Headache in cerebral venous thrombosis
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HEADACHES AND CEREBROVASCULAR DISEASE
Headache in cerebral venous thrombosis Angelo Aliprandi 1 & Paolo Borelli 1 & Valeria Polonia 2 & Andrea Salmaggi 1
# Fondazione Società Italiana di Neurologia 2020
Abstract Headache has been consistently reported as the most common symptom of cerebral venous thrombosis and as the most frequent presenting feature. It is often the heralding symptom, preceding other manifestations of the disease by days or even weeks. This aspect highlights the importance of recognizing headache due to cerebral venous thrombosis, as early recognition of the disease can lead to a rapid diagnosis with appropriate imaging techniques and as early treatment with heparin can dramatically change the course of the disease and alter the prognosis. Unfortunately, although common, the headache has no specific features, and the clinical presentation of CVT is highly variable, making the correct diagnosis in the emergency setting a challenging task for clinicians, even in the case of highly specialized ones such as neurologists. In this review, we will briefly summarize the epidemiology and physiopathology of CVT, and then we will discuss in more details the causes, features, and course of headache, focusing on its relevance for differential diagnosis and on red flags that should suggest the possibility of CVT as the cause of the headache. Keywords Headache . Venous thrombosis . Stroke . Seizures . Coma
Epidemiology According to recent studies, cerebral venous thrombosis has an annual incidence of 13.9–20.2 per million. Older studies reported a lower frequency of the disease; the increase in incidence of CVT over the years is probably due to an improvement in diagnostic techniques and in knowledge of the disease by clinicians [1]. Despite being a relatively rare condition which accounts for 0.5% of all strokes [2], cerebral venous thrombosis is a clinically relevant disease as it is an important cause of stroke among young adults [3]. Studies revealed that more than 65% of patients with CVT are younger than 65 years [4], with a median age at diagnosis of around 40 years. Incidence is slightly higher among subjects aged 31 to 50 years compared with the ones aged 18 to 30 years [5]. CVT is known to have a significantly higher incidence in women than men: recent studies confirm an incidence of 20.3–26.9 per million in females versus an incidence of 6.8– 16.8 in male subjects [1]. The different incidence between * Angelo Aliprandi [email protected] 1
Department of Neurology, “A. Manzoni Hospital”, Lecco, Italy
2
University of Milano Bicocca, Monza, Italy
males and females has been proved to be due to specific gender-related risk factors, which will be discussed later [6]. Women of reproductive age are most afflicted by this condition [3], and some studies revealed that around 50% of females with CVT used oral contraceptives and 18% were pregnant or in puerperium at the time of the diagnosis [5]. Cerebral venous thrombosis is also a relatively frequent cause of stroke in children (mostly newborns)
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