What are the key clinical features that should raise suspicion for cerebral venous sinus thrombosis (CVST) in a primary care setting?

Key clinical features that should raise suspicion for cerebral venous sinus thrombosis (CVST) in a primary care setting include:

• New onset headache that is often progressive, severe, and may be different from previous headaches or migraines, as headache is the most common presenting symptom ¹ (Idiculla et al., 2020).
• Focal neurological deficits such as weakness, sensory disturbances, or cranial nerve palsies, which may develop due to venous infarction or raised intracranial pressure ¹ (Idiculla et al., 2020).
• Seizures, which can be focal or generalized, are a notable feature and may be the initial presentation ¹ (Idiculla et al., 2020).
• Signs of raised intracranial pressure including papilloedema, nausea, vomiting, and visual disturbances, reflecting impaired venous drainage and increased intracranial pressure ¹ (Idiculla et al., 2020).
• Altered mental status or reduced consciousness in more severe cases, indicating extensive thrombosis or secondary complications ¹ (Idiculla et al., 2020).
• Risk factors or predisposing conditions such as recent pregnancy or puerperium, oral contraceptive use, thrombophilia, infection, malignancy, or dehydration should heighten clinical suspicion ¹ (Idiculla et al., 2020).

In primary care, the combination of a new, unusual headache with any focal neurological signs, seizures, or symptoms/signs of raised intracranial pressure, especially in the presence of relevant risk factors, should prompt urgent referral for neuroimaging to exclude CVST ¹. Early recognition is critical due to the potential for rapid deterioration and the need for anticoagulation treatment (Idiculla et al., 2020).