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Headache in cerebral venous thrombosis

  • HEADACHES AND CEREBROVASCULAR DISEASE
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Abstract

Headache has been consistently reported as the most common symptom of cerebral venous thrombosis and as the most frequent presenting feature. It is often the heralding symptom, preceding other manifestations of the disease by days or even weeks. This aspect highlights the importance of recognizing headache due to cerebral venous thrombosis, as early recognition of the disease can lead to a rapid diagnosis with appropriate imaging techniques and as early treatment with heparin can dramatically change the course of the disease and alter the prognosis. Unfortunately, although common, the headache has no specific features, and the clinical presentation of CVT is highly variable, making the correct diagnosis in the emergency setting a challenging task for clinicians, even in the case of highly specialized ones such as neurologists. In this review, we will briefly summarize the epidemiology and physiopathology of CVT, and then we will discuss in more details the causes, features, and course of headache, focusing on its relevance for differential diagnosis and on red flags that should suggest the possibility of CVT as the cause of the headache.

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References

  1. Otite FO, Patel S, Sharma R, Khandwala P, Desai D, Latorre J, Akano EO, Anikpezie N, Izzy S, Malik AM, Yavagal D, Khandelwal P, Chaturvedi S. (2020) Trends in incidence and epidemiological characteristics of cerebral venous thrombosis in the United States. Neurology https://doi.org/10.1212/WNL.0000000000010598

  2. Behrouzi R, Punter M (2018) Diagnosis and management of cerebral venous thrombosis [published correction appears in Clin med (Lond)]. Clin Med (Lond) 18(1):75–79. https://doi.org/10.7861/clinmedicine.18-1-75

    Article  Google Scholar 

  3. Luo Y, Tian X, Wang X. (2018) Diagnosis and treatment of cerebral venous thrombosis: a review. Front Aging Neurosci. 10:2. Published 2018 Jan 30. doi:https://doi.org/10.3389/fnagi.2018.00002

  4. Koennecke HC. (2019) Cerebral venous thrombosis in adults. Vasa. 48(6):473–482. oi:https://doi.org/10.1024/0301-1526/a000788

  5. Coutinho JM, Zuurbier SM, Aramideh M, Stam J (2012) The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 43(12):3375–3377. https://doi.org/10.1161/STROKEAHA.112.671453

    Article  PubMed  Google Scholar 

  6. Capecchi M, Abbattista M, Martinelli I (2018) Cerebral venous sinus thrombosis. J Thromb Haemost 16(10):1918–1931. https://doi.org/10.1111/jth.14210

    Article  CAS  PubMed  Google Scholar 

  7. Heller C, Heinecke A, Junker R, Knöfler R, Kosch A, Kurnik K, Schobess R, von Eckardstein A, Sträter R, Zieger B, Nowak-Göttl U, the Childhood Stroke Study Group (2003) Cerebral venous thrombosis in children: a multifactorial origin. Circulation. 108(11):1362–1367. https://doi.org/10.1161/01.CIR.0000087598.05977.45

    Article  PubMed  Google Scholar 

  8. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F (2004) ISCVT investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 35(3):664–670. https://doi.org/10.1161/01.STR.0000117571.76197.26

    Article  PubMed  Google Scholar 

  9. Gunes HN, Cokal BG, Guler SK, Yoldas TK, Malkan UY, Demircan CS, Yon MI, Yoldas Z, Gunes G, Haznedaroglu IC (2016) Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis. J Int Med Res 44(6):1454–1461. https://doi.org/10.1177/0300060516664807

    Article  PubMed  PubMed Central  Google Scholar 

  10. Martinelli I, Passamonti SM, Rossi E, De Stefano V (2012) Cerebral sinus-venous thrombosis. Intern Emerg Med 7(Suppl 3):S221–S225. https://doi.org/10.1007/s11739-012-0806-9

    Article  PubMed  Google Scholar 

  11. Zuurbier SM, Arnold M, Middeldorp S, Broeg-Morvay A, Silvis SM, Heldner MR, Meisterernst J, Nemeth B, Meulendijks ER, Stam J, Cannegieter SC, Coutinho JM (2016) Risk of cerebral venous thrombosis in obese women. JAMA Neurol 73(5):579–584. https://doi.org/10.1001/jamaneurol.2016.0001

    Article  PubMed  Google Scholar 

  12. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, Camfield CS, David M, Humphreys P, Langevin P, MacDonald E, Gillett J, Meaney B, Shevell M, Sinclair DB, Yager J, Canadian Pediatric Ischemic Stroke Study Group (2001) Cerebral sinovenous thrombosis in children. N Engl J Med 345(6):417–423. https://doi.org/10.1056/NEJM200108093450604

    Article  CAS  PubMed  Google Scholar 

  13. Lovblad KO, Bassetti C, Shneider J et al (2001) Diffusion-weighted MR in cerebral venous thrombosis. Cerebrovasc Diseases 11:169–176

    Article  CAS  Google Scholar 

  14. Yoshikawa T, Abe O, Tuchiya K et al (2002) Diffusion-weighted magnetic resonance imaging of dural sinus thrombosis. Neuroradiology 44:481–488

    Article  CAS  Google Scholar 

  15. Ferro JM, Canhao P, Bousser MG et al (2008) Early seizures in cerebral venous thrombosis and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke 39:1152–1158

