Cerebral venous thrombosis (CVT) is a type of
stroke that can occur in adults, children, and infants. A stroke can damage the brain and central nervous system. A stroke is serious and needs medical attention right away.
CVT occurs when a blood clot forms in the veins of the brain. The clot keeps blood from draining out of the brain. As a result, pressure builds up in the blood vessels and in the brain, which results in headaches. This pressure buildup can lead to swelling and bleeding (hemorrhage) in the brain. Pressure can damage the brain tissue, leading to a venous stroke. This type of stroke can cause numbness or weakness in the arm or legs, and trouble with speaking, seeing, and walking.
Veins in the brain
CVT causing brain swelling
Sinus vein thrombosis with bleeding into brain tissue
Images used with permission from Stephan Moll, MD, Chapel Hill, NC.
CVT is a rare form of stroke. About 1 out of 100 strokes are CVT type strokes.
CVT affects about 10 to 20 people out of 1 million each year. About 1 out of 100,000 children and teens will have a CVT type stroke.
After CVT, about 85 out of 100 people are independent. But half have long-term issues with cognition, pain, fatigue, or mood. These effects may leave them unable to return to work or school.
CVT has many names, including cerebral venous sinus thrombosis (CVST), venous stroke, sinus vein thrombosis (SVT), cerebral vein thrombosis, dural sinus thrombosis, and venous infarction.
Who is at risk
Children and adults have different risk factors for CVT.
Things that increase a baby or child’s risk for CVT include:
- problems with the way their blood forms clots
- having a blood disorder, health condition, or infection like:
- sickle cell anemia or chronic hemolytic anemia
- beta-thalassemia major (an inherited blood disorder)
- congenital heart disease (heart disease you are born with)
- acquired heart disease (heart disease you develop)
- iron deficiency anemia
- certain viral or bacterial infections, such as severe acute respiratory distress syndrome coronavirus 2, meningitis, or sinus infections
- dehydration
- head injury
For newborns, having a mother who had certain infections or a history of infertility can increase their risk for CVT. The risk for this kind of stroke in newborns is greatest during their first month.
Things that increase an adult’s risk for CVT include:
- being pregnant or having given birth in the last few weeks
- having problems with blood clotting, such as antiphospholipid syndrome, protein C and S deficiency, antithrombin III deficiency, lupus anticoagulant, anticardiolipin antibodies, or factor V Leiden mutation
- having a health condition or infection like:
- cancer
- collagen vascular diseases such as lupus, granulomatosis with polyangiitis, and Behçet syndrome
- obesity
- low blood pressure in the brain (intracranial hypotension)
- inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
- pneumonia or COVID-19
- taking certain medicines such as chemotherapy drugs or estrogen supplements, like in birth control pills
CVT affects mostly women under the age of 50.
Symptoms
If you have symptoms of CVT, have someone take you to the emergency room right away, or call
911 to get help. People who have stroke recover best if they get treatment as soon as possible.
Symptoms of CVT may vary, depending on where the blood clot is. Symptoms may include:
- new headaches or very bad headaches (your worst headache ever or a headache that reaches its maximum severity in seconds)
- blurred vision
- nausea and vomiting
- fainting or losing consciousness
- speech problems
- numbness or weakness
- confusion
- seizures
Diagnosing CVT
To diagnose CVT, your healthcare provider will ask about your health history and do a physical exam. Family and friends can also describe the symptoms they saw, especially if you are unconscious or lost consciousness.
Most often, CVT is diagnosed based on how the blood is flowing in your brain. Tests that show areas of blood flow that may be used to diagnose CVT include:
Treatment
The first treatment for CVT is blood thinning medicines called anticoagulants. You may get these medicines through an intravenous (I.V.), by an injection under your skin, or by mouth (orally). You will get blood thinning medicines to prevent the existing clots from getting bigger and to prevent new clots from forming.
Patients are often switched from injectable blood thinning medicines to oral blood thinning medicines as they get ready to leave the hospital.
Caring for yourself at home
Your care needs after CVT will vary depending on how serious it was, what caused it, and how it impacts your function. If you have had a diagnosis of CVT, you may also have a higher risk of developing other vein clots, like
deep vein thrombosis in the legs or
pulmonary (lung) embolism. Talk to your healthcare team about how to manage your health and care.
Some ways you can care for yourself at home after CVT include:
- Go to stroke rehabilitation (rehab) if your doctor recommends it.
- Manage other health problems that raise your risk of another stroke.
- Have a heart-healthy lifestyle.
- Do not smoke. Avoid second-hand smoke.
- Limit alcohol.
- Stay at a healthy weight. Lose weight if you need to.
- Be active. Ask your doctor what type and level of activity is safe for you.
- Eat heart-healthy foods. These include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit sodium and sugar.
- If you think you may have a problem with alcohol or drug use, talk to your doctor.
- Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
- If your doctor prescribed a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause bleeding problems that can be serious.
- Do not take any non-prescription (over-the-counter) medicines or natural health products without talking to your doctor first.
- If you take hormonal birth control or hormone therapy, talk to your doctor about whether they are right for you. They may raise the risk of stroke in some people.
Information for caregivers
If you are caring for someone who has had a CVT type stroke:
- Make their home safe. You may get advice from the stroke team about what changes you can make. They may suggest:
- setting up a bedroom that does not require climbing stairs and making sure the bathroom is on the same floor
- moving throw rugs and furniture that could cause falls
- making sure that the lighting is good
- putting grab bars and seats in tubs and showers
- Provide transportation, as your loved one may not be able to drive. There are steps that someone who has had a stroke needs to take before they can legally drive again, so they may need support with transportation for some time. Learn more about
driving a car in Alberta after a stroke.
- Find out what the person who had CVT can do and what they need help with. Try not to do things that they can do on their own. Help them learn and practice new skills.
- Visit and talk with the person who had CVT often. Try doing activities together that you both enjoy. Encourage other people to visit, too, but be sure to recognize signs of fatigue and pace activities.
- Take care of yourself.
- Do not try to do everything yourself.
- Ask friends and family members to help.
- Eat well, get enough sleep and rest, and take time to do things that you enjoy.
- Keep up with your own doctor visits, and make sure to take your medicines regularly.
- Join a local support group.
- Find out if you qualify for home health care visits or for adult day programs.
When to call for help
Call
911 anytime you think you may need emergency care. For example, call if you have signs of another stroke. These may include:
- sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body
- sudden vision changes
- sudden trouble talking
- sudden confusion or trouble understanding simple sentences
- sudden problems with walking or balance
- a sudden, severe headache that is different from past headaches
- fainting
- a seizure
Call
911 even if these symptoms go away in a few minutes.
Call your doctor or nurse advice line now or seek immediate medical care if you have new symptoms that may be related to your stroke, such as falls or trouble swallowing.
Watch and call if you have been feeling sad, depressed, or hopeless, or you have lost interest in things that you usually enjoy or you have anxiety or fear that affects your life.
Watch closely for changes in your health and be sure to contact your doctor or nurse advice line if you have any problems.
For 24/7 nurse advice and general health information call Health Link at 811.
