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Cerebral venous sinus thrombosis — SCE Neurology MCQ

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HardHeadacheCerebral venous sinus thrombosisSCE Neurology

Two weeks postpartum, a patient has progressive headache, papilloedema and seizure. CT venography shows superior-sagittal sinus thrombosis with a haemorrhagic venous infarct. What treatment should begin?

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Correct answer: C — Therapeutic low-molecular-weight heparin in the setting of the haemorrhagic venous infarct

The best answer is “Therapeutic low-molecular-weight heparin in the setting of the haemorrhagic venous infarct”. Haemorrhage from venous congestion is not a contraindication to therapeutic anticoagulation in cerebral venous thrombosis. “Withhold anticoagulation until all blood resolves” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Use aspirin alone” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Give systemic thrombolysis routinely before heparin” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Perform lumbar puncture despite papilloedema” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: European Stroke Organization guideline for cerebral venous thrombosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC6454824/