    Article  Google Scholar 

  16. Wasay M, Bakshi R, Bobustuc G, Kojan S, Sheikh Z, Dai A, Cheema Z (2008) Cerebral venous thrombosis: analysis of a multi centric cohort from the United States. J Stroke Cerebrovasc Dis 17:49–54

    Article  Google Scholar 

  17. Biousse V, Ameri A, Bousser MG (1999) Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 53:1537

    Article  CAS  Google Scholar 

  18. Crawford SC, Digre KB, Palmer CA, Bell DA, Osborn AG (1995) Thrombosis of the deep venous drainage of the brain in adults. Analysis of seven cases with review of the literature. Arch Neurol 52:1101–1108

    Article  CAS  Google Scholar 

  19. Van den Bergh WM, van der Shaaf I, van Gijn J (2005) The spectrum of presentation of venous infects caused by deep cerebral vein thrombosis. Neurology 65:192–196

    Article  Google Scholar 

  20. Sakaisa H, Kobayashi M, Ito A, Takeuchi K (2014) Cavernous sinus thrombosis: linking a swollen redeye and headache. Lancet 384:928

    Article  Google Scholar 

  21. Ameri A, Bousser GM (1992) Cerebral venous thrombosis. Neurol Clin 10:87–111

    Article  CAS  Google Scholar 

  22. Cantu C, Barinagarrementeria F (1993) Cerebral venous thrombosis associated with pregnancy and puerperium. A review of 67 cases. Stroke 24:1880–1884

    Article  CAS  Google Scholar 

  23. E. Agostoni (2004) Headache in cerebral venous thrombosis Neurol Scien 25:S206–210

  24. Lopes MG, Ferro J, Pontes C et al (2000) For the Venoport Investigators. Headache and cerebral venous thrombosis. Cephalalgia 20:292

    Google Scholar 

  25. Devasagayam S, Wyatt B, Leyden J, Kleinig T (2016) Cerebral venous thrombosis incidence is higher than previously thought: a retrospective population based study. Stroke 47:2180–2182

    Article  Google Scholar 

  26. De Brui** SF, Stam J, Kappelle LJ (1996) Thunderclap headache as first symptom of cerebral venous thrombosis. CVST Study Group Lancet 348:1623

    Google Scholar 

  27. Scooter AJ, Ramos LM, Kappelle LJ (2002) Migraine like headache as the presenting symptom of cerebral venous sinus thrombosis. J Neurol 249:775–776

    Article  Google Scholar 

  28. Martins IP, Sa J, Pereira RC et al (2001) Cerebral venous thrombosis-may mimic migraine with aura. Headache 12:121

    Google Scholar 

  29. Bousser MG, Russel RR. (1997) Cerebral venous thrombosis. In: major problems in neurology, Warlow CP, Van Gijn J WB Saunders, London p27,104

  30. Wetzel SG, Kirsch E, Stock KW et al (1999) Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography. AJNR Am J Neuroradiol 20:249

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Linn J, Ertl-Wagner B, Seelors KC et al (2007) Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses. AJNR Am J Neuroradiology 28:946

    CAS  Google Scholar 

  32. Saposnik G, Barinagarrementeria F, Brown RD Jr et al (2011) Diagnosis and management of cerebral venous thrombosis: a statement of healthcare professions from the American Heart Association/American Stroke Association. Stroke 42:1158–1192

    Article  Google Scholar 

  33. Behrouzi R, Punter M. (2018) Diagnosis and management of cerebral venous thrombosis [published correction appears in Clin med (Lond)]. 2018;18(1):75-79

  34. Bousser M-G, Ferro JM (2007) Cerebral venous thrombosis: an update. Lancet Neurol 6:162–170

    Article  CAS  Google Scholar 

  35. Ferro JM, Bousser M-G, Canhão P, et al. (2017) European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur Stroke J

  36. Dilli E (2014) Thunderclap headache. Curr Neurol Neurosci Rep 14(4):437

    Article  Google Scholar 

  37. Bonneville F (2014) Imaging of cerebral venous thrombosis. Diagn Interv Imaging 95(12):1145–1150

    Article  CAS  Google Scholar 

  38. Sheikh-Bahaei N, Acharya J, Rajamohan A, Kim PE (2020) Advanced imaging techniques in diagnosis of posterior reversible encephalopathy syndrome (PRES). Front Neurol 11:165

    Article  Google Scholar 

  39. Calic Z, Cappelen-Smith C, Zagami AS (2015) Reversible cerebral vasoconstriction syndrome. Intern Med J 45(6):599–608

  40. Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8(7):668–678

    Article  Google Scholar 

  41. Goyal P, Utz M, Gupta N, Kumar Y, Mangla M, Gupta S, Mangla R (2018) Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics. Quant Imaging Med Surg 8(2):219–231

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, “A. Manzoni Hospital”, Lecco, Italy

    Angelo Aliprandi, Paolo Borelli & Andrea Salmaggi

  2. University of Milano Bicocca, Monza, Italy

    Valeria Polonia

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  1. Angelo Aliprandi
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  2. Paolo Borelli
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  3. Valeria Polonia
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  4. Andrea Salmaggi
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Correspondence to Angelo Aliprandi.

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Aliprandi, A., Borelli, P., Polonia, V. et al. Headache in cerebral venous thrombosis. Neurol Sci 41 (Suppl 2), 401–406 (2020). https://doi.org/10.1007/s10072-020-04784-w

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