Have you ever had a severe headache that seemed to get worse every day? Or have you suddenly had a seizure-like condition? These can sometimes be a sign of something serious. Today we're going to talk about one specific condition that can cause this, which is a blood clot in a major artery in the brain.
What is Cerebral Venous Sinus Thrombosis (CVST)?
Simply put, Cerebral Venous Sinus Thrombosis , or CVST for short, is a blood clot that forms inside a large blood vessel, a vein, in your brain. This is a relatively rare condition, but it accounts for about 1% of all known strokes.
Imagine, when a blood clot forms in a major artery in your brain, the blood starts flowing in the wrong direction instead of the right direction. This causes pressure inside the brain to increase, causing the brain to swell. This is like a water pipe being blocked and causing water to back up.
Blood clots like these can usually form in the sinuses in your brain:
- Transverse sinus
- Superior sagittal sinus
- Inferior sagittal sinus
- Sigmoid sinuses
- Cavernous sinus
- Deep sinuses of your cortex
Who is most affected by this (CVST) condition?
This condition (CVST) is more common in women . It is most common in people between the ages of 40 and 50, but it can occur at a younger age, even in infants .
You are more likely to develop CVST if you have any of the following conditions or risk factors:
- Nephrotic syndrome - This is a condition related to the kidneys.
- Cancer conditions.
- Vasculitis - This is an inflammation of the blood vessels.
- Sarcoidosis.
- Obesity.
- Covid-19 (`COVID-19`) infection.
- Thrombophilia - This is an inherited condition in which your blood clots easily.
- Liver disease.
How common is CVST?
CVST is actually a very rare condition . Researchers estimate that it affects between two (`2`) and fifteen (`15`) people per million people each year. It is also estimated that about seven (`7`) out of every million children and infants develop CVST each year. So you can see, it's not that common.
What effects can CVST have on my body?
There are several complications that can occur due to CVST. They are:
- Loss of vision.
- Intracerebral hemorrhage (`hemorrhage`) - that is, blood loss from a burst blood vessel.
- Severe headache.
- Seizure.
- A stroke-like condition.
What are the symptoms of CVST?
Symptoms of CVST can vary depending on the severity of the blood clot and where it is located in the brain .
The main symptoms that can be seen are:
- Gradually increasing, severe headache (this is the most common symptom).
- Seizures.
- Altered mental status and/or new neurologic deficits, such as in the case of a large brain bleed.
What are the causes of CVST?
There are several factors that can cause CVST:
- Being pregnant .
- Use of birth control pills (oral contraceptives).
- Experiencing some serious accident (trauma).
- Having an inherited condition that causes the blood to clot easily, for example, thrombophilia.
- The occurrence of an infection (for example, COVID-19 infection).
Also, a very small number of people have been reported to develop CVST after receiving the COVID-19 vaccine. However, it is important to remember that this is a very rare occurrence .
How do doctors diagnose CVST?
Your doctor will use brain imaging tests to determine if you have CVST. Prompt diagnosis is important to avoid complications.
What tests are used to diagnose CVST?
To diagnose CVST, your doctor may perform imaging tests such as:
- A brain MRI (magnetic resonance imaging) test performed using a contrast dye.
- A brain CT (`Brain CT - computed tomography`) scan is performed using a dye.
- Magnetic Resonance Venography (MRV), CT Venography (CT venography) or Cerebral Angiography (Cerebral Angiography).
In addition, blood tests, such as a hypercoagulability panel, may be performed to check for any clotting disorders.
How is CVST treated?
There are several ways to treat CVST, including:
- Anticoagulants : For example, heparin. These can be given even during pregnancy.
- Thrombolytics (clot-busting drugs) .
- If your blood clot is caused by an infection, antibiotics are prescribed .
- In very severe cases, surgery to remove the blood clot (`Thrombectomy`) is performed .
- Acetazolamide or other medical treatments to reduce the pressure inside your brain (intracranial pressure).
- If seizures occur, antiepileptic medicines are given.
Depending on the cause of your CVST, you may need to take warfarin (e.g. Coumadin®, Jantoven®) or a direct oral anticoagulant (e.g. Rivaroxaban, Apixaban or Dabigatran) for three to 12 months. People with a condition such as thrombophilia may need to take warfarin for life.
