Knowledge of the anatomy of the venous system is essential in the evaluation of patients with cerebral venous thrombosis.
Stroke is the most frequent cause of stroke and transient ischemic attacks. Cardiogenic cerebral embolization is common among patients with any cause of atrial fibrillation, but particularly in atrial fibrillation resulting from rheumatic and arteriosclerotic heart disease.
The thrombosis of venous channels in the brain is an uncommon cause of cerebral infarction relative to arterial disease but is an important consideration because of its potential morbidity.
The symptoms associated with the condition are related to the area of thrombosis. For example, cerebral infarction can occur with a cortical vein or sagittal sinus thrombosis secondary to congestion of obstructed tissue.
Thrombosis of the lateral sinus can be associated with headache and a pseudotumor cerebri type image. The extension within the jugular bulb can cause jugular foramen syndrome, while cranial nerve palsies can be seen in cavernous sinus thrombosis as a compression phenomenon.
Cerebral hemorrhage may also be a presenting feature in patients with venous sinus thrombosis.
The imaging procedures have led to an easier recognition of venous sinus thrombosis, offering the opportunity to take early therapeutic measures.
A blood clot in a cerebral vein can cause pressure that leads to brain inflammation. This pressure can cause headaches and in more severe cases damage the brain tissue.
The symptoms vary depending on where the blood clot occurs in the brain. However, the most common symptoms of stroke may include:
- Severe headaches
- Blurry vision.
If you have a more severe case of cerebral venous thrombosis, you may experience stroke-like symptoms. These may include:
- Disability of speech.
- Numbness of the unilateral body.
- Decreased alertness.
Other symptoms of severe stroke include:
- Limited mobility in parts of your body.
Rare causes of cerebral embolism include fat that enters the bloodstream after trauma, tumor cells caused by atrial myxoma and gas embolism.
What are the Common Risk Factors of Cerebral Embolism?
Blood clots are more likely to occur in your body when there is an interruption in regular blood flow. Although cerebral embolism is an uncommon condition, it can be triggered by a number of factors.
Some of the most common risk factors include:
- Contraceptives or excessive use of estrogen.
- Ear, face or neck infection.
- Protein deficiencies.
- Cranial trauma or injury.
Less common risk factors for stroke include pregnancy and other blood coagulation disorders . Both conditions can make blood clotting easier, affecting adequate blood flow throughout the body and brain.
In babies, the most common cause of stroke is infection, specifically in the ear. In some cases of cerebral embolism, the cause is unknown.
If left untreated, stroke can have life-threatening consequences.
Diagnosis of Cerebral Embolism
When diagnosing cerebral venous thrombosis, doctors will evaluate the symptoms you experience and also take into account your medical and family history.
However, a final diagnosis depends on checking the blood circulation in your brain. To control blood flow, doctors can use imaging tests to detect blood clots and swelling.
A doctor may mistakenly diagnose a stroke if you use the wrong test. While there are several imaging tests available, some are not as useful for diagnosing this condition, as a simple x-ray of the skull.
The two best imaging tests to help detect stroke are:
Magnetic resonance venogram – also known as magnetic resonance imaging, is an imaging test that produces images of blood vessels in the head and neck area.
It can help to evaluate blood circulation, irregularities, strokes or brain hemorrhages. During this MRI, doctors will inject a special dye into the bloodstream to show blood flow and help determine if blood is clotting to diagnose thrombosis
This test is usually used to clarify images from a CT scan.
Venogram with computed tomography : CT scans use X-ray images to show your doctor your bones and arterial vessels.
Combined with a venogram, doctors will inject a dye into the veins to produce images of blood circulation and help detect blood clotting.
Cerebral embolic infarcts and their sources of origin can now be confirmed during life by many invasive and non-invasive procedures, including:
- Computed tomography.
- Magnetic resonance.
- Contrast angiography, digital subtraction angiography, magnetic resonance angiography.
- Carotid Doppler and transcranial Doppler.
- Echocardiography without and with contrast.
These tests visualize the following:
- Embolic occlusions of small and large cerebral arteries.
- Cerebral infarctions resulting in appropriate vascular territories.
- Plaques within the aorta, subclavian, vertebral and carotid arteries, and mural thrombi located within the heart and arteries aortocefálicas.
Transcranial Doppler monitoring of the middle cerebral artery detects small (asymptomatic) and large (symptomatic) cerebral embolisms.
Transseptal cardiac excision, which is a cause of paradoxical embolization.
Holter monitoring detects episodic cardiac arrhythmias. Magnetic resonance imaging identifies cerebral infarcts resulting from virtually all large cerebral emboli.
Early recognition and identification of types of cerebral embolism are important due to the availability of effective prophylactic therapies.
Treatment Options for Cerebral Venous Thrombosis
The options for stroke treatment depend on the severity of the condition. The primary treatment recommendations focus on preventing or dissolving blood clots in the brain.
Doctors may prescribe anticoagulants, or blood thinners, to help prevent blood clotting and subsequent growth of the clot. The most prescribed medicine is heparin, and it is injected directly into the veins or under the skin.
Once your doctor thinks you are stable, you may be recommended an oral anticoagulant such as warfarin as a regular treatment.
This can help prevent recurrent blood clots, especially if you have a diagnosed blood clotting disorder. In addition to helping prevent blood clots, doctors will also address the symptoms of stroke.
If you have experienced an attack of this condition, doctors will prescribe anti-seizure medication to help control the episode. Similarly, if you begin to experience stroke-like symptoms, a doctor will admit you to a stroke or intensive care unit.
It is reported that several medications increase the risk of stroke, including the following:
- Oral contraceptives, including third-generation formulations.
- Epsilon-aminocaproic acid.
- Heparin, heparin therapy has been reported to produce thrombotic thrombocytopenia with associated venous sinus thrombosis.
In the most severe cases of cerebral venous thrombosis, doctors may recommend surgery to remove the blood clot or thrombi and repair the blood vessel. This procedure is called thrombectomy.
In some thrombectomy procedures, doctors may insert a balloon or similar device to prevent the closure of blood vessels.
While rare, cerebral venous thrombosis can become a life-threatening condition if left untreated. When detected early, brain thrombosis can be treated non-invasively with medication.
In all cases of cerebral embolism, doctors will control brain activity. Follow-up venograms and imaging tests are recommended to evaluate thrombosis and ensure no additional clots.
Follow-ups are also crucial to ensure that you do not develop bleeding disorders, tumors or other complications of cerebral venous thrombosis.
It is likely that doctors will perform additional blood tests to see if you have a bleeding disorder that may have increased your risk of developing stroke.
If you begin to experience any of these symptoms, call immediately for emergencies or ask someone to take you to a hospital.
Cerebral vein thrombosis is a blood clot from a cerebral vein in the brain. This vein is responsible for draining blood from the brain. If blood builds up in this vein, it will begin to seep into the tissues of the brain and cause severe hemorrhage or brain swelling.
When detected early, cerebral venous thrombosis can be treated without causing life-threatening complications.
If you start to experience irregular headaches or the corresponding symptoms, notify your doctor immediately.