bacterial (viral, fungal, parasitic) infections, excluding COVID-19, by describing etiology, clinical features, management, and outcomes. Following PRISMA guidelines and PROSPERO registration (CRD42023445694), we searched MEDLINE/PubMed, Scopus, Web of Science, Embase, and LILACS from inception to July 31, 2025. Two reviewers independently performed study selection, data extraction, and quality assessment using Joanna Briggs Institute tools. From 14,127 records, 278 publications from 1958 to 2025 (262 case reports and 16 case series), encompassing 322 patients were included. Median age was 39 years (IQR 25–55); 54% were male. Viral infections (35%; primarily varicella zoster and HIV) and fungal mucormycosis (35%) were the most common etiologies. While neuroimaging was performed in 95% of cases, specific pathogen identification (biopsy, culture, PCR) was used in fewer than half. Mucormycosis typically involved the cavernous sinus and was observed alongside high mortality (68%). Viral infections often affected multiple sinuses and were reported in association with more favorable outcomes (54% favorable). Anticoagulants were administered in 93% of viral cases, but were administered less frequently in mucormycosis (25%). Direct oral anticoagulants (DOACs) were prescribed for only nine patients. Recanalization was reported in 17% of cases, although follow-up data were unavailable or unreported for most (81%). Non-bacterial infections, notably viral pathogens and mucormycosis, are significant causes of CVT with distinct clinical profiles. Management strategies varied substantially by specific etiology, emphasizing urgent diagnostic intervention. Future guidelines should prioritize specific pathogen diagnostics and investigate the role of DOACs for infectious CVT.