What are the complications or side effects of the treatment?
If you are taking warfarin, it is very important to take the exact dose that you are prescribed . That is why your doctor will regularly check your blood clotting. The dose you are given should be enough to stop blood clots from forming that could harm you, but not so high that you would not be able to stop bleeding if you cut your arm or leg. So you need to find the right balance.
How soon will I feel better after treatment?
When you get heparin, either through an IV or an injection, it starts working very quickly . Warfarin can take about a week to work, so your doctor will keep you on heparin until it starts working. After that, you can stop taking heparin and take only warfarin.
Or, if your doctor chooses a direct oral anticoagulant, it can thin your blood to the desired level within a few hours. As the blood clot begins to dissolve and the pressure inside the brain decreases, you will gradually begin to feel better.
How can I reduce my risk of developing CVST?
If you have had CVST during pregnancy, taking an anticoagulant during subsequent pregnancies can reduce this risk.
Oral contraceptives are also a risk factor for CVST. So, you can reduce this risk by not using birth control pills. You can use a progestin-only birth control method instead.
Smoking while taking birth control pills also increases the risk of CVST . Avoiding both of these can help prevent CVST.
If I have (CVST), what should I expect?
In the past, only about 50% of people with CVST survived. But now the situation is much better . The mortality rate from this disease is now very low, between 5% and 10%. This is due to advanced imaging technology and advanced treatment methods.
However, CVST can recur . That's why your doctor will prescribe you blood-thinning medications (anticoagulants).
How long does the (CVST) condition last?
(CVST) can last from hours to weeks. Your condition will likely fall into one of these categories:
- Acute: Up to 48 hours.
- Subacute: More than 48 hours, but up to 30 days. (This is the most common type.)
- Chronic: Lasting for a month or more.
What is the outlook for (CVST) status?
The outlook for people with CVST who receive proper diagnosis and treatment is good . However, CVST can be fatal if not diagnosed and treated early. That's why it's important to seek medical advice as soon as symptoms appear.
How should I take care of myself?
After you have had a CVST, your doctor will want to prevent you from getting another blood clot. This means you will need to continue taking an anticoagulant or “blood thinner” such as warfarin.
Although this protects you from dangerous blood clots, it increases the risk of bleeding from even a small everyday injury. Therefore, you should be very careful when using sharp objects like knives . It may be safer to use an electric razor instead of a regular razor.
When should I see my doctor?
You should see your doctor regularly (maybe every few months) while you are taking blood thinners (anticoagulants). If you miss a dose of warfarin, call your doctor right away.
Three to six months after you have CVST, you may need to have another CT scan or MRI with a dye to check the status of the blood clot in your brain.
When should I go to the emergency room?
If you are taking Warfarin and have any of these signs of bleeding, call 1990 (Sri Lanka's emergency ambulance service) immediately, or go to the nearest hospital emergency department as soon as possible :
- Unstoppable bleeding .
- A very bad headache .
- Bright red blood when coughing, vomiting, or defecating.
What questions should I ask my doctor?
You can ask the doctor questions like these:
- Why did I develop this (CVST) condition?
- How long will I have to receive treatment?
- What is my risk of developing CVST again?
Because CVST can recur, it is important to keep all follow-up appointments with your doctor. They will want to make sure you are taking the right amount of medication to prevent CVST from happening again. If you are taking blood thinners, you should also avoid activities that can cause injury. Even everyday objects like knives and scissors can cause bleeding. So it is a good idea to use safer alternatives like an electric razor.
So, what is the message we should remember from this story?
Simply put, CVST is a rare but serious condition in which a blood clot forms in a blood vessel in the brain. If you experience symptoms such as severe, worsening headaches and seizures, see a doctor immediately . Early diagnosis and treatment can lead to better outcomes. Blood thinners are the mainstay of treatment. You should also be careful about bleeding when taking these medications. It is important to take your medications exactly as your doctor tells you and to follow up with your doctor. Remember, you are not alone, and your doctor is there to talk to and help you.
` Cerebral venous sinus thrombosis, CVST, blood clot in the brain, headache, blood thinners, stroke, seizures
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