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Cerebral Venous Sinus Thrombosis — RACP Adult Medicine MCQ

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ModerateNeurologyCerebral Venous Sinus ThrombosisRACP Adult Medicine

A 30-year-old man presents with a 3-day history of sudden onset severe headache and bilateral lower limb weakness. He has papilloedema. MRI brain shows a sagittal sinus thrombosis with bilateral parasagittal venous infarcts. He takes no regular medications. What is the recommended acute treatment?

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Correct answer: A — Anticoagulation with heparin

Cerebral venous sinus thrombosis (CVST) is treated with therapeutic anticoagulation (unfractionated heparin or LMWH) even in the presence of haemorrhagic venous infarction. This may seem counterintuitive but anticoagulation has been shown to be safe and effective in RCTs. Transition to warfarin or DOAC for 3–12 months depending on underlying cause. Investigation for prothrombotic conditions, OCP use (in women), and infection is essential.

Reference: Stroke Foundation – 2024 – Clinical Guidelines; ESO – 2017 – CVST Guidelines