Dural venous sinus thrombosis: “Not my usual migraine”

Dural venous sinus thrombosis (DVST) is a rare phenomenon which affects nearly three to four million people annually and can present with a variety of clinical findings (Einhaupl et al. Eur J Neurol. 17(10):1229–35, 2010). This condition is characterized by clot formation in the deep cerebral venous circulation. The disease course results in venous congestion and can progress to include cerebral edema and increased intracranial pressure. The challenge in diagnosis arises from the fact that some patients may be asymptomatic, while others may present with a wide variety of neurologic symptoms ranging from headache to altered mental status to seizures or even strokes (Einhaupl et al. Eur J Neurol. 17(10):1229–35, 2010). Diagnosis requires a high degree of suspicion in those patients with thromboembolic risk and presence of neurological sequelae. Diagnosis is often confirmed on imaging with either a CT or MRI venogram, depending on presentation acuity and stability of the patient. Treatment then focuses on anticoagulation of the underlying thrombus, preventing herniation in patients with signs of increased intracranial pressure, and treatment of seizures as well as symptom control.