Overview of Cerebral Venous Thrombosis in Adults: Pathophysiology, clinical presentation, diagnosis, and management

Authors

• Veda Chau, University of LynchburgFollow

Specialty

Neurocritical Care

Advisor

Dr. Sarah Bolander

Abstract

ABSTRACT

Cerebral venous thrombosis (CVT) is a rare but increasingly recognized cause of stroke that disproportionately affects younger adults and women. Delayed diagnosis remains a significant clinical challenge because symptoms are often nonspecific and may evolve gradually. Headache, seizures, focal neurologic deficits, and signs of intracranial hypertension should prompt urgent evaluation. Magnetic resonance venography (MRV) or computed tomography venography (CTV) are first-line imaging modalities for confirming CVT and distinguishing it from arterial stroke.

This narrative review synthesizes contemporary evidence on the pathophysiology, clinical presentation, diagnosis, and management of cerebral venous thrombosis. It highlights key clinical decision-making for advanced practice providers across emergency, inpatient, and primary care settings. Anticoagulation remains the cornerstone of treatment, even in the presence of intracerebral hemorrhage. Low-molecular-weight heparin is preferred for initial therapy, followed by transition to an oral anticoagulant, either a vitamin K antagonist or a direct oral anticoagulant, based on underlying etiology, bleeding risk, and patient-specific factors. Adjunctive management includes seizure control and treatment of elevated intracranial pressure, while endovascular therapy and decompressive craniectomy are reserved for patients with severe or refractory disease.

Implementation of structured evaluation pathways and interdisciplinary collaboration may reduce diagnostic delays and improve clinical outcomes. Further research is needed to clarify the long-term safety of direct oral anticoagulants and to standardize cerebral venous thrombosis management and care outside of neurology practice settings.

Recommended Citation

Chau V. Overview of Cerebral Venous Thrombosis in Adults: Pathophysiology, clinical presentation, diagnosis, and management. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).