What are the potential complications of CVST that I should monitor for in my patients during follow-up?

Cerebral venous sinus thrombosis (CVST) can lead to several potential complications that require careful monitoring during follow-up. Key complications include raised intracranial pressure due to impaired venous drainage, which may cause headaches, papilloedema, and visual disturbances. This can progress to hydrocephalus, both acute and chronic, necessitating clinical and imaging assessment to guide possible cerebrospinal fluid drainage or diversion NICE NG228.

Another critical complication is venous infarction and haemorrhage, which may present with new or worsening neurological deficits or seizures. Patients should be monitored for signs of neurological deterioration, and imaging should be repeated if symptoms worsen NICE NG228.

Seizures are a common complication in CVST and may require ongoing anti-epileptic drug management and specialist review during follow-up NICE NG240.

Additionally, delayed cerebral ischaemia can occur secondary to venous congestion and should be considered if neurological symptoms worsen; maintaining euvolaemia and supportive care are important NICE NG228.

Long-term complications may include cognitive impairment and psychosocial difficulties, necessitating neuropsychological assessment and rehabilitation support NICE NG99,NICE NG240. Audiological and visual assessments may be warranted if sensory deficits develop NICE NG99,NICE NG240.

Finally, given the thrombotic nature of CVST, monitoring for recurrence or extension of thrombosis is essential, often guided by clinical assessment and follow-up imaging Budak et al. 1995.

In summary, during follow-up of patients with CVST, monitor for raised intracranial pressure and hydrocephalus, venous infarction and haemorrhage, seizures, delayed cerebral ischaemia, cognitive and sensory complications, and thrombotic recurrence NICE NG228,NICE NG99,NICE NG240 Budak et al. 1995.