CVST may present with a headache and neurological symptoms, such as weakness, confusion, or blurred vision.

Cerebral venous sinus thrombosis (CVST) is a type of stroke that occurs when a blood clot forms in the brain’s veins. This clot prevents blood from flowing properly, leading to increased pressure in the blood vessels. As a result, the pressure can cause swelling and bleeding in the brain.

Identifying the early symptoms of CVST is important to ensure timely treatment and prevent complications.

Early symptoms of cerebral venous sinus thrombosis (CVST) often start with a headache. This may be accompanied by “red flag” neurological signs, including blurred vision, motor weakness, or seizures.

Headache

A headache is the most common initial symptom and can range from mild to severe, sometimes resembling a migraine or tension headache.

A study involving people with confirmed CVST who had come to the emergency department experienced the following:

  • Acute onset headache: sudden and severe headache, present in 42.1% of patients.
  • Thunderclap headache: very severe headache (often described as the worst headache of one’s life) that reaches its peak intensity within seconds, present in 31.6% of patients.
  • Subacute headache: a gradually worsening headache over days or weeks, present in 26.3% of patients.

Headaches were often described as pressing (63.2%). They occurred in different areas, with the most common being holocranial (covering the entire head) at 57.9%. Other locations include one side of the head (hemicranial), the back of the head (occipital), and the front of the head (frontal).

Neurological symptoms

Neurological symptoms are common in CVST. Here is a breakdown according to the study previously discussed:

  • Neuro-visual symptoms (36.8%): These symptoms involve issues with vision and eye movements, such as double vision or difficulty focusing, often due to problems with the brain’s control of eye functions.
  • Motor weakness (26.3%): This refers to diminished muscle strength and control, which can affect movement and coordination. It’s often a sign of problems in the nervous system.
  • Altered consciousness levels (21.1%): This includes changes in awareness or alertness, ranging from confusion to unconsciousness, indicating possible brain dysfunction.
  • Behavioral disturbances (21.1%): These are changes in behavior or personality, such as agitation or inappropriate actions, often due to neurological issues.
  • Seizures (10.5%): These are sudden, uncontrolled electrical disturbances in the brain, leading to convulsions or loss of consciousness. They are less common in this context.
  • Speech disturbances (less common): Speech disturbances involve difficulty speaking or understanding language.
  • Gait instability (less common): Gait instability refers to problems with walking or balance.

Nausea and vomiting

Nausea and vomiting in CVST are often linked to increased intracranial pressure and brain dysfunction caused by the blockage of venous blood flow. These symptoms may suggest more extensive brain damage.

Approximately 42.1% of individuals with CVST experienced nausea or vomiting.

CVST can be influenced by one or multiple risk factors. Some individuals with CVST may have several contributing factors rather than just one.

Risk factors for CVST include the following:

  • pregnancy and the postpartum period
  • use hormonal contraceptives containing estrogen
  • hormone replacement therapy (HRT)
  • use of tesosterone supplements
  • female sex, due to higher levels of estrogen
  • being under 50 years old
  • anemia
  • inherited thrombophilia (e.g., Factor V Leiden, prothrombin gene mutation)
  • acquired thrombophilia (e.g., antiphospholipid syndrome)
  • systemic infections (e.g., mastoiditis)
  • inflammatory diseases (e.g., lupus, Behçet’s disease)
  • cancer
  • head trauma
  • neurosurgical procedures
  • dehydration
  • obesity
  • use of central venous catheters
  • COVID-19

A 2020 study involved 33 patients with confirmed CVST based on magnetic resonance imaging (MRI) and MR venography (MRV). The participant group included 29 females and 4 males with an average age of 31.36 years.

Of the 29 females, 3 were pregnant, and 26 were in the postpartum period. For 12 participants (41.4%), this was their first pregnancy.

The study found the following:

  • 30 patients (90.9%) had focal neurological deficits (coordination, visual, speech problems)
  • 26 (78.8%) experienced headaches
  • 24 (72.7%) had seizures
  • and 20 (60.6%) were anemic

Researchers concluded that CVST is a significant cause of intracranial hypertension, seizures, and stroke in young people, with symptoms varying widely.

CVST in transgender people

You’ll notice that the language used to share stats and other data points is pretty binary.

The studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

However, blood clots are a well-known risk for some people undergoing both estrogen- and testosterone-based HRT. Your doctor will be regularly testing your blood throughout your use of HRT, but you should make sure to inform them if you also experience CVST symptoms.

If you’d like to learn more about transgender and intersex representation in clinical trials, you can check out this article.

The development of CVST can vary significantly from person to person. It can develop over hours, days, or even weeks. The timeline depends on various factors such as the underlying cause, individual health conditions, and the location and size of the clot.

Here is a general overview of the progression:

  • Acute phase: In some cases, symptoms can appear suddenly and progress rapidly over a few hours to a couple of days. This acute onset is often seen in cases related to trauma, severe infections, or rapid changes in blood clotting conditions.
  • Subacute phase: More commonly, CVST symptoms develop gradually over several days to a few weeks. This progression might be seen in patients with conditions like dehydration or certain chronic diseases.

On average, it takes about 4 days for someone to seek medical help after their initial symptoms of CVST start. This delay can occur because the symptoms may be nonspecific or mistaken for other conditions.

If you suspect cerebral venous sinus thrombosis (CVST), follow these steps:

  • Get medical attention: Go to the emergency room or contact a healthcare professional immediately.
  • Medical evaluation: A doctor will perform a thorough physical examination and assess your symptoms.
  • Imaging: The doctor will likely order imaging tests, such as a CT scan or MRI, to check for blood clots in the brain’s venous sinuses.
  • Blood tests: Tests may be conducted to identify underlying conditions or risk factors.
  • Treatment: If CVST is confirmed, treatment typically involves antithrombotic or anticoagulant medications to dissolve the clot and prevent further clotting. Sometimes steroids are used to reduce swelling in and around the brain, and anti-epilepsy medication may be necessary to treat and prevent seizures.

Can CVST resolve on its own?

Sometimes, CVST can resolve on its own, especially if the blood clot is very small, and if appropriate treatment is started promptly. However, it is crucial to seek medical treatment to reduce the risk of complications and improve outcomes.

Treatment often involves antithrombotic or anticoagulant medications to help dissolve the clot and prevent new clots from forming. In more severe cases, surgery or other interventions may be necessary.

Only a medical professional will be able to tell if someone has CVST and what treatment is needed.

Recognizing CVST early is key to effective treatment. Common early symptoms include persistent headaches, blurred vision, motor weakness, and seizures.

Getting an early medical assessment and imaging are crucial for diagnosis and treatment. Early action improves the chances of recovery and lowers the risk of severe complications.