Raising awareness of a rare type of stroke

The American Heart Association (AHA) recently released new analysis and recommendations for the diagnosis and treatment of a rare type of stroke, called cerebral venous thrombosis (CVT).¹ CVT makes up just 3% of all stroke cases, but it is most common in younger people and in women. While CVT can be difficult to diagnose, early identification and treatment can prevent life-threatening complications.² The AHA’s statement represents an effort to increase CVT awareness for physicians and patients, with the hope of preventing severe illness and saving lives.

The researchers and clinicians at Private Health Management stay up to date on the latest recommendations for managing cardiovascular health. Here’s what you need to know about CVT.

CVT overview
Most strokes are caused by a blood clot in the arteries of the brain, but CVT is a rare type of stroke caused by a blood clot in the veins that drain blood from the brain. A blood clot in a cerebral vein can cause an increase in pressure that can cause headaches and brain swelling, which, if severe, can damage brain tissue.

CVT is most common in younger people, particularly in women and people who tend to form blood clots due to clotting disorders.³ Taking oral contraceptives, being pregnant or postpartum increases the risk of CVT in women. The latest update from the AHA has added obesity and active COVID-19 infection as risk factors associated with CVT.^1,2,4

• CVT makes up 3% of stroke cases
• 2/3 of CVT cases occur in women
• Most cases of CVT occur in people under the age of 55
• 10-15% of CVT cases result in severe outcomes

CVT symptoms and diagnosis
CVT diagnosis can be challenging because the most common symptoms, headaches and seizures, are similar to symptoms of other neurological conditions like migraines or epilepsy. Symptoms vary greatly and can be mild or severe. CVT is usually diagnosed using brain imaging (MRI/CT scans), but these tests may not be routinely ordered for those who are experiencing headaches or seizures.⁵

The updated guidelines from the AHA recommend using a special type of scan called magnetic resonance venography (MRV) to diagnose CVT.

Common symptoms of CVT

• Severe headache
• Seizures
• Blurred vision
• Vomiting

Severe symptoms of CVT

Severe CVT symptoms include stroke-like and potentially life-threatening symptoms.

• Slurred speech
• Trouble understanding others
• One-sided body numbness
• Weakness
• Decreased alertness
• Fainting
• Coma

CVT and other strokes are emergencies – if you or a loved one are experiencing symptoms of CVT or stroke, call 911 immediately.

CVT treatment and outcomes
CVT is usually treated with blood thinners (anticoagulation therapy) to prevent growth of the blood clot, help open the clogged vessel, and prevent future clots. The AHA’s update sheds light on recent treatment advancements, including the following interventions:

• For those who cannot take blood thinners or if the clot is in danger of moving to the heart, a catheter may be inserted into the vein to remove the clot and restore blood flow.
• In severe cases, a surgical procedure to remove of a portion of the skull (craniectomy), has been shown to save lives if done within 48 hours of admission to the hospital.⁵

About 80-90% of people who have suffered from a CVT event and received treatment recover well. However, many people experience long-term symptoms like headache, fatigue, mood disorders, and cognitive delay. About 10-15% of people with CVT experience severe outcomes, including loss of independence, disability, or death, even if they receive medical treatment.²

CVT and other strokes are emergencies
Call your physician right away if you are having symptoms like a persistent headache or seizures. If you or your loved ones are experiencing more severe symptoms of CVT or stroke, call 911 immediately. The faster you are diagnosed and receive treatment, the better the likelihood that you will recover.

References

1. New evidence informs risk factors, diagnosis and care of patients with CVT stroke. American Heart Association https://newsroom.heart.org/news/new-evidence-informs-risk-factors-diagnosis-and-care-of-patients-with-cvt-stroke.
2. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. https://www.ahajournals.org/doi/epdf/10.1161/STR.0000000000000456 doi:10.1161/STR.0000000000000456.
3. Silvis, S. M., de Sousa, D. A., Ferro, J. M. & Coutinho, J. M. Cerebral venous thrombosis. Nat Rev Neurol 13, 555–565 (2017).
4. Novaes, N., Sadik, R., Sadik, J.-C. & Obadia, M. Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic. Life (Basel) 12, 1105 (2022).
5. Ulivi, L., Squitieri, M., Cohen, H., Cowley, P. & Werring, D. J. Cerebral venous thrombosis: a practical guide. Pract Neurol 20, 356–367 (2020).