MRCP revision battle 53.3: Intracranial venous thrombosis

The presentation of intracranial venous thrombosis depends on which venous sinus is affected.

All locations of intracranial venous thrombosis can cause headache.


Isolated sagittal sinus thrombosis (=nearly half of intracranial venous thrombosis) or lateral sinus thrombosis present with:

• headache
• vomiting
• seizures
• papilloedema
• potentially focal neurological signs

Cavernous sinus thrombosis can cause:

• headache
• oedematous eyelids
• proptosis
• painful eye movements/opthalmoplegia

Cavernous sinus thrombosis is often associated with infection spreading from the face or paranasal sinuses.
Remember: cavernous sinus contains CN III, IV, V1, V2 and VI, plus the internal carotid artery.


Sigmoid sinus thrombosis:

• headache
• cerebellar signs

Inferior petrosal sinus thrombosis:

• 5th and 6th nerve palsies

Risk factors for developing intracranial venous thrombosis include:

• pregnancy
• head injury
• recent LP
• oral contraceptive pill

Investigation is:

• MRI/CT
• CT may show 'absent delta sign' which implies a filling defect and therefore a thrombosis
• ?MRV

Management is by specialists, ?heparin



On to the more familiar topic of infective endocarditis...