Symptoms of Cerebral Venous Thrombosis  
The clinical presentation of cerebral venous thrombosis can be highly variable. Onset of symptoms and signs may be acute, subacute, or chronic. Four major syndromes have been described: isolated intracranial hypertension, focal neurological abnormalities, seizures, and encephalopathy. These syndromes may present in combination or isolation depending on the extent and location of cerebral venous thrombosis.

Intracranial hypertension resulting from cerebral venous thrombosis most frequently presents as headache. Headache is the presenting complaint in up to 90% of patients with cerebral venous thrombosis, and is described as subacute in onset 64% of the time. However, some patients report acute onset of severe headache mimicking subarachnoid hemorrhage. Headache can be localized or generalized and may worsen with Valsalva maneuvers or position change.6 Other findings of intracranial hypertension include papilledema and visual complaints. Headache caused by cerebral venous thrombosis is often initially diagnosed as a migraine.

Focal neurological deficits are noted in 44% of patients with cerebral venous thrombosis.5 Motor weakness including hemiparesis is the most common focal finding, and may be present in up to 40% of patients. Fluent aphasia may result from left transverse sinus thrombosis. Sensory deficits are less frequent.

Focal or generalized seizures, including status epilepticus, are observed in 30% to 40% of patients with cerebral venous thrombosis. Because seizures occur less often in other types of stroke, cerebral venous thrombosis should be considered in patients with seizures and other focal findings consistent with stroke. Seizures are encountered more frequently with thrombosis of the sagittal sinuses and cortical veins.

Encephalopathy can result from thrombosis of the straight sinus and its branches or from severe cases of cerebral venous thrombosis with extensive cerebral edema, large venous infarcts, or parenchymal hemorrhages that lead to herniation.1 Elderly patients with cerebral venous thrombosis are more likely to present with mental status changes than younger patients.